Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / Writing as a Healing Act with Dr. Carolyn Roy-Bornstein
Transcript
- Santina Wheat: For the clinician that might be listening today that feels like they're running on empty and maybe writing is going to be a way to help be a first step to moving towards feeling better. Is there a simple prompt that you might recommend that somebody could start today just to get them still started for 10 or 15 minutes? Welcome back to The Hidden Load. I am your host, Dr. Santina or Tina Wheat. In medicine, we are trained to be the witness. But what happens when the witness themselves is overwhelmed? Today, we are exploring how writing helps us release the suffering that isn't really ours while keeping the wisdom that is. Today, I am thrilled to welcome Dr. Carolyn Roy-Bornstein to the show. Carolyn Roy-Bornstein: So the easiest place would be ⁓ my website, which will be in the show notes, but it's www.carolynroybornstein.com. And then you can see where I'm speaking. You can ⁓ order the book, which comes out through Johns Hopkins Press, April 28th. Santina Wheat: Carolyn is a pediatrician and is also the writer in residence at the Lawrence Family Medicine Residency, where she is able to lead narrative medicine workshops to help residents process their journeys and connect to their deepest values. What amazing work. She is also the author of a new book from John Hopkins University Press, A Prescription for Burnout, Restorative Writing for Healthcare Professionals. And her work has been featured in the New York Times, the Washington Post, That is so exciting. And are there any last thoughts that you have to share with our listeners today? Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. Carolyn Roy-Bornstein: Well, I would say there's no time like the present and it's easy enough to get started. It just takes a pen and a paper. Santina Wheat: We will tackle the hard topics and help you conquer your chaos and get to calm all by starting to acknowledge and remove that hidden load. JAMA, and poets and writers. Carolyn is a frequent speaker at major summits like AMWA and Women in Medicine, helping clinicians across the globe use the power of story to transform their hearts and minds. Welcome, Carolyn. I'm so grateful to have you today. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. This podcast is a space for us to name the things that are common, but not normal. Each week, we'll look at the invisible weight you're carrying and explore practical coaching-based tools to help you find more calm, better boundaries, and a sense of purpose that doesn't require you to run on empty. I'm so glad that you've carved time out for yourself today. Let's get into the episode. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. Carolyn Roy-Bornstein: Thank you, it's great to be here. Santina Wheat: Now, Carolyn's journey into the healing power of narrative didn't start in a workshop. It started from a deep personal space of family trauma and what she calls disenfranchised grief. Carolyn, do you mind sharing with us the crash and the aftermath? Carolyn, thank you so much for joining me today. I really appreciate it. And as you said, I will make sure your website is included in the show notes. ⁓ And I hope that this encourages our listeners to try writing as a reflective practice if they're not already doing that. Carolyn Roy-Bornstein: Sure. mean, when people ask me about where this book came from, I think a lot of burnout books come from researchers who have been delving into this issue for some time or physicians who have burned out themselves and now feel they have something to offer other physicians. Whereas my journey, as you said, started long before that. When my son, I have four children and my youngest son when he was 17, Santina Wheat: Thank you everyone for joining us on this episode today. Please remember that this podcast is reflection as well and you are able to get continuing education or continuing medical education credit ⁓ and the link to that is in the show notes as well. I look forward to seeing you next time on The Hidden Load. You can find information on how to reach me in the show notes. don't forget to hit subscribe so that never miss an episode ⁓ and leave me a rating so that others can find too. Carolyn Roy-Bornstein: He was hit by a drunk driver in a crash that killed his girlfriend and left him with a traumatic brain injury. So as you can imagine, my family was devastated. We were just putting one foot in front of the other for a long time. And while he was going to physical therapy and mental health therapy, ⁓ going to meetings to ask for Santina Wheat: and take care of yourself because you deserve to be held up too. And I'll see you next time. Carolyn Roy-Bornstein: learning accommodations for school, this boy who got a perfect 800 on his math SATs, I was processing my own loss and feelings of grief ⁓ on the page. And what was particularly helpful in that time is to have a place to go, a place to set down my anger at the drunk driver who turned our world upside down, but also to process what I think of or came to understand was a disenfranchised grief in that I was the mother of the child who did not die, the child who survived. So when I was talking to my friends or family about all the things that had changed in our family, all the losses, all the upheaval, I heard, but he's alive. And so I stopped talking about it and I just used the page to ⁓ process those feelings, that ambiguous loss. It's not a loss of a life, but it's a loss of what was or what might have been. ⁓ So in that way, writing really helped me. It also helped me to create meaning eventually out of a pretty senseless situation ⁓ in that I so the book ⁓ ⁓ chapters and each chapter has three prompts. So it's filled with prompts and ideas. But towards the end of the book, ⁓ there comes a time when you will have to create your own prompts. And what I suggest is ⁓ a phone open, a