[Music] you
you
you [Music]
imagine that you are Luke Skywalker
imagine that you are Luke Skywalker Darth Vader cuts off your hand and says
Darth Vader cuts off your hand and says
Darth Vader cuts off your hand and says no I am your father the stunning and
no I am your father the stunning and
no I am your father the stunning and surprising plot twist ever someone said
surprising plot twist ever someone said
surprising plot twist ever someone said when something goes wrong with her life
when something goes wrong with her life
when something goes wrong with her life just yell plot twist and move on if that
just yell plot twist and move on if that
just yell plot twist and move on if that actually worked in med school I would
actually worked in med school I would
actually worked in med school I would never have stopped yelling it’s been 21
never have stopped yelling it’s been 21
never have stopped yelling it’s been 21 years since I finished med school and I
years since I finished med school and I
years since I finished med school and I stand before you now with several quotes
stand before you now with several quotes
stand before you now with several quotes on how I try and how I survived how to
on how I try and how I survived how to
on how I try and how I survived how to develop resilience that you have been
develop resilience that you have been
develop resilience that you have been assigned this mountain to show others it
assigned this mountain to show others it
assigned this mountain to show others it can be moved after high school my mother
can be moved after high school my mother
can be moved after high school my mother said you have to get into the University
said you have to get into the University
said you have to get into the University of the Philippines for college if you
of the Philippines for college if you
of the Philippines for college if you want to get into med school I was to be
want to get into med school I was to be
want to get into med school I was to be the first doctor in my family basically
the first doctor in my family basically
the first doctor in my family basically it was you pee or bust because we
it was you pee or bust because we
it was you pee or bust because we couldn’t afford that tuition elsewhere
couldn’t afford that tuition elsewhere
couldn’t afford that tuition elsewhere that was my mountain eventually I got
that was my mountain eventually I got
that was my mountain eventually I got into med school and I thought my great
into med school and I thought my great
into med school and I thought my great chasing and mountain moving days are
chasing and mountain moving days are
chasing and mountain moving days are over but no I got assigned another
over but no I got assigned another
over but no I got assigned another mountain another mountain and then
mountain another mountain and then
mountain another mountain and then another there are many mountains to be
another there are many mountains to be
another there are many mountains to be moved if you want to become a doctor
moved if you want to become a doctor
moved if you want to become a doctor that which does not kill us makes us
that which does not kill us makes us
that which does not kill us makes us stronger I heard that a lot I was told
stronger I heard that a lot I was told
stronger I heard that a lot I was told that a lot in med school together with
that a lot in med school together with
that a lot in med school together with this too shall pass
this too shall pass
this too shall pass just go to work every day it will be
just go to work every day it will be
just go to work every day it will be over before you know it you’re the
over before you know it you’re the
over before you know it you’re the medical clerk on deck for endorsement
medical clerk on deck for endorsement
medical clerk on deck for endorsement with very limited time to study you will
with very limited time to study you will
with very limited time to study you will go up there and get a pen what doesn’t
go up there and get a pen what doesn’t
go up there and get a pen what doesn’t kill you makes you stronger the patient
kill you makes you stronger the patient
kill you makes you stronger the patient was okay this morning and now you’re the
was okay this morning and now you’re the
was okay this morning and now you’re the intern helping run the code and the wife
intern helping run the code and the wife
intern helping run the code and the wife is crying loudly beside you what doesn’t
is crying loudly beside you what doesn’t
is crying loudly beside you what doesn’t kill you
kill you
kill you makes you stronger you know that if the
makes you stronger you know that if the
makes you stronger you know that if the patient can get dialysis he will survive
patient can get dialysis he will survive
patient can get dialysis he will survive but there’s no money so you go to the
but there’s no money so you go to the
but there’s no money so you go to the social worker and ask for help you shell
social worker and ask for help you shell
social worker and ask for help you shell out from your salary this too shall pass
out from your salary this too shall pass
out from your salary this too shall pass the patient dies you have to go to the
the patient dies you have to go to the
the patient dies you have to go to the audit conference and explain what
audit conference and explain what
audit conference and explain what happened what you did what you didn’t do
happened what you did what you didn’t do
