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Permission: Why Is It So HARD To Give It to Ourselves? · The Resting Stitch Face Podcast

• Sarah: Hello and welcome back for another episode of the Resting Stitch Face podcast. I'm your host, Dr. Sarah Harding along with... Erin Sheffield: Dr. Erin Sheffield. Welcome back Sarah: Welcome back. Erin Sheffield: to another episode. So, today we are going to talk about permission. Permission for yourself as a doctor or high achieving person to take care of yourself and not just everyone else. This is so hard to do. Sarah: which is really hard to do. Yes. Erin Sheffield: Let's unpack this. So I was inspired by this. I broke my back last week, which sounds Very dramatic. Sarah: And it kind of is. Erin Sheffield: I slipped down the stairs in slippery stocks on my old historic slippery floor on the way to work and fell and landed straight on my flank and my spine. And man, that was terrible. Sarah: Right? Erin Sheffield: like writhing and crawling and like screaming in pain and luckily all my kids were gone 'cause I think they would have been kind of freaked out. Sarah: Yeah. Erin Sheffield: And then I was like blacking out. And the only reason I didn't pass out Sarah: my gosh. Erin Sheffield: because I was like laying down and just wasn't passing, wasn't passing. And then I'm like trying to puke my guts out in the toilet, but I didn't hadn't eaten, so there was nothing to give. And then my house, when it rains, it pours and it pours inside. I've got a leak inside my house right now. Dumping like a bowl full of water. Like it'll be like a full bowl full of water. And so that's why I'd gone back up the stairs. to get some towels to try to pop Sarah: Yeah. Erin Sheffield: up this seeping mess before I'm on my way to work. I'm already running late and to get the bucket to kind of catch everything. And that's when I slipped. And so I'm like rolling on the ground trying to get towels and stuff Sarah: my gosh. Erin Sheffield: taped up to the wall to capture this water while I'm trying to get into work on time. And I finally I'm like, okay, I think I'm okay. I'd start driving to work and then I'm like, I'm gonna puke. I'm gonna throw up. And I'm I'm a legendary fainter, so I knew that meant that I was like maybe gonna go basil vagal. And so then I'm having Sarah: Yeah. Erin Sheffield: this, what do I do? I'm like a minute from work. Can I make it? Will I be able to tell Sarah: my gosh. Erin Sheffield: if I'm gonna blackout or do I need to pull over into this next parking lot? And I probably made the bad Sarah: my gosh. Erin Sheffield: choice and continued on and made it. My nurse checked me out and okay, we seem like we're okay and Let's just give me five minutes and then we'll see if I should go in and start the I V on the next on the first patient. Sarah: my gosh. Erin Sheffield: Then I'm then next thing you know, I'm laying on the ground because again, I think I'm gonna pass out and I'm gonna throw up. And she comes out. So do you think I should start the IV? Doesn't look like we should are starting IV. And I'm like, you're probably right. Sarah: Good for her. Erin Sheffield: And here I am, still like, maybe I can make it. So Sarah: Maybe I can do it. Maybe. I think it'll be fine. Erin Sheffield: I go in and do the consult, and I just tell him, I'm so sorry. Like, I'm not safe to do this. You know, we'll do just a console. I usually do same day screen extract for a lot of my cases. So we'll do the console, we'll do the screening. Meanwhile, I'm like sitting down halfway through. You know, I'm like barely making it through. So then we're like, okay, let's let's go to either the ER or the acute care clinic and can someone drive me? And so then I go in, I get a bunch of x rays. I get a CT scan with contrast. My first time that was fun. Have you had that Sarah: Yeah. Erin Sheffield: before? You've had it, yeah. Sarah: Yeah, I had, well, yeah, I did. Yeah. Cause I know I've had contrast before, but I can't remember if it was for an MRI or if it was for a CT scan. Maybe it was for both. I don't know, but you do. You feel like you're peeing your pants. Erin Sheffield: yeah. I mean I love being the on the patient side. Yeah, she says you're gonna get really warm and then it's gonna feel like you paid your pants by promise you did it. And I'm like, what the heck does that mean? How would I feel like I peed my pants if I did it? And then I was like, because it gets really Sarah: Yeah, that's how it feels. Erin Sheffield: warm down there just all of a sudden. Sarah: Yeah. And in the distribution of if I had peed my pants. Yeah. Erin Sheffield: Yeah, a hundred percent. Sarah: And I'm like, are you sure? Are you sure I pee my pants? And she's like, don't move. Don't move. And you're like, I can't. I can't because I think I just pee my pants. Erin Sheffield: So after right. Exactly. Yeah, don't move because it feels like you are. Don't freak out. Just hold still. So then turns out I fractured, he told me L one through three. It turns out it was L one through four, the transverse process. So that's the best possible way I've been told to break your back if you have to break your back. So thankfully for that. But then I'm Sarah: Good job. Yeah, always be overachiever. Erin Sheffield: I'm waiting for someone to come pick me up. My staff dropped me off, I need him to come pick me up. And meanwhile, I'm texting Sarah. What did I even say? Sarah: You were like, I'm going back to clinic, should I, do you think it's okay if I just take the afternoon off? They'll have to cancel patients. And I'm like, yeah, I think it's okay. I think it's okay. And I was like, but I understand, right? Because it's really, because people get frustrated and people get really mad. Erin Sheffield: They get really mad. Sarah: But if you'd pushed through that day, like... Erin Sheffield: So I call my nurse and I say, hey, turns out it looks like I broke my back. Maybe we should cancel clinic, I said with a question in my voice. And she's like, basically, girl, we already did. We're done for the day. Sarah: Yeah. Yeah. Erin Sheffield: So thankfully, some of the people in my life had better judgment, but it's been like wearing on my mind, like, what is wrong with me? What is wrong with me that I That that was such a hard decision to make that that was even a question. And then I went home and I was still feeling guilty, like, maybe maybe I could have gone