STOP Normalizing Sleep Deprivation: A Real Conversation about Clinician Wellness with Dr. Laura Vater

Why are clinicians expected to work 24-hour shifts and 80+ hour work weeks? How are we supposed to survive (let alone thrive) while experiencing chronic sleep deprivation?

My guest this week, Dr. Laura Vater, is a TEDx speaker, writer, practicing oncologist, and advocate for change in the healthcare system. Join us for an open, honest conversation about how to navigate a system that violates your values on a daily basis.

You’ll learn:

• The sordid origin story of residency training in the United States
• Why chronic sleep deprivation is destroying our mental health and creating a crisis of burnout
• Dr. Laura Vaters's “writing for wellness” initiative and the therapeutic power of journaling and expressive writing for burnout recovery.

This is such a beautiful conversation and I cannot wait for you to listen in.

GUEST LINKS:
🌐 Website: www.lauravater.com
📷 Instagram:  @doclauravater
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Transcript

Chelsea Turgeon: 2:30

Hello, my loves. Welcome back to another episode of the Life After Medicine podcast. Thank you so much for pressing play today. Today's episode is going to be such a special one, and I know it's something you're really going to love. I am here with special guest, Dr. Laura Votter, who is a GI oncologist, mom, speaker. She's spoken on TEDx stage and given tons of keynotes, more than I can count. She's also a writer and that's a big focus that she's been working on recently. She's been published in Medpage Today. Her writing was also featured in Anna Quinlan's book, Write for Your Life, and she has some other writing projects going on as well, which maybe she'll share about with us today. And then she's also a huge advocate. For the well being of clinicians. And she's really on a mission to make the field of medicine more human. And I've connected with her over Instagram, where she just puts out so much content that speaks to the truth. And it's things I wish I would have seen and heard when I was in medical training, because she really gives such a powerful voice to med students, interns, residents, all of those people within training that often feel overlooked and underappreciated her content really. Speaks a lot to the struggles and the things that they go through. So thank you so much for joining me.

Dr. Laura Vater: 3:44

Thank you, Chelsea, for having me. I'm thrilled to be

Chelsea Turgeon: 3:46

here. And so let's just go a bit into your backstory. How did you become so passionate about clinician well being? Is there a story there or is that just something that's always been true for

Dr. Laura Vater: 3:56

you? It's interesting. When I was nine years old, my mom went to med school and she had three kids. I watched her growing up. She would sometimes fall asleep standing up, but she would study. There's while she was standing up because she was so tired at the end of her days, and then I watched her go through residency, and she went through residency before the work hour changes. My mom, absolutely, I think, from a very young age, I think I understood the rigors of medicine more so than most. And so I was hesitant if I was going to even go into medicine, what, at all, and I decided that was the path for me after doing, I had I did a year of international teaching in Haiti. I did a 2 year masters in public health, and then I decided I did want to go into medicine after all. And it was really then through my own personal journey of sleep deprivation and long working hours and being a mother. So I had my daughter when I was a 4th year medical student, and it was the culmination of these things that made me start to step back and question some of the things that were happening in medical training, not just for me, but for. The, around the country residents around the country and really saying, this sleep deprivation and reading more about it. And I'm learning more that my mind is not function nor does it scientifically. My attention goes down. My concentration goes down. My memory decreases my ability to do physical functioning goes down. So to perform procedures. And I'm learning that if I'm sleep deprived, I'm more likely to get in a car accident to have a needle stick to really to make a medical error. And these things really. Thank you. Began to terrify me and I said why aren't we talking about these at a to a greater level to my knowledge? None of the peers I was connected with through social media or other residents or attendings and practice really even talked about it. They saw this overwork and sleep deprivation, just as a right of passage of medical training, something we had to endure. And I really stepped back and I just started whispering, is this a right of passage? Or is this a violation of human rights? And there just started to be other people that said. I've thought the same thing, but I've never had the courage to say it. And so it just became more of a collective kind of rising of voices, but also me finding my own voice through this through my own training. And I think, especially as a trainee, you understand this Chelsea, you're in a very vulnerable position where you don't. Want to speak out. You don't want to rock the boat. You don't want to lose your spot. And so I think for me, it took a long time of developing relationships with people at my program. Thankfully, I went to a both a residency and a fellowship program where the leadership were very receptive. We had open town halls. We talked about issues. We brought data and we actually made a ton of changes, did away with 28 hour calls and our residency. Doing away with home call to the level of kind of malignancy that it was in my fellowship. And so I was very lucky and I understood that I was in position of power and privilege to be able to start to talk about some of these things. But very early on, I think it was shaped by my mom and then by my own experience. And then also just seeing the experience of others as well, and wanting to try to in a small way, try to make some change.

