Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 3 Jillian Horton, MD

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Flourishing in Medicine: From Surviving to Thriving Episode 3 Jillian Horton, MD · Flourishing in Medicine: From Surviving to Thriving

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Welcome to flourishing in medicine.
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Welcome back to flourishing medicine.
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I'm your host, Dr. Mick Krasner, and this podcast is being produced by EmPRO, a medical
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professional liability insurance carrier headquartered in New York State, dedicated to protecting
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New York, New Jersey, Connecticut, and Pennsylvania's physicians, healthcare facilities, and healthcare
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providers.
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This podcast is part of EmPRO's forward thinking peer support activities.
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In this podcast, we strive to explore ways health professionals, physicians, nurses,
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nurse practitioners, PAs, mental health providers, therapists, and others can flourish in the
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complex and challenging world of healthcare.
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I'm excited to share with you my conversation today with the curious, multi-talented, and
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incredibly creative Dr. Gillian Horton, a general internist who has served in multiple
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leadership positions at University of Manitoba's Max Rady College of Medicine in Winnipeg.
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These have included the inaugural director of the colleges and faculty of health sciences
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program in physician and learner wellness, director of the Allen Class Health Humanities
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program and associate chair of the Department of Internal Medicine.
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She has also served as the associate dean of undergraduate student affairs at the medical
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college.
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She has won numerous awards for mentorship, professionalism, and teaching.
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There's a lot more to Dr. Horton than that part of her bio.
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She's also an accomplished musician.
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Please look up her music on YouTube and writer.
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Among her many projects is an advice column that she pens called Ask Dr. Horton and a
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podcast called Medlife with Dr. Horton for the Canadian Medical Association Journal where
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she explores the emotions, unanswered questions, and complexities of the human side of medicine
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inviting and shaping national conversations on meaning, purpose, and humanity in medical
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practice.
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She contributes regularly to the Los Angeles Times as well as other prominent newspapers.
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She's the recipient of the AFMC Gold Humanism Award and lecture that was created in 2018
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to emphasize, reinforce, and elevate the ideals of humanism and patient-centered care within
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the healthcare community in Canada.
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She co-authored a poignant graphic novel, Medicine, which focuses on the intense challenges
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of a medical student.
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And her latest book, a Canadian bestseller, We Are All Perfectly Fine, is a memoir about
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mindfulness and reclaiming our full humanity and a call to reimagining medical education.
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I encourage all of you to read this beautifully written, highly personal, provocative, humbling,
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and at times shocking look into bringing oneself completely to the serving of others within
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the medical profession.
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This conversation was simply a joy for me, although as you listen to it, I hesitate to
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use that word, yet it truly was.
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We had a wide-ranging conversation.
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And now our conversation with Dr. Jillian Horton, sharing stories of how the resiliency
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of her family contributed to her choice of medicine as a profession and vocation.
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She also speaks of how the character of Hawkeye Pierce in the TV series, MASH, and the persona
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of Alan Alda has been a blueprint for her survival.
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She challenges the pursuit of joy in medicine, or rather has us examine deeply what is meant
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by joy and how we must first attend to foundational needs among the hierarchy found in living
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this human experience.
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She explores how relativism can often discount the needs for humanism and meeting each person
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where they are in the medical encounter.
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The power of deep listening, the centrality of presence are messages.
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She lives and offers as gifts for us to explore as we work towards flourishing in medicine.
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Thanks for joining us on this podcast, Flourishing in Medicine, of which you have personal connection
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with, of course.
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And what I'd like to do, I'm making a habit in this new podcast of kind of asking guests
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a similar question, each of them just kind of capture their history.
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And that question has to do with my experiences in healthcare as an educator and in other
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ways with students, with clinicians, teachers, academics, and others.
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And I've been really impressed by the unique narratives about why they went into the health
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professions.
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Now, you've written partly about this.
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Sometimes they share stories of early or profound experiences with health and illness, their
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own or someone close to them, often very poignantly.
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So I'd just like to allow our listeners to hear a little bit about your path.
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What were some of those really early experiences that sort of created that inspiration for
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you to enter the health profession to become a physician and healer, we could say?
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Well, it is so lovely to be here talking with you today, Mick.
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You know, I'm such a fan of your work, it's had such a transformative impact on my own
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life.
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And I think what you are asking me to talk about right now is a place where I also love
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to start when I talk to physicians, which is my origin story.
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So for me, I grew up in a small town in the Canadian prairies with two very disabled siblings.
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And in particular, my experience bearing witness to the development and encounters with the
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health care system of my oldest sister, her name was Wendy, had an absolutely formative
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impact on me and I think is unequivocally the root of my why, the why I became a doctor.
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So there were some really good experiences that I bore witness to.
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You know, my sister was diagnosed with a brain tumor when she was six by a very, very compassionate
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physician who sort of took on almost mythologic proportions in the lore of our family history.
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And this, by the way, was before I was even born.
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But unfortunately, our encounters with the medical system also included dealing with
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a lot of people who were not kind, who were not compassionate, who were perhaps what we
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consider to be technically skilled, but a human piece was absolutely missing.