in. Sarah: Right. Because then you have nothing on the schedule. have nothing to do to occupy your mind and then you just have to sit there. And so you're like, if I'm just sitting here, I could just be sitting at work and actually seeing patients or taking care of things. And like, here I am just sitting here and can't do anything. Erin Sheffield: Yeah. And they're like, most of patients were really nice. One guy was really mad because he took off work. And I'm like, Yeah, me too. Sarah: I Erin Sheffield: And my whole staff took off work. They're not getting paid. I'm Sarah: Yeah. Erin Sheffield: not getting paid. I probably just paid a few thousand dollars in medical bills, you know, like I get it. I promise I get it. Sarah: Yeah. Yeah. Erin Sheffield: But I know I'm not alone in this. And I know this is not the first time or the last time that I'll probably like face this kind of Dilemma. Sarah: Yeah. You know, it's really interesting because I almost feel like that was bred into us during residency. And then we expect that of ourselves now. And so now patients expect that of us as well, that Erin Sheffield: Mm-hmm. Sarah: we're somehow invincible and that we can just push through and that their health means everything and our health doesn't. But then when you ask them, they're like, of course I want you to take care of yourself. Unless it's inconvenient for me. Erin Sheffield: Of course. Sarah: But then I was talking to a friend of mine who retired from clinical medicine and is doing more on the insurance side. And she works less than she was working, making probably the same amount of money. And she has days that she's off. And the people that she works with are so flexible and so helpful and so like everybody that's like, I've got this play for my kid that I need to go to. And everybody's like, great, have fun, enjoy. We'll see you back. And everybody makes it work, like with Erin Sheffield: Yeah. Sarah: their time, right? And so I know I have to get this amount of stuff done. And so I can still get it done, but I can still take like two hours at lunch and I can come back and I can work a little bit later. And Everybody is so much more pleasant because they're able to manage life and be able to work also. But our schedules are so different because we're booking patients out like, you know, six, eight weeks for your four months, you know, Erin Sheffield: Yeah. Sarah: and patients have been waiting a long time and it's so hard because we really do respect their time. Erin Sheffield: Right. Sarah: We also have to respect our bodies and our health and our longevity. Erin Sheffield: Right. Well, and they I think they think we don't. There's so many comments online or Sarah: Mm-hmm. Erin Sheffield: little threads online saying things like, My doctor's office charges me if I'm late or if I miss an appointment, but I had to wait this long and I maybe I should charge them. And I totally understand the sentiment there, but I was thinking just the other day, I had had to go to the bathroom for probably like two or three surgeries. And I was running a little Sarah: Yes. Erin Sheffield: behind, and it was A real thought process. I had to stop myself and go, should I take like two minutes is it okay if I take two minutes to go to the bathroom before this case, or should I push through? And it's kind of getting to the point where maybe you don't want to w push through another 45 minutes. Like maybe Sarah: Right. Erin Sheffield: maybe you can't even physically do that. And I still Sarah: Yeah. Erin Sheffield: had to like grant myself permission. Like, it's probably okay. Like they probably won't notice two minutes to go to the bathroom. But those are the kind of Dilemmas we put ourselves Sarah: Mm-hmm. Erin Sheffield: in, and where does that come from? What are these origin origin stories? And one Sarah: Right. Erin Sheffield: thought I had there is this story I have from residency. I was an intern, an on-cat intern, trying to get in to the program. And so I'm working more than anyone, I'm taking more call than anyone. It was the first summer, still kind of figuring out how things work. And so it was my first weekend off call since we started. And so my husband had bought tickets to a Cubs game in Chicago. And so, you know, it was like three and a half hour drive, but we're gonna make a weekend of it and we were excited. And then I found out that there was a trauma lecture on Saturday morning. And I didn't know that we ever had lectures on tr Saturday mornings. I'd never seen that before. Looking back, we maybe did that once a year. This was not like a typical thing. So I'm just dumb. I'm naive. I don't know that that can even be a possibility. So that week I found out, make sure you're there on Saturday for this trauma lecture. And so I went to the attending who was putting it on, and all I said was, Hey, what time do you think this thing gets over? Because my husband bought Cubs tickets, and I'm just wondering if he should go with a friend. And he got so offended that I wasn't just like, my whole life is revolving around. Trauma lecture that he went Sarah: Yeah. Yeah. Erin Sheffield: and talked to the program director and said, What do you want me to do with this request? Well, it wasn't a request. I Sarah: Yeah. Erin Sheffield: wasn't requesting anything but information. I just wanted to know what time so I could plan. Sarah: Yeah. Erin Sheffield: I was not even like apologetic about giving the tickets away. I just wanted to know so I knew what to do. Was it gonna be done at 10 or was it gonna be done at three? And I was so offended that then I was in trouble. And I got brought into the principal's office and I got scolded and I got chided for my lack of commitment. And if I wanna get into this program, I gotta show that I'm committed. And how dare you ask for time off? It doesn't look good. I'm like, I never asked Sarah: Right. Erin Sheffield: for to to not be there. I never hinted in any way that I wasn't going to be there. I just wanted to know. And I guess Sarah: And it's not time off. I'm not scheduled to be on call and it's not a scheduled like clinic day. I'm not asking to be off. just had made. Yeah, they do. Erin Sheffield: But they own you. Like it feels like they own you. And so that's just one of many stories where, well, no wonder I didn't know if I could take time off when I broke my back. Because it's been beat into you time Sarah: Right, right. Yeah. Erin Sheffield: and time again that you don't matter. Your life doesn't Sarah: Yeah. Erin Sheffield: matter. Your health doesn't matter. And I remember Sarah: Yeah. Erin Sheffield: the only time I ever went home sick was because I was like puking my guts out and everyone was worried about getting some GI bug from me, so they let me go home. Sarah: Yeah. Right. Yeah. Erin Sheffield: Like two hours early, you know? Sarah: Yeah. Yeah. Erin Sheffield: It's like I shame myself on one Sarah: Mm-hmm. Erin Sheffield: end. Aaron, what's messed up about you that you can't give yourself permission? I feel bad. I feel guilty if if I do and I feel d guilty if I don't. Well, no wonder. Sarah: Yeah. Yeah. Well, and I remember too, in residency, it was like, you're on call, right? And so as dental residents, we weren't under the same ACGME rules, technically. Erin Sheffield: Right. Right. Sarah: They pretended like we were, so we still had to log our hours into that little thing, but we were told to lie about our hours. So Erin Sheffield: Mm-hmm. Right. Sarah: like, so because you would get, well, not really lie about it, but you would get an error that said, well, that you've worked over the 80 hour work week. And so you had to... go back in and change it. And one time I didn't go back in and change it. And I was like, yeah, that's what I worked. I worked 110 hours this week and I'm going to put it in there and I got in trouble for it. Yeah. And so then, right. And then it's like, Erin Sheffield: No, you absolutely get in trouble for it. Even if you try to be honest, yeah, you get taken down. Sarah: you're there for your 24 hour call in-house call and you admit something and it's going to go to the OR that day. so instead of being off Well, you're off call now, but then if this case posts at... Because you're on call from what 7 a.m. to 7 a.m., right? And then let's say the case posts at noon or the case posts at 10 or the case posts at four. It's like you're not, quote unquote, expected to be there. But I remember so many times either it was a really Erin Sheffield: Ha ha ha Sarah: good case and I wanted to be there or Erin Sheffield: Right. Sarah: like... It was like, was so tired and I needed to go home and they're saying, well, you know, it's, is an opportunity that you're going to miss out on and it's your patient that you admitted. And, and, and our program, we always did clinic the next morning. And so we would always have surgeries that next day. And then we would go home at noon. Right. And then, but, or we didn't because we would be missing out on an opportunity, Erin Sheffield: Yeah. Sarah: you know? And so I think that. that in and of itself is like, this breeds this FOMO of, Erin Sheffield: Yeah. Sarah: well, you you're going to miss out and how dare you drop this in our laps and then Erin Sheffield: Mm. Sarah: we're going to have to do all the paperwork or whatever it was, right? Erin Sheffield: Yeah. Our program was not that way. It was very much like when you're off call, you go home. Like, Sarah: Mm. Erin Sheffield: don't stay for the extra case, you know, unless you're like already in it. And even then it a lot of times they were good about like sending you home. But it was if you were there on a weekday and it doesn't matter if you'd been up for 24 hours straight, you still gotta be there till at least five PM the next day. So like 36 hour shifts were not unusual. And it kind of becomes a pissing match of who. Sarah: Yeah, who can handle it? Yeah. Yeah. Erin Sheffield: Can handle it the most. Like, I've only had one granola bar in 36 hours and Sarah: Yeah. Erin Sheffield: 20 minutes of sleep, but I've had four Red Bulls, you know, and it would become like Sarah: rain. Erin Sheffield: this comparison thing. And I just remember thinking it was so weird that people who are supposed to value health and be teaching health and helping people achieve health have this toxic mentality around themselves and. our peers, I just thought, boy, it just doesn't match up. It it doesn't make sense. And then don't even talk Sarah: Yeah, yeah. And I think... Erin Sheffield: about the mental health side of it. Sarah: Yes, do not. Erin Sheffield: What's Sarah: Yeah, so then I had a really funny experience a couple of weeks ago. One of my friends is an endodontist and is a practice owner. And I was like trying to meet up with him, guess, to deliver avocados or whatever. Erin Sheffield: Mm-hmm. Sarah: I was going to drop them at his office, which is closer to my house than his house is to my house. And he's as like, okay, I can come by and he's like, I actually canceled my day today. I went out with my like co owner, partner, whatever. And we had a little bit too much to drink and I feel terrible today. And so I canceled my patients and all Erin Sheffield: Mm. Sarah: I could think was like, my gosh, my gosh, my gosh. I like, and Erin Sheffield: You did that? Whoa. Sarah: I was like, I even said, was like, that's amazing. that you did that. Because Erin Sheffield: Right. Sarah: I'm like, my heart started racing when you said that because, I mean, all I could think was like, God, the fallout from this is going to be horrendous, you know? And it wasn't. Erin Sheffield: Right. Well, and I feel like that was kind of a consequence of not such great choices. So I gotta punish myself by suffering through. Sarah: Right. Yeah. You know, like, I should known better and Erin Sheffield: I did it to myself. Sarah: I shouldn't punish other somebody else because of my own choices. Erin Sheffield: Yeah, precisely. Well, even when I had my twins, I worked almost up till the day of the delivery. I did have to take a week or two off at maybe thirty two weeks 'cause I was in preterm labor and luckily we were able to stop that. but other than that I worked all the way up until the the day my water broke was like the day I'd gone to work. So so I felt like I gave my all. And then They wanted me back at four weeks. And and I said, no, I can't come back at four weeks. Like I almost died in delivery. Premature birth. I got these premium twins. We're still checking them out for these health issues. We're Sarah: Mm-hmm. Erin Sheffield: hardly like even feeding. I'm not sleeping at all. There's no way I can come back at four weeks. Sarah: Right. Right. No. Erin Sheffield: And they were really pushing it and they were very mad and they were laying on the guilt trip thick. the patients