Episode 18 - Turning Grief into Beauty

Join this beautiful conversation with Dr. Michael Foti, internist and author, as he discusses his very personal journey through grief, anxiety, and depression. 

Hear how he has transformed his pain into something beautiful that he shares with his colleagues and the trainees in his program, and how he advocates tirelessly for physician wellbeing.

Read Dr. Foti's book, Grief: A Doctor's Battle with Anxiety and Depression, found here on Amazon.

Support Dr. Foti's NAMI Fundraiser here - http://namiwalks.org/orangeny

Connect with Dr. Foti -

https://www.linkedin.com/in/michael-f-6324b526a/

https://www.youtube.com/@theupwardspiralpodcast1

Instagram - @drfoti129

Content warning - there is discussion of suicide in this episode.

If you are in need of emergent help, please dial 911 or seek care immediately. 

Transcript

0:08

Welcome to the PurposefulMD Podcast. As a physician, you've sacrificed so much of your life for other people. Your patients, your family, your friends, and your colleagues. What would it feel like to spend time doing what you enjoy, and to live without guilt? I'm your host, Dr. Laura Suttin a family physician, certified coach, and business owner. If you're a medical professional on a journey towards your most purposeful life, a life with more time and energy, and ultimately more joy, then this is the podcast for you. For our listeners, a content warning that there is discussion of self harm and suicide in this episode. Welcome to the purposeful MD podcast. We've got Dr. Michael Foti with us today. Dr. Foti, welcome. Thank you. Thank you so much for having me. Yeah. It's good to talk to you. I'm excited to dive in. So Dr. Foti is an internist trained at Greenwich hospital, Yale New Haven health. He's currently a clinical assistant professor of internal medicine at Toro college of osteopathic medicine. And is also the coordinator of the standardized patient program. He's a member of the national faculty and the national board of osteopathic medical examiners and the clinical department of internal medicine, geriatric medicine, and dermatology. Also a member of the board of directors for New York state osteopathic medical society and vice president of the national alliance on mental illness in Orange County, New York. And also the author of a book called grief, a doctor's battle with anxiety and depression. And I know you'll share more about that. Thank you so much for being here. Dr. Foti is great. so much for having me. So I've heard your story a little bit on a previous podcast with AMA, but I'd love to have our listeners hear your story again and, and how your story brought you to where you are right now. Definitely. Yeah. So, um, when I was an intern in internal medicine, uh, the second half of that being 2020, uh, it was when COVID 19 first arrived. Uh, in the United States. So obviously, you know, that was a very chaotic time. Uh, we witnessed, you know, all of us in the healthcare field, you know, much suffering and death, and it wasn't just the frequency of that, but also the fact that so many of our patients were young, they were, you know, in their thirties and forties, and it was very devastating and, uh, that coupled with the fact that around the same time, uh, my mom passed away relatively suddenly to what we found out to be, uh, stage four lung cancer. She passed away within a few weeks of her diagnosis. And so it was a very difficult time. Uh, fast forward a couple of years later, I graduated from residency is when I developed a very severe anxiety and depression. Um, and it took many months for me to finally get the help that I needed and realize what was going on. And I did, I did eventually get that help thankfully. And, um, I'm in a much, much better place, thankfully. Um, but, you know, I, I very much know what it means to suffer in silence and I did for months. And because of that, and thankfully being in a better place, uh, I've definitely become a very strong advocate for, for mental health awareness so that others don't suffer in silence like I did. Yeah. Thanks so much for sharing. I'm so sorry for the loss of your mom. Thank you. Yeah. Okay. I lost my dad to lung cancer too. And so it's, um, yeah, it's terrible. And on the other side of that, I'm so glad to hear that you're doing well now and, and here talking with us and advocating for mental health. So tell us if as much as you can, just your experience. I want to hear more about your experience being an intern in the second half of your second half of your year being the spring of 2020 essentially, and then The level of support, or I'm picking up, assuming probably lack of support related to mental health and really your own mental wellbeing and that of your classmates. Tell us a little bit more about your experience with that. Yeah, definitely. I mean. Again, these were, you know, it was all hands on deck. These were 12, 16 hour days. They pulled everyone from elective or outpatient, uh, rotations. Our outpatient center closed. Uh, we were all in the hospital. Uh, I was part of, uh, so we were, we were, you know, we were divided into teams as residents. You know, residency programs often do. Um, the team that I was on responded to RRTs or, uh, for those who may not know, that's rapid response team. So that's, uh, uh, basically responding to emergencies in the hospital. And so, you know, pre COVID, you know, you're talking maybe once or twice a day where I trained, at the very least. Um, during that first wave of COVID, we were, We were in and out of patient rooms every hour, right? And this was usually because the patient's oxygen level was dropping very quickly and we had to try to go up on that oxygen level with whatever we could. And, uh, uh, eventually, you know, again, this was