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And what I could not understand and struggled with as I grew up and watched my parents and
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my sister and the rest of my family deal with the fallout of that lack of, you know, compassion
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and engagement and humanity was just a profound kind of vicarious trauma and anger and not
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really understanding why when those humanizing aspects of dealing with patients and supporting
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patients and just simply connecting with people, you know, why people couldn't deliver that
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as well.
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I think I understood immediately that if you weren't meeting people's human needs in some
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basic way, you actually weren't providing excellent care.
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And so that became for me the basis of, you know, my just compulsion, I think, to become
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a physician.
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It wasn't even a choice.
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There were other things I dreamed of doing with my life and wanted to do.
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And some of them I've come back to later.
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But I just felt that knowing what I knew and understanding that so viscerally, it would
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not have been true to myself to not choose a life where I could use those experiences
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somehow for the better.
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And that really laid the groundwork for me to become a physician and also a medical educator.
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Thank you.
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You know, we as healers, physicians, other health professionals share so much of this
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origin story.
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Interestingly enough, I have the brother closest to me, there's six of us, also had a degenerative
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neurologic disease that eventually took his life and really informed also my why in a
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very profound way.
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So I knew that about your story.
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I'm not sure if I ever shared that about my story as well.
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But of course, not surprised, Jillian, that has us connected as it has us connect to so
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many others.
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You know, those are very difficult and challenging experiences, both having that in your family,
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but also having encounters with the health care system that are less than optimal.
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And you could see that writ large in your own personal experience in that way that you
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describe.
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But if we flip that around, how does this formative origin story experience, those that
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you just described, contribute to flourishing, to your flourishing?
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And how do these, if we generalize, can contribute to the flourishing of others of our health
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profession?
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Well, I think, and you know this, Mick, from your own work, and it's one of the messages
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that you reinforce so constantly in your own teaching and kind of the speaking and work
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that you do with physicians.
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But I think we know when the literature tells us very clearly, not just in medicine, but
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in other things across the board, if we can stay connected to our why, if we can not just
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know it for ourselves, but kind of constantly renew our vows to it and see it showing up
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in our day to day work, both the work that we find the most meaningful, but also even
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things that it's a little harder for us to tease out the relationship between what we're
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doing right now and what our why is, and we have to work a little bit to find it.
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You know, we know that that helps us maintain some immunity against burnout.
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And I think it also helps us to deal with the feelings of helplessness and hopelessness
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that we so often encounter when we are encumbered by things like the absurd administrative burden
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and certain things that you in the United States have to deal with that I, in Canada,
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don't have to deal with, like volumes and volumes and volumes of insurance paperwork
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and other considerations like that.
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So retaining that connection and making that a conscious part of our medical practice,
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of our personal practice and something we articulate to other people and kind of explore
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from different angles.
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You know, I think writing about these things is also incredibly helpful because it allows
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us to go through a process of kind of emotional consolidation and remind ourselves of things
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that we've really forgotten or stories that we don't typically share in a medical forum.
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You know, you reminded me, I host a series for the Royal College where one of the things
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that I get to do is talk to fellows of the Royal College about their why and interesting
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experiences that they've had that have really shaped who they are.
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And you know, one of my conversations recently was talking to a fellow physician about when
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I was giving a grand rounds at a large Canadian hospital a few months back.
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And afterwards, somebody shared in a public forum, so it's not a confidential story, but
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they shared that, you know, they too had grown up with a really disabled sibling.
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And when they tried to share that story years ago as their why, I think it was when they
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were applying to medical school, they were told by a mentor, don't ever do that again.
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That's your personal life that has no place here.
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And again, I think there's a powerful message for us, right, that when we divorce the personal
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who we are, which is so often where those deep and profound whys are located, again,
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we actually really jeopardize ourselves.
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We kind of toss the thing aside that we potentially need the most in order to stay in this very
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high pressure marathon of a job.
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Yes, you just reminded me that I'm thinking about what's become increasingly clear is
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how compassion and our decision, say as health professionals to help care for others is an
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imperative as a species, something that's reinforced very profoundly in terms of our
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physiology and something that is so completely intertwined with our survival that it's very
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clear that someone articulating that they had that experience and it informed why they
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want to help others would want to be in the health professions.
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So you kind of have connected the dots a little bit with the connection of your why with joy
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and meaning.
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And I'm just wondering if you could talk more about what do we mean by joy in the work that
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we do?
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What do we mean by meaning?
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And what's the importance of it?
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After all, we have jobs, we have jobs that the public respect in general for the most
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part, we get paid reasonably well, etc., etc.
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But why is our meaning and joy important?
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And what do we mean by it?
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What do you mean by it?
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So, you know, joy in medicine, I think, is a really interesting concept.
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And I think joy is actually a triggering word right now for a lot of physicians and not
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in a good way.
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And that makes a lot of sense, right?
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Because when you think about Maslow's hierarchy of needs, and as we look at, you know, kind
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of what the base of that pyramid is, what we need in order to experience fulfillment
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and all these other kinds of things that we are programmed to strive for as a species,
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you know, at the very top of that pyramid are things like self-efficacy and, you know,
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feeling meaning in our work, for example, is kind of clustered in there.
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But at the base is psychological safety and physical safety, right?
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Physical safety being the very, the very core piece of that pyramid.
