Hey, doc. I just wanna give you a heads up. In this episode, I'll be talking about miscarriage and some
explicit details from one of my call shifts as an OBGYN. So if you don't think that you want to hear about that, I understand, and this is the time to tune off and catch me on the next episode. Okay?
Hey, doc. I wanted to talk to you about a technique that I use to get myself through stressful situations, and it's actually one that I realized I use with my patients who are very anxious for their pelvic exams, which is a lot of people, and something that I use on labor and delivery for women who can't tolerate the cervical exams.
Like, I use it all the time with my patients. But this very particular situation that I was reminiscing about, I don't know if reminiscing is the right word, but I was thinking about the last shift that I had at one of my locums sites that was probably one of the worst calls of my life, and it was very stressful, and I used a variation of this technique, and I really want to share it with you.
Uh, just so you know, it's about to get real woo-woo. So if you're not into woo-woo, you can stop listening right now. But it works, it is helpful, and I highly, highly recommend that it becomes part of your practice to get you through. It's not like you're gonna do this thing and then all of a sudden be stress-free and happy-go-lucky and everything's better.
It is literally to get you through those really hard moments when you feel like you're going to crumble. So one of my very last calls at this place in middle of nowhere, Southern California, I was already starting to be really disillusioned with this hospital because it was one of those places where they had a ton of private doctors who probably haven't read anything since they left medical school 50-something years ago.
Standard of care, evidence-based medicine they were very much doing, "Well, this is what I've always done." And there was this one anesthesiologist that decided that he didn't like how I worked.
He decided that based on his extensive experience of watching other gynecologists do D&Cs, that my blood loss was too high. Now, this is a place that I had been working at f- since I started locums, so maybe two years, and I did not even 50 calls there. Maybe 20-something, I don't know, because I didn't work full-time, and I used to split my shifts.
So when you think about the likelihood that he would have worked with me, the likelihood that I would have had a D&C because I was there doing labor and delivery coverage, I would have to take people back for a D&C, maybe for a retained placenta that came back in or somebody who came in through the ER.
This was a small hospital. It was not that busy. So he decided over a handful of nights, 'cause I only did nights, and the rare time I would have to take somebody to the OR, that in general, my blood loss on D&Cs was too high, and that meant that I didn't know what I was doing. So when somebody came in with an incomplete AB and was literally hemorrhaging, he refused to take them back to the OR because this Podunk hospital didn't have blood for her.
I don't remember what the situation was, but they needed to get blood from somewhere else. The blood bank, there was something going on
So he knew I was on call. I said this lady needed to go because she's bleeding, tachycardic. Like, not just, "Oh yeah, she's bleeding. We'll get to it." No, she's starting to show signs of hypovolemia. And he was like, "No, we are not going back until there's blood in this hospital because , and I have been in situations with her where there's been a lot of blood loss, and this is unsafe."
So I was just like, " What the fuck?" First of all, this doesn't make any sense. She's actively bleeding, so waiting for blood while she bleeds out when I could have been done with this already doesn't make any sense. Let's take care of the problem, and then you can transfuse her when the blood comes. That's how medicine works, right?
That- that's just what makes sense. But also, the last time I had a D&C with you, which was, again, who knows when? This was somebody who came back in two weeks later with a retained placenta. And for those of you listening who are not OB, those people bleed. That's just what happens. There's old ass placenta that's in there that has already started to attach to the wall, all sorts of things, and now I'm going to scrape that up, like agitate the area, remove it from the wall.
It is going to bleed. So by definition, that's a case where you tend to have more bleeding in general. And because it's a retained placenta, the risk of perforation is higher. So I am a very good gynecologist, so I go slowly, and I use an ultrasound to make sure I don't perforate this woman's fucking uterus and suck her bowel out of her vagina, all things that could happen, and I know this because I'm a seasoned OBGYN.
So his problems were that the blood loss was too high and that I took too long. And I was just like, "You are penalizing this woman. You're not even penalizing me, penalizing this woman because you don't know how gynecology works and because you have decided that being careful Is not acceptable because you're used to these cowboys out here that will just swipe the curette two times and be like, "Okay, she's good."
Meanwhile, these young women, come back and they have a ton of complications that you don't hear about because you're just on call in this hospital. So I just was like, "You have to be effing kidding me." So I call this man, and I'm explaining all of this to him, and I was just like, "Why do I even have to explain this to you?
This woman is bleeding." Like, are we forgetting the main thing? So I had to escalate, and I was just like, "Well, f- find somebody else if you don't want me to do it, but I am going to document that you are impeding this woman's care right now because I'm the only doctor that's here, and she is bleeding and tachycardic."