and the community and our staff, they just need you so much. And luckily at that point I was like, I absolut I can't. I have a doctor's note that says I can't. And the state of Iowa says I'm allowed six weeks. I put my foot down, Sarah: Yeah. Yeah. Erin Sheffield: but then I was fired for it later. retaliation Sarah: rain. Erin Sheffield: for doing that. And and I feel for them. Sarah: Yeah, so again, it builds that same guilt, right? It builds it because you're like, can't do that again, I got fired last time. Erin Sheffield: Right? I mean practice comes first. Sarah: Yeah. Erin Sheffield: It doesn't matter that, you know, I'm still bleeding and Sarah: Yeah, not sleeping. Like, how can you take good care of anybody if you're like... Erin Sheffield: It not sleeping. And I was commuting 75 miles each way. And that was a big concern is just can I Sarah: Right. Erin Sheffield: safely drive to work every day? Because I'm not sleeping at all with pre-me Sarah: Yeah. Erin Sheffield: twins that don't eat. And I'm trying to pump and nurse and bottle feed. Like it'd take me Sarah: I know. Erin Sheffield: a full hour to feed each baby. And then I'd start over the next hour with the next baby. It was terrible. But Sarah: Yeah, you'd have to wrap your car like a murder vehicle, right? You're bleeding and pumping and all kinds of things are happening, but you still got to drive 75 miles each way. so, you know, if you stop, that's an extra however much time. So you can't do that either. You know. Erin Sheffield: It's tough. That's a hard transition. And that and Sarah: Yeah. Erin Sheffield: I always tell postpartum moms, like you're gonna feel like you need to go back, but you just never get that time back. You never get those moments back with your baby. You never have that time Sarah: Yeah. Yeah. Erin Sheffield: to heal. Like childbirth is so crazy. It's a one time where you have like maybe one of the biggest procedures in your life, or you go through the mo one of the most life-threatening situations most women will go through. And then On top of it. Like when I Sarah: hormones. Erin Sheffield: had my tummy tuck, people were taking care of me and I wasn't required to Sarah: Yeah. Erin Sheffield: do anything. But it's like times at times two with the C section. And now not only do you have to recover, but you gotta be up three to four times a night taking care of someone else. That's Sarah: Mm-hmm. Yeah. Erin Sheffield: asking a lot and then add going back to your practice Sarah: Yeah. Erin Sheffield: on top of that too early. That's Sarah: Yeah. Erin Sheffield: tough. It's really hard. Sarah: Yeah, yeah, it is really just very interesting how we've created this problem for ourselves, you know, like, and it perpetuates until we don't let it and then we get fired and then, you know, and then we worry about that for the rest of our lives. Yeah. Erin Sheffield: Mm. Well yeah, we've been primed. We've been primed. It's a calling and I've been thinking about this a lot lately, the calling Sarah: Yeah. Erin Sheffield: of medicine. Because when it's a job, if you go to your job and you clack it clock in eight to five, I feel like you could have like pat yourself on the back and go home and have a beer and put your legs up, you know? And not that I drink beer, but that's what I'm imagining. Sarah: Yeah. Collect your paycheck and right. Yeah. Erin Sheffield: And maybe a salary, maybe they require a little bit more, but as long as your boss is happy with the work you're doing and you're like hitting your metrics and maybe you get to go home. But like the calling, it's your whole Sarah: Yeah. Erin Sheffield: personality, it's who you are. How can you put that down? You can never put that down. And Sarah: Right, right. Erin Sheffield: someone was talking on one of the Facebook forums about how their patient had maybe a compli complication. It sound even like some swelling and they went to the ER and Sarah: Right. Erin Sheffield: then they got like admitted to the ICU and then Sarah: yeah, that's all that. Erin Sheffield: The plastic surgeon got called in to drain them and then they didn't even drain anything. And you're half wondering if it's even really infection because anything in the mouth is like, my gosh, it's two days after surgery, but it's an infection. Yeah. Sarah: Yeah, yeah, and you're like two days post-ops, of course you're swollen, right? Erin Sheffield: So she's kind of wondering. And then she even said, like, that's what I get for going on vacation. I feel like I can't go on vacation anymore. Is that what it was? Sarah: No, it was to a family wedding. It wasn't even vacation. was just like out of town for a wedding. Yeah. And it was, you know. Erin Sheffield: And it's like, you're allowed to take vacation. We're allowed to go to family events and patience there's always gonna be patients. There's always gonna be someone who has some kind of complication or something going wrong and we can't control that, but we care and we take more Sarah: Yeah. Right. Yeah. Erin Sheffield: of that on than we need to. Sarah: And you know, I thought a lot about that too, because the other thing was this with this hospital privileges thing, like we're supposedly required to have hospital privileges or have a transfer of care through the board, right? But this Erin Sheffield: Yeah. Sarah: patients, this doc had hospital privileges, but the patient went to a hospital where she doesn't have privileges. And so even if she was there, she can't go and, you know, see her own patient. Erin Sheffield: Yeah, you're right. That's Sarah: And so she's then Erin Sheffield: true. Sarah: stuck to the phone because she's so concerned that like what's gonna happen. She's talking to the patient's mom and like so concerned about like what care they're getting and wants to know what the labs say. She doesn't have any access to any of this information and trying to get one of the attendings or the residents on the phone is sometimes hard. And then Erin Sheffield: Yeah. Sarah: it's like all of that to say she's done everything right. But like she's still worried about getting a board complaint. She's still worried about getting Erin Sheffield: Mm-hmm. Sarah: sued. She's still worrying about who's going to pay all of these hospital bills. I can't even take care of my own patient because she's at a different hospital. And if you transfer care to another hospital, then it's a whole other expense. And