Season 2: STORIES FROM THE FIELD. Episode 10: LEXINGTON

Empowered Sleep Apnea: THE PODCAST
Season 2: STORIES FROM THE FIELD
Episode 10: LEXINGTON

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For a PDF transcript of this episode (includes the cartoon! HUZZAH!), click HERE.

Climb aboard the Beautiful Blue Balloon for a trip to LEXINGTON KENTUCKY, to discover the real meaning of patient care, with the help of a teacher...who ironically teaches NOTHING AT ALL.

Join person-centered dentistry champion Dr. Paul Henny for his transformative tale about a hot day, a long walk, and the man who changed everything, at a time when professional burnout seemed inevitable...

To view the cartoon for this episode, "Choice Cuts", click HERE.

Storyteller for this Episode:
Our Storyteller for this episode, Dr. Paul Henny, maintains an esthetically-focused restorative practice in Roanoke, Virginia. Additionally, he has been a national speaker in dentistry, a visiting faculty member of the Pankey Institute for Advanced Dental Education, and visiting lecturer at the Jefferson College or Health Sciences.

Dr. Henny has been a member of the Roanoke Valley Dental Society, The Academy of General Dentistry, The American College of Oral Implantology, The American Academy of Cosmetic Dentistry, and is a Fellow of the International Congress of Oral Implantology. He is Past President and co-founder of the Robert F. Barkley Dental Study Club.

Dr. Henny is the author of the book: Co-Discovery: Exploring the Legacy of Robert F Barkley DDS.

More information: https://paulhennydds.com/about-dentist-roanoke-va/

Our Website: https://www.empoweredsleepapnea.com
Official Blog: "Dave's Notes" : https://www.empoweredsleepapnea.com/daves-notes

To go to the BookBaby bookstore and view the BOOK, click HERE!

Transcript

Empowered Sleep Apnea: THE PODCAST

Season 2: STORIES FROM THE FIELD

Episode 10: LEXINGTON

All copy ©2024 Empowered Sleep Apnea, LLC

www.EmpoweredSleepApnea.com

00:00 Change the Channel

Salesman Schmoe: …get this…this product is absolutely gluten-free, lact…

Kids in the Hall: CHANGE THE CHANNEL!

Tycoon Tom: …and sometimes I  think about my billions and billions of—

Kids in the Hall: CHANGE THE CHANNEL!

Newsman Neil: …and in tonight’s news…everything is still off, and scientists say it’s probably your fault—

Kids in the Hall: CHANGE THE CHANNEL!

[DING!]

Everyone: HUZZAH!!

00:22 Disclaimer: Empowered Sleep Apnea is an educational podcast, which is a bit different from a medical advice show. Clinical problem-solving in Sleep Medicine can be complex and even empowered patients need a partner. So…play it smart, and make sure you discuss it with your qualified healthcare provider before making any changes to your medical treatment plan.

And now…on with the show!

00:48 Opening Titles

 Empowered Sleep Apnea: THE PODCAST

Season 2: STORIES FROM THE FIELD

Episode 10: LEXINGTON

 01:15 PROLOGUE: Back to the Blue Balloon

 This is Dr. Dave McCarty. 

Once again, I’ve loaded up the Beautiful Blue Balloon with supplies, after having once again found our ship this morning, patiently tethered to the upper heli-deck of the Empowered Sleep Apnea Knowledge Bunker.

As I’ve mentioned before, the Blue Balloon seems to have a mind of its own…it arrives on its own accord, but you have to be watching for it…otherwise…you might miss it.

It just takes me a few moments to get loaded up. It looks like Ellen is already on-board and is getting the fires going…

            (Stage notes: Ellen smiles and waves)

 Hi Ellen! One more bag of (umph) stuff on board, I release the mooring tether, and we’re off…up…up…up we go…

A brief check on the Navi-Bobola-Bu-Lometer and I can determine our destination…we are headed to…Lexington?...

 …no, not that Lexington. 

 No, we’re not going to that place in Massachusetts, famous because it was the very first place Americans engaged with England in our war for independence against a mad king, way back in April, 1775.

 No, we’re going to a place that early Kentucky settlers called Lexington, dubbing the new name in June 1775, only two months after their brethren American colonialists popped a few caps at a few redcoats, up in Lexington, Massachusetts…inspired, it would seem, by the shenanigans. 

 Lexington, Kentucky, it would seem, got its name because it was inspired by a revolutionary spirit. 

 Kind of like crows teaching crows.

 Our story today concerns the unimaginable possibilities within a choice. Every step we take. Every decision we make. Should I go this way, or that way? Should I stay in, or throw in my hand? Should I leave him? Should I stay? 

 Should I? Should I? Should I?

 Because, as we’ll see, the seemingly banal choices we make in life are, in actuality, each a tiny gem, refracting our future in a million different directions. The moments of our greatest challenges can ultimately resolve into the moments that made all the difference. In hindsight, the suffering becomes meaningful, having realized that the pain is what opened our heart to change.

 Our Beautiful Blue Balloon is descending now, and a city is coming into view. The sun has already passed beyond the rooftops of most of the buildings, and the city has a quiet, deserted sort of feeling, being mostly in shadow. 

 As our balloon descends, we get closer to buildings from a bygone era—the historic district of old Lexington! As we get closer still, we see a 19th century schoolhouse.

 In front of that schoolhouse is a bus stop, with a bench. 

 On that bench, is our next story teller.

 Life-Fans, it’s my delight to introduce you to pioneering person-centered dentist and author of the book CoDiscovery: Exploring the Legacy of Robert F Barkley DDS…

 …Dr. Paul Henny is our storyteller today. And today, he’s going to tell you a remarkable story about life’s changes, the choices that come our way, and what happens when one decides to walk through certain doors…

 …it is my hope that, just like this city took its name from the revolutionary place that inspired it…you will find this tale of personal transformation…inspiring.

 …as usual…stick around after the story’s over…Ellen and I will be here to talk about it afterward…and of course we gotta have a cartoon…and a Dad joke…so listen to the end…

 …Dr. Henny’s true story today is called THE LONG WALK…sure hope you enjoy it.