But I just was so upset, as you can tell. It's been like two years and I'm still very upset because most importantly, you are putting this woman's life in danger. Now, that's number one. And very close second is that you are saying that I don't do a good job at my job, at the job that I take a lot of pride in and have excellent outcomes with.
And I was just like, "You have to be kidding me." He was shouting at me. We were going back and forth, and I could feel the tension in my body. I could feel it in my neck. My head was pounding. I was so angry because I was like, "If this woman bleeds out in the ER, what leg do we have to stand on?"
Luckily, earlier that day, 'cause like, like I said, I only did 12-hour shifts by this time. I'm like, "I'm not doing 24s anymore. Screw that." So earlier that day, when I was in my hotel waiting for call, I happened to join a Zoom call with one of my fellow physician coaches. She is a meditation coach. Shout out to Rashmi She is a wonderful human being, family medicine in Florida, but mainly she's a meditation coach, and I had worked with her in the past, and I was in her coaching program as a guest. I think... I don't remember why she invited me. What was the situation? I think I was starting my group, and she just had me come in to see how she runs her group, which was so kind and generous of her.
But during that group session, she was talking to her clients about trauma and how we hold trauma in our bodies. You may have heard the saying, you know, "The body keeps the score." It's all different ways of talking about the same thing, right? Something happens to you, and it's traumatic, and I love how she broadened that definition of trauma because I think especially as physicians, I know especially as OBGYNs, we think about trauma as this very specific thing.
You know, somebody has a trauma, like they have an MBC, that's obviously a trauma, or you witness somebody getting murdered. That's obviously a trauma. But I think we downplay to ourselves and sometimes to our patients, which can, damage your trust relationship, how other situations can be quite traumatic.
I know that happens a lot in OB when, you know, we see a patient who comes and tells you they had a traumatic birth, and you either externally or internally roll your eyes because you read the notes, and the notes say she had one D-cell and decided to have a C-section. Y'all know that has happened. My OBs that are listening, you know you come in, this person's telling you how it was so terrible, it was so bad, and you read the notes, and it's like, yeah, she had a one-minute D-cell, and patient elected to have a C-section.
But that's not what she's describing. And because of how I was trained, because of the cynicism and, you know, all of those things, I would do the eye roll as well. But what I had to realize Is that to that patient, that shit was traumatic. And also, our documentation doesn't always convey their experience.
So regardless of what actually happened, trauma is in the eye of the beholder, right? So for us, it may have been not a big deal, and for her, it was this traumatic experience, and who's to say that that was not right, right? So Rashmi talked about how we can have these traumatic experiences as you go through the day, and you hold it in your body.
And she talked about thinking of your body as a hollow tube, and allowing the trauma to pass through you so that it does not stay in your body. And of course, you know I'm not a meditation coach, so if I mess this up, Rashmi, if you're listening and I mess this up, I apologize. But it was so firm in my mind, and it helped me later on that day that, you know, I just had to, to share this.
So she took us through exercises where we would use our breath And imagine yourself as this hollow vessel and using your breath, letting that traumatic experience move through you instead of staying within you. And not that all of a sudden you do this exercise and everything's fine, like I said, but it kind of brings down the intensity of the situation.
It allows you to continue functioning and to continue to move on and to continue to heal from this traumatic event. And even though I, like I said at the beginning of the episode, I use these techniques all the time, you know, using breathwork, using kind of this meditative state to get people through pelvic exams.
Just the way that she explained it was so different and it was so timely because when I was going through this situation with this anesthesiologist, I could feel it. I was clenching. Every part of my body was tense, and that trauma was in me. And remember, I was on call. So this patient was just one person that I had to deal with.
I had people in active labor. So when they called me for a delivery, I collected myself, of course, tried to keep it professional for the other people, but I am human. And this thing was ongoing. Because let me tell you the end of that story. I left that call in the morning, seven AM, and she had still not gone to the OR.
So this was an all-night fight with this anesthesiologist. So I am doing my other work and still fighting at the same time. So I was at this woman's perineum in a delivery, and I am doing perineal massage, waiting for the next contraction. And when I checked myself, I realized I am, like, massaging the shit out, out of her perineum because even though I was physically present, my mind was on that lady in the ER and this anesthesiologist that was impeding the standard of care for this patient.
And I was so tense. Every part of my body was clenched. And I was like, "Oh, shit, I need to, I need to get it together and be here for this person, this patient in front of me." I remembered Rashmi's teaching, and I took the time to close my eyes and to use my breath And allow that traumatic experience to flow through me so that I could be there, really be there for this woman on one of the best days of her life.