happened what you did what you didn’t do as the resident in charge what doesn’t
as the resident in charge what doesn’t
as the resident in charge what doesn’t kill you makes you stronger never mind
kill you makes you stronger never mind
kill you makes you stronger never mind if your family hasn’t seen you or you
if your family hasn’t seen you or you
if your family hasn’t seen you or you haven’t slept properly for days or you
haven’t slept properly for days or you
haven’t slept properly for days or you do not know when your next sit down
do not know when your next sit down
do not know when your next sit down decent meal will be this too shall pass
decent meal will be this too shall pass
decent meal will be this too shall pass what doesn’t kill you makes you stronger
what doesn’t kill you makes you stronger
what doesn’t kill you makes you stronger perhaps but we don’t know that
perhaps but we don’t know that
perhaps but we don’t know that physicians have high rates of anxiety
physicians have high rates of anxiety
physicians have high rates of anxiety stress depression and suicide if it
stress depression and suicide if it
stress depression and suicide if it doesn’t kill you will it break you the
doesn’t kill you will it break you the
doesn’t kill you will it break you the Bambaataa bands is stronger than the
Bambaataa bands is stronger than the
Bambaataa bands is stronger than the hope that resists so the bamboo has
hope that resists so the bamboo has
hope that resists so the bamboo has resilience resilience is a capacity to
resilience resilience is a capacity to
resilience resilience is a capacity to overcome adversity and not break to bend
overcome adversity and not break to bend
overcome adversity and not break to bend and not be broken to bounce back so you
and not be broken to bounce back so you
and not be broken to bounce back so you may think that resilience is a trait I
may think that resilience is a trait I
may think that resilience is a trait I draw you’re a tough cookie or you’re not
draw you’re a tough cookie or you’re not
draw you’re a tough cookie or you’re not but resilience is a process it is an
but resilience is a process it is an
but resilience is a process it is an adaptive response a way to cope with
adaptive response a way to cope with
adaptive response a way to cope with whatever passes your path and resilience
whatever passes your path and resilience
whatever passes your path and resilience can be learned and if you look at the
can be learned and if you look at the
can be learned and if you look at the literature there are many ways to
literature there are many ways to
literature there are many ways to develop resilience you are not required
develop resilience you are not required
develop resilience you are not required to set yourself on fire to keep other
to set yourself on fire to keep other
to set yourself on fire to keep other people warm the long lines of patience
people warm the long lines of patience
people warm the long lines of patience at the Philippine General Hospital are
at the Philippine General Hospital are
at the Philippine General Hospital are as legendary as its trainees frustration
as legendary as its trainees frustration
as legendary as its trainees frustration with poverty at one particularly toxic
with poverty at one particularly toxic
with poverty at one particularly toxic clinic day the doctor beside me just
clinic day the doctor beside me just
clinic day the doctor beside me just snapped the patient had not taken her
snapped the patient had not taken her
snapped the patient had not taken her medicine and without even asking
medicine and without even asking
medicine and without even asking why she just started berating the
why she just started berating the
why she just started berating the patient I can see you dyed your hair you
patient I can see you dyed your hair you
patient I can see you dyed your hair you got a manicure and a pedicure but you
got a manicure and a pedicure but you
got a manicure and a pedicure but you did not drink your medicine how can you
did not drink your medicine how can you
did not drink your medicine how can you be so irresponsible now your blood sugar
be so irresponsible now your blood sugar
be so irresponsible now your blood sugar is high you will get complications you
is high you will get complications you
is high you will get complications you might die etc etcetera etcetera and the
might die etc etcetera etcetera and the
might die etc etcetera etcetera and the patient just held out a gift for the
patient just held out a gift for the
patient just held out a gift for the doctor she had gone home to the province
doctor she had gone home to the province
doctor she had gone home to the province to attend the wedding that’s why she had
to attend the wedding that’s why she had
to attend the wedding that’s why she had her hair dyed had a manicure and a
her hair dyed had a manicure and a
her hair dyed had a manicure and a pedicure she forgot to bring her
pedicure she forgot to bring her
pedicure she forgot to bring her medicine and she had eaten at the
medicine and she had eaten at the
medicine and she had eaten at the wedding feast that was why her blood
wedding feast that was why her blood
wedding feast that was why her blood sugar was high the doctor bowed her head
sugar was high the doctor bowed her head
sugar was high the doctor bowed her head she just murmured her thanks and excused
she just murmured her thanks and excused