~ ~ ~ ~ ~

 05:28 The Long Walk

The Long Walk

Written and performed by Dr. Paul Henny
Oral Essay Produced by Dave McCarty

I’ll start with this: my name is Paul Henny…and I’m a practicing dentist, although for a while it didn’t seem like it was going to end up that way. 

 My office is in Roanoke, Virginia and I live in the nearby Blue Ridge Mountains —and I’m very grateful that I work with a great care team and am blessed to have a devoted patient base that come from all over the area and all walks of life. 

 I partner with each person to create solutions and strategies that optimizes their oral and systemic health. They enjoy and respect me as I do them. And all the while, I make a good living doing what I’m good at —and enjoy doing the most.

 Because I’m more holistic and root-cause oriented in my philosophy, I’m often thinking about airway and sleep apnea when I work with patients —which is why I’m with you today. 

 Sleep quality and airway functionality are part my comprehensive assessments which often lead me into helping others navigate the complex territory that often accompanies those types of findings.  

 …I’m a dentist, although it wasn’t always clear to me that it was going to end up that way.

 Let me clarify what I mean when I say that.  

 It was clear to me that I would become a dentist —that destiny was almost set from birth. You see, my father and uncle were highly regarded specialists in dentistry and my family’s high expectations made that decision almost mandatory. 

 What wasn’t clear to me was whether or not I would—or could--keep practicing.

 That’s what this story is about. 

 It’s about a very long walk on a very warm day, and a very interesting man —perhaps the smartest person I’ve ever known— who taught me something that I’ll never forget.

 But I’m getting a little bit ahead of myself here.

 Let’s start with this: early-on in my professional career, I thought about giving it all up —dentistry, what I’m talking about…and that’s what I want to tell you about today. I want to tell you about the moment in my life that, as I now look back on it, was a fulcrum point, an event that permanently demarcated “before” from “after.” 

 And it started on a long walk —on a very warm day.

~ ~ ~ ~ ~

 It was a warm day in Lexington, Kentucky, warmer than usual for early March. 

 I remember my shirt sticking to my back and the warmth of the sidewalk as I walked through the historic district; a dapple of clouds offered up only a scant amount of shade. 

 At that point in my life, I’d developed the habit of walking around the historic district by myself. It was a way for me to get the jumbled thoughts in my mind more straightened out. There was a lot going on in my life at that point, and I’d intermittently find myself becoming anxious —and pressurized, by all the thoughts that were bouncing around in my head.

 And my habit of walking seemed to help me work through that.  

 Whenever I felt my head was getting too “full,” I’d just go take a walk, and somehow, the rhythmic movements, the sounds of the city, and the beautiful old buildings helped me put things into a better perspective. 

 Walking was my psychological reboot, my reset, my control-alt-delete.

 That day, I really needed a reboot —as my head was completely “full.”

~ ~ ~ ~ ~ 

 I was doing exactly what I’d been taught to do —I was working in a busy practice, and against that, I balanced three different part-time teaching positions at the dental school – plus what people today like to call a “side-gig”—more on the side gig part of the story in a little bit later, because it figures prominently in the story.  

 The point is: I’d made it through college and dental school, and I was very, very, busy.

 Successful? I guess you might even be able to call it that, too.

 The reason I needed a reboot that day was this: I was miserable, and I was seriously thinking about walking away from most of it. But at that point, I didn’t possess the words necessary for me to describe what I was feeling —or—or even why. On the surface, everything looked great…on the surface, my professional trajectory looked like what many people dream about creating.

 But in my heart, it wasn’t anything like that. My high-flying dream was devolving into a rut. 

 My relationships with my patients felt stiff, unnatural, transactional —sort of like an over-starched shirt that was rubbing me raw. Most of my patients only wanted to do what was covered by their insurance plan, and they suspiciously looked at me through the corner of their eye when I’d try to steer the conversation toward addressing the causes of their problems; they’d look at me as if I was trying to sell them something they didn’t need. 

 So, rather than regarding me as a knowledgeable and caring professional, they viewed me as a smooth-talking salesman.

 The feeling made me cringe.

~ ~ ~ ~ ~

 I studied under nationally-known speakers to improve my pitch, and memorized their verbiage and their strategies.

 However, my efforts were met with even more indifference and even more resistance. Why did my efforts to become more “complete,” more “comprehensive,” more “correct” lead me toward more frustration —and worse, more cynicism?

 I was weighing my options. 

 So…here’s where we loop back and talk a little bit more about my “side-gig.” 

 My “side-gig” involved a partnership in a new high-end kitchen shop —think: Williams-Sonoma before they became a national phenomenon. In that environment, the concept of being a salesperson didn’t carry any negative baggage; in that environment, my relationship with each person was invited and helpful. I enjoyed going to the store in the evenings and weekends because the customers enjoyed learning about sophisticated cookware and German knives and French pepper mills and coffee beans that we were importing from around the world. 

 There’s an image on the internet that seems ubiquitous these days; it’s a meme. It’s an image of a young man walking down the sidewalk with his arm around an attractive woman…who is presumably his girlfriend. 

 And in it, the young man is craning his neck to catch a glimpse of another beautiful woman who had just passed them by. 

 And the young woman who is with him is scandalized by his behavior.

 In my life at that moment, I was the young man, walking down the sidewalk with my arm around dentistry. 

 And my new kitchen shop was that beautiful woman that had just caught my attention.

~ ~ ~ ~ ~

 On that spring day, my head was full, partly because my practice was crazy-busy and largely unfulfilling, but mostly because I’d just finished reading The Road Less Travelled, by Dr. M. Scott Peck. 

 If you haven’t read that book, you should—it’s a wonderful mediation on the benefits of the examined life and the true meaning of love. I think it should be required reading for pretty much everybody…it’s such a tremendous book.

 These days, there’s a lot more awareness of mental health than “back in the day,” and it has subsequently become a lot easier to find a therapist or a “life coach” that can provide advice. 

 Back then, the concept of seeing a therapist had kind of a negative valence associated with it; it was something that only fragile or sick people needed to do.

 It was something that successful professionals might recommend, but weren’t very likely to do themselves. 