And let me tell you, I'm getting emotional even thinking about it, because it was one of the most beautiful deliveries. I love when women decide that they want to help deliver their own babies. It's something that I ask all the time, and most people were freaked out, and they would say no. But she said yes.
So after I'd done the breathwork, I'd collected myself, and I was fully present. she was crowning. I was like, "Do you wanna grab your baby?" And she was like, "Yes." And she reached down and pulled her own baby out. I was able to protect her perineum, no tears. She was so happy. It was so beautiful. And I was able to be there for her and create that experience for her and not bring my own stuff into her moment.
And I was just so happy that that tool was so fresh in my mind, because I had gone to that coaching call just a few hours before. It was something small that I could do to immediately change my state, to do what I had to do, and to allow me to really enjoy such a beautiful moment. And I will be ever grateful for Rashmi,
for inviting me to her group to experience that, and the universe for putting me in that coaching call right before this thing happened. And I hope that listening to this episode can be that for you, that you will listen to it in just the right time to be able to use this to get you through these very difficult moments.
And I use this all the time, and I think you can use it all the time too once you expand your definition of trauma, because it may sound dramatic and like, "Oh my gosh, I'm not having trauma every day," but aren't you though?
There are so many examples that I can go through where if you take away the baggage that comes with that word, you can think of situations where you can feel the tension in your body, and it is so significant that it is affecting your mood, your presence, your ability to do your job well, to take care of your family well, to interact well with your husband, any of those situations when you can use this, and
I found imagining your body as a hollow vessel that allowed those traumatic experiences to pass through, it just worked for me, and I think it's because I'd already used a version of that with my patients. If you've had a baby, you listen to this podcast, you've had a baby, and you've had a cervical check, most people, what they do when they, they see us coming, is they tense up.
Everything gets tense. Your butt gets tense. You start closing your legs, and you retract, right? That tension actually just makes things worse, and usually what I'll have people do is, "Close your eyes, take a big deep breath in, and as you breathe out, use that breath to blow away all the tension in all of your muscles.
Imagine that you are blowing it all away and that you're melting into the bed or the table if you're in the office." And usually if you're really tense, it takes more than one breath, but that's okay. With each breath, take a big deep breath in, and as you breathe out, let that breath blow away all of the tension in all of your muscles and just imagine yourself melting And it's the same concept if you imagine your body as a hollow vessel and that breath blowing the tension and the stress and the trauma through the vessel out of your body
And you can repeat that as many times as you need to get to a place where you can function, where your head isn't throbbing, where your jaw isn't clenched, where you're not chipping your back tooth because you're so stressed out. That may or may not be a real example from my life But it's all the same thing.
So take whatever technique, whatever visualization works for you Just to get you back to a state where you can function, whatever you need, whatever situation you can use this
And let the trauma flow through you, flow out of you Let your breath blow away all the tension from your muscles And the way that I like to imagine it, especially when I use this when I'm going to sleep, is that I visualize each muscle group, each part of my body that is tense. And it's not just, "Oh, let me relax my body."
Taking it body part by body part allows you to release more tension because you may not even realize all the places that are tensed up because you are so stressed. this may sound really silly, but if you start with your scalp, start from the top. You take a deep breath in and blow away the tension in your scalp.
I bet you never thought about your scalp being tense, but I'm telling you, if you're stressed, if you are busy, if you are a mom, if you are a physician, I guarantee you even your scalp is tense. Then you go to your forehead Your eyelids Your jaw, even your tongue, your neck, your shoulders. Your shoulders, your arms, your abdomen, your butt, your legs. Go all the way down. And breath by breath, blow all that tension through and out of your body. And this takes, like, a minute, if that much. A few breaths to get you back right
So I know this was a little bit of a different episode, but this came up. I don't know why this memory came up, but I wanted to share this with you I know that you can probably relate, and I know this will be helpful, and I really hope it finds you in the perfect time, just like it was for me before that call. And I hope you find some peace, some relaxation, some presence, strength, and joy that you were able to change your state and reduce your stress even for a moment so that you could
function and be proud of who you are in that moment, because that's how I felt with that delivery. I was proud that I was able to create that experience for her and just be there and to be the best obstetrician that I could be and be a part of such a beautiful moment So thank you again to Rashmi, and thank you for listening.
And share this with another physician mom who needs a quick but powerful technique to get her through. And I will see you on the next episode of Stethoscopes and Strollers