Chelsea Turgeon: 6:41

Yeah, and really sharing your voice, like you're doing, is so important, because not only are you raising the issue by your own voice, but you're showing other people, oh, this is not okay. And so who knows who what other voices you're empowering through talking about it. Because one of the things that's so hard to do is when you're surrounded by something, for a lot of like people who went through the medical path, we didn't have jobs really outside of like before going into training. So a lot of times working within the hospital, working within the medical field is our first job. And so we don't really have a sense of what's okay. What's not okay. What's normal. What's not normal. And you just know what's around you. And so it is really hard to look around when everyone else is normalizing something. And be able to step back and question it and question that status quo. So I think that's so powerful that you were able to do that.

Dr. Laura Vater: 7:30

Yeah. Yeah. And I think that it's 1 of those things to where I think just sometimes being able to be in a position where you can talk about those things openly makes other and present data. Collect the data and then present the data and that's what I do through my social media pages and through the things I write is really just questioning not blaming anyone knowing that this system has existed for more than 100 years more than way more than that since the 1890s by just the traditions we've set up in the training of medical programs and not blaming people not blaming leaders, but really coming together and saying here's the data that we have now over the last 30 years about sleep and overwork and burnout and mental health and. Okay. Let's find a better path forward because I believe we want the same things. We want well trained doctors, but we also want doctors who are well and there's really something to that about really coming together with our, I don't think it's an us versus them. It's the doctors above me who are trying to, abuse me. It's really. They have also been through very traumatic things. And when we come together and talk about evidence based medicine, we bring it to them in a kind, compassionate, respectful way. That's how we generate change is being part of the solution. And there have been many people that you mentioned that I have many people that reach out to me that say, I presented this data, the things we've talked about here to my own program, and we've made changes. So I do think that there is. At a program based level, there are many changes that are happening, and I know that there are many people also working to hopefully continue to create change at a national level.

Chelsea Turgeon: 8:54

Yeah, I love that so much. And speaking of all the statistics and the data, I want to just, I have two posts of yours that I saved from Instagram, so I want to just go ahead and read them. It's like the first page to people. I'll do one first, and then we can just talk a little bit more about it, because these were two that I saved probably months ago, because they were just So striking to me. And this first one in particular in the 1890s, Dr. Halstead created the model for residency training as we know it today. Residents work long hours with little sleep. Sadly, we now know he was using cocaine to stay awake and morphine to sleep and relied on residents working nonstop to cover his addiction.

Dr. Laura Vater: 9:30

This is a really sad thing that I mean, I think Dr Halsted was experimenting with cocaine for an anesthesia back then, and unfortunately became addicted to it. And he was, the hierarchy was really, he was trained in the German model and the hierarchy really existed in many ways to. In many ways, fueled this ability to train others up so it could cover up the addiction. And so really thinking, this is not. Being able to stay awake for 30 hours or 40 hours or for those who are fellows who are doing calls for 72 hours or 80 hours or 100 hours straight. This is not humanly possible. If you're going through this and you're experiencing fatigue, decline in your mental health, hallucinations, you are not weak. You're not defective. You're a human being and human beings need sleep. And these models were created with artificial stimulants that just make it impossible to continue the standard.

Chelsea Turgeon: 10:26

Yeah, and it's so wild that it's even been perpetuated for as long as it has, it's like we're really starting to become become awake to it now. There's I think even just in the past when did the work hour restriction start? It was definitely before we both went to residency. But I don't think it was too much before that time. It

Dr. Laura Vater: 10:43

was the early 2000s. Okay.

Chelsea Turgeon: 10:45

Yeah. So it's like even thinking of for a hundred years. There was literally no restrictions. It went completely unchecked, and it's like now things are starting to change progressively. But... It's just, I don't understand how people were able to function for so long.

Dr. Laura Vater: 10:59

Yeah, it was first in the first limits came in New York, the state of New York or was it New York City from the Libby Zion case where this young woman unfortunately died at the, unfortunately, because of a mistake made by a resident. Her father was a hotshot, really smart lawyer. And that those work hours first. came into place because of that, because there was acknowledgement that tired brains just cannot function the same way that rested brains can function, no matter how intelligent you are, no, matter how well trained you are. And I believe that data is becoming even more clear. We're even finding that. You may be talking about this a little bit more data, but if you're awake, for certain hours, it's equivalent to being quite impaired.

Chelsea Turgeon: 11:38

Yeah, that's another one of the posts I had bookmarked from you. It's like being awake for 24 hours is the same as having a blood alcohol content of 0. 10%, which is higher than the legal limit for driving.

Dr. Laura Vater: 11:48

Yes, exactly. And, of course I have to credit these researchers who have done this work. And a lot of this is actually publicly have been available for many years. And the CDC talks about this from, when you're talking about driving, when you're exhausted it's a public health hazard to drive when you are tired, right? When you're fatigued, but we've also, if you actually look at studies, looking at tired doctors. We are not robots. We are fallible. We make mistakes and we then carry those mistakes for the rest of our lives. I do believe there is something unethical about asking a doctor with minimal training to become sleep deprived and to run an ICU overnight and then possibly, be subject to making a mistake because of the sleep deprivation that they're, They must do for their program and that harm that may happen to a patient. First of all, that poor family and that patient, right? But then also that doctor, that person that then for the rest of their life is going to carry that with them. And there is a trauma that happens when that happens.

