Recovery Diaries In Depth

A Doctor with OCD Advocates, Treats, and Thrives; with Dr. Rachel A Davis | RDID Ep. 107

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What if the very challenges that seem to hold us back are actually the keys to our success? Join us as we uncover this possibility with Dr. Rachel A. Davis, a psychiatrist and medical director who turns her personal journey with obsessive-compulsive disorder (OCD) into a source of strength and empathy in her professional life. Rachel shares the transformative experience of becoming a living organ donor, a milestone that marks her triumph over childhood health anxieties and her unwavering dedication to the medical field.

Rachel's story is one of resilience, from her early years marked by religious scrupulosity and health anxiety to her pursuit of a medical career despite these challenges. With candid reflections, she reveals how a tough-love upbringing and specialized OCD treatment helped her navigate these anxieties, ultimately leading her to thrive in high-pressure environments. Her experiences as both a medical student and now a practicing physician highlight the nuanced ways OCD has shaped her approach to patient care, making her a compassionate and conscientious advocate for mental health within the medical profession.

As we explore the evolving culture in medical education, Rachel offers valuable insights into the importance of mental health support for future physicians. Her dedication to breaking down stigma and fostering open conversations about mental well-being stands as a beacon for change. From the pressures of medical school to the shifts in educational approaches aimed at reducing stress, Rachel's journey underscores the importance of supportive environments where medical professionals can excel, not just survive. Tune in to discover how Rachel's personal battles have fueled her passion to transform the landscape of mental health in medicine.

https://www.youtube.com/@TransplantTalks-Podcast

Conversations like the ones on this podcast can sometimes be hard, but they're always necessary. If you or someone you know is struggling, please consider visiting www.wannatalkaboutit.com. If you or someone you know is considering suicide, please call, text, or chat 988.

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Gabe Nathan:

Hello, this is Recovery Diaries In-Depth. I'm very excited to be talking to our guest today. Her name is Rachel A Davis. She's a psychiatrist and medical director in Aurora, colorado. She wrote an essay for us back in 2017 called how Does a Doctor with OCD Navigate Life Career and the. Every Day We'll be talking to Rachel about her essay about managing her mental health symptoms as a physician and where she is today.

Gabe Nathan:

Each week we'll bring you a Recovery Diaries contributor folks who have shared their mental health journey with us through essay or video format. We want to see where they are in their mental health journey since initially being published on our website. Our goal is to continue supporting our diverse community by having conversations here on our podcast to follow up and see what has shifted, what has changed and what new things have emerged. We're so happy to have you along for this journey. We want to remind you to follow our show for new and back episodes at recoverydiariesorg.

Gabe Nathan:

There, like the podcast, you'll find stories of mental health, empowerment and change. You can also sign up for our mailing list there so you never miss a new podcast health, empowerment and change. You can also sign up for our mailing list there so you never miss a new podcast episode, essay or film, and you can find this podcast pretty much anywhere. You get your podcasts. We appreciate your comments and feedback about our show. It helps us improve, make changes and grow and, of course, make sure to like, share and subscribe. Hi Rachel, hi there, thank you for being on the show with me.

Rachel Davis:

Thanks for having me.

Gabe Nathan:

It is a pleasure, as it was a pleasure to edit your essay all those years ago. Do you remember when it was no?

Rachel Davis:

It was. That sounds about right. Yeah, it's been a while, though.

Gabe Nathan:

Part of the reason why we're doing this podcast is because we as an editor and a writer have a comparatively short time together. When we work on a personal essay, we go back and forth, there's a revision or two, the essay gets published and then frequently I never hear from the person again published and then frequently I never hear from the person again. And it's just such a wonderful thing to be able to catch up and see how you are. What has changed since we were last together, and it has been a long time. So how are you now? Where are you now? What's going on in your life? How are you?

Rachel Davis:

now? Where are you now? What's going on in your life? Catch us up. Those are a lot of questions. But how am I? I am good I am still working at University of Colorado on the CU Anschutz campus. I think that's where I was when I wrote the article I am now. I have several different roles, so my main role is Vice Chair of Clinical Affairs in the Department of Psychiatry. I'm also Medical Director of our OCD program and Co-Director of our OCD Surgical Program, so we do deep brain stimulation for severe and refractory OCD severe and refractory OCD and then I'm chief of all of our outpatient psychiatry practices, and so I'm busy, but I like what I do. I still have OCD, so still manage that every day. And yeah, was there anything else you asked that I didn't?