happening all day, every day. It was getting to a point where we were making decisions on whether the, you know, our patient needed to be intubated and put on a mechanical ventilator, calling family members to explain that to them. You know, their 30 year old brother or sister, you know, was basically dying and they needed to be put on a ventilator. We were making those phone calls and we were making those decisions. Right. And this was all day, every day for months. Uh, so that's, that's what made it very difficult, uh, for sure. Um, you know, in terms of resources, there's, you know, there wasn't really so much. I mean, you know, we had. Um, you know, like a telehealth type employee assistance program. But, uh, and this, I speak for any, and probably all programs across the country, that's probably the most of what they have in terms of providing mental health resources, it's not enough. Right. But at the same time, the, the frequency with which we were working and the amount of hours probably wouldn't have been able to, uh, really take advantage of any resources had they been there, whether they were sufficient or not. So, so I, you know, I, they did, they did the best that they could. And again, this is nothing to, you know, to do a Greenwich themselves and they're a great hospital and program, but that's more a systemic issue in the country that we need to work on, but, uh, yeah, we, there was no time to think about any of this, this all, this was very much, uh, you know, emotional trauma. That I'm sure I'm not alone and now, you know, that I, that I suffered the consequences of years later, you know, and I'm sure there's others out there as well. So, you know, that's, I think that's the basis of that. Yeah. I mean, you're talking about mental health resources. Excuse me, in that scenario and, and I'm thinking to physical health resources, right? I mean, if I put myself back in April of 2020, um, you know, just for your awareness and for our listeners, I was seeing patients, but in an outpatient setting, and it wasn't a big part of my, my role, my clinical role. And so I'm just, I'm picturing, you know, don't have enough PPE, right? Um, we didn't know really what. Was needed to treat the virus and to treat these patients. I know we were putting them supine for a lot of that time to try to help with their lung capacity and so there was so much unknown, lack of PPE, lack of Really this network where we could share information with each other. I'm sure like you probably texting colleagues across the country. What are you doing? What are you seeing? What's worked, what's not worked. Um, so lack of any sort of evidence to treat patients. And then you mentioned long hours. I mean, so I'm. Thinking even eating, sleeping, you know, making sure that your physical health is taken care of, making sure that you didn't also get sick with COVID and become one of those patients. And so, you know, if we think about the Maslow's hierarchy until we address those physical needs, then the mental health isn't going to get taken care of. And yet when we put our bodies physically under that much stress, we know that it affects mental health and want to get into that a little bit too. So, um, uh, I'm curious your your thoughts on that. It sounds like that's that was your lived experience. Yeah, for sure. I mean, there was definitely that fear every day of going into work because you didn't want to bring it home. Uh, you know, I got to tell you during that first wave, we didn't know what it was. And I, I wasn't thinking about I might get this and die. Like I didn't, it wasn't crossing my mind. I didn't want to bring it home. I mean, that's for sure. Um, but, you know, I was running in and out of rooms all day. I never took my N95 mask off, right? So, I mean, um, fear wasn't existent because you couldn't, you wouldn't be able to do your job if you, if that really crept in. Right. So, we were kind of just leaving that at the door, so to speak, and doing what we needed to do. It was very much like a war zone. I'm gonna be honest with you. This was, you know, uh, PPE left and right, IV carts up and down the hallway, running in and out of rooms. This was, you know, It was, it was chaotic, to say the least, and, um, uh, as, as, I say this in my book, as organized as chaos can be, um, it was, you know, we did our best and, uh, but it was tough. Yeah. Have you, are you still in touch with any of your classmates? I'm curious what some of their experiences were as well. Yes. Yes, actually. Uh, so I, uh, recently started a podcast with one of my very good friends, Dr. Ginamarie Papia, uh, or Dr. G as I like to call her, um, called the upward spiral podcast. We're only into maybe four episodes in and, uh, we were both interns together and we've remained very good friends since, um, you know, we did our very first rotation as interns together, night shift and, uh, you know, um, Yeah, our experiences were very different, and we talk about this, we actually talk about it during our first episode, uh, where it was just me and her, and uh, I was on the floors, you know, as I mentioned, in our R. T. team, and she was in the I. C. U. So, you know, it's, it's something I never thought about, but she speaks often about how we had such different lived experiences, because she was in the I. C. U. where by the time patients came to her, they were intubated and on a ventilator. And yes, they were talking to patients, families, of course, whereas I'm on the floor is talking to the patients and their fear in their eyes of how is this happening to me? I'm 30, 35 years old and you're telling me that I have to go on a ventilator, you know, so it, you know, we, we talk about it often, how different our experiences were and, uh, just like, you know, corridor to corridor in a