Wellness Discussions with Dr Cassie Ferguson

Transcript

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Chris: 0:38

Welcome to pulse check, Wisconsin.

1:20

Good morning, good evening, good afternoon. This is Dr. Ford from PulseCheck Wisconsin. And I wanted to wish you all a very happy new year, we are wrapping up the holiday season And new year, new PulseCheck Wisconsin episode for everyone out there. This episode, I wanted to cover the topic of wellness, specifically wellness for all of our healthcare professionals, but for everyone out there in the pulse check audience, this episode, we were very fortunate to have with us Dr. Cassie Ferguson, who is a pediatric ER doctor, and she specializes in wellness for not only healthcare professionals, but also for our medical school trainees, now with that being said, Although this is a new year, in looking back at the previous year, we unfortunately saw a tragedy that happened in Madison, Wisconsin. My home institution of University of Wisconsin was affected, and University of Wisconsin hospital staff and faculty participated in the care of those victims. If you guys want to go back on the YouTube channel and I'll post it here as well Just a little excerpt. We did a video myself and some of the alumni throughout the country As well as some state officials including the governor and lieutenant governor representative Francesca Hong who represents the area at the state assembly level came out and gave some words of encouragement to the healthcare providers that took care of the victims of this mass shooting. During our politics of public health. Episode with Dr. Megan Schultz, as well as representative Deb Andraca. We talked about the groups that are most vulnerable and that is our pediatric demographic. And so, you know, I won't go in and rehash a lot of the things that we discussed in that episode, but feel free to go back. And unfortunately we got to keep working towards our goal of reducing the amount of school shootings that we see, or reducing the amount of mass shootings that we see in this country. But I wanted to extend my sentiments still to University of Wisconsin Hospital, to the entire Madison community, as well as to all those affected by that shooting. So again, To introduce Dr. Cassie Ferguson, she is a professor of pediatrics. She's previously served in the roles of quality improvement and patient safety. As a lot of you remember from our first season, she was paramount in putting together our health scholars pathway. And that program again is to, Encourage and to get more matriculants from the community into medicine in hopes of giving back to the community. And so I wanted to bring her on to talk about some of her experiences as well as talk about some of the next steps now in order to help push the envelope and to help create open dialogues, dealing with community issues, dealing with community building, mental health treatment for healthcare professionals as well as How we reduce stigmatization about Mental health treatment. that being said is my Distinguished pleasure to introduce my friend. Dr. Cassie Ferguson

Chris: 4:57

Okay. Well, again, thanks for being with us here today. I gave an intro at the very begiNning, talking about all the amazing things that you're doing both in the city of Milwaukee and at Children's and just for the state of Wisconsin. But if you could, could you give us a little bit of your background and tell us, what inspired you to pursue this amazing career in medicine?

Cassie: 5:16

Sure. Absolutely. I'm actually a Milwaukee transplant. I grew up in Oakland, California which it's, you know, there's certainly some similarities between Oakland and Milwaukee and really strong positive ways in some ways that aren't as positive, but I loved growing up in the Bay area. I think it had a lot to do with how I approach both my career and my personal life. But my dad was an architect. My mom. I think you could best describe her as a social justice advocate. She's done a lot of work in many different areas but I think that sort of best captures what it is she did. So there was really no one in my family, whether it was my immediate family or extended family, who was in medicine or in health care at all. I think growing up, I at one point wanted to be a chef designer an elementary school teacher all over the map. I think what was important was that my parents, no matter what I had decided that I was going to do that week or that month or that year, were always very supportive of what I wanted to do. My mom's main rule was that whatever I chose, I had to be the best at that thing, or at least, you know, attempt to be the best thing. So I certainly still hold that maximum really, really close to my heart. And I also saw how my parents lived their lives, and I realized that to live in, or to work and live in service of other people was probably the most satisfying way to live. So then I went off to UCLA, and in my third year, I went to do an externship at the Health Policy Research Center at George Washington University. Mm hmm. At the time, I thought that I wanted to do something along the lines of public health or epidemiology, and I spent, I mean, honestly, I really went because my best friend was going. I wanted to, to spend three months in Washington, D. C., and while I was there, I did a, I did work on really looking at infant mortality rates between black mothers, Latino mothers and white mothers. And specifically because I was in Washington, D. C. I had a lot of interaction with women who had moved from El Salvador, Central America, mostly And I had the opportunity to really spend time in a lot of clinics talking to people who cared for women who were, you know, having families. And I learned a lot about how we were, as a country, failing mothers. But it really stood out to me that we were failing black mothers in particular. And that there was no social support, there was no network of support. And as a result, you know, infants were dying and I really learned during that time that I didn't want to be studying these women from afar. I wanted to be taking care of them directly. And so I got home one day when I was still in D. C. and I wrote all the classes. I was a psychology major at the time, and I wrote all the classes that I would have to take to go to med school, realized that that would mean an extra year in college. And so that's what I did. I You know, I, I took an extra year and then another year to apply and work, make some money, and then Off I went to Wisconsin, which was a state I had never visited nor, at the time, could probably reliably pick out on a map since Californians are so, we're very California centric. That's a problem. That's fair. Yeah. So, and here I am.