she just murmured her thanks and excused herself I smiled at the patient and said
herself I smiled at the patient and said
herself I smiled at the patient and said you do know she cares very much about
you do know she cares very much about
you do know she cares very much about you and the patient nodded and left
you and the patient nodded and left
you and the patient nodded and left medicine is a vocation but what happens
medicine is a vocation but what happens
medicine is a vocation but what happens when doctors start to care too much
when doctors start to care too much
when doctors start to care too much about their patients when I go to work I
about their patients when I go to work I
about their patients when I go to work I bring a measure of joy and I try not to
bring a measure of joy and I try not to
bring a measure of joy and I try not to run out when it rains look for rainbows
run out when it rains look for rainbows
run out when it rains look for rainbows when it’s dark look for stars I don’t
when it’s dark look for stars I don’t
when it’s dark look for stars I don’t ever want to go to the point where I say
ever want to go to the point where I say
ever want to go to the point where I say I am not even a person anymore I am just
I am not even a person anymore I am just
I am not even a person anymore I am just stress and sadness we admitted that one
stress and sadness we admitted that one
stress and sadness we admitted that one year old woman with a plastic anemia
year old woman with a plastic anemia
year old woman with a plastic anemia holy bed blood transfusion she was very
holy bed blood transfusion she was very
holy bed blood transfusion she was very stable all we worried about was where
stable all we worried about was where
stable all we worried about was where we’re gonna get the blood donors one
we’re gonna get the blood donors one
we’re gonna get the blood donors one moment she was talking the next thing
moment she was talking the next thing
moment she was talking the next thing she’s collapsed on her bed our
she’s collapsed on her bed our
she’s collapsed on her bed our first-year medical resident rushes in to
first-year medical resident rushes in to
first-year medical resident rushes in to put a tube in her airway so she could
put a tube in her airway so she could
put a tube in her airway so she could breathe but better English coke blade
breathe but better English coke blade
breathe but better English coke blade it’s light wouldn’t light up it was
it’s light wouldn’t light up it was
it’s light wouldn’t light up it was busted she couldn’t see the nurse had to
busted she couldn’t see the nurse had to
busted she couldn’t see the nurse had to give him the spanner English scope still
give him the spanner English scope still
give him the spanner English scope still it would not work so while they were
it would not work so while they were
it would not work so while they were doing that we were bagging the patient
doing that we were bagging the patient
doing that we were bagging the patient with oxygen there’s a mask but she’s
with oxygen there’s a mask but she’s
with oxygen there’s a mask but she’s training blue so the nurse had to run to
training blue so the nurse had to run to
training blue so the nurse had to run to the other world and get that working
the other world and get that working
the other world and get that working laryngoscope we finally have the patient
laryngoscope we finally have the patient
laryngoscope we finally have the patient stabilized but she still dies the
stabilized but she still dies the
stabilized but she still dies the resident is very upset
resident is very upset
resident is very upset besides to file an incident report
besides to file an incident report
besides to file an incident report against the nurses its third job to make
against the nurses its third job to make
against the nurses its third job to make sure laryngoscopes are working during
sure laryngoscopes are working during
sure laryngoscopes are working during rounds he is silent and withdrawn the
rounds he is silent and withdrawn the
rounds he is silent and withdrawn the senior medical resident taps him on the
senior medical resident taps him on the
senior medical resident taps him on the back and says it’s no one’s fault this
back and says it’s no one’s fault this
back and says it’s no one’s fault this is not the first station to die of a
is not the first station to die of a
is not the first station to die of a bleed in the brain because of low
bleed in the brain because of low
bleed in the brain because of low platelet count there was nothing anyone
platelet count there was nothing anyone
platelet count there was nothing anyone could have done there was no further
could have done there was no further
could have done there was no further debriefing or discussion of this case
debriefing or discussion of this case
debriefing or discussion of this case and the next thing you know the next
and the next thing you know the next
and the next thing you know the next morning the resident quits it’s another
morning the resident quits it’s another
morning the resident quits it’s another case of burnout burnout is a syndrome of
case of burnout burnout is a syndrome of
case of burnout burnout is a syndrome of depersonalization emotional exhaustion
depersonalization emotional exhaustion
depersonalization emotional exhaustion and a diminished sense of personal
and a diminished sense of personal
and a diminished sense of personal accomplishment so how do we prevent