Chelsea Turgeon: 12:52

yeah, thinking about it from all of those different perspectives of, like, all the people that could be hurt from this, and all the people that are hurt from it, and all the different health implications, right? There's the safety aspect of it, there's the physical health, and then there's the emotional and mental health of, the chronic sleep deprivation and it's just such a unsustainable system. And, like you, we were talking about, when you're in it, it feels very normal. It feels Oh, this is the right of passage. Oh, I got my 24 hour call today. Oh it just feels so normal. And the interesting thing is now, since I've left the medical field and, most of my friends in real life are not. Not medical related at all. And when I tell them things like, oh yeah, I used to work a 24 hour call, like the way people's minds are blown by that thought, they're like, wait, doctors stay up for 24 hours. They don't understand at all. And it seems crazy to them. They're like, oh my gosh, I would never want somebody operating on me who was at the end of a call shift. And I was like they probably are like,

Dr. Laura Vater: 13:49

and it probably is. 72 hours. If they're working the weekend, if it's Sunday, if it's Monday morning, Sunday night, that doctor that's probably operating you, on you, is probably going to wait for 72 hours or more, most likely. Yeah,

Chelsea Turgeon: 14:01

and so it's just so interesting to see how within one subset of the culture, it can be so normalized and seem oh, no big deal. We'll just do this. And in another subset of the culture, they're appalled by the fact. That exists and so it's you just don't really realize how detrimental something like that can be until you're able to zoom out and look from a different

Dr. Laura Vater: 14:22

perspective. Yes, absolutely. And we know we have clear man mandated hours that a truck driver must sleep between shifts. And the same is true for a pilot for these people that have lives in their hands and the safety of the public in their hands. I think that there is something about training a doctor to function while sleep deprived and then you get into practice where there's no more work hour restrictions and many doctors they're just so accustomed. So beguines. Many surgeons, I'm a medical oncologist. And part of the reason I chose this field is because I have very few emergencies and very little call, which is a gift to me. But I still take overnight call, but it's not to the level of many others, but you get so accustomed to that sleep deprivation in your training. That then you take a position that says, okay this weekend, you're on call and you're probably going to be delivering babies for three days straight and probably going to be in clinic on Monday. So hope you're okay with that. Okay. And so then you set people up for a lifetime of a career where they're sleep deprived and overworked and exhausted. And I think what happens is we end up with physicians who they may be present still in the practice of medicine, but emotionally. And psychologically, they've checked out. They're so exhausted. They are maybe they're chained by their debt, their medical debt. Maybe they're chained by their own expectations or the expectations of their family. Maybe they have no family to support themselves. So they end up practicing medicine in a way that was never how they envisioned practicing often without sometimes without compassion or without the thoroughness or the care that they had dreamt of. All those years ago, and I think it's this tragic thing that patients are now finding themselves on the other side of this health care world, where their doctors are really busy and their doctors are really distracted and their doctors are really tired and burned out. And so now we're facing with we're facing a whole population of physicians and nurses and just in general health care providers who are very. Burned out for a number of factors, and then the public is feeling that right? They're feeling that. And I think there's something so tragic about that because our patients really deserve to have thorough, compassionate care when they're in the most vulnerable moments of their

Chelsea Turgeon: 16:30

lives. Yes, and all the things you're describing it's just it's just all the different repercussions that happen due to sleep deprivation due to other factors within the system. And then you're talking about with the patients, they're feeling it. And then there's this, it seems like the relationship between doctors and patients broadly, obviously on individual basis there's exceptions, but it seems like there's this sort of broad tension within the relationship of doctors and patients. Even I see on social media, like people saying things like things your doctor won't tell you. And there's just a lot of like tension around the idea that like doctors are too busy for you and they don't care. And all of these things when it's I understand where that's coming from, but then it also, it just makes the whole aspect of, being a clinician less fulfilling. And so there's just, it just has created this whole spiral of impact.

Dr. Laura Vater: 17:16

It really has. And we live and work within a system that is for profit, right? And so physicians, are often seen as the culprit, but really, there are a lot of other people that are getting paid a lot of money in this system that are trying to extract as much as they can from the patient and extract as much as they can from the provider. And I think we've set ourselves up for a model that in many ways, unfortunately, does not facilitate compassionate, thorough, present patient care.