Gabe Nathan:

I think that was a pretty good catch up, and you have a podcast, correct?

Rachel Davis:

I do. It's called Transplant Talks and it's about transplant organ donation.

Gabe Nathan:

Are you an organ donor or a recipient?

Rachel Davis:

I'm a donor, so I donated the right lobe of my liver in January of 2022. January of 2022. This is actually something I learned about in medical school, 22 plus years ago, and I was sitting in lecture and the professor was talking about how you could donate part of your liver and it would regenerate. I thought that was really cool. I actually reached out to him afterwards and thought I was interested in doing it and you know, back then non-directed donation wasn't really a thing yet or giving to an anonymous, or giving anonymously. But he took me seriously and he met with me and at that point he told me I would need to get a psychological evaluation as the next step. And I thought, oh no, I don't think I'm necessarily psychologically okay, because this was before I got treatment for OCD or anything and in all reality, I didn't have time to donate part of my liver. As a medical student, I mean it's too intensive a procedure and recovery. But it's always been there in the back of my mind and you know, fast forward 20 years.

Rachel Davis:

I was doing my charting online and I came across an article that UC Health had put out about someone who's a double donor. So she had actually donated one of her kidneys and part of her liver to an infant and there was a link to the form and, without really even thinking, I just filled it out and you have to put in all your medical history and all your medications and I take a lot of medications and I have OCD and so I followed it up with an email. I said, hey, I just put in this application. You're going to see my medication list and think, oh no, but you know, actually I function quite well, I'm on faculty here and, yeah, I just gave him heads up.

Rachel Davis:

And so a few months later I was donating the right lobe of my liver to someone I didn't know at the time, but I've met since then and she's an important part of my life and for me. You know, we haven't really started talking about my OCD yet, but this was very significant to me because as a child I was afraid of my body and I had health anxiety, what we used to call hypochondriasis, and you know I would stay up late learning all the symptom flow charts and anyway, to be able to go from that to feeling confident enough in my body to undergo a major surgery was a big milestone, and also to be someone with mental health diagnoses, who takes a lot of medication, who could also be found to be healthy enough to make a decision to donate part of her liver. So that was a very long answer to your question. Yes, I'm a liver donor.

Gabe Nathan:

Extraordinary one at that, and thank you so much for sharing that. And you also answered my follow-up question, which, of course, in preparation for this interview. I went back to your essay and, as you were talking earlier, I was thinking about Rachel the child, and could she have possibly envisioned that she would be undergoing a procedure like this? What an unfathomable progression. And if she could see you now. But of course she can.

Rachel Davis:

Right right.

Gabe Nathan:

In addition to asking about updates and things like that. Do you still have the sun conures?

Rachel Davis:

Well, I have. No, I don't. So one of them died of old age and one of them died tragically, got caught in his sleep hut. But I have, I don't. So one of them died of old age and one of them died tragically, got caught in his sleep hut, but I have. I rescued her when she was 19-year-old Sunday Conyer, so she's a mix between a Sun Conyer and a Gen Day Conyer, and so she's probably about 21 now. She's a chronic plucker, which is kind of like a bird version of trichotillomania, so she's bald. She doesn't have feathers on anywhere she can reach, so she's cute and bald.

Gabe Nathan:

Cute and bald what I someday aspire to. You wrote in your essay. I still do not often feel calm and you know, as I was listening to you really talk about your bio and your various professional positions, in addition to being an individual who's living with OCD, I was thinking to myself well, of course she's not, of course she rarely feels calm, but that was in 2017, feels calm, but that was in 2017, you wrote that and I'm curious about now do you still feel that way and what helps you if you do? What helps you attain those rare moments of feeling calm?