it's just like, it doesn't make sense. None of it makes sense. Erin Sheffield: Yeah. Yeah. Well, and you can see why we make the choices we do and feel like we have to take it on because there's just enough negative pushback that makes it Sarah: Mm-hmm. Erin Sheffield: uncomfortable enough that it's hard to stick up for ourselves. And even when I decided to go in and get checked for my back, I was sitting at the front desk and I was like, Okay. We should probably cancel at least the next few patients. I'm not feeling too good. I sh I should probably go get checked. And Maybe someone can drive me. And we're like, when's the next patient coming in? And then right then, ding, ding, ding, you know the door. She walks in. We're like, man. And my nurse is standing there and she says, We're so sorry. We were hoping to see you today, but doctor's not feeling well. And so we're gonna have to reschedule. We're really sorry about that, but we'll try to find a a time to accommodate you. And she was clearly annoyed, for good reason. And she says Sarah: Right, I understand. Erin Sheffield: To call me? No no one could let me know. This is the first time hearing. And I'm sitting right there. I was fine, like raise my hand. I am so sorry. I'm the doctor and I was on my way to work when I got hurt and I'm like going to the ER now. So I was really hoping and planning to see you, but I don't even feel safe like in my own body right now. So I really appreciate you being patient. She was kind like taken aback and well sorry, but she still seemed Sarah: Yeah. Erin Sheffield: annoyed. Then we luckily somehow, even though I booked out forever, got her in the next day. I'm in clinic. And then we I'm just everyone's trying to keep my privacy, but I'm like basically like, girl, I broke my back. Sarah: Yeah. Erin Sheffield: And then suddenly she's like, my gosh. You know, she like Sarah: Yeah. Erin Sheffield: was understanding in that moment, but I felt uncomfortable. I felt bad. Sarah: Yeah. Erin Sheffield: I didn't like disappointing the patient. That was uncomfortable. And disappointing Sarah: Yeah. Erin Sheffield: the patient and having to figure out how to reschedule them is enough pushback that I'd rather come and work through a sore back. That's honestly what it comes down to. Sarah: Yeah. Well, it's also like, if it's egregious enough, then they'll understand. Right? Like Erin Sheffield: Yeah, sure. Sarah: I broke my back as opposed to like, I sprained my pinky. But like, Erin Sheffield: Mm-hmm. Sarah: can you imagine? Like one time when I got hand, foot and mouth and from my kiddo and Erin Sheffield: no. Sarah: my palms hurt so bad, but it wasn't like, I mean, I could push through it. But it wasn't Erin Sheffield: Yeah. Sarah: like egregious enough, like breaking your back that I could be like, I really am having a hard time retracting with my Minnesota because my palms are on fire and every little part of it that I touch hurts so bad. It's like Erin Sheffield: Right. Sarah: knives going through my hand the whole time, but you just push through it because it's like not enough to like make people feel bad. Erin Sheffield: And also is that like do patients want someone with that with their hands in their mouth, you know? That's a contagious disease. But again, they still Sarah: Thank you. Thank you. Yes. Erin Sheffield: are calling the COVID team in to treat the COVID patients, you know, like we Sarah: Mm-hmm. Erin Sheffield: well now I'm remembering I blocked this from my brain and maybe we've talked about this already, but when I was sick a couple of weeks ago, about a month ago with GI disturbance, and again, it's like You wake up at like just that 5 30 a.m. Like, well, maybe I'll be okay before it works. I'm texting my nurse just so you know I'm Sarah: Yeah. Erin Sheffield: feeling terrible and I'm right by the toilet. I'll let you know. And then like, ugh, I don't think I'm gonna make it. Let's cancel the first couple patients. And maybe I'm okay now. Sarah: Yeah. Erin Sheffield: Took some Zofran. So I go in and I see a few patients, and it seems like I'm okay. And then I literally poop my pants at work. Sarah: You're like, I thought I was okay, but on second thought, or actually number two, I'm not. Erin Sheffield: been in the hospital, I could have like taken a shower and changed, but Sarah: Yeah. Erin Sheffield: like I don't have another pair of scrubs. I should ha keep a separate pair there. Now Sarah: Yeah, that's fair. Erin Sheffield: I should learn my lesson. But I was like, I don't know what to do. Like clearly I should go home and get changed, but that's gonna take like forty five minutes to an hour. And I'm already stacked with some patients. And luckily someone hadn't really been answering. And so I just said, leave a message, tell them not to come. And if they show up we just say, sorry, we tried to call you and that's why I had I still had two patients on deck. So I went in the bathroom and I threw my underwear away and I like cleaned myself up as best as I could. And then I was wearing a gown and I was just like, please don't be able to smell me. And I went in and did the friendliest, fastest consults I've ever done in my entire life. And I don't think they knew any wiser, but like that was terrible. Sarah: Yeah. Erin Sheffield: And that was clearly like you should not have been there, Erin. Like Sarah: Right. Yeah. Erin Sheffield: But I'm still asking. I broke my back. She's okay. Should we cancel clinic? I don't learn my lessons. I d I don't. They're too ingrained. It's Sarah: I'm gonna fly flying around. I know, I know. Erin Sheffield: who I am. It's my calling. Show up no matter what. Sarah: Yeah. So here's a question for you, speaking of your back, because Carrie and I just did that episode about opioid addiction. the biggest takeaway that I had from it is these people aren't addicts, right? Erin Sheffield: Yeah. Sarah: If they had never been introduced to this, would they have continued down the addict pathway or would they have been just fine human beings? And so Erin Sheffield: Sure. Sarah: it's really hard for somebody who's never experienced an injury. But now that you've experienced something that like clearly throws people into the chronic pain category, you can really see how it can happen, right? Because Erin Sheffield: Yeah. Sarah: Your back may be feeling better, but you've got these other sequelae that are creating significant pain