 Over the years, I’ve always considered myself to be a pretty self-motivated learner —and  don’t really like unsolicited advice. Subsequently, I’d never considered myself to be the type of person who would spill my guts, and then be told—and accept—the remedies that they offered up for how to fix my life. 

 Scott Peck’s book allowed me to understand that therapy could take on many forms. 

 Subsequently I realized that walking was a form of therapy…

 …my close friendships were a form of therapy…

 … my participation in my local church was a form of therapy. 

 So, it dawned on me that day, as I walked down the sidewalk, that the message was that I needed to find a therapist myself…I needed find a therapist – not for the purpose of fixing anything, but for the purpose of finding something.

~ ~ ~ ~ ~

 It was quite serendipitous that I found his office. 

 The French have a word for an aimless walk that leads to somewhere important, a walk guided seemingly by the invisible forces of the Universe—they call it a flaneur. 

 A flaneur led me to Bob.

 ~ ~ ~ ~ ~

The sign outside of a gentrified 1890’s schoolhouse read: Bob Insko, PhD, PhD, PhD. And right below it —a single word: COUNSELING.

 I’m not sure how long I stared at that sign before I realized what was happening. A woman walked around me and went into the building and then I realized I was in her way, so I began moving towards the door, myself. 

 I found myself opening up the door, and then I followed another sign…and then I walked up the creaking wooden stairs to the second-floor. 

 And then down the hall, a name was painted on a frosted glass door as if it read: Philip Marlowe, private eye. 

 CUE OLD TYMEY RADIO: Poetic justice, baby! That fire hose threw Mr. Chief-Inspector Atkinson off the roof!

 But it really read: Robert Insko, PhD, PhD, PhD, COUNSELOR. 

 But that’s what it felt like, in a way…kinda like finding a Private Eye…a personal Private Eye.  Because I needed help with a private investigation.

 To be sure--very private. 

 So private, in fact, that I had never allowed anyone to know about it, because the question and the possible answers were too scary to ponder for very long.

 I needed to investigate whether or not I wanted to continue identifying as a dentist. It was a potential betrayal of myself and my family heritage.

 Part of me seemed to be looking for someone who would give me the permission to NOT BE A DENTIST…

 …to give me the permission to toss it aside and embrace the joy that I had discovered in my little kitchen shop…someone who would tell me it was ok for me to spend my days helping others learn how to become better cooks and entertainers and appreciate a fine brew of coffee, or feel how a German knife balanced perfectly in your hand. 

 I knocked on the door, and it vibrated on a hundred-year-old hinges. 

 I waited.

 I swallowed my urge to flee.  

 A moment later, the door opened, and a gray-bearded gentleman in his mid-70s invited me in, and asked me to take a seat. 

 “Hello, I’m Bob!” he said as he shook my hand, while looking at me, with his gentle eyes. Bob was fully in the moment and acted as if he had all of the time in the world —a feeling that I experienced every single time we met.

 I told Bob about reading Scott Peck’s book, my flaneur on that day, the unplanned discovery of his office, and about my interest in pursuing personal growth counseling. 

 As I spoke, a grin spread across Bob’s face. 

 “I understand,” he said. “Did you know that book was written several years ago and that almost nobody read it, when it was first published? Life can be like that sometimes —timing, and making ourselves ready to receive a message can sometimes be just as important as the message itself.” 

 I felt like a fifty-pound weight had just been taken off my back. 

 I soon came to know Bob’s curious, easy, joyful, and respectful communication style. In a quiet, reassuring voice, he said: 

 “I think I might be able to help you…tell me a little bit more about what’s on your mind!”

~ ~ ~ ~ ~

 Over the next two years, I did just that. While I still practiced my walk for personal reasons, the aimless flaneur morphed into a more purposeful journey with Bob functioning as my Sherpa, my friend, mirror, spiritual guide, and even a coach. 

 Long before I started working with him, Bob had obtained terminal degrees in three different subjects: Engineering, Theology, and Psychology. You’d think that somebody smart enough to achieve three PhDs would spend most of their time telling other people what to do, how to live, and how they should think. At least, that’s what I would have thought —before that critical point in my life. 

 Would you like to know the single most important thing that Bob did for me?

 He never told me to do a single thing. 

 Instead, Bob helped me find my own answers — answers that had been available to me all along —I just hadn’t yet prepared myself to discover them.

 ~ ~ ~ ~ ~

 One day, after I shared how difficult it was, and frustrating it was to work on patients who didn’t want to listen…who didn’t want to pay their co-pay, and who’d often just turn around and accuse me of trying to sell them things they didn’t need,  Bob smiled, and quietly laughed. And as usual, he was not providing me with any answers. 

 Instead he asked, “What do you think about that? How does that make you feel?”

 “It makes me feel lousy…disconnected…disrespected. I didn’t become a dentist to become disrespected and treated like I was a cold-calling salesman!”

 “But you are a salesman!” Bob said, as he smiled. “And you’re a darn good one at that! Your store is doing great! What is it that happens to you when you leave the store and enter your dental office?”

 I thought out loud as Bob patiently listened: 

 Why were the two experiences so different? And what was the common denominator? 

 —Me! I’m the common denominator! Why do my patients think that I’m not looking out for their best interests?  What is it that I’m doing that makes me feel like I’m only looking out for myself? 

 …What’s different about that?... 

 At the store they ask me to help them learn and become better at whatever they are interested in, and then they buy things from me! 

 At the office, I tell them what they need to do – I examine them, I direct them on what they need to do next…often without being asked —and then I expect them to buy from me!  

 The kitchen shop customer voluntarily enters a fun, creative, colorful, and wonderful smelling place…

 …and the dental patient enters a threatening, scary, unfamiliar, and undesirable place where they feel vulnerable and have to rely on my specialized knowledge to make decisions.

 Bob considered my answers for a minute, and then, as usual, asked another question:

 “So, let me make sure I have this straight, you treat people differently at the store than you do at the office and then you wonder why they react differently? Is that one of the main problems with the practice of dentistry today?” 

 As Bob spoke, he looked me in the eyes, with a trace of a smile, acting (as always) as if he had all the time in the world.