Chris: 8:54

Awesome. Well, you know, what a amazing journey and, you know, the selfless journey to a lot of, a lot of folks that we have on, have a similar pathway through medicine or pathway through whatever work that they're doing here. We had a couple of folks on from VotE R that had a similar journey through, you know, started out as a teacher and then went to advocacy and get more information, get more hands on experience with that population. And so one of the things that I commend you for doing is to take that step back, especially rerouting your career and saying, okay, this is what I want to do. And the steps that I need to take in order to not only. Help the situation but identify it in that first person stance and the work that you do now as well It also is a testimony to it because currently you're in pediatric er over at children's, correct?

Cassie: 9:44

Yes, I Did my residency training in pediatrics and my fellowship training in pediatric emergency medicine in denver, colorado And then came back to milwaukee in 2010 and i've been at children's ever since

Chris: 9:58

And, and, you know, a lot of, a lot of that, what you said in the beginning, we, it mirrors to what my mom said as well, you know, the fact that whatever you're going to do, you got to be good at it. Right. And so you hear that over and over again with pediatric emergency providers, as well as on the adult side too. We have all these things that, that, that we're interested in and kind of focusing it in, but the recurrent theme is to help people. And so that's the, that's the good part about it.

Cassie: 10:24

Yeah, I think, you know, I enjoy being that sort of that adage, the you know, Jack of all trades, master of none. I don't, I don't mind not knowing, you know, so much about so many things, but I really. Love the fact that I can walk into almost any room, get a sense for what the family needs, what the patient needs pretty quickly, and then be able to draw on resources, whether they're my own, you know, or my colleagues or a social workers or a nurses and. And put together, you know, a plan for the patient. And I think that's what's so incredible about emergency medicine is that, you know, we really we really understand that it takes a whole bunch of people to take care of other human beings. So.

Chris: 11:14

You know, exactly. And especially another one of the hats that you wear is that you are co director for the health equity scholars program that we had on last season as well. So very much commend you for that. But one of the things that is very consistent in programs like that and that program in general is to take in, To account the entirety of the patient too. I feel like emergency medicine is very unique in that respect and that we are sort of the gatekeepers of the hospital, right? So it's the only place where you have patients that come off of the street and then they become a patient, right? And all that that goes into you know, that, that presentation and, and, and considering Those factors when you're considering next steps to disposition as well as how to treat this patient. And also, you know, what's the safest way for them to go home? What is the most realistic way for them to pursue treatment or even have access to that treatment?

Cassie: 12:05

Yeah, I think that that is you know, and perhaps this came, I remained a psychology major when I was in college and always found it really interesting to, you know, to understand, to sort of have the skills or the tools to be able to try and unlock What people need in any given situation, and I think that that is, it's honestly what drove me to be a part of the health equity scholars program, because this idea that we cannot care for other people without a holistic understanding of what it is that we need. need, which entails, you know, really understanding their strengths and what they're bringing to any situation. And, and I think we forget that in patients, particularly when we're seeing them at their most vulnerable is this idea that, you know, there are whole people outside of our emergency department and you know, they have whole lives that have nothing to do with us and we're really just there for a sliver of time. And so how do we be, you know, how do we take into account Everything about them in that very small, you know, period of time that, that we are, are there to help. And I, I really, I see that as a challenge, but the most interesting part of, of our job.

Chris: 13:25

Yeah. And, and not only patients, one of the things that you also have specialized in is, is leading focus on the well being of physicians and medical students in your career. What led you to focus on that? I know you said you had a background in psychology, but what other things kind of led you to focus in that, in that pathway?