Rachel Davis:

Yes, I still feel that way and that is, I think, one of the reasons I stay so busy, because it's easier to manage real problems than to manage the imaginary problems. Your brain makes up with OCD and your brain has a lot more time to make up problems if you're not doing things. So, fortunately, I've been able to find things that I really enjoy doing. I love my career. I couldn't ask for a more perfect job or positions and I think I'm good at solving real problems and I like kind of high acuity situations and I like managing crises and really I think it comes down to it's so much better to actually be able to do something about a problem than with OCD, where you're like thinking about these what ifs and there's absolutely nothing you can do about it, but you're doing all these compulsions trying to do something about it and it doesn't actually change anything.

Rachel Davis:

Relaxing is hard for me. I mean I don't do well at having a lot of downtime. I generally try to keep myself busy, but that's okay. I mean it's the life I have and I like my life in general Doesn't mean it's not hard still, but I like my life Does the podcast help you feel calm.

Rachel Davis:

Yeah, it does. It gives me something to focus on. So I get to use the creative part of my mind. I get nervous recording things and so I'm always a little bit nervous when I'm talking to guests, but I enjoy it. And then the editing part is a lot of fun. I do all the video editing and that takes up a different part of my brain and is a really good distraction.

Gabe Nathan:

So when you were talking about high acuity situations and how you're kind of drawn to those and of course I know you were an emergency medical technician in your early days this might be a weird question Do you consider yourself an action junkie?

Rachel Davis:

That is an interesting question, because not, no, I don't tend to pursue things just for, like the sake of adrenaline, but I do like to do things that have a lot of purpose, and often that involves action. So I guess the closest thing to being an action or adrenaline junkie would be maybe I like climbing but I'm terrified of heights. But I still do it and there's not really a purposeful goal there other than, like getting to the top of something right. So I enjoy that. But I think the other things that I've done in my life that are kind of action-oriented all are driven by a purpose.

Rachel Davis:

So you know, being an EMT, I felt I was helping people, donating part of my liver. I felt I was helping someone. And I think one of the things about having OCD at least for a lot of us is we're hyper aware of all the bad things that could happen and also hyper aware of all the badness in this world, and it is an awful feeling to feel paralyzed and like you can't do anything about it. So I think I put myself in situations where I feel like I'm doing something about it, even if it's just for the person in front of me, where I feel like the badness isn't. I'm not paralyzed by it because I'm doing something about it.

Gabe Nathan:

Yeah, that's so interesting and it's also so interesting to me that when you were talking about the various things that may have seemed action junkie oriented, you mentioned the liver donation. I never would have thought to put that in there, but in a way it is A it's purpose-filled, it is also helping other people and it is I don't know if the word I'm looking for is dramatic, but it's intense. It's an intense situation to put one's body and mind and being in, and I wonder if you felt all of that at the time.

Rachel Davis:

Oh yeah, I mean, it definitely gave me something to focus on. It occupied all my thoughts for some time. I did a lot of research about it, learned what I was going into, and then there was a whole actual experience. I was in the hospital for about six days and then the recovery was intense. So, yeah, it was a meaningful way to occupy my mind and also do something in line with my values, Can you?

Gabe Nathan:

talk a little bit about how your OCD manifested in your youth and the ways in which you responded to it, and how those are different today responded to it and how those are different today.

Rachel Davis:

Sure, so I'd say, as a kid, my OCD probably started around the age of I don't know, somewhere between like nine and 12, but I had probably two main themes. So one was like scrupulosity, or fear of doing something wrong, and in my case it was going to hell. I grew up Southern Baptist and so you know we had a lot of like tent revivals and altar calls and things like that, and so that drove my fears of going to hell. And then the other area was health anxiety, so worry that I was going to get, you know, cancer was one of the main concerns, but really any sort of illness, but really any sort of illness. And so I guess, what did I do? How did I manage the health anxiety? I mean, I would sneak upstairs, grab this AMA home journal thing which had symptom charts, and I literally probably had every symptom chart memorized. And then I do a lot of checking, like look at my tongue, look at my lymph nodes, I think once I went to the doctor and I told him I thought I had polycythemia vera, which is a disease that mostly old men get.

Rachel Davis:

And in terms of the religious scrupulosity, I had a prayer that I repeated over and over. I did a lot of confessing. I would always tell my mostly my mom the things I thought I had done wrong during the day, and at one point she told me you know, rachel, you don't have to tell us everything that you do during the day, you don't have to tell us all of your thoughts. But I was often afraid I was going to commit blasphemy. So I was always trying to figure out what blasphemy was, because I didn't really know what it was, but I was afraid I was going to do it. So that's kind of how it showed up as a kid.