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And you know, I actually think this is a problem with this conversation right now.
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I absolutely love the work on joy in medicine and the movement is critically important.
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But I think it's really hard to talk to people about finding joy in their work when they
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don't have physical safety, when they're worried about, you know, physically being injured
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in their workplace, when they're profoundly sleep deprived, when they have not had a vacation
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in eight months, when they don't work for psychologically safe leadership.
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And so I actually find to some degree at this particular moment in time, I don't really
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want to talk about joy in medicine.
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And it isn't because I don't experience joy in medicine or because I don't believe it's
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an absolutely worthwhile goal.
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I worry, I don't know if you saw, Mick, there was a piece I wrote for the Los Angeles Times
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a couple of years ago that got a lot of traction.
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And it was about a concept I called muffin rage.
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And the idea behind muffin rage was it was an experience that I had as a resident and
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walked into the hospital one day, I see a big banner, Resident Appreciation Day, and
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there's a plate of muffins on the table.
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And it's 7am and I'm reaching out for a muffin.
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And suddenly, as I go to mindlessly take this muffin, I'm overcome with a feeling of rage,
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like I want to use the muffin to, you know, physically damage the building that I'm in.
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And I think what I remember looking back at that is this just feeling of indignation,
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but also of abandonment.
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You know, thinking, I don't need a muffin.
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I need to sleep.
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I need to see my family who were a thousand miles away who I hadn't seen in six or seven
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months.
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And my sister at that time, I think was critically ill and in and out of the ICU.
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I probably needed, you know, kind of counseling, therapeutic support.
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I didn't really feel that I was working in an environment where my workload was commensurate
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with, you know, the skills that I had as a resident.
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And so again, there's this mismatch, right, that we experience when we talk about some
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of these things and the basic needs aren't acknowledged first.
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And I think we're seeing that time and time and time again, when we look at how health
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care workers are responding to a lot of the initiatives or conversations around these
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issues, especially, you know, events to show appreciation.
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And I think there's actually a strong case to be made that, you know, conversations about
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joy and medicine also feel that they are missing the mark for a lot of folks because again,
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they're not coming from, you know, it's not you and me sitting on a couch talking privately,
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dealing with our own, you know, making the choice to have that conversation.
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It's our organization.
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You know, when we of course, the literature tells us unequivocally that organizational
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factors are the primary drivers of burnout period, full stop without a caveat, right?
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That resilience, individual resilience and, and the meaning that we find in our work.
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I mean, mission alignment kind of has some overlap with the organization there.
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But you know, the personal piece is small.
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So I just think that is important grounding that when organizations are leading these
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conversations or when they're coming kind of from within institutions that we understand
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there's almost like a trauma informed piece, right?
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That we get why a lot of people don't want to sit and have that conversation with us.
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And we think they're being obstreperous and we think they're being difficult and we think
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they're just burnt out and need to, you know, learn mindfulness.
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And in fact, the problem is what we're sometimes telling people that we're what it feels like
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we're not acknowledging or seeing when we go to that place.
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So kind of a not meant to be a difficult answer, but it's, you know, one of the reasons why
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right now I almost question whether first we, we need to get all that other stuff out
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of the way.
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And I think it's helpful because then people kind of go, okay, you know where I'm coming
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from.
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You get this.
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Maybe now we can talk about, you know, the why.
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But yeah, just just an observation I've made speaking to groups quite quite a bit over
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the last few years.
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Joy is a joy is a trigger word.
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I agree as is burnout, as is resilience.
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And especially when it's laid upon our us as our responsibility individually to obtain
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it.
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You know, I think Aristotle, I think had a better word for it.
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What's called you daemonian.
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If you look at that, the root of that word within that word daemon also related to demon.
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So it's a deeper, deeper sense of flourishing.
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That's why actually we were calling this podcast flourishing in medicine, not joy in medicine,
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because even when even with those needs that haven't been completely addressed, especially
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the psychological and physical safety that you talk about, we can still kind of work
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towards some way of flourishing because we need it and our patients need it as well.
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And I wanted to use this as a way of segueing into a discussion about, again, what I commented
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on earlier in one of your prior reflections, the imperative as a social species to care
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for others.
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You have been personally inspired by the character of Dr. Hawkeye Pierce in MASH, in the TV series
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MASH.
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And more recently in the persona of Alden Alda, the actor who played Hawkeye.
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And in fact, you've been quoted as saying that MASH gave you the blueprint for survival.
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And I just would like you to tell us a little bit about that.
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If you think about just MASH, this is a group of army physicians caring for, no matter where
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they come from, the wounded.
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And with humor and lightness and with actually a depth, a eudaemonic eye toward what's really
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meaning, meaningful for them.
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So go, yeah, please take us on that journey a little bit, how that became a blueprint
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for survival for you.
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You know, it's interesting, Mick, looking back at my childhood.
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I think one of the ways that my family coped with the incredible adversity that was part
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of day to day life was with humor.
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And I often think back to, it's hard for me actually to untangle my earliest memories
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kind of around the age of nine or 10.
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And thinking about late at night, my one sister who, like me, had been spared these major
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health issues and late at night would sneak into her room and we'd watch after my parents
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had gone to bed, we'd watch reruns of MASH.