hospital. Yeah. Um, I, I can only imagine, I'm glad that you have worked or are working with her now to kind of share those experiences. I love that. I love that, that visual of the, the upward spiral. Um, and so we'll put a link to that in our show notes because we want listeners to check that out too. Thank you. So how, take me again, kind of through your intern year, you mentioned developing anxiety and depression sometime later. And so was that a something that I, what's coming up for me is the, the book, The Body Keeps the Score, um, about how our bodies internalize these, these experiences that we have and they can sometimes manifest as, um, as anxiety and depression and other, um, things. You know, other health challenges. So that at least that's the visual that's coming up in my mind. So tell me, tell me your experience with first being diagnosed and what resources are available to you at the time and your story from there. Yeah, so, you know, it really didn't manifest until after residency, which is pretty interesting, but I think it was because the challenge of being in attending and the fact that I internalized all of this trauma that. I just had no resilience to really, uh, overcome that challenge of that transition in my life, is what I now know, obviously I didn't know at the time. So it began really as, uh, you know, I, so my first position out of residency is I was a, actually a residency preceptor at another, uh, hospital in Connecticut. Uh, very much interested in academics, as now we all know I'm teaching, but, um, What happened was it was a nightly, basically very severe panic where I'd have a very intense, uh, pressure in my chest as if someone was trying to, you know, literally rip open my ribcage and a very, um, severe squeezing sensation on my left arm and really the most unbearable sensation I'd never wish on anyone. And this was every night. And every morning waking up with a very intense fluttering in my chest, uh, which I carried through, you know, the rest of the day and this, again, three, four, five months pass, and I was just thinking that I was stressed from work, that it was just too much to transition on me to an attending life, and I didn't think of more than that, just stress, right? And, uh, eventually Uh, I switched jobs thinking that it was the job and so I went to general primary care, uh, but it continued, you know, to the point where I was not sleeping. I was, I felt sick. I was, I had colleagues covering my patients because I was leaving early thinking I was sick, uh, eventually though, um, and I remember it was December of, uh, 2022 and, um, I had the worst panic attack up to that point where honestly I thought, well, maybe this is my heart because it wasn't going away. I couldn't breathe. Uh, so my wife brought me to the emergency room and, uh, you know, they did all their testing and obviously my heart was fine. And I wound up seeing a psychiatrist in the emergency room. But a very long talk with me, and I really appreciate it. She was, uh, she probably doesn't even know it, but a big turning point in my life. Uh, she sat with me for like about an hour or two at my bedside in the nursery room, and we just spoke, and she just asked me what's been going on recently. I mean, the best approach probably she could have ever taken, because if she, if she didn't have said that, I probably would have said, oh, I'm just stressed from work. And so I told her everything that happened, like, I'm telling you and your listeners now, and uh, You know, she told me, like, why are you surprised? I mean, look at everything you've dealt with, right? You lost your mom, you lost a ton of patients, and, you know, you're grieving, and you're, you're, you're now, you know, suffering from anxiety and depression, and that's when I was diagnosed. Um, so, I, I took a medical leave, you know, talked to the question you mentioned about the support I had at the time. I had no option but to take a medical leave. You know, this is something again, I'm not blaming the physician but, you know, something at the system level that we need to change where we don't have enough mental health resources and outlets for physicians and that really anyone in the health workforce, you know, it's treated solely as a, you know, A disability and you got to take time off and come back when you're, you're, you know, ready to go. And, and so, unfortunately, I think that's something that needs to change, but that I could speak on after. But I think that, um, you know, I, I, I took a medical leave and that was the best thing I could have done. I, you know, I saw my primary care doctor. He started me on an antidepressant. I went to see a psychologist weekly and, uh, it's the best thing I could have ever done. And, uh, I'm in a much better place for it. Oh, I'm so glad that's that those experiences sound just so frightening. What you, what you felt, the, you know, the chest pain and the. Um, yeah, it just sounds really frightening and I'm, like I said, I'm glad that, glad that you got the help that you did. Thank you. Yeah. So what, cause you, you touched on it and I, I really want to spend some time on this too. What, what are you seeing as. You know, are we starting to make changes to the resources that we offer for our trainees and our, or any of our physicians and what still needs to be done? So I think awareness as it has changed and has increased, right? You know, we have wonderful organizations like the Dr. Lorna Breen Heroes Foundation. For which I'm an ambassador, you know, which they, you know, they led to the Provider Protection Act, that legislation that's passed, um, you know, you have wonderful organizations like NAMI, you know, raising awareness on mental health, um, and just physicians speaking up on this, right? I see this