and significant alteration of function and inability to live your daily life. And if you have this Erin Sheffield: Yeah. Sarah: easy help button that does make you feel better, it's really hard to not see how that can be. Erin Sheffield: Yeah. I've been nervous about that. They Sarah: how that can happen. Yeah. Erin Sheffield: gave me like 30 hydrocodone and 30 Tramidol at the same time, like choose which one you like, which I just thought was crazy that it could give me two at once. And Sarah: Right. Do you think that they did that because you're a doc, or do you think that that's what they do? Erin Sheffield: I don't know. I bet it's kind of what they do. Like they're just like, this is gonna hurt really bad for a long time. But I will say I wasn't taking it very routinely, partially because I'm just a little nervous, and then Sarah: Yeah. Erin Sheffield: it just wasn't working that well. Sarah: Yeah. Erin Sheffield: I'm having like really bad cramping pain, but it's not like acute, like throbbing, stabbing, aching pain that you normally think about. And so I would be taking Like I worked a whole day. My first day back, I worked and and I was okay mostly through the day. I obviously wasn't taking any narcotics. And then I got home and it was like, maybe I'll take something. And then once I did, it was like, thank goodness. Like I didn't realize how much pain I was having. But then I had to take a second one for it to touch me, you know? And so it wasn't that effective. And then I started having headaches and my back's been feeling okay. And I started on a muscle relaxant that helped so much. Like the crampy back pain like went down significantly. It was a total miracle. It's like you have to have the Sarah: Yeah. Erin Sheffield: right drug for the problem. Sarah: Right. When we're not even diagnosing what the actual problem is, what's causing the cramping, what's causing the headaches, right? It's just like, Erin Sheffield: Right. Sarah: here's just a centrally acting pain medication and then just wipe everything out. Erin Sheffield: Right. So so I'm having headaches that have just been ramping up since then, intractable tension Sarah: Yeah. Erin Sheffield: and migraines. It's been terrible. It's been putting me out. And so I have all these medications at at my disposal. I Sarah: That will. Yeah. Erin Sheffield: can use them. And I'm going, I would never take hydrocodon for a headache. Sarah: Right. Erin Sheffield: And my back is open. Feeling okay. It's like a two, Sarah: Yeah. Erin Sheffield: three, four. So I don't really feel like I need that. But do I take it for this headache? Because this headache's killing me. Then I'm taking it for my headache and it's not touching it. I'm taking two narcotic. It's not Sarah: Right. Mm-hmm. Erin Sheffield: touching it. I'm like loading up the muscle relaxing and two narcotic and the NSAIDs. And then I'm getting gabapental. Like I'm laying layer on layer and layer and layer, which is kind of scary. Polypharmacy. Sarah: Yes. Erin Sheffield: And I'm getting no relief, but I'm thinking it's so easy to be like, well, it's there. And I've had even someone was like, Well, I'm kind of just tired of being pain in pain and it's not terrible, but like maybe I should take it because it's there. I Sarah: Yeah. Erin Sheffield: can see how you just get into trouble. And my husband, Sarah: Yeah. Erin Sheffield: his oral surgeon, before he met me had an implant placed, and he was a pretty prominent, well known guy. In the area, and he ended up having some problems with his back and got hooked on narcotics. And then they figured out he was siphoning medication from sedations from patients because they're all like, How come none of our patients are sedating? How Sarah: Yeah. Erin Sheffield: come everyone's awake? And they like finally figured that out. So he got Sarah: you Erin Sheffield: the slap on the wrist and wasn't able to do sedations for a year, is what I was told, but still practicing, and then had more problems and ended up in jail. And here's Sarah: Aww. Erin Sheffield: disrespected doctor in our Sarah: Right? Erin Sheffield: community. And again, it you can see how easy it would be to start. You have this real problem and then it turns into this snowball effect of something much bigger than it ever started. And Sarah: Yeah. Erin Sheffield: that's really hard. Sarah: Yeah. Yeah. And it's, I mean, it's just like we were talking about with Carrie. It's, it's, it is so life shattering for like, not just the person, but everyone in their sphere. It's, Erin Sheffield: Yeah. Sarah: you know, and, especially somebody like that, because that affects our whole profession. Right? I mean, because Erin Sheffield: Yes. Sarah: we've all heard it and then we've heard it multiple times. And then it, you know, it just is, it's just. It's just terrifying to me that somebody that knows better... can do that because their pain is so great, Erin Sheffield: Yeah. Sarah: you know? Erin Sheffield: Well, and you wonder too, again, just with the achievement philosophy and the culture of not telling people you need help and always look like you're okay and to be that like person, that pillar for everyone else. Not getting help when you need it. Not like being vulnerable and being able to kind of look at yourself and get the help you need and those pressures. Sarah: Yeah. Erin Sheffield: Like, well, I could see it'd be like My patients need me, but my back is killing me. I'm just gonna like take an oxy Sarah: thrill. Erin Sheffield: and see if we make it through, you know, and that's when Sarah: Yeah. Erin Sheffield: you get in trouble. Sarah: Yeah. Yeah. So I just think that it's like Carrie and I were saying, we just have to find a better way forward. And I think it's getting better now that more light has been shown on it. But I don't think that I don't think that we have good solutions. I mean, and you've demonstrated that to me in this like last week and a half. I thought we'd gotten better, you know, and then then like Erin Sheffield: Yeah. Sarah: we haven't we haven't gotten better. And so Erin Sheffield: Well, and I I finally went in over the weekend and again giving yourself permission to get help. I was Sarah: Yeah. Erin Sheffield: Abe had been gone at some like men's conference for like Friday evening until midnight, and then he like left early until like the middle of the day. And he came home and he's like, How are you? And I've