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And I think one of the things I was always struck by was the parallels, how these people
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in the midst of these really intense emotional circumstances, being surrounded by suffering
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and obviously on a totally different scale than the microcosm that I lived at home.
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But I was always struck by kind of the rawness of it, including just how humor carried the
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day.
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And often loving humor, compassionate humor, sometimes shocking humor, things that people
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didn't expect.
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And I know that kind of idea that retaining our spirit, retaining that spark of, see,
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I almost found myself using the word joy, that even in the worst moments that if we
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could find that, kind of hold on to that little burning candle, that that was important.
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And that was certainly a huge part, I know, of how our family coped with everything that
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we experienced.
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And I also think, like so many of us, I mean, as you know, I've written quite a bit about
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this.
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I had this delightful experience of writing a piece in the LA Times almost exactly three
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years ago that went viral, that ended up kind of connecting me to Alan Alda.
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We were on Inside Edition together, and I had the thrill of being on his podcast and
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talking about my book.
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And then I actually more recently did a documentary on this for the Canadian Broadcasting Corporation,
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a one-hour radio documentary, looking at how that love of kind of mash had shaped my perception
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of what it was going to mean to have a life in medicine.
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And that included some of those positive things that you say, coming together kind of as the
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company, you know, the team-based aspect of it.
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If you think of our years as residents, many of us would use the words in the trenches
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to describe what we went through when we thought of ourselves as kind of being on this front
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line and being in battle and being part of the Corps, pursuing a mission.
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There was actually, even if we maybe didn't think of it this way, there was a really deep
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sense of kind of meaning and team identity during the best moments of that.
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And again, when I think of, you know, not just how mash shaped that concept for me,
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but interestingly, learning about this in particular for this radio documentary, you
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know, kind of how concepts of 19th century war sort of shaped medical education as well.
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There's all kinds of fascinating stuff there when we look at what the groundwork was for,
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you know, how our training became influenced by some of those models and, of course, were
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needed medics and sophisticated medicine in order to continue to carry on and be successful.
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But I think at the end of the day, how that show influenced me, the positive piece, and
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how that character of Hawkeye influenced me was just the idea that we can resist, you
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know, we don't have to become inhumane, that systems actually often do exist with a structural
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intent to dehumanize us, and that we don't have to give in to that, you know, that resistance
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is sort of one of the most powerful things that we can nurture inside of ourselves.
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And I think one of the ways that we continue to demonstrate resistance and keep it alive
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in ourselves is through a kind of humor that is very deeply connected to something personal
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that can be hard to articulate, but we all know it when we feel it.
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Thank you.
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Yes, I agree with you.
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But you know, in many ways, as you point out, that show illustrated and showed us the universality
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of suffering in a certain way, how it really knows no borders.
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It isn't just soldiers, it's civilians.
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We're all on this planet together and have to figure out a way to live together.
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Yet for yourself, you describe in your writings and in your speaking about how you have had
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to learn that your suffering also mattered.
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You've spoken about the process of developing an understanding of the universality of suffering,
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and it's allowed you to address your own suffering as something valid as well as useful.
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Maybe you can talk to us a little bit about, you know, how realizing however small or large
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one's own individual suffering, how it's valid, important, and also becomes a crucible
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out of which one can, you know, translate into healing for others.
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I think we as physicians have a tendency to devalue our own suffering, and there are lots
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of reasons for that.
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You know, for me, when I look at my, again, my personal life, I think growing up with
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siblings with profound illnesses, you know, subconsciously in sort of the early formative
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years, you can come to believe that there is a hierarchy of suffering, you know, you
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can come to believe that the only problem that is really a problem is a very dramatic
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thing like a brain tumor or a degenerative neurologic illness, and that everything else
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is just you complaining and, you know, not being grateful enough for not having those
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problems.
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I think we unconsciously can come into medicine with a lot of stories like that scripted in
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the back of our minds, and we're not even aware of them.
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So that I think is part one.
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But part two, you know, if you think of how we are indoctrinated in medicine, on one hand,
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we sort of say, well, we take all problems seriously, but actually we don't.
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There's totally a ranking, you know, that I think, again, we just sort of accept during
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medical school that some people's problems, you know, we see preceptors modeling this
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behavior, we see our teachers kind of saying, gee, that person just needs to toughen up
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or this is a functional problem, it's not worth our time, it's not organic, it doesn't
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have a biomarker.
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And so we kind of fall in line with some of that too.
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And that we also engage in, Brady Brown, of course, talks about comparative suffering,
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but we also engage in a lot of physician-centered framing.
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And so, you know, physician-centered framing basically, as you know, as it's talked about
27:31
in the literature is we have one data set.
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So somebody, you know, comes in with their symptoms could be pancreatic cancer and we
27:38
investigate them and we find that they don't have pancreatic cancer, but they have, you
27:43
know, some other disorder that we don't deem, that we think they dodge this great bullet.
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And in fact, we diagnose them with a chronic illness.
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So you know, great example of that.
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And the example that I love from the literature is how we talk to people about having CLL
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versus having other forms of leukemia.
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So we all think of CLL as this more benign process, even though it's certainly not benign,
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but we think of it as, you know, winning the lottery.