Gabe Nathan:

So here's my question, and I don't know if you covered this in your essay and of course you're going to read it, which I'm very much looking forward to what was your parents' response to issues relating to the scrupulosity, issues relating to the health anxiety? I mean, did they know that this was going on? Were you constantly asking them to take you to the doctor to get examined for this, that and the other thing? Were there alarm bells that were going off? Or was it just oh's, rachel, um or somewhere in between?

Rachel Davis:

I well, mental illness wasn't really a thing either in our family, or at least it wasn't talked about, and I grew up in a really small town, too, where there was a lot of stigma, so they knew I was anxious. Um, I think my mom described that even as a an infant. I didn't like to be touched or held, especially when I was crying. I just like to be let alone, and I didn't ever sleep very much. So they knew I was anxious. Their way of dealing with it, though, wasn't necessarily to seek out treatment. They encouraged us to do the hard things anyway. In fact, they kind of made us.

Rachel Davis:

I had a lot of separation anxiety, and I went to music camp because I was good at music. I played French horn and piano, and I dreaded going and I would get so homesick and I'd spend probably the first four weeks crying and then the second four weeks crying because I was going to miss everybody and having to go home. But they, you know, they told me I was going anyway. I think a lot of people's families with OCD over-accommodate. They try to appease the anxiety, and, for better or worse, my parents didn't do that at all. They just were kind of like you're doing it. Anyway, I don't care. I do think, even though that was hard and hard, in many ways it has served me well. I mean, it has helped me push forward in life.

Rachel Davis:

I had a thought that I just forgot about. Oh, I remember once. So, yeah, I would often, I think, tell my parents I thought I had something. And I remember once I was convinced I had skin cancer and I even took up pictures from the book and I showed them. And they're like no, and I'm like no, you need to take me in. And then the doctor also was you're like 15, you don't have skin cancer. And they biopsied it. I had skin cancer.

Gabe Nathan:

So I felt like you see, I know what I'm talking about.

Rachel Davis:

It was basal cell carcinoma, so it was the best kind of skin cancer to have. But I still needed to have it excised with wide margins and I was like I almost felt vindicated. I'm like, see, I'm not just crazy here, I'm. You know, sometimes my fears are true.

Gabe Nathan:

Did that add fuel to you at that point? Did that make? Did that make the health anxiety worse?

Rachel Davis:

It didn't actually. No, I mean no.

Gabe Nathan:

That's so interesting.

Rachel Davis:

Wow. And so what is different today? I mean, I'm sure, quite a bit in terms of managing the OCD and how it manifests. I also did. I've been in therapy for a long time now and some of that therapy was OCD-specific therapy. So exposure and response, prevention. So I've learned a lot more about how to, you know, not do rituals although you know I still do rituals sometimes but I think I have a better understanding of what's going on in my brain, which makes it easier to, you know, keep moving forward, and I also have a better idea of how to respond to it.

Rachel Davis:

In college, before I got treatment, I was miserable. I studied all the time. I couldn't study at home because I would cry and I couldn't figure out how to stop crying. And so I finally realized if I went to like Barnes and Noble or a coffee shop, there was enough distraction that I wouldn't feel so sad. I was crying and I wouldn't feel so anxious. I was crying, I could actually study. So I spent all my spare time at either Barnes and Noble or Starbucks or whatever coffee shop there was, and I just wanted to be done with college so that, in my mind, then I can go home or I can go to medical school. I knew I wanted to go to medical school, that I basically got A pluses in every single class and I graduated in three years just because I wanted to be done. I wasn't living life, I was surviving. And now I actually, even though my OCD is still present, I am doing things I like, I enjoy my life, even in the presence of things that are hard, versus everything just being surviving.

Gabe Nathan:

You know, speaking of surviving, I'm curious about the health anxiety just in terms of yourself, because as we get older, things are going to happen and I'm just curious about how you're living with that part of it now.