left and right, you know, wonderful colleagues, uh, that I can now call colleagues speaking up on this, but at the actual system level, in terms of providing these resources, they're very much lacking. It's very inconsistent, you know, from hospital to hospital and medical school to medical school. And in my opinion, again, when we're not there, every medical institution, medical school and healthcare institution, could be campaigning on mental and wellness for their health workforce and for their medical students. It should be right then and there, everywhere, right? And there should be a dedicated behavioral health center for our health workforce and for our medical students that they're only seeing, they're our medical students, they're only seeing our health workforce. And so these two steps, what it does is it says to someone in the health workforce, or it says to a medical student, it's okay to not be okay, right? Get that help. We're here for you, right? It empowers them to seek out that help and get the help that they need so that they don't suffer in silence. Right. Like I did. And so I think those are two big steps that, you know, as a country we need to take. Yeah. I love that. It's so important. It, it's, it's like reducing the stigma is kind of what I hear from you and, and encouraging people to, to say, Hey, I'm, I'm struggling and I need some help and that we can, like you said, empower them and show them that it's that it's okay that we don't have to go through this alone. I mean that even not in a pandemic, the experience of residency is traumatic and there's so much going on so much just that we're trying to learn first of all and then we put our bodies through so much stress and then to add that add in there a global pandemic like none of us have ever seen in our lifetime. I can't imagine why. Um, anybody wouldn't need any sort of resources related to mental health and stress. And I think at least, I feel like there's still, and I'm curious your perspective too, is there still kind of this suck it up mentality, like, well, it's just tough, we got to tough it out. And I get a badge of honor for sleeping the least on call. And are you still kind of seeing that, that there's this really tough exterior that we're, that we're up against, that is getting in the way of improving the mental health of our workforce. Of course. Yeah. And this is, this has been perpetuated by the culture of medicine for years and it continues to be right. So you're having, you know, that message, not only to our medical students, but to our residents to say, oh, well, You just gotta dig in, right? Uh, this is a resilience thing. You just gotta be more resilient, right? And what that takes is just digging in, right? That that's the message, right? Yes, it's hard work, and I don't think we need to tell them that. I think they know that. Uh, but they should feel safe. To get the help that they need for that very reason that you said, it's a very difficult time, medical school, residency, that's the toughest part of the journey and they should feel empowered to get that help. Um, but yeah, I think it's definitely a culture that unfortunately, you know, continues to persist and, um, something that we have to change. Yeah. You've mentioned the word resilience a couple of times. I know that's kind of a charged word because at least I hear it almost in a negative sense in the, when talking with other physicians in the sense of like, well, don't tell me I need to be more resilient because I'm already resilient enough. And you mentioned it, that, that, that's something that you said, like, I didn't have this resilience when I was in my training. And, and I think. I mean, as clinicians, we are already very resilient as physicians going through this. Um, but the medical training system kind of sucks it out of us to some extent. And then it makes, it can make us feel, and I, again, I, I, when I went to school, I feel like, Um, my program was along the same lines as every other program, right? I'm not, I'm not saying that my program did anything, um, did anything that was really kind of degraded or degrading our training or mental health or anything like that. That was just the, it's just the culture. And like you said, it needs to change. But yet it can make the, the physicians feel like, well, there's something wrong with me. And especially if people aren't talking about it, because then, like you said, they're suffering in silence. And we feel like, well, I must be the only one that feels this way. And that must mean there's something wrong with me because everybody else around me can hack it. Why can't I, why am I the one that's struggling? And so I love. The messages that you're putting out there in this environment that you're creating to help the trainees and help the, the people in your institution really thrive. And just even just talking about it, I just, I I'm really impressed by that. Thank you. Yeah, I think it's just normalizing, right? Getting help. Um, you know, because, uh, when you have, you know, articles like one I saw recently that was titled, Are we talking too much about mental health? That tells you that there's still an issue, right? And I think that the previous generations of physicians, when they say the word resilient, What they need to say is they survive. All I can say of those physicians is that they survive. They survive their surgical weekends that they'd like to call right there. 