like, I've had this killer headache since the last time I saw you. I'm taking all these things, it's not touching it. I feel terrible. I feel sick. This is awful. And he's like, Do you want to go into the acute care clinic? And I was like, What? I what? I get hmm. I guess I could. And part of it's because I'd just been there, you know, like how many times can you go Sarah: Right. Erin Sheffield: to the doctor in a week? But okay. yes, let's go. Sarah: Yeah. Erin Sheffield: But then the funny thing is he was like doing dishes and stuff, and I'm like thinking we're walking out the door and I was like, finally, just take me. Now that Sarah: You Erin Sheffield: I decided I want help, I'm like ready. Please just take me there. Sarah: Yeah. Yeah. Erin Sheffield: And then and then it's Well, should we get a CT scan? That seems like kind of a lot. And it's probably just, you know, tension and, you know, the injury and stuff. But okay, let's do it. And I got Ivy infusion of some meds and started on more medications. And I don't know, it helped a little bit maybe, still feeling terrible. So then I went into neurology and one of the docs was so nice and got me in last minute. And so they're starting me on nortripline. but That takes like six weeks to ramp up. So what do I do in the meantime? Sarah: Yeah. Yeah. Erin Sheffield: It gave me a migraine bailout, but that's not touching the tension part of my headaches, which is the worst part of it. So Sarah: Yeah. Erin Sheffield: I can see how people kind of take matters into their own hands sometimes. Sarah: Yeah. Erin Sheffield: And they're taking me very seriously also. I mean, that's a whole other thing of people whose pain gets discounted and have to find their own ways Sarah: Right. Yeah. Yeah, I'm dismissed. Erin Sheffield: to manage, but that's tough. Sarah: Yeah. Yeah. Erin Sheffield: What do you think we can do? Is there s anything we can do? Maybe maybe we're too small to really change the culture of medicine, but what can we do in our own lives to feel like we can have permission? How do we stop this from happening? Because clearly I haven't learned my lesson. It happens way too frequently. Sarah: Yeah. Yeah. I don't know. I don't know if there's... I don't know how we do it. As I'll say this, because we've talked about this before with my little panic attack things or whatever it was that I had back in dental school. And when I realized this isn't worth it, right? Like the stress that I'm putting on myself to do great on this test, the... all of that, it's not worth it. Like I don't need to be a dentist. It's fine. If Erin Sheffield: Mm-hmm. Mm-hmm. Sarah: I can get by with studying less, that's what I'll do. And if I can't get by, then I wasn't meant to be a dentist. Right? And so I think that establishing that boundary early on gave me permission. Now it doesn't mean that it's easy. It means that I know where that can spiral to. if I just keep people pleasing and doing what I think that other people expect of me. But that's not sustainable for me. And Erin Sheffield: Yeah. Sarah: if I don't set my boundary now, people will just expect that I'll keep giving and giving and giving, and I can't, because Erin Sheffield: Yeah. Sarah: I won't make it. And so I think for me, that's what I did. I just don't, sorry, don't care. Erin Sheffield: Yeah. Sarah: Like I may miss out on opportunities and I may miss out on something great or cool or whatever it is, but if it means that I can hang out with my kids or that I can live five years longer or if I can, you Erin Sheffield: Mm-hmm. Sarah: know, have time to breathe, then great. That's what I'll do. Erin Sheffield: Yeah. Well that reminded me I've heard from two different people. Have you heard this? Two different people told me that the sixth I think they said the sixth dentist in Colorado Springs or the Denver area. I think it was Colorado Springs, like took their own life and I don't know in what time period we're talking about, this year or Sarah: No. Erin Sheffield: something terrible. But I had two different people bring that up to me. And I feel like doctor self-harm is definitely something I don't know if it's More on the rise, or we're just talking about a little more, but I can totally understand this idea that it sounds safer and easier to take away your life than to just take away that part of your life, the doctor part. And that's crazy. Like we can't we can't put that down. So the only option is to leave altogether. And that's so sad. If anyone feels that way, if you're listening, please reach out to us. We would Sarah: Yeah. Erin Sheffield: love to talk to you and and talk you through anything that you're going through. And I know we both have had times that have been dark and we've been there. Or please find someone else to talk to. But I see you. I can understand that mentality, Sarah: Mm-hmm. Erin Sheffield: which is kind of sad, but I get it. It's so hard Sarah: Terrifying. Erin Sheffield: to put it down. And it just feels like Sarah: So many people are relying on you. Yeah. Erin Sheffield: Sometimes that that's yeah. So it'd be better for me to go than to just maybe take a break, take a week off. I've also Sarah: Yeah, yeah, yeah, because again, people understand egregious. They don't understand. Erin Sheffield: Sure. Sarah: Like gentle boundaries, they don't understand, well, I'm I'm going to go work three days a week instead of five because I'm not doing Erin Sheffield: Right. Sarah: well. They're like, but we have patients we have. We have you have to pay the bills. You have to pay the staff. What if what if what are you going to do? What's your staff going to do if you're not there and they're not going to get paid? And and you have to consider them because they have families, too. And it's this whole thing. But if you. You know, like, that's the thing is it's it's fine. Erin Sheffield: Yeah. You don't you don't have to keep doing this if you hate it. It's okay. Sarah: Right. Yeah. Erin Sheffield: It feels like you do though so much of the time. I think for me it's so important to have scheduled breaks. And I travel a lot and I think that's part of it is just me choosing myself first. And the more I take that time off, the easier it gets. But when I get into trouble, it's that acute thing. It's that same of the moment. Yeah. Sarah: because you've gotten into tunnel vision. Yeah. And I think that, Erin Sheffield: That's where it's hard