Cassie: 13:45

You know, so when I, when I started as an attending physician, I had just left fellowship in Denver and coming back to Milwaukee. And you know, there's that first couple years when you are suddenly, you know, a real live doctor. And, you know, You know, I, I took some time to really understand what it is I wanted to do with the part of my life that wasn't clinical you know, as an academic physician. And what I was drawn to immediately was really the area of quality improvement and patient safety. I was both, like, fascinated and completely terrified that, you know, You know, we had all of this knowledge, all of this information about how to best care for patients. And yet, you know, in some cases, less than half of our patients were actually receiving that. That treatment and, and that's, you know, across the board, not just pediatrics, but in adult medicine as well. And that it felt like a waste. It felt like we had this opportunity, you know, we've been spending millions and millions of dollars to try and, you know, into to research into what would best serve our patients and really through through an ignorance of, of what it meant to, you know, Get those treatments to the bedside and into patients homes We were really wasting all of that money and so I Kind of dove into pay into quality improvement right away both into doing projects focused on Patients with chronic illnesses who were had to come to the emergency department frequently because of They're illness, so patients with diabetes, for example, who would present with diabetic ketoacidosis our patients with sickle cell anemia who are presenting a pain crises and recognizing that they spent hours. in our emergency department and how, how could we better care for them and ensure that they are getting the treatments that they, that they should be getting. So that's how it, that's how I started my career. And, and one of them, I would I taught this program called the quality improvement and patient safety pathway, which was really meant to teach student medical students who were interested in quality improvement. sort of help them learn more about it. And I had a group of faculty members advising me, and one of those faculty members, who's a pediatric critical care doctor, handed me this paper. This was back in, I think, 2015 or so, handed me this paper, and it was something, it was called Finding Joy and Meaning in the Workplace. And it was written by this this institute called the Lucian Leap Institute, which was a patient safety institute. And it was the first time I had ever read something that sort of took the Health care workers perspective into consideration when they were talking about patient safety and the bottom line was, we, if we are not safe, if we don't feel safe as providers as clinicians we cannot provide safe care to patients and that was sort of just opened my eyes to this. This whole other aspect of quality improvement that I felt we hadn't really, you know, really explored as a profession. And so, right then, that year, I started to teach our quality improvement students, burnout specifically. And I had I had someone Paula Davis who was a lawyer and became a, an expert in, in burnout and resilience. And she and I started something called the MCW resilience project. And we just put together a curriculum for those students and it was pretty basic at the time, but that was how I got started.

Chris: 17:32

Yeah. And you brought up a couple of good points there, especially the impact of burnout. And I feel like that's not only unique to our specialty but you see it in, in, in healthcare. You see it, you know, kind of throughout, you know, any other professional careers for physicians specifically, could you talk a little bit about, you know, what burnout is and the consequences for burnout for both Not only physicians, but medical students, both professionally and personally, especially as we're starting to see more and more mental health crises and healthcare professionals, unfortunately, in recent years.

Cassie: 18:04

Oh, absolutely. So I think, you know, before digging into the consequences of burnout, I think it's really important to highlight and to make it very clear that burnout is an occupational phenomenon. This is not you know, we don't see burnout outside of the workplace. And it's, it's really a group of symptoms that result from chronic workplace stress. It. Thank you. It didn't appear for a long time in, in the medical, like, in the list of our diagnoses, it didn't appear. It was really described throughout the decades, really from the 1970s just in, in the workplace in general, it wasn't specific to medicine and, but we have sort of co opted the term in medicine and, and in some ways we use it as sort of a catch all for, for unwellness and in medicine. And I want to make it clear that. That this is what I, when I think of burnout, really that, that sort of trifecta of emotional exhaustion and cynicism and sort of a sense of that you've lost the ability to do what it is you want to do. When I think of that, I think of. Really that, that while there may be ways that, that we can manage it as, as healthcare workers, really, it's not within our power to eradicate it. And physicians and physicians and training you know, I think are sort of are made to feel as if they have more power over their level of burnout than they really do. So so that being said, I think, you know, their burnout can lead. To a lot of you know, mental and physical distress that could, you know, that then sort of sits outside of of the definition of burnout. Things like substance abuse depression anxiety disorders, suicidality, you know, I want to make it, you know, really abundantly clear that those don't sit under the umbrella of, of burnout. They are a direct result of burnout. In some cases of of chronic workplace stress, and there are study. I mean, you can find just about any study linking burnout to any workplace. You know, any type of bad outcome that you can imagine. So, you know, I've mentioned some that are really individually, like depression and anxiety and suicidality. But there are also a considerable number of studies that link that link burnout and. In medical professionals, specifically physicians to things like worse, you know, worse quality of care physicians who are burned out are more likely to report having made serious medical errors. It's linked to decreased patient satisfaction, decreased clinical productivity. Lapses in professional behavior decreases in empathy. And then students who are burned out. And again, you know, linked to the structure an organization medical school they're more likely to also have lapses in their professional behavior. There's studies that shows that students who are burned out are more likely to cheat, for example, on on exams. And because of that, you know, that group of, of consequences, it certainly impacts patient care. But when we think about how it impacts the entire system, the other thing we have to think about is turnover. So physicians who are burned out are more likely to leave medicine early retire early change jobs. And so there's, I saw an estimation that burnout costs the medical or the healthcare system almost 5 billion a year because of, you know, increased turnover. And then, and physicians reducing their work hours because. You know, they, they really need the time to recover.