notebook, ⁓ as you go through your day, if there are interactions, conversations that you think, ⁓ want to delve into this deeper. became the ambassador for the Brain Injury Association. So I spoke, did a lot of public speaking to high school students during prom week and college students during alcohol awareness week. And I always had people coming up to me afterwards telling me their stories of brain injury, stroke, trauma, infection. And I feel like we were less alone. We had each other in that journey. And James Pennebacher, who's the I want to understand this more. ⁓ ask yourselves those questions. What ⁓ the universe trying to teach me in this interaction? What am I to gain from this? What meaning can be ⁓ from this? You can ask your own questions about ⁓ that doesn't quite sit well with you or something that went really well that you want to figure out. What did I do here? What happened that made this so meaningful, so easy, so ⁓ whatever it is? ⁓ father of expressive writing in many ways said writing is pain turned into language and language turned into connection. And that's what I discovered organically before I even heard of James Penebacher is that's what writing does for us. It gives us a place to connect. Santina Wheat: I love that. One of the things that I do is I have a very long commute to get to and from my clinic. And so I will actually do the voice memos. I actually use the notes and just do ⁓ a transcription while I'm driving even so that because it always comes when I'm doing something else and then I can go back and look and say, ⁓ I wanted to write about that. Carolyn Roy-Bornstein: Me too. Santina Wheat: Thank you so much for sharing that. And I'm so sorry that this has been your experience. Carolyn Roy-Bornstein: Yep, that's what I do too. Santina Wheat: Carolyn, thank you so much for joining us today. If our listeners want to find your book, if they want to contact you, how do they do that? when you were ⁓ your grief, when you were feeling your devastation, when you were feeling the anger, were you consciously choosing to write to heal or was it something that came out of it for you? Carolyn Roy-Bornstein: Well, no, I was really consciously choosing it, especially when it seemed to me that it was my only friend at that point, the only place I had to go, but it was empowering. Eventually it was, and I think writing can do that for us, give us a sense of agency. I was at a conference called the Examine Life Conference. It's a writing conference for physicians at the University of Iowa. Nellie Herman, who's at the Columbia University in the narrative medicine program she was presenting. And she had written a novel based on a tragedy in her life. And someone in the audience asked, first, why did you choose to write it as fiction? And just why do you write in general? And the words she said, and this was some years ago, stuck with me to this day. And she said, we write to take control of something that we don't have power over, which is the past. And I've always felt that way, that we can't change what happened, but we can ⁓ create the narrative. We can own our own story, which can be very empowering. When I eventually wrote a memoir about the crash, I made a literary decision that felt very empowering. I didn't name the drunk driver throughout over 200 pages, he's simply the drunk driver. And I did that because at that point, I felt he didn't deserve that humanity. My position may have softened over the years, but at that point, it felt very empowering to just make that tiny, small decision and writing gave me that agency. Santina Wheat: That is absolutely amazing. Can you tell me a little bit about how writing works, how you talk about writing as a useful tool when you share it with those that you're leading through your workshops? Carolyn Roy-Bornstein: So as the writer in residence at a family medicine residency program, I narrative workshops with the residents. And there we start, we don't dive right into writing. We start with ⁓ literature, humanities, a piece of art, a poem, an essay, a story. And we discussing that. And even before we get into the writing, we are other residents are starting to connect their own personal and clinical experiences with the piece of art that we're discussing. And then when we get into the writing about it, the connections the connections ⁓ themselves, they're connecting to their own deepest ⁓ their deepest values, and connecting with each other when we get to that affiliation part narrative medicine, that third movement as Rita Sharon talks about it, the goal is affiliation with each other, with our patients. ⁓ what I see also is an affiliation with the deeper selves. ⁓ Santina Wheat: And can you share with me a little bit about how you writing, either for you or for the residents that you're working with, as a way to that mask that we sometimes have to wear at work, that doctor face, if you will. Carolyn Roy-Bornstein: Yeah, you know, in medicine, in any kind of healthcare, nursing practice, social work practice, we bear witness to great suffering every day. I don't think anyone would disagree with that. And in fact, Rita Sharon, who heads the program in narrative medicine at Columbia, tells us that doctors have to develop a porousness, a permeability in order to absorb those stories of illness from our patients, those stories of suffering. And I agree with that. I agree that we need to understand our patients, where they're coming from, their illness journey. But I think too often we just keep carrying that suffering and no one has told us it's okay to set it down, that we don't have to keep carrying it. And how do we do that? I think writing can be that filter that kind of back door that we take in the suffering into our hearts as we listen, as we are actively, radically listening to these patients' stories. But then we can, it's okay to let go of what isn't ours, what doesn't belong to us, and still look for, create, extract the meaning