and I'm still practicing on that. Sarah: yeah. And I think taking those breaks, really, enables you to like take a 50 foot view, give yourself some perspective, look around a little bit, because I think especially with what we do, we are like in it, right? And patient management is really difficult and we expect a lot of ourselves. We expect a lot of our staff. We expect patients to like us, you know, whatever it Erin Sheffield: Mm. Sarah: is. But it's, but I think taking, time away gives you so much perspective and enables you to give yourself permission because you look around you and you're like, look at all these other people, they're living their lives and they're fine. Erin Sheffield: Yeah. Yeah. Well, and that's that's a big part of the retreat that the doctor's all in Sarah: Yeah. Erin Sheffield: that you know, I founded is just giving yourself permission to show up for yourself because we're not allowed to do that. And that's what this is all about. It's about coming and filling your cup so that when you go back, you're better capable of not just taking care of yourself and others. But I s hear these messages so often. One of the women there was talking to a friend who was there this last time, and the friend was like, This resort is amazing. I wish I could stay even longer. I came a day early. Next year I'm coming two days early, probably. It's so Sarah: Yeah. Erin Sheffield: wonderful. And you should Sarah: Yeah. Erin Sheffield: next time you need to come on Thursday because it starts Friday afternoon, Friday evening. And she said, There's no possible way I could justify taking Thursday off. And we were both like, girl, you can justify it. Sarah: Yeah. Yeah. Erin Sheffield: You can. Sarah: Yeah. Erin Sheffield: You probably because you say that, you probably absolutely need to. So I'd Sarah: Yeah, that's fair. Erin Sheffield: encourage people to think about what you really need and to flex that muscle and to practice choosing you. Practice blocking off some time. It's usually time is what we really need, right? Sarah: Yeah. Erin Sheffield: But practice saying yes to yourself as many times as you can so that you stretch that muscle 'cause that's not a muscle that we've really been allowed to use. Sarah: Right, and also practice saying no to others. Erin Sheffield: That too. Sarah: That's really hard and really important skill to have because if you keep saying yes, people just expect, I found this in the Navy, people just keep giving you more and keep giving you more and keep giving you more, right? And you look around you and you're like, everybody else is going home at two. I'm here at six. Hmm, Erin Sheffield: Mm-hmm. Mm-hmm. Sarah: what happened here? And then you've got Erin Sheffield: Exactly. Sarah: the people that are like, well, that's... just because your job is an oral surgeon. And so if you want to promote, you're going to have to, and I had my ex-o tell me this, if you want to promote, you need to take on those other jobs and you're just going to have to take care of that after working hours. And I was like, nope, I guess that means I'm getting out because I'm not interested because I've got kids, I've Erin Sheffield: No Sarah: got a family, I've got other things. And I'm like looking at all of these other people that are promoting and doing all this stuff and then they're leaving. before even working hours are over. And I'm like, Erin Sheffield: Yeah. Well on my face. Sarah: I'm sorry, that's not actually going to happen. So you can find another oral surgeon. Erin Sheffield: I had similar advice. My partner's been out sick on medical leave now for probably nine months and we're backed up so long and there's so many people trying to get in. I just I can't get all the people in at the time they want to be seen, and people are falling off the sk like referrals are going other places and things like that. But one of the docs I know is like, well, you're just gonna have to work more hours so that you can accommodate the patients. And yeah, logically, yeah. Sarah: Hmm. Erin Sheffield: Okay, that would accommodate more patience, but there's always gonna be more patience. There's Sarah: Yeah. Erin Sheffield: always weeks and weeks. Like I was booked out weeks and months and months before, and now I'm booked out even more months. But Sarah: Right. Even more, right? Erin Sheffield: there's always more patience. There's always someone trying to utilize your time to take your time and That's not serving me. That's not taking care of me. And so I just I'm trying to push back on that. I picked up a few more hours here and there. But really I don't just because there are more patients doesn't mean I have to sacrifice myself on the altar of martyrdom to make it happen. Sarah: Right. There's also an oral surgeon that is actively trying to get to your practice to help you see those patients. But here we are still trying, months later. Erin Sheffield: I was like, my back is hurt, wouldn't this be great time for Sarah to Sarah: Yeah, that's supposed to be there next week. No problem. Okay. Hi. Erin Sheffield: Hopefully next month, right? Sarah: Yeah. Yeah. Erin Sheffield: Well, I think this is something we're gonna continue to work on and it's definitely a mantra of mine that I'm still not practicing what I preach, but I'm getting better. I'm recovering. Sarah: Yeah. Yeah. I am practicing that. But Erin Sheffield: Hahaha. Sarah: it is like, I still have that when people ask me, are you working? I'm like, well, I've got this and I've got this and I've got this. I can't just be like, no. You know, I still feel like justify it. Erin Sheffield: You still yeah, I feel like you still have to like make the excuse to yourself. Yeah. I see that. Yeah, for sure. We don't have to. Sarah: And so I'm working on that. So we've all got things to work on. Erin Sheffield: We all do. Sarah: Yep. All right. Well, here's to giving ourselves permission and setting boundaries and hopefully healing because clearly your body is trying to tell you something over these last few weeks. It's like chill the F out, Erin. Erin Sheffield: Yes, ma'am, doctor's orders. Sarah: All right. Well, thanks again for joining us on another episode of the Resting Stitch Face podcast. We'd love to hear from you and hear how you are able to set boundaries and give us some tips, give us some hints and give yourself permission. Erin Sheffield: Catch you later. Sarah: Bye! Erin Sheffield: Bye.