 “No…well, yes…maybe… I think...” 

 I hesitated, but moved forward, realizing that I might be on to something: “It’s not… it’s not about the dentistry per se, it’s about the nature and the quality of the relationships…” 

 “…It’s about the roles we are playing and whether it’s leading toward curiosity, significant learning and better decision-making, or if it’s leading toward fear, concern, confusion, delaying or even refusing to make decisions...” 

 “…It’s about how well I’m managing the creation and development of each relationship.”

 “Tell me more about that,” Bob said.

 “It’s about trust!” I burst out. “The patient needs to be able to trust…they need to believe that I’m looking out for them!” 

 Bob paused and said, “So, then, if you have different patients with different complex problems and different attitudes towards those complex problems, what’s the solution?” 

 His expression didn’t change —still fully present without a hint of judgment. 

 No, it wasn’t about trying to change people; that didn’t feel right. And it wasn’t about pitching my point of view.  

 What could the answer be? 

 Bob patiently waited for my response —as if he had all the time in the world.

 “The doctor and the team have to change the way they relate to their patients,” I murmured under my breath, as if I’d just woken up from a dream. 

 Bob grinned from ear to ear and then said. “That sounds true to me. What do you think about that?”

 What did I think about that? 

 Once again, I thought out loud. Once again, Bob patiently listened with his kind eyes.

 What did I think about that? 

 A truth about most dentists is that most of us are frustrated micro-engineers at heart. We like solving problems that require deconstruction and reconstruction. 

 We like precise, predictable processes, and we don’t like to be interrupted or questioned. We like everything to go as planned, and we don’t like it when patients interfere with any, or all of that! 

 Bob took all of it in.

 “So, let me make sure I have this right,” Bob said, “You don’t like your patients —who are seeing, feeling, and sensing human beings—to interfere with your engineering projects? And you don’t like it when human beings act like…human beings?”

 The thought caused me to take a deep breath and hold it. Strange as it seems today, I’d honestly never thought about it that way before.

 So…what’s the problem? I asked myself. 

 What if I treated my patients the same way I do my customers at my store? 

 What if I start out by learning more about them? 

 What if…and what would happen if I spent more time learning about where they were stuck, or what they want to learn more about —or what they wanted to finally get resolved?

  What if I treated them like a partner instead of a patient —a partner who will lead me over time toward the development of the best solutions from their point of view after they have had some time to learn more about the complexity of their situation? 

 Would patients buy more appropriate and sophisticated solutions to their problems if I treated them more like the people who came in my store?

 “I think you’re starting to understand,” Bob said. 

~ ~ ~ ~ ~

 “I’d like to know if any dentists have developed a practice model that’s founded on truly helping, health-centered relationships, and then learn more about how they did it.”

 “I’ll bet somebody has done that,” Bob said. 

“After all we’re simply talking about the fundamentals of human nature, and every good salesperson selling a sophisticated product or service designed a to address complex problems knows that they can’t just go in and tell people what they need to do to fix their problems.  First, they must develop a relationship that helps reveal the nature of their problems, and then how they feel about those problems, and then how much they want to resolve those problems.”

 ~ ~ ~ ~ ~

 A door opened for me that day, and I walked through it. 

 Once I understood what I was looking for, I was able to find mentors and resources to guide me on my journey. Along the way, I learned about Bob Barkley and L.D. Pankey and Pete Dawson and Frank Spear and Carl Misch and Mark Piper and Ben Miraglia and Kevin Boyd and Bill Hang, and many many other people. And I realized that a true person-centered practice was not just a dream, but it had been done many many times over! 

 So, I made my choice. I stayed in dentistry and —over time— was able to create a practice that felt just like my kitchen shop when I walked in the front door.

 And so, this is the tale of a career path that almost wasn’t. 

 There’s no telling what would have happened, if my flaneur hadn’t landed me on Bob Insko’s doorstep that day. If I hadn’t walked up those creaking wooden steps, had I not had the courage to knock on that frosted glass door and walk through it and initiate my personal private investigation. 

 Miracles can sometimes be the result of the smallest of decisions.

 I now say for certain that I’m really glad that I took that walk that day.

 And I’m forever grateful to Bob Insko—the person who taught me everything I needed to know, by telling me…absolutely…nothing! 

 He taught me that the process of self-discovery isn’t about finding the right someone who’ll give you all the right answers.

 It’s about opening the door that’s right in front of you, and then having the courage to walk through it.

 My name is Paul Henny…and this is my story of EMPOWERMENT.

26:59 CUE MAJESTIC THEME MUSIC

 Ellen: Welcome back to Empowered Sleep Apnea, the PODCAST where we learn about the complexity of Sleep Apnea through the power of stories with a patient-centered perspective…I’m Dr. Ellen Stothard, and I’m here with Dr. Dave McCarty…

 Dave: …Hello! It’s so good to be back here in the Empowered Sleep Apnea knowledge bunker!

 Ellen: …here we are…down in the Bunker…nice and cool on this…hot summer’s day

 Dave:  …I know I know! It…promotes better rational thought! (laughs)

 Ellen: …yeah…keep everything from overheating…the Super-Computers and what-not! 

 Dave: …so how ‘bout this story?

 Ellen: …um…two very intelligent people…meeting in “the wood”…what’s going to happen? …and the perspective from someone who comes from a totally different…they…they both have engineering training…but it’s turned into very different things, right?

 Dave: I think it’s funny how the word “engineer” you know…”engineering”…that word keeps coming up, you know?

 Ellen: It does! It does…I keep hearing it, which is really interesting…

 Dave: …well, it’s the idea that when you understand the moving parts behind something, you can more logically come to a conclusion as to how to solve it…the engineering mindset, you know?

…so how ‘bout this Bob Insko character?