Rachel Davis:

You know that part of it isn't really a thing anymore. I don't know why, but I'm not really anxious about my health, but that part is just kind of resolved, I think. So as a kid I was hyper-focused on anything medical, so it wasn't only a fear, it was an interest, like almost a hyper-fixation. So I loved my mom's ladies' magazines. I would find all the medical articles and read them. I was fascinated. I think my favorite gift was when I got this anatomy model as a kid that I got to put together and I was very proud of Everything medical I loved, and so it was weird to have that juxtaposition. And now, if I have something medical going on, like donating part of my liver, I was fascinated by it. I found it interesting, I loved researching it, but I wasn't afraid of it. So that fear part has gone away. I don't know exactly why.

Gabe Nathan:

And the scrupulosity.

Rachel Davis:

Scrupulosity is still there. It's not religious scrupulosity anymore. You know, I, like I mentioned, grew up in a very conservative family, religious family. I am also gay and for a while in college and early in medical school that caused a lot of distress in my head, trying to reconcile how I grew up with what I knew about myself, and so I spent a lot of time doing partly what was useful but partly what was also probably compulsive reading the Bible and comparing the Greek translations and the Hebrew translations. And what does it really mean? And all these passages people say about why it's wrong to be gay and ultimately landed on. I don't actually think it's wrong.

Rachel Davis:

This is just kind of rhetoric that people have passed along and I need to make my own choices and my own decisions. And you know, I know what it means to me to be a good person, to be a kind person, to be a compassionate person, and I can do that. So I'm not really focused anymore on going to hell or, you know, sinning per se, but I do still. I would say I may be kind of a hyper moral person. I'm always worried about doing the right thing. I don't want to hurt people. I'm often afraid I'm hurting people, I often, you know, find myself wanting to apologize, excessively, super conscientious. So I guess it's turned into more sort of moral scrupulosity as opposed to religious scrupulosity, but that part's still there.

Gabe Nathan:

The part in your essay which we're going to get to after this bit that really resonated with me, just as a person and a human being and also someone who lives with mental illness, when you wrote about how I think it was a supervisor who turned to you and said you know, you always come into work looking like you've done something wrong. And I used to work at a locked inpatient psychiatric hospital and my supervisor said to me one morning you always look like you're coming in about to be fired, like this is your last day here, and for five years, every single day, that was how I lived my life and my shift started at 7 am. I would be in the parking lot at 5.15 in the morning. I would come in. The overnight nurses would still be there. They were never supposed to see me because the shifts changed at seven. But I got to know all the overnight nurses very, very well because I would come downstairs, clean up all of the messes from the night before, do all of the paperwork for my supervisor in the morning that I wasn't even supposed to be doing, get all the schedules ready, learn everything about the patients who had been admitted overnight.

Gabe Nathan:

I could not stop myself and I could not stop myself from waking up at four o'clock in the morning, three o'clock in the morning, obsessing about who had been admitted overnight, who had gotten assaulted the night before, what was the acuity on the unit, and even still I was terrified that I was going to be fired that day, that I had done something wrong, that I was going to say something wrong, that they knew I was an imposter, that I had no business working there. Just such empathy for you in that moment of just knowing what that feels like and what a shitty way it is to go through each day with all of that noise in your brain. I don't believe I'm a competent professional at your level, but I know I did the job that I had to the very best of my abilities and yet you're still hijacked by that internal monologue that's so abusive and harmful. So I just wanted to tell you that.

Rachel Davis:

Yeah, I mean totally. That's the thing about OCD is it doesn't matter how well you're doing or how thorough you are or how competent you are, you just don't feel that you are. And part of the problem is we want to feel that way. Right, that's what most people get to do. They get to do a good job and they get to feel like they did. But we don't feel like they did, but we don't. And I always tell my patients too, like that's not really fair, it's kind of a. It's a very difficult way to go about life. It's almost like going about life with chronic pain, except this is chronic pain in your brain, and you have to learn how to move forward, even without feeling that things are okay, without feeling that you're good enough, without feeling that things are, you know, going to be fine. You just have to move forward anyway.

Gabe Nathan:

Yeah, because that just may never come.

Rachel Davis:

Right.

Gabe Nathan:

Well, with that, I would love it if you would turn to your essay in your hymnal, written for us in around 2017. And it is called how Does a Doctor with OCD Navigate Life Career and the Everyday by Dr Rachel Davis, whenever you're ready.