in that sacred doctor-patient relationship, in that interaction, in that. moment. There was a study that came out not too many months ago from the University of Michigan ⁓ about sacred moments ⁓ where Saint and his team asked over 600 internists whether how often they had sacred moments with their patients and they defined it as ⁓ brief interactions with a patient and ⁓ over two-thirds said yes. recognize that, I know what you're talking about, and yes, that's happened to me. ⁓ experienced that. But follow-up question, have you shared that with your colleagues, was mostly And I think that's where also narrative medicine can help to kind of bring this ⁓ idea that do have sacred moments, that this is why we got medicine and we can. ⁓ even for that small brief moment, a moment of joy, a moment of meaning, that that's also agency in a time in medicine and healthcare where we can feel like we don't have agency. Santina Wheat: Absolutely. You mentioned in your book that writing can be helpful for the dimensions of burnout. How does restorative writing help us release the trauma narrative without losing that meaning that you're talking about that we gain from our patients? Carolyn Roy-Bornstein: Well, I think very often just in writing about it, Joan Didion said, I write entirely to know what I'm thinking. And I think she didn't necessarily mean she doesn't know what she thinks until she writes it down. But I do think very often we don't fully understand the impact that a situation, a conversation, an interaction has had on us until we. start writing about it or even until we share it with our colleagues. It's been a number of times where people in my workshops have said, you know, after writing, they just sit back kind of exhausted and say, wow, I had no idea I was carrying that I had no idea I was so afraid. I had no idea I felt that guilt. I was so mad. ⁓ don't understand the impact of it until they start writing about it. So I think writing can help. illuminate that meaning ⁓ ⁓ it for us. ⁓ Santina Wheat: I think that's so important. One of the things that I talk about is sometimes just awareness is that first step. And this is an amazing way to bring that awareness of those feelings, those thoughts, those loads that are weighing on us. ⁓ And it sounds just like an amazing experience for the people that you're talking about. ⁓ Carolyn Roy-Bornstein: Right, and awareness. create the prompts for these. We do the reading and then we write to prompts that I create in order to bring out whatever theme it is we're discussing ⁓ or whatever theme we want to talk about. And the first prompt is always just write about the situation, just who was there, what was said, what do you remember? And then we get into what did you think about it, what did you feel? There's a lot of perspective taking too that happens. ⁓ can of put yourself, ⁓ can even write in the second person, you can write in the third person. So there's a lot of ⁓ flexibility. You really put yourself in the ⁓ patient's position say, did that ⁓ feel like them? We don't know that, but we can try to understand it. ⁓ And if in primary care, we can go back to that patient and say, you know, I was thinking. ⁓ I was thinking maybe it was like this for you. What do you think? And just validate what you came up with in your writing. Take it that one step further. Santina Wheat: Having done this for a while, are there certain themes that you are finding coming out frequently as you're leading others through these exercises? Carolyn Roy-Bornstein: Yeah, I think the agency is a big one. And I think what can come from that, I can't give particulars about situations, obviously, that happened with the residents, because one of the things you do is try to create a safe space that honors their ⁓ privacy. But advocacy can come out of that in situations where they may have felt ⁓ like they you know, we're part of the team, but we're overruled with something and maybe they thought they knew what was good for the patient or the family and they weren't really being listened to. I think what can come out of that is finding their voice and finding their role as advocacy or just finding their role as the bearing witness. know, sometimes we really don't have ⁓ We don't have a say and we don't have control. Patients at certain stages of life, we've done what we can do. We can't do much more, we can always bear witness. We can always be there. We can always bring our presence. We have our protocols and clinical guidelines, but we can also bring ourselves to the interaction. Santina Wheat: I would argue that's one of our most positive or most important strengths that we can bring ⁓ that witness. ⁓ We're both physicians. ⁓ And so that means we like data, we like science. Can you tell us a little bit about the evidence that writing can actually help heal physical, mental, spiritual wounds that many of us are facing? Carolyn Roy-Bornstein: Mm-hmm. Sure. mean, starting back with James Pennebaker, he had this theory that the reason that we humans were suffering from so much stress is that we were keeping things all bottled up inside. And what he did at University of Texas, Austin is he was a college professor and he divided the, he did a randomized control study where half the students wrote about their deepest thoughts and feelings and the other half, either didn't write at all or wrote about more mundane topics. He used as a health outcome measure visits to the student health office. The students who wrote about their deepest thoughts and feelings had not just clinically significantly fewer, but dramatically fewer sick visits. That's been shown time and time again with patients with asthma. asked to write about stressful situations where you'd think intuitively, wouldn't that make you more stressed writing about stress? ⁓ But it actually can relieve that stress and pulmonary function studies improved, objectively improved. And we know from MRI, functional MRI studies that just