 Ellen: It’s really interesting to have a secondary character…a supporting actor with all those credentials…and to have a leading character in Dr. Paul Henny with amazing training and perspective that he had, to bring this story to us, in that way…eloquent…and, you know, I felt like I was there on that walk on that hot summer’s day with him…

 Dave: …one of the things I keep coming back to on this story is this concept of somehow being ready for something…you know?...the flaneur concept…that…you’re just going to go walking and somehow guided by unseen forces, you’re gonna end up someplace…maybe…and…the fact that he was receptive to that…  

 Ellen: …yeah! I was really struck by his descriptions of Bob…he said he was CURIOUS…EASY…JOYFUL…and RESPECTFUL…and the image-…the feeling of being put in that environment…how could you not succeed? How could you not come into that and change your perspective?

 Dave: …well, if you ask someone to put a picture in your head of what it looks like to go to a counselor…I’m sure many people still have that Freudian…you know—I’m going here because I’m damaged and I need someone to show me the way…and I was kinda thrilled to hear this very strong person describe that it’s not about fixing something, it’s about finding something…

 Ellen: I had no idea that there were personal growth counselors out there…that it’s really about having someone as a sounding board…but not someone to give you the answers…someone to help you find your way…to the answers for yourself.

 Dave: I’m thinking about what was at stake here for our hero—his very career…and I’m thinking about our country and our world right now, and the world of medical care…the burnout and disillusionment rate is astronomical…people are quitting the profession, you know? And it’s for a lot of the same reasons that he was talking about…the relationships are different…they feel transactional and starchy and wrong…and he found a way to save himself…you know? WOW! In a world where people give up and quit…he found out a way to make it work…there’s a legendary quality to this story that makes it resonate with me…it’s just beautiful…

 Ellen: It’s so interesting to present that as burnout, because he never actually called it that, in the story. 

 Dave: Yeah, you’re right…he was miserable and he was ready to walk away …

 Ellen:… but he had this other opportunity that showed him that his chosen profession…his primary profession…didn’t have to be…the feelings that he was feeling there…weren’t necessarily his destiny.

 Dave: So here he is… feeling guilty about being a salesman…but on the other hand…he’s actually BEEN a salesman…and he was good at it…and there was nothing wrong with THAT relationship…so this story is the moment at which he was receptive enough to reconsider EVERYTHING…

 Ellen: …when you walk into a store, you expect a salesman…you’re going there for a purpose 

 Dave: (interrupting) …you’re going there voluntarily!

 Ellen: Yes! So it’s something about the…the expertise that you’re seeking! The reason I go to a store…like REI or something…is I need an expert in sleeping bags!

 Dave: Right? And you go there, with the expectation that someone there is gonna help you! Right? It’s not like the guy is like forcing it on you…y’know?

 Ellen: It’s not like “You need a sleeping bag…so you ALSO NEED A BACKPACK”, or this, that or the other…there’s some sort of agreement that I’ve entered into a transaction that I have in mind…my expectations are matching their expectations.

 Dave: …and I think the revelation that Dr. Henny had…one which was modeled by the zen Jedi in this story, Bob Insko, was that this process requires probing and listening and understanding…and ultimately it’s an act of sublime empathy…to put yourself in the patient’s shoes…to know where they’re coming from…so you can give them the guidance that they need.

 Ellen: …and it’s really interesting to hear you describe that, as a provider…because I’ve never cared for patients myself…so I don’t have that experience of sitting down in the room with someone and trying to get them from where they are…to where I think they need to be…but I’ve studied it a lot, and I’m very curious about the process because I feel that it is broken, in a lot of scenarios, and that’s something that speaks to me, and that’s something that I’m passionate about helping with… 

 But the thing that I really really thought was interesting is there’s something about—that he acknowledged—in the difference between the place where he is selling things and the place where he is a care provider..is a difference in the person’s level of expertise that’s coming to him. Right? So he said something about …you know the people who are coming into this cooking shop…they wanna learn about the knives…they wanna learn about the French peppermills…there’s an assumed level of interest and expertise already, in cooking.  

 They have the funds…they have the opportunity, they have whatever…to do this transaction. But they’re—they--…it’s not like somebody who’s like: “I hate to cook! And I’m being dragged here by my wife!”

 Dave: (laughs) right? That would be a similar thing! It’s like: “And I have $25 given to me by the state to buy my whole cooking set!”

 Ellen: Exactly!

 Dave: And then you’re like: “Well, you really can’t do it…with…that…” and then, all of a sudden people feel like you’re jerking them around .

 Ellen:  Exactly! And that was something I thought was really interesting. When the counselor said: “What’s the difference between these two scenarios?”

 It’s the OTHER PERSON! You’re expecting them--…you have this like totally different balance of…of expertise and interest and motivation…that you have to navigate. But it is a similar transaction.

 Dave: …no, no…when you said “balance,” I was thinking: It’s a different balance of power. And I see that vulnerability factor…you know…as being absent in the Kitchen Shop…you’re there because you want to be there. Right? And it’s a beautiful place, and you’re like: “Hey, this is awesome, and I’m learning!” So it opens up a new way for your brain to work. 

 You know? And I think you and I discovered this early on in the Empowered Sleep Apnea project…is that if we’re going to get across and transmit some of this really complex and kind of scary jargon-y information, we had to put it in a form that made sense as a story. You know? We learned that really early on. 

 Um. In many ways, Dr. Henny’s experience feels a lot like the experience of Robert—Robert’s story. You know? Where he’s like: “You guys are trying to sell me something I don’t need!” 

 And, so, you know, I, I resonated with this story, because I’ve experienced that phenomenon, and you know, in many ways, this where the Empowered Sleep Apnea project gets its birth…maybe that’s why Dr. Henny and I have found a common ground in this…is that we have---, you know…

 …we have to figure out first what is it that we are trying to do for this patient?; 

 …we have to Co-Discover their narrative. You know? That’s the part where we get to know them, and understand what their goals of therapy are. It’s all about, you know…the first part of our Book!

 Ellen: Yeah! And: establishing them as a partner! That was the other thing that he said.

 Dave: Yeah! AS A PARTNER. That word struck me too: partnership. Yeah.

 Ellen: Because how can you take someone who has had that level of education and detail and expertise and really get a novice…what expertise does the patient have? They have the expertise of themselves! Something is wrong with them, and they may not know how it works exactly, but they know what is happening to them. 

 Dave: I buy that, and I believe it. 