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If you're going to have a leukemia, that's the good one.
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And you know, this is nutty, right?
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Like this is actually, again, looking at the data set of the worst thing, you know, gee,
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today my car's brakes failed and I drove into a brick wall.
28:22
Well, the other person that I heard of whose brakes failed drove over a cliff.
28:26
So just be glad you didn't drive over a cliff.
28:29
But you know, again, how does that relativity help the person in the moment when they're
28:32
dealing with the multiple injuries sustained driving into the brick wall?
28:37
So this, you know, again, is another interesting thing that we use data sets that we have been
28:43
drilled into us from day one.
28:45
We accept those scripts.
28:46
We think about people's experience of suffering, not from the perspective of what it's like
28:51
to live with the particular set of symptoms, diseases, or experiences that that person
28:57
is living with.
28:58
Instead, we think of it as well.
29:00
It's not the absolute worst thing.
29:02
And it's just a it's something that we're not even aware that happens to us.
29:06
And you know, interesting in the literature, when we look at Tate, Shanafelt has done beautiful
29:11
work on this in his life as a hematologist, not not in his life as a world expert on physician
29:18
health, that when we use phrases like, you know, you have the good leukemia, if I could
29:25
pick a leukemia, I'd have the one that you have, don't worry about your leukemia, that
29:29
actually patients whose physicians use those phrases have a worse quality of life than
29:34
patients whose physicians do not use those phrases.
29:37
So again, this relationship, it's actually such a lovely illustration of how what we
29:42
say actually then can go on to infect our patients, right, and have an impact to be
29:48
experienced as minimizing as invalidating.
29:51
So we do that unknowingly.
29:53
We do that with you know, we think good intentions, we're trying to be helpful, but the effect
29:58
is absolute opposite of the effect that we want to achieve.
30:01
And I would argue that we do that same thing to ourselves day after day after day, you
30:05
know, we we deal with our own physical ailments, our own emotional and mental suffering, or
30:12
whatever else is happening in our lives.
30:14
And we say, well, gee, it's not as bad as what I saw on the word today.
30:17
So what's my problem?
30:18
Why can't I just, you know, suck it up and deal with this?
30:22
And we, we miss a lot of opportunities in those moments to improve our own quality of
30:28
life.
30:29
And I think just to go back to one of the other things that you said, is the banality
30:34
of suffering, you know, again, we can use this as something to minimize our own experiences
30:38
to say, who cares about my suffering, it doesn't matter, versus to say, you know, the experience
30:43
is universal, what's different is the details, you know, so sort of the sorting the discernment,
30:49
you know, we get really caught up in the details of our own experiences, because we know them
30:53
so intimately, and they're so important to us.
30:56
But actually, again, when we zoom out, if we can put the details aside, what we can
31:00
see is that undercurrent of pulsing the experience, the suffering, what it feels like to suffer,
31:07
what we know to be true about just what it's like to be in those moments.
31:10
And I think when we can really kind of have beginners mind about that, kind of allow ourselves
31:17
to look at that experience without judging it, it's when there is the possibility, I
31:23
think for all of us for tremendous healing, actually paradoxically, be free of that load,
31:30
because we are able to divorce a little bit from all the particulars and say, my brother,
31:35
my sister, who practices next to me, I don't mean my literal brother and sister, I mean,
31:39
all of us in, in the pursuit of the work we do, we are all dealing with something.
31:45
And instead of saying, well, we're all dealing with it, therefore, it doesn't matter.
31:48
We're all dealing for it with it.
31:50
Therefore, we are all here together in this place to sort of comfort and console each
31:55
other.
31:56
And it just changes.
31:58
It's just an entire shift in our emotional and cognitive stance in terms of how we see
32:03
ourselves, how we see other people.
32:05
And for me, I think it's opened up the most interesting chapter of my life as a clinician,
32:10
as a person, as a writer, as a teacher.
32:13
I often say I'm grateful that I lived long enough for that to happen, because it's when
32:18
we get to experience that one of the most important reorientations, I think, is, you
32:23
know, we see our experiences in a new light, that's actually much more interesting than
32:28
the old light, because it's so universal.
32:30
Yeah, very well said.
32:31
I was just thinking about that way we use that relativism, and how it can affect one's
32:38
experience of their own suffering.
32:40
And I had the good fortune in 12th grade of being called down to the office.
32:46
I thought I was in trouble, but I was actually called into the library to have a conversation
32:50
with a few other students with the author, James Baldwin.
32:54
And it reminds me about James Baldwin, he had a statement which I'll paraphrase, something
32:58
like, our suffering isn't what separates us, our suffering is our bridge that connects
33:03
us.
33:04
I just think you've articulated that in a very real way, and that let's leave relativism
33:09
behind and let's just address what's present, what's here.
33:12
I wanted to just shift a little bit, we have a few more questions I'd like to ask.
33:16
The first is, you know, I've just always been amazed and just full of joy, I must say, even
33:23
though we're going to hold that word in contempt a little bit, with just knowing you and having
33:30
you as a colleague and as a friend.
33:32
You have many talents, you're a trained and accomplished musician, a skilled and gifted
33:36
writer and engaging and interesting speaker, not to mention you're pretty funny and witty.