Chelsea Turgeon: 17:44

Yeah, through, present patient care. That's so huge. If we could be more present in, each interaction, there's so much more value there for everyone involved. There's more fulfillment for the provider. There's more there's better care for the patient. Like just the presence in and of itself would be a powerful way for us to operate. And there's a whole

Dr. Laura Vater: 18:05

book written about this topic called compassion omics and anyone who's listening who's interested in this topic. It's really about why compassionate care makes a difference. And there's, a ton of studies that have been done in this realm when patients feel like their doctor cares about them and is caring about them deeply and showing compassion. They're more likely to take their medicines. They're more likely to come to their appointments. They're more likely to have lowered anxiety when they come to their appointments, they're more likely to be vulnerable and be honest. And so doctors are more likely to get the diagnosis, right? They need fewer diagnostic tests, fewer referrals to specialists. They have overall better healthcare outcomes, decreased healthcare costs. And then of course, doctors are much more fulfilled in their work, have a greater sense of meaning and lowered rate of burnout. And so these things matter, not just because it's what the patient needs. I take care of patients with metastatic. Cancers of the GI tract. So liver cancer and pancreatic cancer and colorectal cancers. And I'm taking care of people often meeting them in the hospital or in the clinic for the first time, or they may not know all the details of what's going on with their health. And if I'm rushing through that, or if I'm too busy to sit with them in that moment and to help them work through their emotions that they're feeling and being a support to them, that it's not the same, it's not the same care. And so I think that our patients really deserve and they need. They need to have compassionate care. And I could tell you stories about my own experiences within the healthcare system with my mom when she was ill. And there are so many reasons for all of us. We're all, we all are going, we're all on the patients. Even those of us who are clinicians who are all gonna be on that side. Where we have other people taking care of us at some point or another. And we all need that. We all need someone to be there in this most vulnerable moments of our lives. Someone we can trust someone that is well trained someone that is thorough and caring because. those are going to be the hardest moments of our lives and we, we need that and we need to get back to that in healthcare. Yeah, I

Chelsea Turgeon: 19:53

completely agree. And a lot of the people I work with, it's they're the kindest, most altruistic, good people, but there's just a moment where they've been broken. By the system, and it's they wish they could be that way with their patients, but it's just not they can't access that. Maybe it's from burnout, moral injury whatever it is, there's just a sense of it's broken, like their ability to reach inside and summon up, and this is like something I experienced too when I was going through my burnout and residency. It's you watch something and objectively, there's a, your mind cares on some level, but it doesn't connect to your emotions and your body. And there's just like a lack of. The ability to summon up the empathy that you wish you could have. And so for people who are going through that, where it's sleep deprivation, burnout, just like on an individual level, how do you recommend that they start to advocate for themselves so they can start to recover from burnout?

Dr. Laura Vater: 20:51

Yeah. And so if you're a resident physician or a fellow, so someone in training this is very tricky, but I think here's the best tips that I can give you is keep track of the true, the hours that you're truly working in the sleep deprivation that you're truly facing. Cause I think that oftentimes that can be hidden. Even though there's certain rules and restrictions, oftentimes people are expected to just document a certain thing when the reality is very different. Even if it's for yourself, keep some idea of how much you're actually working and how much you're actually sleeping. The other thing is we talked about a little earlier really try to make. Relationships with your co residents, your chief resident, your, if you're an attending physician, right? Creating relationships with the people around you and then, starting to talk with peers that you feel like you may be able to trust. Maybe it's just even a whisper of wow, I worked this many hours last week and then, I have a number of friends who are, surgeons who are in training who worked 110 hours within the last week and reported 80. And I think a lot of people reach out to me through through social media platforms and tell me the real stories that they're facing. And so I just hope that, that you're not alone that if you're experiencing burnout or decline in your mental health, know that there's people around you that probably look like they're doing just fine. I think. All of us do that. We're very good at pretending. So just know that you're not alone and then try to create relationships and then bring data. I recommend the book. Why we sleep by Matthew Walker. There's a whole chapter there about sleep deprivation and residency and fellowship and in doctors and errors. And there's a lot of really good data there that. You could look through and sort through and even bring some data. I think that leadership is very receptive to data, particularly safety data and mental health data. And so bring some of that. And then, it's hard. It's hard to know. It's hard to know if you can trust your leaders and say is any change going to happen? It may just be that they say, oh thank you for sharing this with me. And then nothing ever happens. And just know that you might make things slightly better for someone who comes after you. I think that if you are in a. Position where you have more flexibility, like you're an attending physician, you're done with training. Don't feel like you have to stay in a place for a whole career where you don't feel like your mental and physical health is supported. Easier to say that than to do that and to find a place that truly supports your mental and physical health. But I think it often comes down to how much are you working? How much are you sleeping? How much support do you have to do the work that you need to do on a daily basis to try to eliminate all the hassles that can come with medical training? And it's a very general answer, but for me, I think creating relationships in my institution as a resident, knowing my chief residence and bringing them data and talking with him about it. And then as a fellow, knowing who was in the program leadership and bringing them data. I even wrote down for my whole week on call. This is how many times I got paged and about what issue every single time I got paged at every single hour, and they were truly shocked by the volume. They had no idea what the volume was actually like, or the issues that we were handling that. We're below what we needed to, at our training. And so I do think, and I like to give people benefit of the doubt that most people want well trained doctors, and they also want their trainees to be mentally and physically. And so rather than thinking, they're the enemy really saying they're part of the solution. So bring them data. Bring them the problem, but also be willing to bring solutions because I think it's so easy just to bring what problems are happening, but try to offer solutions as well of well, could we split up call this way? Or can we get coverage this way? And just also know that a lot of these issues are monetary and staffing usually comes. It's usually a money thing. And so know that even if these are really good people and they care about you, sometimes their hands may be tied, depending on a budget. And so any creative solution you can try to find just work with others and see if there might be something there.