72 hour weekends and they're 120 hour, uh, work weeks and all these different things they want to say, right? You survive. That's not resilience. Okay. Uh, resilience in my opinion is thriving. That's not thriving, right? You have to have a proper balance of. Uh, grit, sure, but self care, self compassion, they go hand in hand, because I think, you know, we could, we can go on and on, but I think there's data, right? The physician suicide is on the rise. Mental health is a hot button topic for a reason, all right? So we're not just making this up, we're trying to save people, right, meaning our physicians and workforce, so that they can save others, right? So, you know, it's, it's, we're in, we're in a dire time, but we, we need to continue to speak up. Yeah. Yeah. I love what you said about, about resilience, that it's just surviving is not resilience. It's thriving because, you know, we think about the number of, of physicians that are in mid to late career that would say, I wouldn't do this over again. And Yes. Thank you. Then who's going to take care of our family members and then who's going to, who's going to train the next round of physicians and how are we going to maintain a healthy workforce unless, unless we're all thriving? Yeah. A hundred percent. What is it that you're doing in your, in your program specifically to help the trainees and the physicians thrive? Yeah, so, um, we also, you know, as I mentioned, I'm part of NAMI, which is the National Alliance on Mental Illness in Orange County, New York. Uh, NAMI wonderfully also allows for student organizations. Uh, so we now have NAMI on campus and, uh, we're going to be doing wonderful events for our students on campus, uh, such as I'm going to be leading a guided meditation for our students, which would be great. And, uh, most especially, so NAMI Orange County, New York is holding Our first ever NAMI Walks, which is a fundraiser, uh, for NAMI to continue to provide mental health resources, uh, basically at no cost to our community. And so that's September 1st. And, uh, yeah, so, you know, we're, we're getting it, uh, approved as a student, uh, run event, a student sponsored event, rather, as well. And, uh, just to continue to, to speak up and raise awareness and provide mental health resources. Yeah. That's awesome. Thanks so much. I, NAMI is a great organization and I know, um, they do a ton of good all over the country. So yeah, we'd love for our listeners to, to help support that effort and we'll put that link for the fundraiser in our show notes too. Yeah. Well tell us about your book. Your book is called grief. Yeah. Yeah. I have it here. Yeah. It's called grief, a doctor's battle with anxiety and depression. Yeah. So it's, you know, it's interesting. So I started writing down my. Experiences and the very kind of vivid details of what I, uh, mentioned, right. Really the, the lived experiences on paper, really, it was something therapeutic at first to help process that grief, right. As it's titled. And, uh, once I started, you know, I've been doing so many speaking engagements and I realized that my story can help other people, which really I'm so humbled by that. I have a story to tell that's actually helping people. Uh, I figured, well, why not put this in print and try to reach more people and try to help more people, right? Cause obviously being an author is not a full time gig for me. It's not something that, you know, is keeping the lights on. It's I'm just trying to help others and reach as many people as I can with my story. That's awesome. What's been the response to your book? Great. Yeah. I mean, it's, it's been wonderful. Colleagues, friends, family, everyone reaching out to me. They love it. And, you know, they said it's very powerful and, uh, um, some people like coming up to me that I know that I'm sorry, I didn't even know you went through that and you know, a lot of that as well. But, uh, yeah, it's, it's been very positive. That's great. Yeah. We'll put links to that as well. Uh, available on Amazon and then Barnes and Noble as an ebook. Yeah. Thank you. Yeah. Yeah. I know writing is not for the faint of heart. I'm, I'm right there with you. So, and especially when it's so personal, I mean, you, you have this lived experience and, and it's just, it's such a testament to your character that you are now, you know, you're turning this into something that can help other people and you're, you're sharing about it. Um, and allowing that to really help others and, um, so other people don't feel so alone. And so that's taking, you know, you're taking that pain and making something beautiful out of it as beautiful as can be. So, um, I, I just, I really admire that. Thank you. I really appreciate that. Yeah. Well, it's so wonderful to have you, Dr. Foti. Is there anything else that you'd like to share with our listeners? I mean, no, that's it. If you could, you know, uh, support our fundraiser, I think that'd be amazing. And, and, you know, I'd love if you read my book. I think it's, especially if you're going through any of what I went through similarly or know someone who, who did or is. That'd be wonderful. Yeah. And we will put your links for your LinkedIn profile and your Instagram as well. And our show notes, our listeners can stay connected with you. Thank you for your work, Dr. Foti. It's, um, it's really inspiring. And again, I'm just so glad that you're here with us and sharing your story and spreading your light to others. Thank you. Thank you. Really appreciate it. While I am a physician, the information presented in this podcast is for educational purposes only and should not be considered medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Please consult with your own healthcare provider before making any significant changes to your lifestyle or routine. By listening to this podcast, you are not creating a physician patient relationship. Thank you for listening to The Purposeful MD Podcast. If you like what you hear, please rate and review the show. Please also visit my website, www. thepurposefulmd. com for free downloads or to discuss working with me as your coach.