Chris: 21:58

And I like one of the things that you said there too, in that I feel, especially, you know, in the last 10, 15 years, especially since I've been in medicine, you, you see this shift at least in theory that physicians have control over this and that, you know, we, we have the keys to the car, to the vehicle, essentially of driving burnout or not. And so, you know, there are some methods that have been introduced, you know, their, their wellness, you know, retreats and things like that to kind of identify it. But I, I, I think that it's a gift and a curse in some respects, right? Because at the same time, A lot of things that burn physicians out, and I can speak for some of our partners, and I feel like every medical professional, especially any of us that have practiced through the pandemic, have felt it at one point or the other. You, you can see things that are occurring in the healthcare system that are causing burnout, right? So like if you don't have access to, you know, the medications that you need, if you don't have access to even the rooms, you know, the physical space to see your patients, you feel as though you're not, you know, Providing the adequate care to your patients that you could otherwise do if those things were remedy, right? and to a certain extent a lot of those things are outside of you know, The the control of the physicians in in the moment, right? And a lot of has to do with you know things, you know at a legislative level things at a you know Insurance level at a private equity level all those things are playing a role in it but you know, I I appreciate that you brought that up because this is something that A lot of, you know, amongst us professionally, we all talk about and identifying it is a, is a key point, but there are other things that are going into it that, that may not be within the purview of us controlling as physicians, but it is good to know and good to see those signs in yourself.

Cassie: 23:47

Yeah, and I think you know, the, the problem that I see that's happened, and, and I do, I absolutely appreciate that health care systems, hospitals, medical institutions are trying to take some responsibility for this. The well being of their employees of their staff, but the bottom line is they are not they were not designed. They were not set up to take care of us in that way. Right? So, like, wellness retreats or mindfulness modules, meditation, yoga, all those things that, you know, sort of are creeping into our our hospitals and our clinics. That's just not what. What that's not what they're good at,

Chris: 24:37

but what

Cassie: 24:38

they could be good at. Is everything else that you just mentioned, right? They could be good at really and they should be at looking at the underlying drivers of burnout, specifically, meaning the occupational hazards that we encounter every day. The fact that our administrative burden is you know, You know, so high the fact that as you point out, there's a tremendous amount of moral distress that we encounter because our values and how we want to take care of patients don't seem to be lining up with the resources that were provided in our clinical workspaces and, you know, from that standpoint, that, you know, I, that there's not a one size fits all and in, in that and in my section. So in our, section of emergency medicine, what makes me well from an occupational standpoint is not what makes my colleagues in anesthesia well. And, you know, I learned that when I was the professional health committee chair at Children's for several years, and one of the things that I learned When I started was to talk to every single section in the Department of Pediatrics and then all the pediatric divisions of our colleagues in the, on the adult side. And, you know, something like, for example, Epic most. Most sections I spoke with had a lot of problems with Epic, right? It's usability, the amount of time that they spent at home charting on patients. But then you go and you talk to Anesthesia and they were like, this is the best thing that we've ever had. This makes my life a thousand times easier, right? Cause it was, it was designed really well for them. And so, you know, if, if hospitals are going to say, Set aside resources and time to make changes. structural changes that would impact burnout. Not only do they have to recognize that that's their lane. They also have to understand that it's local and that entail, you know, it's hard to have to put all of that on a chief wellness officer, right? Who's responsible for the entire. healthcare system. You, that, that responsibility really should be diffused throughout the organization. And those people at the local level should be empowered to make the changes that they need to make in order to change the working environments of their people.

Chris: 27:11

Yeah. And for, for some of our younger listeners, we have a lot of medical students that listen to the program as well. People who are pursuing careers in medicine, et cetera. What are some of the signs? You talked a little bit about it, but just, I feel that identifying it in the beginning and identifying those signs in yourself are, are things that could be very helpful in terms of, you know, riveting your situation. Either it be, as you said before, a career change or learning how to you know, improve those measures within your own discipline. What are some of the signs and symptoms of burnout that you normally will teach

Cassie: 27:48

sure. So, you know, I, it's interesting because I talk less and less about burnout with my students. And and more and more about it with physicians, but because it, you know, it's, it looks so different in medical school than it does in the clinical space. But for medical students, I, you know, there's, there's the three main components of burnout. The first is emotional exhaustion. And that is really You know, I talk about that in terms of when you are presented with a problem, maybe you go and you're talking with a standardized patient and you cannot, you can't muster the, the sort of the interest or the compassion or the empathy for the person sitting across from you because you just, it's just, The well is dry. You just

Chris: 28:41

can't

Cassie: 28:41

pull it from someone. You're sort of going through the motions. It's almost mechanical. You know, that's one of those, those sort of telltale signs of emotional exhaustion that I advise students to pay attention to and whether the underlying reason for that is burnout or, or something else. It's, it's good. It's good to recognize when that's happening. The second component is cynicism which, You know, I think emergency medicine physicians sort of reliance and