Chelsea Turgeon: 24:39

Yeah, it's so hard. And I know that's such a general question, but I think all like the overarching ideas of advocating for yourself and generally knowing it's okay to advocate for yourself. It's okay to come to the people in power. And like you said, bringing some creative solutions. I know I met with someone on zoom one time and he created a system For his him and his co residents, he ended up leaving residency, but while he was there, he created a system for him and his co residents so that no one ever did a 24 hour call. It was some sort of like a group text or chain or something where it's anytime someone had a 24 hour call, they posted in the group. Someone takes half of it. They split it and it just like always went like that. And I don't know exactly how they monitored the system or what they did, but I think it was just a, like a peer created and supported system. And they had a big enough residency program to be able to do that, which that wouldn't work for like smaller programs, but I think just, creative solutions like that can be really helpful.

Dr. Laura Vater: 25:30

Yeah. Sometimes even just in my residency program, we also had. Almost 100 residents, right? And so you can come up with creative solutions when you have a bigger residency, but just saying, okay if we're not going to do, 28 hour calls on our wards anymore, how are we going to do this? And so you just, you have to be creative about the schedules and the handoffs. And I always say to people are always so worried about more handoffs, meaning more errors, right? You're going to hear this argument all the time. And I believe that the solution is to improve handoffs. Okay. Improve

Chelsea Turgeon: 26:01

communication, right? Why is that? Why is that so hard to do? I remember giving that argument to somebody just like talking with some friends about this is why they do that long of call and they were like, in business and communications. They're like. That's a very easy problem to fix through communications training. That would be maybe a week long workshop tops for everyone to really improve the communication. And instead, the solution is very lazy in that it's we'll just keep working longer and longer because we can't figure out how to communicate to each other. No, that does not need to be the solution.

Dr. Laura Vater: 26:34

Yeah, exactly. And it was always so interesting to me because at my residency, we worked, I have a great residency where I trained, but we worked at 4 different hospitals and some of them needed 28 and some of them were night float. And so we were like why is it? Okay, that we can hand off for this hospital, but we can't at this. And so I think that's true across the country, right? Is that if you have a really solid handoff, if you've got a well trained doctor, who really knows when a patient is sick and has the chance of declining overnight. That you are very clear about what's happening to that patient. And you're very clear with someone that, you know, and trust who can handle that. And I think that really is the key.

Chelsea Turgeon: 27:07

Yeah. Yeah. It's so funny how like we create a bigger problem by not being willing to fix a smaller problem. It's no that's not, let's not do that. And so how did you, how do you deal with. With the overarching system, because it seems like your values are humanity based, and, being, and health and wellness, and all of those things, and then there's so many components of the system that oppose that, and it sounds, it seems like your You know, you have enough strength and resilience to continue fighting from within the system. And I just wonder, like, how do you really maintain yourself to continue fighting in a system that can occasionally violate some of those values?