 Ellen: And there’s some sort of dis-….dis-something. I don’t know what it is. Maybe it’s a lack of meeting at the same level…I don’t want to say “dis-respect”…

 Dave: …but it is a disconnect…

 Ellen: …it’s a disconnect!

 Dave: And I think what we’re talking about is a management style that in Dr. Henny’s office would be deliberately and incessantly collaborative…with the patient sort of…being the driver.

 And, you know, if we sort of look back at the verbiage of the Empowered Sleep Apnea project, that’s what it’s about. It’s about EMPOWERING the patient with the knowledge of this..you know…complexity…but giving them the reins, and say: “So these are the choices with this complexity, and here’s how it all fits together, now where would YOU like to go?”

 Ellen: But I think that that’s actually the key there…is: WHERE WOULD YOU LIKE TO GO?

 Dave: Yes! But that’s different from the “top down” management approach, which is…”label-based.”

 Ellen: Yes, and I’ve been guilty of that before, too! Like when I had my ACL (tear), I went into my doctor and said: “What’s wrong with me, and what do I do?”

 Dave: Yeah.

 Ellen: …and I expected that person to--…I was just blindly trusting them. That THEY are the expert and they’re gonna fix me. 

 Dave: Yeah.

 Ellen: …and eventually they’re gonna tell me what to do; I’ve gotta do the P.T. and all that other stuff, and I’m gonna do that! My part is to be told what to do, and to DO IT.

 But I think we’re on the verge of something different here. 

 This is what we’re advocating for—to less be TOLD WHAT TO DO, and to be a partner in the conversation…because, some of these situations are a little less clear than a torn ACL. 

 You need to know enough to be able to identify “this is what’s happening to me.” So that you can articulate it to the doctor so they can say: “THIS is what you may want to consider, for these reasons….”

 Dave:  The management trajectory of a mechanical injury like a torn ACL…that could be construed as something that’s very complicated…right?...there are linear relationships with all of these things, and in that provider’s hands, you know, they can feel very confident that “if you do what I tell you…we’ve got a 95% chance that this is going to get better to full function.”

 But with a complex situation…which—I maintain, all Sleep Medicine scenarios are complex, because we don’t know yet what we don’t know. And the label “Sleep Apnea” carries no meaning by itself…because it represents such a broad spectrum. 

 So, in order to approach complexity, it has to be done collaboratively. Because otherwise the patient doesn’t know how to sleuth for you. Right? But once the shared complexity is kind of complete, and the patient is involved…that’s when the magic happens.

 Ellen: Yeah. Absolutely. Absolutely. 

 Dave: Because they’ll come to you with things you never suspected.

 Ellen: Yep.

 Dave: …and usually they’re right! Right? (laughs)

 Ellen: Oh, yeah! I mean…

 Dave: If you tell ‘em how to do the search, they’re right!

 Ellen: Yeah! Well you do, like we’ve always talked about, have to put your detective hat on, as a Sleep Medicine doctor because you can’t look at them, right in front of you and say: “Mmmm, yes, I can see what’s wrong!” It’s not like a broken bone, right? 

 They have to go home and experience the thing, make the tweak, do whatever you have talked about, and come back and tell you about it!

 Dave: …And REALITY TEST IT! Yeah! “Geez, that didn’t get better.” 

 Ellen: Yeah!

 Dave: “What” – you know, “How do we think about this now…?”

 Ellen: …and we have to set people up for the expectation that THAT could be possible. That the “back and forth” is part of the process.

 Dave: Yes. And it should be part of the process. 

 Ellen: Yes.

 Dave: Once we accept the difference between “complexity” and “complicated”…right?...once we accept that, the decision-making MUST be collaborative. 

 Ellen: But isn’t it funny to bring it all the way back around…we don’t expect to show up to therapy…and get a pill or a patch, or a whatever…and be FIXED tomorrow. We know that It’s a building process…

 Dave: And I think that’s part of what he talked about is the RELATIONSHIP needs to change. You know, from the very beginning, his patients understand that he is not trying to sell them something, he is trying to navigate towards a destination that they both share.  

 Ellen: Yeah, and he said something about…”I have to trust.” 

 Dave: Trust!

 Ellen: There has to be trust there, and I have to believe them…they have to believe me. 

 Dave: Question: can that occur in a 15-minute visit? 

 Ellen: I mean…

 Dave: It’s hard, right?

 Ellen: Sheesh. You have to be kind of a human magician, I think, to be able to do that.

 Dave: Well, we have to at least share the language of the game. And if, you know…if at the very least (and this is PIE IN THE SKY), but let’s say we all kind of adopted the Empowered Sleep Apnea…

 “Yeah there are Five Reasons to Treat,” right?....oh, yes, let’s go back to the Five Finger Approach if we don’t know what’s going on…at least the patient would be equipped to come see any number of providers, and begin the search anew…

 Ellen: Mmm Hmmm. Yeah, absolutely. You could figure out a way to converse with anyone and get on the same page quickly…you don’t need that history necessarily to have built up that relationship to be…

 Dave: …and the patient carries the narrative with them…right?...rather than expecting you to defend it for them…

 Ellen:  I’m still stuck on this thing that he said about the counselor, where…”He never told me to do a single thing!”

 Dave: Boy, that floored me!

 Ellen: Well, I was thinking about the smartest people that I know…never tell me what to do! 

 Dave: Wow.

 Ellen: All of the mentors and scientific experts that I know ask more questions than give answers.

 Dave: Wow!

 Ellen: And to me, that’s something that I…I  strive to do…a lot…I don’t do it every day…(laughs)

 Dave: It’s profoundly difficult to hold back if you think you know what’s good for someone! (laughs)

 Ellen: Oh, yes! It’s so hard! It’s so hard, especially if it’s a…say, a little sister…or…a kid…

 Dave: yeah…a spouse…

 Ellen: Yup! Exactly! Someone that you have a vested interest in….

 Dave: Yup…including…

 Ellen: …including a patient!

 Dave: Yeah! A vested interest in improving! 

 Ellen: Yeah.

 Dave: Yeah, so obviously, these relationships can get strained! And so…I thought this was wonderful modeling…that we got to see what that type of counseling feels like.