Chris: 29:13

I was going to say, and that's another, that's another very specialty specific thing to, but

Cassie: 29:19

I happen to really thrive it with sarcasm and a little bit of cynicism, because I think, you know, when we're not using it as a defense mechanism humor can really sort of boost all of our, you know, Moods, but that being said if you really feel like you Like, it's not worth it that nothing, no matter what you do, nothing's going to change. You know, and in students that can feel like it doesn't matter how hard I study. It doesn't matter how many hours I spend, you know, studying for step one or for this exam. Like, it, it won't matter in the end. I'm, I'm not going to do as well as I want to. And then the loss is the, the last is really sort of a loss of personal efficacy. What's interesting to me is that both in medical students and in physicians, this is really the last, sort of the last sign of burnout. It's almost like you, Not as many people reach that point, and I think it's because we are sort of a group of people who really have at least to convince ourselves that what we're doing like, that we can, we can do it, that we have that, that if we really just put in enough time, it will be fine, but, but when that, when that gets lost, when you feel as if that you are not going to be able to help Someone in front of you that you are not going to be able to, to really be the kind of physician that you want to be that's sort of the final nail in the coffin. As they say, it's really it tends to happen in that order and emotional exhaustion tends to be the most commonly seen symptom in both medical students and physicians.

Chris: 30:59

Yeah, and like you said, I think a lot of it, too, is based on our culture, right? And so, especially in medicine, we have this delayed gratification. A lot of us who have been working at this for years, it starts in undergrad. For some people, it starts before that. It starts in high school. You know, you're on this pathway of achieving this goal of being a physician, or being a PA, or being whatever, a healthcare professional, and it'll be better when. Right. So everything is bad now, but it'll be better when I get to residency. Everything is bad in residency. It'll be better when I become, you know, a fellow, et cetera, et cetera. It goes into your career. And on the whole, if you're starting to feel those stages and like Cassie said, which we get to that, to that tertiary stage there, then you're at that position where it, no matter what, you know, your outlook on things are remaining the same. And so I think it's really important and very prudent, especially as a group of individuals who are caring for other people who are depending on our empathy, who are depending on us, bringing the best part of us, or the, you know, the best version of us to work in order to care for them. It's very important to care for yourself in those situations first before it spins out of control. Yeah,

Cassie: 32:13

I think that it's a hard thing to talk about with students and physicians, too, because, you know, the response is, and this makes sense is like, well, what control do I have over over these conditions? Right? And and students in particular, I think just feeling at the mercy of the structure of medical education the amount of work. Yeah. The amount of studying that's required to get through medical school doesn't, it doesn't feel like you have any say over that whatsoever. And, you know, in, in large part, you don't. And

Chris: 32:49

even recognizing

Cassie: 32:50

that and saying, okay, Yeah, there are what do I have control over and and what is outside of my control so I can let go of that and really focus on the things that land and under my control and focusing on those. And, you know, 1 of those things that I talk about frequently is just pausing. It's, you know, 1 of the most powerful tools we have is, rest and recovery and and that idea of pausing and, and this is something that carries over into the clinical space as well. You know, we are always. Going, going, going, and we rarely give ourselves permission to stop and to just kind of take, take inventory of what's going on emotionally for us and, and naming those emotions and and, and then choosing our behavior based on, on what we're feeling. And I think that when we get deep into burnout. We neglect to pause, and our emotions drive our behavior because we're not recognizing them. We're not we're not realizing that we're angry, for example. We're not realizing that, that we're in grief. And, and so they just drive how we act in the world. And that never, that doesn't end well for students or physicians.

Chris: 34:19

Yeah. Well, Kathy, I'll tell you, you, you, you are one of my heroes and have, have been for quite some time. I remember I rotated through the peds er back when I was a medical student, and I believe that's right when you first started. And so, you know, I I, I have always you know, been in awe of how you manage some of these things. And in addition, how, how you teach and are able to carry that message through to, you know, your colleagues as well as. Some students coming up, but could you share with us how you personally manage stress and maintain, you know, your well being throughout your career?