Dr. Laura Vater: 27:51

Yes, I think it's a, that's a great question, Chelsea. I feel like I'm always It's going back and forth of oh my gosh, there's so many problems I want to solve. And then oh my gosh, I'm only one person or, oh my gosh, I want to fix this broken healthcare system. And right. And I feel like I'm one person amidst a sea of many people that work within a system that we know doesn't work. It's like the mouth I see our healthcare system is like the mousetrap. It's okay, this thing, and then, okay, now we're going to build this. thing. And okay, that's it. Now we're going to try to build a work around and it's this really convoluted system of like why it exists. And if you dig into, I've read many books about the history of our healthcare system, I won't get into it. I have a background in public health. Long story short is that I wish we had a healthcare system that focused on public health and prevention and not just a healthcare system, but a society as a whole. Because I really see in my patients, we're looking at how much. Health promotion and prevention could prevent these cancers in many ways or delay these cancers that I treat every day. And I also see the social determinants of health environments in which we live and work that affect all of these things. And so it's a huge problem just beyond who pays for our health care, right? It's a huge national problem, and it really needs, I believe that we really need to see, we need to focus on communities and we need to focus on essentially the well being of people as human beings. And that's a, that's a. A big topic. As I navigate through the healthcare system as a clinician, right? I oftentimes I'm very busy with clinic day in and day out, right? This week, I'm on the hospital service, meaning I'm also in clinic 3 days a week, which is my normal schedule 3 full days a week of clinic. And then I have 2 days, my Tuesdays and Wednesdays where I get to write and I do. Teaching and we have a right for wellness, narrative medicine program, and I get to focus on these other things I care about. And for me, that's a great balance. But the weeks I'm on service, like this week, I'm, a bit more split. And I think many people that find themselves working within the healthcare industry were sometimes so busy and overwhelmed by our day to day problems that it's sometimes how do you step back and look at the issue as a whole? For me I try to, continue to read and I continue to educate myself and I continue to try to find allies and advocates. I think I'm sure this is going to evolve as I progress throughout my career. And I have things about this topic that I have essays bookmarked that I'm going to write about these things. But in terms of how do I survive personally, as I'm navigating through this, I think it is hard when you live and work in unfair healthcare system that, some people are. Have worse outcomes because of where they live and where they work and the health access that they have. And even today, right? I see patients all the time. I'm not going to obviously, for privacy reasons, go into the details of this patient's care, but a person who had a very. Good chance of survival from a cancer before the pandemic, and then had language barriers and many other barriers lost to follow up and presented with an advanced cancer. And so these are things that we see all the time. And how do you deal with that as a person? That's just in this and seeing this and I think that. You have to know that there's only so many things that you can control that you're 1 person. You can continue to care about these things, but also knowing that person in front of you is what you can control and you can be kind and you can be compassionate and you can provide them thorough care and you can continue in your communities and in your workplace advocate for. All sorts of improvements and then I think in my personal life, right? I think we all have to be able to detach in some way, right? To know that this work is going to affect us deeply. And as an oncologist, I have many patients who pass away all the time. And so having ways that I process and cope and honor them, but that I'm also able to. Go for a walk outside and I'm able to exercise and I'm able to laugh and have a dance party with my seven year old daughter and I'm able to also pour into the hobbies and the things that I love. There's, I think we need to have as much as possible saying that we always say, be more resilient and it's on the provider. It really, it's the environment we work in that is very hard on us. But I do think as much as possible, having personal strategies that allow you as much as possible to, not just. Cope, but then also learning how to have boundaries, learning to say no, learning to advocate for yourself.

Chelsea Turgeon: 32:11

Yeah, I love that and it's so hard and I'm so impressed that you're able to keep going with this because it's just like you just have such a big heart and you're such a, you're one of those people who seems so just caring and compassionate for patients and I just feel like I see so many of those people who burn out so quickly because of the system and so I love that you're able to keep yourself sane so that you can stay in this because it seems like this is what you want to be doing and then also continuing the to fight for changes within the system. So I think that's incredible. And for, yeah, so you were talking about hobbies and the things that you love and your outlets. And so one of the things I wanted to talk about was your writing, which is way more than just a hobby at this point, because it's such a big part of your life. And yeah, tell us about how you started writing. Cause I believe it was like your initial story that you wrote was in med school and you were like coping with a

Dr. Laura Vater: 32:59

loss. Yeah, when I was a medical school, essentially a third year student, I was also pregnant. I, as a non traditional student decided to have my daughter before residency for a number of reasons. And I was, on the high risk maternal fetal medicine rotation. So on my rotation, and I was pregnant and there was a woman who had a miscarriage at the same essentially gestation that I was pregnant. And I was like, observing this ritual of loss and I was observing I was in my scrubs and I had my short white coat on. I was I remember vividly, standing by the window and just observing this grief and this loss. And. In the moment, I was just this passive observer and I walked, I remember walking out of the hospital like two or three in the morning and it was like February and it was freezing and I was on my way to drive home and I just started bawling like this had finally caught up to me and I'm like this. I was kept thinking, this family, had they, we had just picked out our crib, had they painted the walls of their nursery? Had they I was thinking about all the things that they were, where they were, because we were in such, similar, stages of pregnancy. And I just needed an outlet for that grief. And that's where writing began. I started journaling, of course, in a way that didn't keep any of my patient identifiers or things like that, but journaling in a very private way for a long time, just about all of the challenges that I all of the, the hardships, right? And some of the beautiful things to write that we see in medical training, but mostly a lot of the hard moments. But then writing developed into so much more that I started turning some of these short little snippets into essays, narrative essays that I would publish. And then I had this idea for a novel. Actually, the idea came to me when my daughter was two months old. So I was in like this postpartum, like dream, awake, colicky phase. And I had this idea for a novel that I just like rapidly wrote down. And then I was like thinking like, why God, why would you give me the idea for a novel when I'm two months postpartum? But it took me like three years, three more years to finally find the courage and the know how to actually start writing. So that by that time I was applying for my fellowship. And then that was 2019. So that was about four years ago. And so I completed the novel last year. I've been working with a professional editor for about a year. I'm working with some beta readers now and fingers crossed. I am going to start sending the initial like 10 pages with a kind of a cover letter query to agents. And so this thing that became, was just a dream has turned into this. Novel, I never could have imagined in this little journaling practices turn into so much more. And that's really where I see my career going. Hopefully, as in again, not necessarily tied to the success or outcome of a novel, but really to the process of writing of really. Finding ways to talk about humanism and medicine and mental health and all of these things through story, because I think that there is power in storytelling. And also, it's just fun. It's so fun to get to. I love to read. I love to write. And so I'm, I have ideas for now about 8 more novels, if you can imagine. And so I have all these other things that I want to write. And so I'm hopeful that medicine will always be part of my life, but that writing as I step into this next, hopefully decade of my life of writing will become a bigger and bigger part of that.