33:42
And this may sound like an odd question, and maybe a non sequitur, but I'd like you to
33:47
just go with it.
33:49
Why?
33:50
Why?
33:51
Why am I that way?
33:53
Well, you know, if we go back to that origin story, there are a couple of key pieces, I
34:00
think, you know.
34:01
The first thing is, I learned growing up in my family of origin, the power of humor.
34:12
You know, I talk about seeing it on MASH and I talk about how we used it to cope, but I
34:16
learned that, you know, the surprise element, if, you know, you could be having the absolute
34:22
worst, most difficult day.
34:24
I mean, my sister's physical disabilities were so profound and her suffering was so
34:29
great.
34:30
And, you know, the greatness of her suffering, I think, was only matched by the absolute
34:36
amazing nature of her personality and her hilarity and kind of the just, you know, the
34:43
incredible intactness of her person.
34:45
You know, so you could be having the absolute worst day and just pulling your hair out and
34:51
wishing you'd literally never been born.
34:54
And then, you know, she would say something that was so absurd and so funny that you would
34:58
just fall to the ground laughing until the point of tears.
35:01
And you know, a ray of sunshine would come out again.
35:04
And in that moment, you just felt like there'd been a reprieve of something.
35:10
And you know, for me, that feeling of, you know, the urgency of humor, but also, you
35:17
know, the urgency of relieving suffering, of finding something in that moment, a way
35:23
to feel better, whether it was for you, whether it was for someone else.
35:27
And that being the most critical, you know, thing in the world, that laid all of that
35:32
groundwork, you know.
35:33
And I think for me, there are other ways that I explore that same challenge.
35:38
I explored it in music.
35:39
You know, music is a way that we try to alleviate, whether it's through, you know, songwriting
35:44
or performing.
35:45
It's a way that we try to eliminate suffering and also experience that same kind of catharsis.
35:50
And writing, you know, for me, my writing is just intimately connected to all of those
35:53
things, too.
35:54
And often going back and exploring some of those early experiences from different angles.
35:59
And as you know, my book was very much about, I think, finally putting a lot of those things
36:04
as much as we can ever put them, you know, to rest, you know, finally hitting a place
36:08
of peace in my life with some of those early experiences.
36:11
But I also think, you know, there is a peace because I've had a pattern in my life of just
36:17
attacking things, right, which I think is very common to positions.
36:20
We don't just become runners.
36:22
We have to do the Iron Man.
36:25
We don't just play piano.
36:26
We have to perform with a symphony or be in the, you know, Van Clyburn.
36:31
Like we're really, in many cases, people who border on extremists in a lot of ways.
36:38
And again, for me, where did that come from?
36:41
For sure, it came from a home where I saw two of my siblings basically cut down in the
36:46
prime of their life, never have the opportunity to do anything.
36:49
Did I feel additional weight, I think, to compensate as a result of that?
36:53
For sure I did.
36:54
Where did that come from?
36:55
It just came from my life.
36:56
Nobody, nobody put it on me, but it was circumstantial.
36:59
So I think those are both of the whys, you know, and there's one that's maybe a little
37:02
more has a tendency to go from maladaptive adaptive to maladaptive.
37:06
And that's the latter one, that extremism that really has to be managed.
37:11
But the other one is more positive, you know, just I feel it when I'm in a room with a patient
37:18
and they're in despair, I want to find the key that will fit in that lock.
37:23
And the lock is different for every single patient that just, I want that person to leave
37:28
that encounter with me feeling a little bit better.
37:32
And you know, often, as you and I both know, that better isn't because of anything I've
37:36
prescribed or a diagnosis that I've made.
37:40
It's through listening, it's through validating, it's through mirroring, it's through empathizing,
37:45
it's through presence.
37:46
I don't think you or I could imagine what it would feel like to be a doctor and not
37:51
to be able to do that.
37:52
I think, again, it ties into some of this lack of connectivity that people feel, you
37:58
know, we do these difficult jobs for 16 hours a day and you go home and you wonder why you
38:03
feel empty.
38:04
It's because in some cases, there are many other factors, administrative burden, all
38:08
these other things that we've talked about, organizational dysfunction, but for sure,
38:12
for sure, one of the direct mechanisms of, you know, being divorced from that, having
38:19
that most powerful therapeutic tool taken away from us is not being able to be present,
38:26
not even having those short little intervals of time to make those connections, but even
38:31
more importantly, not having the orientation, having that orientation taken away from you
38:37
and validated or just because it's been so long, no longer knowing how to do that.
38:41
And so I think for sure, when we're talking about older clinicians, we have to restore
38:46
that for people.
38:47
They have to relearn it.
38:48
When you've had a stroke, neuroplasticity tells us, you know, your brain can learn again.
38:53
Maybe it's going to be another part of your brain, but I know with all your years of experience
38:57
in this too, Mick, you've seen people relearn those skills, right?
39:01
That they've kind of forgotten parts of their, one of their therapeutic modalities that they've
39:05
abandoned.
39:06
And you can, again, not suggesting it's easy, not suggesting there are not huge organizational
39:12
and systemic factors that make it really, really difficult, but this is part of where
39:15
we can reclaim some of our autonomy, some of our why, and, you know, restore a feeling
39:22
of a locus of control.