Cassie: 34:53

Yeah so I think there, I had a turning point as many of us did in 2020 in the pandemic. And you know, when I, and I've had the opportunity to sort of look back and reflect on what that period of time has been like. Look like and meant for me. And, and I think that that was as much as I had really been talking about and teaching about wellbeing, I don't know that I truly understood exactly what I was talking about until I had the opportunity to go through the pandemic with, with the rest of the world. And, you know, I remember sitting in my living room and we were actually listening to the school board discussion and and our And listening to them talk about how well, you know, the kids were gonna be out of school for two weeks. And I was like, that's unimaginable. What am I going to do with my kids for two whole weeks? Right. And, and then as the reality kind of set in, not only was I, you know, trying to figure out how I was going to. I had, you know, three kids and the youngest of whom was in the 1st grade at the time, how I was going to manage school at home and then was going, you know, thinking about, well, I'm now I'm also going into the emergency department where we were facing things like we, we didn't have a 95. we didn't have gowns. We didn't have well, we didn't really have anything, but we didn't have any idea what it was to take care of a patient with coven what that meant as far as our risk, what it meant to the risk that I was bringing home to my family. But my, my initial. instincts and what kicked in was, like, okay, well, you know, my kids are going to, they're going to get online and they're going to learn how to write from, like, the New York Times and they're gonna they're gonna do, we're going to do yoga together at lunchtime and we're going to take nature walks. And, you know, I I was gonna learn to make, Sourdough bread, all the things that I was like, okay, well, if I, you know, if I don't have control over this, then I'm going to take just Matt, I'm going to take control over everything else in my life. And, and I, you know, because my natural way of dealing with things, and I think a lot of ours who are in the medical profession is to over function. That is our response when we are presented with a challenge. How do I do? Not only what's necessary, but like 10 times that and and that's what i've learned Is is a way, you know, it's as a result of practice Of being perfectionist. It's also sort of arm helps us armor up against feeling vulnerable, right? So if if we're just working working working we can't ever stop and and understand how how vulnerable we feel And so I kept I kept that up for about two months And then I suddenly well, not suddenly, but I started waking up at like three in the morning and every day it would be three. I would roll over and look at my clock. It was 3 a. m. and I couldn't fall back asleep. So I would get up and I would start, you know, doing something, working, doing something related to the kids school. And this went on for a couple of months every single, every single morning. I started having, like, feeling my heart race, like where there's a point where I couldn't catch my breath. I would cry on my way to work. I would cry on my way home from work. I would get really upset when, like, if my husband would make very sensible suggestions, like, you know, you don't need to sleep at the hospital. Like, just come home, change your scrub, you know, like, You can stay here. I would get just incensed like he didn't understand what I was having to deal with and, and and I did all of that. And this was what I think was the biggest takeaway is I was experiencing all of that alone. I didn't tell anybody else. I didn't tell my family. I didn't tell, you know, my sister, who's a confidant of mine. I didn't tell my best friends. And it wasn't until I. Broke down in front of one of my friends who luckily also happens to be a psychiatrist and she said, okay Here's what you're gonna do. You're gonna call your primary care doctor You're gonna get on a zoom visit with her and you're gonna tell her that you would like some Lexapro and that's what I did and I started Lexapro in May of that year and It didn't it didn't take away every, you know, it didn't wipe everything away You But it meant that I slept, it meant that I stopped having headaches, it meant that I stopped, you know, having heart palpitations, and it at least gave me sort of that pause, right, that, that just that, the ability to rest and recover when I needed to, and it, I think that that, the biggest shift that happened was that I now reach out when I'm hurting, like, even if it's just to like text a friend and just be like, hey, okay. This horrible thing happened at the hospital. I don't really know what to do next. Or to say, hey, can we go get a cup of coffee? And so I have this very this very specific way. Like, when I am. When I notice I'm not doing well, I, I try and name the feeling like, is it exhaustion? Is it grief? Is it anger? I sort of, this is going to sound crazy, but I welcome those emotions into the fold. Sometimes I name them. So like I have this particular voice in my head that's very critical, that sort of, you know, it's like, Oh, you're not doing as well as you should. You should be doing these 20 other things. And I named that voice Reese Witherspoon for a variety of reasons. So I'll say, you know, like, okay, there's Reese Witherspoon. I'll give myself some compassion for those feelings. And then, then I'll just try and check off the easy things, right? Am I thirsty? Sometimes I just need a glass of water. You know, am I hungry? Do I need to get outside? And if it's more than that, if it's truly overwhelmed, then I will stop. And I, as I said, I will reach out to people. And I think that that has been. A game changer and it's that sense of interdependence and interconnectedness and, you know, and that real feeling that we are all sort of entangled with one another. And that that makes us so much stronger. That has been key to my. You know, staying well, or at least recognizing when I'm not well and being able to recover.