accomplishment so how do we prevent
accomplishment so how do we prevent brenna
brenna
brenna burnout hopefully by developing
burnout hopefully by developing
burnout hopefully by developing resilience details of your incompetence
resilience details of your incompetence
resilience details of your incompetence do not interest me so said Miranda
do not interest me so said Miranda
do not interest me so said Miranda Priestly from The Devil Wears Prada and
Priestly from The Devil Wears Prada and
Priestly from The Devil Wears Prada and I had a mentor just like her who taught
I had a mentor just like her who taught
I had a mentor just like her who taught me insight and insight is a component of
me insight and insight is a component of
me insight and insight is a component of resilience the awareness of one’s
resilience the awareness of one’s
resilience the awareness of one’s limitations and errors and yet being
limitations and errors and yet being
limitations and errors and yet being able to still try problem-solving online
able to still try problem-solving online
able to still try problem-solving online I call myself the endocrine witch and I
I call myself the endocrine witch and I
I call myself the endocrine witch and I call that myself in honor of dr. Miranda
call that myself in honor of dr. Miranda
call that myself in honor of dr. Miranda that her real name one of the original
that her real name one of the original
that her real name one of the original endocrine witches of the Philippine
endocrine witches of the Philippine
endocrine witches of the Philippine General Hospital she always knew what I
General Hospital she always knew what I
General Hospital she always knew what I did not prepare for for example all our
did not prepare for for example all our
did not prepare for for example all our service patients should have a summary
service patients should have a summary
service patients should have a summary of the blood sugar records in front of
of the blood sugar records in front of
of the blood sugar records in front of the child not at the back in the nurses
the child not at the back in the nurses
the child not at the back in the nurses notes so as a diligent senior resident I
notes so as a diligent senior resident I
notes so as a diligent senior resident I made sure of that
made sure of that
made sure of that however she shows up at rounds and she
however she shows up at rounds and she
however she shows up at rounds and she says I don’t want to see our white
says I don’t want to see our white
says I don’t want to see our white patients let’s go to the emergency room
patients let’s go to the emergency room
patients let’s go to the emergency room and the first try she sees does not have
and the first try she sees does not have
and the first try she sees does not have that blood sugar monitoring chart in
that blood sugar monitoring chart in
that blood sugar monitoring chart in front so she gives me that look the look
front so she gives me that look the look
front so she gives me that look the look that says earth peace swallow me now but
that says earth peace swallow me now but
that says earth peace swallow me now but know every ranch brought new challenges
know every ranch brought new challenges
know every ranch brought new challenges but it also gives me insight on how I
but it also gives me insight on how I
but it also gives me insight on how I could improve and it helped me develop
could improve and it helped me develop
could improve and it helped me develop resilience the second component of
resilience the second component of
resilience the second component of resilience is self-care my alone time is
resilience is self-care my alone time is
resilience is self-care my alone time is for your safety it has been proven by a
for your safety it has been proven by a
for your safety it has been proven by a research that divided attention tasks
research that divided attention tasks
research that divided attention tasks tasks that required the integration of
tasks that required the integration of
tasks that required the integration of information across several sources is
information across several sources is
information across several sources is very vulnerable vulnerable to stress
very vulnerable vulnerable to stress
very vulnerable vulnerable to stress such as what happens when a physician is
such as what happens when a physician is
such as what happens when a physician is managing a patient because the attention
managing a patient because the attention
managing a patient because the attention might shift from the task at hand to the
might shift from the task at hand to the
might shift from the task at hand to the source of the stress and so medical
source of the stress and so medical
source of the stress and so medical students and doctors need alone time to
students and doctors need alone time to
students and doctors need alone time to actually eat the stress I did this in
actually eat the stress I did this in
actually eat the stress I did this in watercolor pens still I also draw now I
watercolor pens still I also draw now I
watercolor pens still I also draw now I collect fountain pens I do loom band
collect fountain pens I do loom band
collect fountain pens I do loom band bracelets I call it a creative
bracelets I call it a creative
bracelets I call it a creative procrastination it is also possible to
procrastination it is also possible to
procrastination it is also possible to have alone time together when I was in