externalizing those painful emotions, just naming that emotion ⁓ can, you know, brain regions that tend to activate with distress ⁓ deactivate when we externalize and name those painful emotions. So there is a lot of science behind it, behind what I found personally and organically all those years ago. Now that I'm delving into the science of it, it's there in spades. Santina Wheat: Can you share with me a little bit about how when you decided to start sharing your writing, how did you do that? How did you determine where to go first and move forward? I'm sure there's others listening that maybe are writing in their personal journals and have thought about sharing it, but don't know how to do that yet. Carolyn Roy-Bornstein: yeah, ⁓ and gets back to creating meaning ⁓ through writing. ⁓ And shared, for example, ⁓ you what can be sort of a hidden disability, ⁓ a brain injury ⁓ with disabilities journal. ⁓ I shared ⁓ a journal in JAMA, you know, what ⁓ if something I experienced with my child might help you with your child. How should I share that? Should I share that at all? I explored that in a medical journal. I explored ⁓ the loss that I felt was ambiguous to other people, but true and real to myself within a ⁓ mom's literary journal. ⁓ So these are just thinking about... what you're passionate about and thinking about the audience that you want to reach. Those are just some examples of creating meaning and creating connection. Santina Wheat: And then how did you make the decision to write your book? How did you get there? Carolyn Roy-Bornstein: So for a long time, it didn't start out being the book that it is. It's kind of like proselytizing. Like once I was just so convinced that what I had experienced in writing could be experienced by others. And so, well, one thing I did was I approached the Chicken Soup for the Soul people and the editors and producers of that series and said, let's do a book on traumatic brain injury. And we did that. And I connected with a lot of the authors there who said the same things that I was talking about, wow, I really am grateful for my brain injury. And I never realized that until I started writing about it, how transformative that experience has been. And so I wanted to write a book about reflective writing and how important it is, how transformative it can be, but I was struggling a little bit with the audience. And then right before the pandemic hit, there started to be in the zeitgeist ⁓ a lot of ⁓ work and talk and studies about physician burnout. And I realized reflective writing could be really helpful to my people too. And this is an audience I know. was a You probably don't know this about me, Tina, but I was a nurse for 10 years before I was a physician. So I kind of know this world pretty well. ⁓ And I just really felt ⁓ connected with that audience, that ideal reader being that burnt out or burning out or stressed ⁓ physician, nurse, educator, social worker. ⁓ And that's when the work, having the focus made the work flow much more easily. It was a book that I had been working on for some time, but once I had the audience in mind, then it just took off in my mind. Santina Wheat: amazing. Now I'm going to share that early on in my residency, my program director did try to bring a writing workshop to our residency and I personally viewed it as something that wasn't as important as me seeing the patients, that it was the thing that wasn't ⁓ the best use of my time, that I had a little at the time and I if I wasn't seeing patients I would have rather have been home. Looking back I was wrong in those thoughts but how do you reach someone like Pastina who who thinks that the softer things aren't an important part of this profession or your training? Carolyn Roy-Bornstein: Well, think it's twofold. And I think the first is very practical and it's just time. one of the studies, there was a study out of Hong Kong that looked at giving physicians just 15 minutes a day of writing. And that showed a significant drop in depressive symptoms, in perceived stress symptoms. So I think just. understanding that even short investments of ourselves in this activity can be helpful. ⁓ And I think also just doing it and having a skilled facilitator to help with it can sometimes open our eyes. I mean, there's always going to be ⁓ cynics, cynicism being one of Christine Namaalak's ⁓ dimensions of burnout. so, you know, there will be naysayers. But I think if you give it a chance and do it for just a short period of time, it can be really ⁓ powerful and really meaningful. Those studies that I referenced earlier with ⁓ James Pennebaker and the students and the ⁓ There's a wound healing study, there's asthma and arthritis study. Those effects, even though the intervention was only done for a couple of weeks, those effects stayed for four months, six months, however long they did the follow-up. It is sustainable too, and it's a sustainable practice if you're only doing it 15, 20 minutes at a time, 10 minutes at a time. Santina Wheat: amazing. So ⁓ primarily speaking with this podcast to the ⁓ the educators. ⁓ is it important for them to be thinking about this for their teams? ⁓ Carolyn Roy-Bornstein: Yeah, think just ⁓ recognizing the issues in healthcare, recognizing the demands, recognizing ⁓ the constraints on our time, the lack of agency in a lot of our decision-making, ⁓ space for ⁓ both. ⁓ I like to say there's things that I can't control. admins and CEOs and I can't control insurance companies, those things, but I can control this, this, can offer this one tool, this one small thing. And I think if leaders can find a way to offer that one small thing, a gratitude intervention, for example, ⁓ just starting, starting meetings with a gratitude intervention, just going around and asking. not what the problem is, but what's working, what are you grateful for that's actually working in our team and our system and recognizing everyone's input and ideas and innovations. can go a long way.