Chris: 41:54

Yeah. And, you know, thank you for sharing that because I feel like a lot of us, especially in medicine, but you know, just, just in modern society, we try to push off those feelings, right? Especially, you know, in the medical field, we're told to just continue to push and take care of your patients and move the meat and emergency medicine, right? That's, that's, that's the adage to just kind of get patients to their disposition. Yeah. But to take that time to, first off, like you said, identify the feeling and then secondly, name the feeling and then try to figure out a way, you know, how you're going to not only accept that, but also move forward. Those are things that, that we, we typically don't do especially if you have any other strains, you know, both personally in your family and financially for a lot of folks too. And I feel like the, one of the silver linings out of the pandemic was to. Provide that silence for a minute, right? Like we had so much that we were dealing with in the moment and a lot of that was unknown as well. We didn't know what we were up against and we didn't know sort of the social strains and the economic strains that it would have, but it provided that time for us to look further into that, right, to, to build our emotional IQ to say, you know, this is something that I'm feeling and that's okay. Right. It's okay to seek that treatment. It's okay to take a step back and not care for everyone, but care for yourself as well. And without doing that, you know, it would, the, the symptom is manifest and it can turn dangerous, especially in the medical field, as we've seen in the, in the most recent years, we've seen a number of folks who unfortunately have been at their time of crisis that, you know, have committed suicide or, you know, have turned to substance abuse, et cetera, et cetera. And so, you know, naming that goes a long way in preventing those those outcomes and it's prudent for us to do so as the stakes are very high and, and, and you need to know that about yourself.

Cassie: 43:44

Yeah, absolutely. And I you know, I, I think that one of the things that that we don't teach medical students, I, I don't think that anyone really learns this, honestly, and no matter what profession or career or job they have you know, we, In medicine, we're, we're witness to suffering like that is, it's really sort of the central part of our job and, and perhaps more in, in emergency medicine than, than other fields, but it doesn't matter, you know, we are we're witness to all sorts of, of pain and suffering and whether it's our own or Or our patients or friends or colleagues or whoever, we're not really taught the impact that that can have short and long term. And we're certainly not taught what to do with it. And one of the things that has stuck with me, there is a meditation teacher. Named Ram Dass. He died a couple years ago, but he, he has this he, he says, he says this a lot and, and basically he said that we have, as a species, as human beings, we have a natural aversion to suffering. Right. And, and that our tendency is to try and distance ourself from it. And in many ways, the pandemic made it impossible to do that. It's suffering. We were steeped in it. And and I think it sort of showed where the cracks were in our profession in particular around. Well being because you know in even in a perfect system, even if our health care system Decided tomorrow that they were going to implement every Structural and organizational change that we needed in order to you know Support health care professionals. The fact of the matter is is you and I would still show up tomorrow and we would still be witness to you know to Telling somebody that they have leukemia to being a child try and die by suicide to seeing kids drown, right? So we see just enormous pain in our job, and that's not going to go away, even if our hospital changes all of its policies to support our well being. And if we don't develop the skills to sit with that suffering and, and really metabolize it, as opposed to like, Use all of our skills to push it away and to maintain our distance from it. We're going to be, you know, we really are going to be consumed by it. And, and that's like, when we chew it, when, Instead of sitting with it, we do things like try and numb ourselves, right? So we that's why we have substance abuse issues. You know, we, we try and compartmentalize it away. And. Those types of responses are what got me to where I got in, in 2020. That's right. I literally was sort of consumed by it because I wasn't responding to it and not able to sort of see it for what it was. And those are really the skills that I think that I feel a responsibility to teach to students and to physicians who never learned them as students. And, and that's where I feel like I can make. A difference, right? I mean, that's where I feel like we have, we have a locus of control there. We have leverage there. Again, we may not be able to force the hospital to make changes, but, but we can really work on how we sit with suffering.

Chris: 47:49

And, you know, I wholeheartedly agree with you on that. And just to get back to some of the other things that you're doing too, you recently wrote a manuscript on, you know, outlining some of the principles of medical student wellbeing. But as we discussed before this too, I feel like this message should be. Brought out to everyone. I feel like this this could have applicability for everyone in every walk of life, and you're currently working on on that manuscript as well to Encapsulate everyone else too Can you give us an overview of some of the key themes and some of the key messages in your book and that message that? You're that you're that you're giving out.

Cassie: 48:27

Yeah. Well, and it it really starts with that The central premise is that all of us, like all human beings are a witness to suffering and that we don't really deal with the fallout of what, of what all that witnessing does to us as well as, as well as we could. Mostly because, as I said, we tend to find suffering aversive You know, a recent story came to mind when I was thinking about, you know about what this means and what this actually looks like in the practice of medicine. And, you know, I took care of a little boy who had gone to a friend's pool party, and by the time other parents had noticed that he was gone, he was, he had been at the bottom of the pool for several minutes. And EMS was able to get a pulse back before they brought him to our trauma bay, but he was really sick and I was the one who was responsible for telling his father you know, his dad who had just dropped him off at this party hours before perfectly happy, perfectly healthy. And I was responsible for sort of deciding how much truth was merciful, right? Like this idea that, you know, I didn't think that his son would ever leave the hospital and, and I, And I had to tell him something along those lines. And so all of us are constantly reminded of how fragile life is. I mean, I, at the, I had a son, I have a son who's the same age as, as his son. And, and it seemed natural to want to turn away from that pain, to completely avoid it. Completely avoid talking about it. And so that the attendance or really sitting with it is so it feels so counterintuitive because we think that we're going to be swallowed up by it and. You know, what Ram Dass said was that when we do that, then we be, then we're really at the mercy of suffering. So the book is really about how we keep our hearts open amidst suffering from how we bear the unbearable. And I tell it obviously through my lens as a physician, but also as, you know, a daughter and a mother and a wife and a friend. And And I tell, I really talk about the skills that we need in order to be present with suffering through stories. So certainly my own stories that I have from medical training and, and medical practice. And then my colleagues I interviewed many medical students for the book. Who told me their stories and really sort of use that, that framework to talk about and introduce specific, very specific strategies and skills that we can kind of operationalize what it means to sit with suffering, right? That's. That sounds really great. Sounds very poetic but what does that actually look like in everyday practice? Like what does that look like in all of our lives and how do we actually make that happen? And so that's, that's really what the book is focused on.