Chelsea Turgeon: 36:27

I love that. It's so fun to watch you get so lit up talking about writing, cause I'm here with her on zoom. I know you guys are listening on the podcast, but I'm here with her on zoom and she is just like lighting up talking about her book and reading and all of that. And that's, I love seeing that. That's one of my favorite things to witness in people when they really come alive, talking about their passions. Thank you.

Dr. Laura Vater: 36:44

I'm, it's been I've grown a lot through this experience of learning how to write a novel. And it's just I always say, it's like learning medicine. It's like you start out not knowing very much and then it just starts to grow and grow and grow and grow until you've developed into, a whole new skill that you didn't have before. And so it's very fun and for me, very fulfilling.

Chelsea Turgeon: 37:06

I love that. And do you feel like writing was one of the ways? That you've been able to avoid burnout or keep burnout, like just have that sort of outlet to help you process and deal with some of the more complicated, painful and heavy emotions that come with, being a clinician. Do you feel like writing played a big role in just like processing for emotions for you. Absolutely.

Dr. Laura Vater: 37:27

I think before. So I have, I've had a therapist now for about two years coming up in January, but I was very nervous for whatever, lots of reasons to have a therapist I met with all the time and now and again, like we meet once a month, but, and that's therapeutic for me. And I talk a lot about it, but about some of the hard things that happened in my work, but. Writing is something that I do every day that helps me to process and cope when I was a resident. I used to journal every day post call. So I'd have been awake for, you do 24 hours and need 4 more hours of extra tasks. So you leave there and you've been awake for about 28 hours. You get home. It's been about 30 hours. You've been awake by that time. And I used to. Really just take 5 or 10 minutes to journal because I would and sometimes it would not be until I woke up after I was post call because there would be so many, especially in the ICU. And I used to take care of. Sometimes we'd have multiple people that had coded and died overnight and all of these things and these hard conversations with families and sometimes uncertainty of why did that happen in that way? I think that. Writing really helped me to process and cope in ways that I may not have been able to. And also I also saw patterns in my own health. I would write when I was really tired and. I would free write. And so sometimes I would just close my eyes and write whatever I was thinking or feeling and I would notice that I was a lot more numb when I was sleep deprived and I was a lot my mental health. I would, I noticed a decline in my mental health when I was repeatedly sleep deprived on those post call. And so that was another reason that made me think, is there something here that happens with sleep to mental health? And I was like, yeah. Oh, my gosh, the data is their increased risk of depression, increased risk of anxiety, increased risk of suicide. And so I think that writing has helped me to process and cope, but it's also helped me to know myself. It's helped me to understand, and it's helped me to find my voice for others. And so has been in many ways, a very powerful tool in my life.

Chelsea Turgeon: 39:23

Oh, I love hearing that so much cause I've had a journaling practice. I started junior year of college. I remember specifically, it was like my birthday of junior year and I was an American Eagle and there was a really cool notebook and I was like, Oh, this is really pretty. And so I bought it as a gift for myself. And then I opened it up that night. I was sitting on the balcony of the sorority house where I lived and I just started writing. And I was like, huh, yeah. What is this magical thing that I'm doing? And I really kept about one journal every year ever since then. Now I do significantly more, but it has been a huge part of my life and I wasn't able to start. a process of growth until I had a process of self reflection. So it's like I was stuck in the same patterns over and over again, just repeating like the same, just the same behaviors, the same thoughts, the same patterns. And it was when I started reflecting on me and my thoughts and my feelings and, how things were going, then I could start to, to figure out the patterns of what's going on here, just like you were describing with the mental health. And so it's it's just such a powerful practice.

Dr. Laura Vater: 40:25

I love that. And if writing feels For those of you who are listening, if it feels like hard to access, how do I do that? I actually just have keep an open Word document on my computer and then I just type into it and it feels like that's easy to access to if the actual writing. I love to write. Also. I like to handwrite. But I do both. I a little bit of handwritten journal, but I do most of my journaling through electronic of just this is my open Word document. It's just like a word dump. My writing coach, she has write 11 things. You could even write three things, this is on my mind today. This happened, and I think it's actually really neat to look back. I'm sure with your journals like so organized part of me wishes. I like had the physical copies all the time. I could go back to, but there's something about going back and saying, oh wow. That thing I was so worried about a year ago is not, it's just a tiny little blimp on my radar, or gosh, that thing I cared about five years ago has faded so much, or oh, I was so worried about not being able to learn that skill. Now I'm doing that skill every day, right? And I think that there's something to that perspective as well.