 Ellen: MmmHmm.

 Dave: …that it’s really an exploration of what you already knew, deep down…I loved that, how he phrased that…you know? You have to have the courage to walk through the door that’s right in front of you.

 Ellen: MmmHmmm. Mmm Hmmm.

 Dave: Wow!

 Ellen: Yeah. Absolutely fascinating just to think about how you could change your interaction with people, and how you can build different bonds and different trust and different…you know?...thought processes…the things that you could learn!

 Dave: What I’m taking away from this as a clinician is the relationship that we’re building is important…and it’s different…it’s a different kind of relationship…people will decide they’ll come…when the relationship feels different…cuz they’ll seek that out…the ones who need that will seek it.

~ ~ ~ ~ ~

 Ellen: What do you think you would do if you were a patient, and you went to your doctor…and all they did was ask you questions? And they didn’t give you any answers…

 Dave: Well, in some ways, this is the challenge of the Empowered Sleep Apnea project.  I get people writing to me over the email…and they say “This is great stuff” you know, “I’m learning a lot”…and sometimes they’ll say “Hey, can I ask questions?”

 And really, it’s a difficult scenario, because I don’t want to be in the position of being somebody’s DOCTOR over the internet with no real formal relationship, because that’s ethically suspect. But, I also never turn my back on a student! So I feel like, in some ways, when people ask questions, like: “Hey, I’m on CPAP…and I’m not feeling any better…” …right?...I can say: “Hey! This is a job for the Five Finger Approach!”…you know?...make sure you get with a clinician who speaks the same language…and go through it!  

 And see if you can untangle this mess! 

 And sometimes that leads to a lot of revalations.  You realize that…YES, they’re on CPAP. But you look at the data…and the numbers are all over the map. So: their problem is not yet solved! 

 If we did that on the Five Finger Approach, that would be on the Pinky Finger (primary sleep diagnoses)…but, HEY! It’s not just obstructive sleep apnea anymore…now, they’ve got “treatment emergent central sleep apnea” to contend with. 

 So, we’ve had a structured way to go through it, and now we’ve got another thing we can concentrate on…together!

 Right? So…anyway…long story short…I think we’re doing that!

 Ellen: We are succeeding in drawing the parallels from other areas, from other trainings, from other experiences…to say: “Hey! You know, you could think about it this way…”

 Dave: MmmHm.

 Ellen: …and we could all think about it differently. And I think the last thing that I do want to point out here was…his journey with…and against…the medical insurance, or dental insurance systems. 

 Dave: Yeah!

 Ellen: So we were having an interesting conversation about this before… it comes back to the expectations of the patient coming into the appointment…they’re saying: “Ok…what will my insurance pay for?”

 And some of these things like you say: 

 “Go back with a clinician and troubleshoot.” 

 The system is not always set up to bring you back in, and troubleshoot! And deal with these things. 

 Dave: It’s set up to sort of give you your treatment, then BOOM! Move you on! 

 To the patient, that doesn’t feel quite right.

 Ellen: Yeah, but, sometimes the patient comes in and says “What will my insurance cover?” Because the first thing that they’re thinking about is “I’ve already bought into this system…so I need to use my benefits.” 

 And that’s not necessarily--…that’s gonna take a whole different charge to change, right? To change people’s idea to being like: “Is this what is best for me?”

 Dave: Right, right! 

 This goes down the whole rabbit hole of the different language for the scoring metric –the AHI—and how Medicare describes it THIS WAY, and the Academy of Sleep Medicine calls it…the other way…so…it--it’s a difficult conversation to have with a brand newbie patient …brand-new on Medicare…that YES they have the diagnosis of obstructive sleep apnea…based on the, y’know…the current standards…but NO, Medicare won’t treat it.

 Because their number isn’t high enough.

 Ellen:  “If it passes a certain threshold, we’ll treat it!”

 Dave: Yeah.

 Ellen: “…the SAME as we’ll treat it if it’s It’s terrible…if it’s MODERATE…or if it’s…quote unquote “MILD”. 

 It doesn’t have any reflection on the patient’s physical experience. It’s not about: “Is it a resolution of your symptoms?

 Dave: Right! It has nothing to do with their…with their presentation! Right? Yeah.

 Ellen: Absolutely. And there’s not a mechanism for dealing with that—y’know, there ARE, in some ways, but it’s not what’s part of the RULES…it’s not the way the insurance system is set up…to—to benefit the quality…of the patient experience. 

 Dave: Yeah…it feels more label-based.

 Ellen: Yess!

 Dave: “Do you have the label?” (Yes or No). And sometimes when they say “No”—well, you still WOULD have it, if we scored it different, and maybe there coulda been something that we coulda done. You know. It’s a weird little labyrinth to get stuck in. 

 Ellen: …or you’re experiencing these aspects of the label, but you don’t have this one large part of it? So we can’t do that. So our hands are tied, because of the regulations, or whatever.

 And it’s…just a point that I make, not to be negative about the system…because I understand that we’re better off WITH IT than WITHOUT IT… but…to understand that there are shortcomings, and there are people that ARE being left behind, because of the way that it’s set up…and as a clinician, it’s important to recognize that there are a number of people that may need more help advocating for themselves, because they’re in those cracks! 

 Dave: Yeah! And a structure for doing so…

 Ellen: Yep.

 Dave: …that we all can share, and that puts the patient at the center of the journey.

 Boy! This was a great…a great episode…it just tingled so many parts of my experience, you know?

 Ellen: Yeah. Yeah. Absolutely! And as, like a “PhD-PhD-PhD”…you know…I just have so much respect for the ability to…um…not be up on a pedestal, and to be able to have a conversation and share that with others.

 Dave: Yeah: “Hi, I’m Bob.”

 Ellen: Yeah!

 Dave: Right?

 Ellen: And he had “all the time in the world” for me.

 Dave: Boy! Boy, that phrase…repeated, didn’t it?

 Ellen: Yeah, it did! I loved it! I loved it.

 Dave: …and it reminded me of our Coffee Hut.

 Ellen: Oh, YEAH! Absolutely, I didn’t even think about that!