have alone time together when I was in
have alone time together when I was in residency we had the three o clock habit
residency we had the three o clock habit
residency we had the three o clock habit every 2 p.m. the morning shift nurses
every 2 p.m. the morning shift nurses
every 2 p.m. the morning shift nurses would endorse to the afternoon shift
would endorse to the afternoon shift
would endorse to the afternoon shift nurses and we couldn’t do anything
nurses and we couldn’t do anything
nurses and we couldn’t do anything because they held all the charts so all
because they held all the charts so all
because they held all the charts so all my batch mates would gather in the whole
my batch mates would gather in the whole
my batch mates would gather in the whole room to just chat to pause and breathe
room to just chat to pause and breathe
room to just chat to pause and breathe deeply before going back to work it was
deeply before going back to work it was
deeply before going back to work it was the highlight of our day the other
the highlight of our day the other
the highlight of our day the other component of cell K another couple of
component of cell K another couple of
component of cell K another couple of resilience is values finding meaning and
resilience is values finding meaning and
resilience is values finding meaning and purpose in one’s life and in medicine we
purpose in one’s life and in medicine we
purpose in one’s life and in medicine we often talk about work-life balance as if
often talk about work-life balance as if
often talk about work-life balance as if the two are separate entities that are
the two are separate entities that are
the two are separate entities that are in competition with each other the work
in competition with each other the work
in competition with each other the work and the life outside work as if it is
and the life outside work as if it is
and the life outside work as if it is only possible to find happiness outside
only possible to find happiness outside
only possible to find happiness outside of work I prefer the term work-life
of work I prefer the term work-life
of work I prefer the term work-life integration which implies a synergy
integration which implies a synergy
integration which implies a synergy between the two difficult roads lead to
between the two difficult roads lead to
between the two difficult roads lead to beautiful destinations
beautiful destinations
beautiful destinations that’s my son Ryan he turned 11 last
that’s my son Ryan he turned 11 last
that’s my son Ryan he turned 11 last yesterday and that marks 11 years since
yesterday and that marks 11 years since
yesterday and that marks 11 years since I have stopped having Saturday clinics
I have stopped having Saturday clinics
I have stopped having Saturday clinics not good for the
not good for the
not good for the but it is a choice I have made because I
but it is a choice I have made because I
but it is a choice I have made because I find that there are connections to be
find that there are connections to be
find that there are connections to be made that to work with patients and with
made that to work with patients and with
made that to work with patients and with colleagues that make the work fulfilling
colleagues that make the work fulfilling
colleagues that make the work fulfilling and satisfying and I am more open to
and satisfying and I am more open to
and satisfying and I am more open to those connections when I have my
those connections when I have my
those connections when I have my revitalizing weekends and so every
revitalizing weekends and so every
revitalizing weekends and so every summer I take two weeks off for vacation
summer I take two weeks off for vacation
summer I take two weeks off for vacation I take early Christmas break and ashram
I take early Christmas break and ashram
I take early Christmas break and ashram clinic after the New Year my patients
clinic after the New Year my patients
clinic after the New Year my patients understand that this is something I need
understand that this is something I need
understand that this is something I need to do in order to serve them better this
to do in order to serve them better this
to do in order to serve them better this is my improves block 1996 can you find
is my improves block 1996 can you find
is my improves block 1996 can you find where I am since then I have been an
where I am since then I have been an
where I am since then I have been an interest monitor I’ve been on the
interest monitor I’ve been on the
interest monitor I’ve been on the residency training committee I have been
residency training committee I have been
residency training committee I have been a mentor and sadly hierarchical tension
a mentor and sadly hierarchical tension
a mentor and sadly hierarchical tension and the hidden curriculum still exists
and the hidden curriculum still exists
and the hidden curriculum still exists I trained during a time and it was
I trained during a time and it was
I trained during a time and it was acceptable to be told at the morning
acceptable to be told at the morning
acceptable to be told at the morning endorsements you practically killed your
endorsements you practically killed your
endorsements you practically killed your patient it was objectionable to go home
patient it was objectionable to go home
patient it was objectionable to go home even when you were not on Judy because
even when you were not on Judy because
even when you were not on Judy because your patient was dying it was