39:24
So Jillian, there's a number of ways in which our listeners can connect with you and your
39:28
work and you've been involved in a number of different speaking engagements, podcasts.
39:33
Can you share a couple of them that our listeners might be interested in?
39:37
So I have a few different projects that are ongoing and some that were capsule projects
39:42
that live online.
39:43
I did a series called Medlife with Dr. Horton for the Canadian Medical Association Journal
39:48
that lasted for just over a year.
39:50
If folks are interested in that series, they can just Google and find a number of conversations
39:56
with people like Victoria Sweet, Chris Sinsky, Ron Epstein was part of that series, Tate
40:03
Hilton, and I'm really just trying to drill down into core concepts, building literacy
40:07
around physician health and wellness from a number of different perspectives.
40:12
I have a series that is running right now for the Royal College of Physicians and Surgeons
40:17
of Canada.
40:18
It's called Conversations with Jillian.
40:21
And this is just a really lovely little project that the Royal College asked me to co-develop
40:25
with them, talking to our members about, you know, interesting and very humanizing life
40:31
experiences that they've had that inform their practice or have shaped the way that they
40:37
see the practice of medicine.
40:40
So I launched that series with a conversation that is still one of the most important conversations
40:47
that I've ever had with a dear friend, a colleague that I trained with who at the time was dying
40:52
of a glioblastoma.
40:55
And you know, those conversations, I think, really allow us to tap in from different angles
40:58
into the why.
41:00
And then there's a series that I host that's ongoing that is really one of my joy projects.
41:06
It is at the National Arts Centre in Ottawa.
41:09
It's a series called called Arts Medicine Life.
41:12
And we have five lectures there in Ottawa every year and it is released in podcasts.
41:19
And in that series, I get to talk to just some of the most interesting people I have
41:24
ever met.
41:25
So there's some really notable conversations there that I think listeners might enjoy.
41:29
One is with an incredible Canadian, Hayley Wickenheiser, four time Olympic gold medalist,
41:35
considered the women's the greatest hockey player in women's hockey of all time.
41:39
And some Americans might dispute that.
41:41
But in Canada, that's what we call her.
41:43
And Hayley has actually subsequently gone into medicine.
41:46
She's just finishing her third year in emergency medicine residency, just an absolutely incredible
41:51
person with a phenomenally interesting perspective on what excellence in medicine really means.
41:58
And with Kate Bowler recently, author of Everything Happens for a Reason and Other Lies, I've
42:02
loved it.
42:03
Just really shed a lot of light for me on the experiences that we can inadvertently
42:08
create for patients in terms of trauma by not bringing our whole selves to medicine.
42:14
So just lots of conversations again.
42:17
We talk to writers.
42:19
So we talk to well-known physicians.
42:22
I talk to a lot of physician writers as well.
42:24
But that series for me has just been a constant thread these last few years of going back
42:29
and looking at that why from different perspectives.
42:34
And then people can always find my writing in the United States.
42:37
Most of it appears in the Los Angeles Times, as well as other outlets by syndication in
42:41
the US.
42:42
And then a number of Canadian news outlets that I have the privilege and the joy of writing
42:48
for pretty regularly.
42:49
And often what I write about is medical culture.
42:52
Kind of what it's like for us, our emotional lives, I think, as physicians.
42:57
So I feel very, very, very privileged and overjoyed to get to kind of peel back the
43:04
curtain and give non-healthcare workers a bit of a peek into our inner lives, which
43:10
I think sometimes are far more complicated than even we necessarily know.
43:15
That's great.
43:16
We're going to include all that in the show notes.
43:19
So thank you for going over that.
43:21
The final thing I'd like to ask is kind of a little imaginary exercise, imagination exercise.
43:29
It came about with something that you shared about MASH.
43:32
And also a prior podcast interview we had where this physician talked about as a kindergarten
43:39
student wearing this white coat that was too long and then feeling what it may be, what
43:44
her future self may be.
43:46
So if you can imagine yourself on the set of MASH in the midst of its filming and you
43:55
put on the uniform of Dr. Hawkeye Pierce, imagine what that, what are the feelings,
44:02
even physical somatic sensations and even what's happening in your mind as you don that
44:09
persona that has been so inspiring to you as a physician?
44:14
I'm going to answer that question in a bit of a different way because I think I kind
44:17
of got to live that feeling, Mick, during the COVID pandemic.
44:21
And it wasn't even as a clinician specifically, about a year into the pandemic, not quite
44:28
that long.
44:29
We kind of had a tipping point in Canada where it really became clear that some of our decisions
44:37
locally were going to cost hundreds of lives.
44:42
I had actually become kind of brave in stages in the months leading up to that.
44:46
I'd had that MASH piece which sort of had taken on a life of its own.
44:50
But really, one day for me, I was asked to do an interview on national television about
44:58
what was happening in my province.
45:00
And until then, I'd always found reasons to say no.
45:03
I'd always found reasons not to speak publicly about these things.
45:07
Physicians don't find it all that easy, I think, historically to talk to media.
45:11
And we often kind of keep out of that particular space.
45:15
But finally, one day, I was so angry about what was happening to here.
45:19
We had a weekend where almost 60 senior citizens died in one care home in our province.