 Dave: Remember how we talked---…it’s—it’s--…it’s just this place where…you don’t feel rushed. 

 Ellen: Yeah.

 Dave: You know, to me, that was the most important part of this discussion…when you really have that “Five Reasons to Treat” discussion…is that it must be patient-centered…and that means that it just has to SLOW DOWN…and the patient does not…need to see the doc lookin’ at their watch. 

 Ellen: Oh, yeah! Or their computer. 

 Dave: Right! So I think that was curious that he noticed that…and he said it…multiple times that he had “all the time in the world” …that was something that left a mark.

 Ellen: MmmHmm.

 Dave: You know what I mean? Maybe we, as clinicians, can learn something from that. 

 Ellen: Oh, certainly! I think that that is…incredible. It’s an incredible thing to be remarked upon, and to be felt, in that experience. 

~ ~ ~ ~ ~

 50:13 Cartoon Showcase

 Dave: …and that sound of cheering inner-children is the sign that it’s time for the cartoon for this show! 

 This story got me thinking about the power of choices. In each moment is an endless possibility. Each moment is a doorway. Do we have the courage to go through it?

 Every single choice we make…you know? It just opens up these opportunities that we may not have even known would be there… 

 I was thinking specifically about that weird day…that I called you and said: “Hey, Ellen…you wanna do a PODCAST?” (laughs)

 Ellen: (laughs) yes! Absolutely!

 Dave: …and that one YES answer has changed the trajectory of everything about this project, you know?

 Ellen: Yeah.

 Dave: So: one little YES…one little door…so anyway I was thinking about that and then I was having a laugh about it…so here’s the cartoon…I’ll let you sort of…process it for the public!

 Ellen: It’s very…clean…but also…energized…and…you know…it says:

 I’ve been thinking about life in a whole new way!

Every little choice is a door…either we open it and walk through it, or we don’t.

Behind each door, there’s like a whole new world, you know? 

With all these new doors to consider…it’s all so exciting!

Each choice leads to a new adventure, new opportunities…so what do you think?

 And then there’s a little…a little aside…and he says:

 I’m thinking you should go ahead and get the fries.

 So, there’s room in everyday life for some deep pondering…

 Dave: Yeah…it reminds me of that Lyle Lovett song…”Make it a CHEESEburger!”

 Ellen: Oh yeah? Oh, that’s funny! That’s a good one! 

 Yeah, I mean…it’s true, though…it’s true that you have the opportunity to look at these things, and decide if you want to make something of them…or you could just…ya know…go to the doctor’s office and get your arm bandaged.

 Dave: Yeah.

 Ellen: You know…you can make things into a bigger opportunity if you just say YES to it more…

 Dave: Ellen…in all seriousness…on tape…I am so grateful that you said YES to this journey. Thank you.

 Ellen: Thanks for asking me! I mean: it’s been an adventure this whole time!

 Dave: It has been a great adventure!

 Ellen: …and the thing that’s crazy to me…it keeps coming up…outside…in the world….the things that we talk about…on this PODCAST, in this room…between each other, when we’re, y’know…coming up with ideas…I’m out there and I’m like: “This is an example of that…”

 Dave: Yeah.

 Ellen: It’s not just US…y’know…thinking THIS IS HOW IT SHOULD BE.

 Dave: We are exploring this together…and we are realizing that other people are doing the same thing.

 Ellen: Oh, yeah! Yeah, yeah, yeah.

 Dave: So I think that what’s happening is that we are gonna find ourselves…y’know, banding together with like-minded people that are in search of the humanity of medicine. That’s really what we’re doing. 

 Ellen: I really really hope that it continues to gain the momentum.

 Dave: Yeah! Onward and upward!

 Ellen: Yeah, absolutely!

 Dave: Excelsior!

 Ellen: Absolutely!

 53:18 End Credits

 This is Dave McCarty. 

Empowered Sleep Apnea: THE PODCAST is a production of Empowered Sleep Apnea, LLC. Today’s opening spoken-word essay, The Long Walk was written and performed by Dr. Paul Henny, and was produced by Dave McCarty. 

 The show was otherwise written and performed by David E McCarty MD, FAASM and Ellen Stothard PhD.

 Music was provided by the enigmatic and resourceful house band, 25% Fred. The CARTOON this week was found inside an alien spacecraft excavated from a hole that’s part of an ongoing archeological dig, at Denver International Airport. 

 Dr. Stothard’s scientific acumen this week is flavored by a love for humanity. Dr. McCarty’s dietary choices this week are reportedly guided by microbes, but the story for this is still developing.

 Before we get to the Dad Joke…an aside…This episode is dedicated to my Dad, Terry “The Ter-Bear” McCarty…McCarty paterfamilias and generator of good Dad Jokes…who shared a bit of wisdom that’s perhaps the most META of all DAD JOKES…it’s a bit of wisdom about a simple choice of lens…about how we regard newness and strangeness and potential danger…and how we rise to the surface and laugh anyway…It’s a bit of advice he gave me when I was small, and we were camping in Yosemite…there was a rushing river nearby, and my Dad knew he wouldn’t be able to keep me out of the water…

 I think about this advice a lot, these days, as we enter into times that feel very much like the social equivalent of roaring rapids…

 "David"…he told me…"if you fall into the River…point your feet downstream…keep your head above water…and enjoy the ride."

 And you know what? 

It worked!

 Ellen and I want to thank you for tuning in today. 

 So, until next time:

 EMPOWERMENT SAVES!

And now…your Sleep Medicine Dad Joke.

 ~ ~ ~ ~

 55:32 Sleep Medicine Dad Joke

 Dad: Hey…what does James Bond do when he goes to sleep?

 Not Dad: Dad, be quiet the movie is starting!

 Dad: No…seriously…what does James Bond do when he goes to sleep?

 Not Dad: Dad!

                 Awwww.

 Dad: He…he goes…under cover….

 Not Dad: Dad! Shhh!

 Dad: Get it? He goes…UNDER COVER!

 Not Dad: Mmmph

 Dad: That was funny. That was funny. THAT WAS FUNNY.

 56:20 END PROGRAM