Chelsea Turgeon: 41:23

Yes. I love that. And you started a new initiative called writing for wellness and that's narrative. Can you tell us a you structure

Dr. Laura Vater: 41:33

that. Yes. So I'm in my 2nd year of attending practice at a major cancer center so I'm an academia I have been trying to figure out how do I take this love of writing and actually. Bring it into my career, and so I've actually collaborated with 2 other doctors, and we have created initiative called writing for wellness, which is really meant to be a tool for clinicians on campus for essentially therapeutic writing community and unburdening is the goal of it. And so we do it once a month, and we just do it all virtual now. And it's, I usually pick out some type of passage that I've read recently or something. I love that. I've. Found years ago, and it's usually really short, less than a couple of minutes. We read together what things, really struck us, or did we have, we ever had a similar experience. And then we take about 15 minutes and I create a prompt of some sort, and then we just write. And so then we write together and then we share together. And it's become this incredible thing where we have shared all sorts of experiences. Of course, we keep it confidential within our group of things that they've been through good and bad and hard and messy and beautiful. And I think that it makes people feel less alone and the things that they go through and also is an avenue to help to develop writing as a tool for these things for this unburdening and for this community. Yeah, it's been wonderful.

Chelsea Turgeon: 42:52

I love that like the words you said therapeutic writing and unburdening like that just sounds who doesn't need that. That's so powerful.

Dr. Laura Vater: 43:00

Exactly. I know. I love that. We're finding ways on campus to come together and hopefully continue to write.

Chelsea Turgeon: 43:07

Yes, and so I know we could probably talk about so many different things. I took so many other notes around your content. And there's definitely more that we could cover, but I want to disrespect your time and our listeners time. So we'll go ahead and start bringing it all to a close now. But before we close out, I'd love to hear what advice would you get? I know you've given so much advice already in this episode, what's one little nugget of advice that you'd give someone who's feeling unfulfilled, unhappy, burnt out, but just they don't know what to do?

Dr. Laura Vater: 43:35

Just remember that this is a single moment in time. That you may be feeling like this right now, but you are a incredible person with incredible talent. And there are so many options that are available to you. And if you're finding yourself in this moment, feeling this way, 1st of all, know that you're not alone. Many other people feel this way. It's not something that's wrong with you. It's something wrong with the environment that you find yourself in and that you can find a different way, even if it feels like the boss or the program that you're in, 1st of all, you can always completely step away. You can also step away for a period of time, a week, a month, a year. You can also, depending on the control you have over your schedule, you can cut back, you can switch gears. And just know that this moment is not forever that you're important and you are talented and that you deserve to have the health and being that you strive so hard to give to others.

Chelsea Turgeon: 44:38

Yeah. What an important thing to remember that you're not alone, that you have options and that it's not forever. Those are such important pieces of advice to carry with you. Thanks for the work

Dr. Laura Vater: 44:48

that you do too. I feel like making people feel like they do have options and that's what worries me most is when people feel like they don't have options and they end up dying by suicide. And that, of course, is by far the most tragic thing. And I think that in the work that you do, Chelsea, of just helping people feel like they're not alone and that there is a way out that is not that way out, I think is so important and so powerful.

Chelsea Turgeon: 45:15

Yeah, thank you for that reflection. And I totally agree that like every time I see something around someone else who has died by suicide, it just hits me in the gut somewhere. And I think part of me is that could have been me if I didn't get myself out. And so it really could be anyone because if you feel like there's no options and that's the only way. It's just hard and you're sleep deprived and all of these things are happening. It's just, it's a lot. So I think it's important to have these conversations and to just let people know that they're not trapped. It really does feel like it, but also you're really not. And so where can people like connect with your content and find you? Where can

Dr. Laura Vater: 45:51

they go? Yeah, probably the easiest is my website. Just my first and last name. So Laura V A T E R dot com. And that links you to all my socials as well. I'm also on Instagram and threads and a little bit I try to do tick tock. I'm not as good on there. I'm not as cool of a tick tock. But yeah, it's just a at doc. Laura Votter.

Chelsea Turgeon: 46:12

Yes, everyone who's listening to this, if you're resonating with the things she's saying, I would definitely recommend following her on Instagram. That's where I've connected with her, and she just posts these Text posts. It's just like the exact text you needed to see that day. And it's just always wow, how did you know that? And for me, it's I'm forwarding it to my clients. I'm like, Hey, you need to look at this. Exactly. It's a really positive place and it will definitely help you feel like you're not alone and help you feel supported wherever you are in

Dr. Laura Vater: 46:39

your journey. Thank you Chelsea for that and for all the work you do. I appreciate it.

Chelsea Turgeon: 46:43

Yeah. And thank you for your time and for just coming in and having this really honest conversation with us today. And yeah, thank you so much for being a part of the show. Yep. Thanks again.