your patient was dying it was
your patient was dying it was unthinkable to complain even if you
unthinkable to complain even if you
unthinkable to complain even if you suffered verbal abuse from your
suffered verbal abuse from your
suffered verbal abuse from your superiors but what you are now is what
superiors but what you are now is what
superiors but what you are now is what will continue and we should not allow
will continue and we should not allow
will continue and we should not allow what dr. Marshall Myers calls the
what dr. Marshall Myers calls the
what dr. Marshall Myers calls the damaging culture of medicine a culture
damaging culture of medicine a culture
damaging culture of medicine a culture that values what Danielle Ofri refers to
that values what Danielle Ofri refers to
that values what Danielle Ofri refers to as the tyranny of perfection where to
as the tyranny of perfection where to
as the tyranny of perfection where to have burnout is to have a Badge of
have burnout is to have a Badge of
have burnout is to have a Badge of Courage much has been said about
Courage much has been said about
Courage much has been said about generational differences my oldest son
generational differences my oldest son
generational differences my oldest son is 14
is 14
is 14 he’s a millennial every time I feel the
he’s a millennial every time I feel the
he’s a millennial every time I feel the urge to tell a student you know during
urge to tell a student you know during
urge to tell a student you know during my time I imagine my son in my head
my time I imagine my son in my head
my time I imagine my son in my head rolling his eyes at me
rolling his eyes at me
rolling his eyes at me so I couldn’t stop myself because when a
so I couldn’t stop myself because when a
so I couldn’t stop myself because when a flower doesn’t bloom you fix the
flower doesn’t bloom you fix the
flower doesn’t bloom you fix the environment at which it grows not the
environment at which it grows not the
environment at which it grows not the flower so it has been said medical
flower so it has been said medical
flower so it has been said medical students and doctors
students and doctors
students and doctors need to be supported not trained in
need to be supported not trained in
need to be supported not trained in resilience we need to push for
resilience we need to push for
resilience we need to push for organizational change that has lead to
organizational change that has lead to
organizational change that has lead to an environment that can actually nourish
an environment that can actually nourish
an environment that can actually nourish resilient healers and medical educators
resilient healers and medical educators
resilient healers and medical educators have found many ways to do this either
have found many ways to do this either
have found many ways to do this either through mindfulness meditation training
through mindfulness meditation training
through mindfulness meditation training peer supervision counseling all of these
peer supervision counseling all of these
peer supervision counseling all of these activities and they have also found it
activities and they have also found it
activities and they have also found it necessary to point people towards
necessary to point people towards
necessary to point people towards resources that they can use when they
resources that they can use when they
resources that they can use when they want to escalate concerns or when they
want to escalate concerns or when they
want to escalate concerns or when they need support because they have been
need support because they have been
need support because they have been bullied or harassed in the U P College
bullied or harassed in the U P College
bullied or harassed in the U P College of Medicine every first-year medical
of Medicine every first-year medical
of Medicine every first-year medical student is assigned a mentoring group
student is assigned a mentoring group
student is assigned a mentoring group and I am my husband were privileged to
and I am my husband were privileged to
and I am my husband were privileged to mentor nine such individuals and I
mentor nine such individuals and I
mentor nine such individuals and I graduated last year we still keep in
graduated last year we still keep in
graduated last year we still keep in touch with them and I feel it is our
touch with them and I feel it is our
touch with them and I feel it is our small contribution to helping medical
small contribution to helping medical
small contribution to helping medical students thrive in med school and beyond
students thrive in med school and beyond
students thrive in med school and beyond I started with Darth Vader let me end
I started with Darth Vader let me end
I started with Darth Vader let me end with God what we feel our plot twists
with God what we feel our plot twists
with God what we feel our plot twists are actually part of God’s grand plan
are actually part of God’s grand plan
are actually part of God’s grand plan and if we feel we are drowning let’s not
and if we feel we are drowning let’s not
and if we feel we are drowning let’s not be afraid why because our lifeguard
be afraid why because our lifeguard
be afraid why because our lifeguard walks on water
walks on water
walks on water Matthew Freudian verse 25 thank you
Matthew Freudian verse 25 thank you
Matthew Freudian verse 25 thank you [Music]
”
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