45:26
And I just, someone called me and said, will you do this interview?
45:31
And I said, actually, I will.
45:33
And in that moment, and in the subsequent months and years of kind of advocating with
45:39
colleagues here, trying to stand up for vulnerable populations, for people who didn't have a
45:45
voice and to speak out against private interests, I found myself, I think, feeling exactly the
45:52
way that I might have imagined that you just described.
45:54
If I put on that coat and inhabited that personality, I just suddenly understood who I was.
45:59
And I suddenly understood that all the experiences that I'd had in my life advocating for my
46:06
sister, all the years of being a bit of a good expletive disturber, I think, in medicine
46:14
and in an adaptive and by functioning way, suddenly I saw all of those things were preparation
46:23
for this experience and how each of those had contributed to being able now to live
46:30
as myself in a public space, in a public way, as a public voice.
46:37
And I think it's been, again, another totally unexpected iteration for me of my career,
46:45
where you sort of learn another aspect of your own power.
46:48
My colleagues and I, the first, we organized a news conference here during a very low point.
46:53
There was actually covered and reported in the New York Times, a news conference held
46:57
by just a group of physicians on Zoom in Winnipeg, in Winnipeg, Manitoba.
47:02
So you say to yourself, all this subversion, again, it has to be healthy.
47:08
We have to have a deep sense of our why, make sure that we're not falling into just narcissism
47:15
or what I call narcissism, which is the combination of narcissism and activism.
47:20
But really, why am I doing this?
47:22
What am I standing up against?
47:25
Who around me will tell me if it's too much, if it's damaging to me, et cetera?
47:30
I think it's just kind of an amazing, another fascinating chapter for me of kind of what's
47:35
happened in my own life.
47:36
And again, along with a lot of other people, it's not just me, right?
47:39
It's a movement, it's a collective.
47:41
But the experience of going through that, you know, did Hawkeye lay some of that groundwork
47:49
for that to be possible?
47:50
Yes.
47:51
Did so many other pieces of my life lead me to this moment?
47:54
Yes.
47:55
And I think I want to say, you know, all the work that I did in those, you know, early
48:01
years, whether not that early, but, you know, years ago with you and Ron, when we first
48:06
met, helps us to learn to tolerate the difficulty of those things, right?
48:10
So we don't like negative feedback.
48:12
We don't like criticism.
48:14
We don't like being anything other than perfect as physicians.
48:16
And we know when we step into the public space, especially with something as charged as COVID,
48:21
we're going to get a lot of toxic stuff coming back at us.
48:25
But when we have done the hard and difficult work, I sometimes talk about it as bracing
48:30
ourselves first, before we move into that public space, we're able to plant our roots
48:35
and withstand it probably much more effectively than we ever would have imagined.
48:40
So I often joke that, you know, training with the two of you and learning this work and
48:44
then subsequently becoming a teacher of it was probably the best pre-pandemic work I
48:49
could have done for the mental fortitude required to exist in that public space that anybody
48:55
could ever have done.
48:56
I, again, just one more curious development in my life where you sort of can't believe
49:05
how things unfolded and yet here you are.
49:07
Well, thank you.
49:09
That's lovely.
49:11
And I appreciate your reflections.
49:14
Thank you very much for listening.
49:15
We will include a summary of today's podcast and links to Dr. Jillian Horton and other
49:20
references that were discussed in the show notes.
49:24
I'd like to conclude today's podcast with a practical exercise to help you flourish
49:29
during your workday.
49:30
The intention is for you to develop a toolbox of skills that you can draw upon to enhance
49:35
purpose, meaning and wellbeing.
49:39
Given what you learned of Jillian's talents as a writer, a musician, a creative, this
49:45
creative instinct for creativity is truly a human quality that we all share.
49:52
To cultivate it is to support our flourishing as unique individuals in our professions,
49:57
having a motivation to enact compassion, to see the suffering of others and take some
50:03
action to relieve that suffering.
50:07
Today's practice is both a reflection and a living actions.
50:12
I recommend spending two to three minutes from time to time engaged in this practice.
50:17
So perhaps at the beginning or end of your workday, perhaps moments before entering your
50:22
home at the end of your workday, the practice is simply to reflect on what you did that
50:30
was compassionate during the day.
50:33
Listening to patients, staff, colleagues.
50:38
What did you do that recognized the difficulty of others?
50:44
How did you resonate empathically?
50:50
And then what action did you take, however small it could be, to do something to relieve
50:56
that?
50:57
Maybe just give advice, maybe simply just recognizing common humanity and naming that.
51:06
Perhaps even more powerfully, just simply offering your presence.
51:18
And now as you are about to move into the next moment, setting your intention to recognize
51:23
challenges you may encounter now in the next moments and set an intention to enact even
51:29
in the smallest way, compassion, something to help.
51:35
I hope you found this podcast and this simple exercise useful to you and look forward to
51:40
having you join us for our next episode of Flourishing in Medicine, From Surviving to
51:46
Thriving.
51:47
For more information about EmPRO, please visit www.myempro.com.
51:56
And for more information about me and my work, please visit www.mickcrasnermd.com or www.mindfulpracticeinmedicine.com.
52:10
Hope to see you next time.