Chris: 51:39

Awesome. So where, where can our listeners, I know that you're currently in the process of working on it, but where, where will they eventually be able to find your book and how can they learn more about your work?

Cassie: 51:51

So right now I'm in the process of editing, so it could be. This is the first time I've written a book, so I am not sure when the time will come. My hope is, you know, sometime late next year, but it will be widely available, is my hope. Right now I do write on Substack, so I have a Substack account, which I'm happy to share with you for, it's under Cassie Cron Ferguson, and that, I really use that as sort of just a, A holding space for stories that I that are in my head that I want to get out on paper, some of which will, you know, appear in various forms in, in the book itself. And some of which are just sort of musings that I, you know, just want to get on paper. But that's probably the best way. And then, you know, certainly as far as. You know, other things that I do at MCW as you mentioned, the thing that I'm most involved with and is closest to my heart are the health equity scholars and the health equity scholars program. And that program can be, you know, information about that program can be found on MCW's website.

Chris: 52:59

Awesome. Well, definitely link all that too. I know the health equity scholars program is already linked to the website, but we'll definitely link your sub stack and some of the articles that you've done in the past and some of the amazing work that you've done. And I want to thank you so much for coming out and sharing your thoughts. This is very valuable for. Not only our medical students, but for all of our listeners I feel like wellness and, and especially, you know, building up our emotional intelligence, talking to ourselves through some of the issues that we're going to, and actually allowing ourselves to feel those feelings will go a long way in terms of healing us as, as a whole person and then going forward. But with that being said, do you have any final thoughts or any final messages that you would like to share with our audience?

Cassie: 53:40

Hmm, no, I think, you know, I, I want to say. Thank you to you too. I, I feel like so often physicians stories aren't told and that the more that we can make the lay public, you know aware of what it is, you know, we do every day and the kinds of situations we find ourselves in, you know, I think one of the things that's been hardest And I think it's really been difficult for physicians and medical students well being recently and post pandemic is sort of this, you know, the politicalization of, and I said that word wrong, but making,

Chris: 54:29

making

Cassie: 54:30

vaccines, for example, making science political and That I think has been really hard for those of us who are doing this every day to withstand and to feel as if, you know, we are really seen for what it is we're trying to do, which is, you know, To compassionately care for other people and, and everybody, you know and so I think, you know, you putting yourself out there on this podcast and, and pulling in voices of physicians and people who are really connected with the healthcare system is a powerful part of changing that narrative and, and really making it clear that, you know, That we are all interconnected, and we all rely on one another so intimately that that to, to sort of to view health care through that lens will be. It hurts. It hurts us. So I appreciate you doing what you're doing and thank you for having me on.

Chris: 55:37

Absolutely. Well, thank you so much, Cassie. I appreciate it. And best of luck with everything you do and I'm sure I'll be in touch with you. Hopefully it'll help out in any way that I can with the scholars program as well.

Cassie: 55:47

Absolutely. Thank you.

Chris: 55:49

All right. Thank you.

55:51

Very special. Thanks to Dr. Ferguson for coming out and speaking with us. We're very much looking forward to seeing all the things that she's going to continue to do with the health equity scholars program, as well as all the things that she's going to do with healthcare provider wellness. I want to thank you all for coming out and listening again, as always, we're very much looking forward to the new year we're going to have some great episodes on the horizon. We're going to have some things that we're going to be doing with the show as well. So looking forward to unveiling that and to have you all involved as you always have been since the beginning of the show. So feel free to continue to reach out, continue to ask questions and to provide your insights so we can tailor this to how you all want. This is a community show. We're looking forward to using this show as we have been in the past to help improve the issues as we see it in our communities, as well as to help create a grounds for discussion of these topics. Tune in, in the upcoming weeks, we've got another great episode on horizon. And with that being said, as always take care of yourselves, take care of each other. And if you need me. Come and see me.