Rachel Davis:

In medical school, my peers described me as a mousy person who just kept to herself. Not long ago I heard through the grapevine that a former classmate remembers me as a not a nice person. I immediately felt angry, sad and defensive, but I know why I was perceived that way. I kept to myself and seemed to only care about grades. I know that people didn't really like me. I seemed standoffish and cold, but I didn't mean to be. I wasn't trying to honor everything. I was just trying not to fail. I was trying to manage debilitating anxiety so I could become a doctor. As I think back about my time in medical school, I'm sad about how I was trying to manage debilitating anxiety so I could become a doctor. As I think back about my time in medical school, I'm sad about how I was perceived and how much I struggled. I feel compassion for myself now, as something was going on, something that even I didn't fully understand, something I'd wish I'd known when I was that 22-year-old medical student.

Rachel Davis:

I grew up in a religious family in rural southeastern Colorado and, for reasons I still don't entirely understand, I always wanted to be a doctor. For that desire I am eternally grateful. It is a gift that has given me purpose and direction. When I was three so legend has it I wanted to be a brain surgeon. When I was 11 or 12, I would sneak upstairs after my parents had gone to bed, grab the American Medical Association family medical guide and stay up late memorizing symptom flow charts. By the time I was 13, I determined I had polycythemia vera and possibly Hodgkin's lymphoma. One night I stayed up late into the early morning hours sitting on my bathroom sink trying to make sure I wouldn't accidentally swallow my tongue. The thought consumed me. The human body fascinated me and it terrified me. I was a creative child and creativity in my mind fostered boundless worries. When we'd drive by a car accident, I would perseverate on gruesome images and horrible thoughts about what must have happened to the people inside. Weekly Sunday school Bible studies and Southern Baptist revivals fueled my fear of going to hell, and I would attempt to prevent this outcome by habitually reciting Dear God, please forgive me, I love you very, very much. In Jesus' name, I pray Amen. For as long as I can remember, I have lived with a constant sense of dread and a fear that something was and is terribly wrong.

Rachel Davis:

I took an emergency medical technician EMT class when I was 15 and started volunteering with our rural ambulance squad. I worked as a certified nursing assistant at our local nursing home. I exposed myself to blood and death. I comforted a 19-year-old boy as he died in a ditch, crushed beneath a van. I prayed that a beautiful, blue-eyed, blonde little girl would live, as a police officer dragged her lifeless body out beneath a van. I prayed that a beautiful, blue-eyed, blonde little girl would live, as a police officer dragged her lifeless body out of a lake. She did not live and instead I sat with my hand on her mother's shoulder as she screamed. I comforted a woman with dementia as I dried her after a bath. I remember her timid, beautiful voice as she started singing when peace, like a river, attendeth my way. I joked with a 73-year-old man as I cleaned the pus from around his catheter, trying to help him preserve some sense of dignity. I washed glass out of a man's hair sullenly and quietly. A couple of hours after we picked up the body parts of his friend off the highway. This is how I began to learn to live. Helping others during the worst times in their lives gave meaning to my life. Now I understand that this meaning was also helping me move beyond the horrible noise in my head.

Rachel Davis:

I was tortured during my first year of medical school. I barely slept. I learned it was easier to get up in the morning if I drank a lot of coffee before going to bed at 2 am. I snuck away between each lecture to be by myself for a few minutes. Attempting to calm my mind, I recited the Lord's prayer over and over and over and over. My preceptor asked if I was all right because I was so thin, not so thin, too thin. I was too thin partly because I didn't make enough time to eat and partly because I was so worried about money that I didn't buy enough food. I was so ashamed that my preceptor had noticed. I couldn't let go of the images I had seen during my time as an EMT. Things were unraveling 9-11 happened during first-year anatomy and I couldn't stop thinking about death.

Rachel Davis:

My experiences as an EMT were necessary and critical in helping me move past my anxiety and actually live life. It was less painful to deal with real trauma than to be helpless against my fears. I could actually do something about real-life disasters, even if it was just being with people as they died. But these experiences as an adolescent and early adult did add another layer of traumatic experience to the primary trauma of living in my brain. My time on the ambulance was a double-edged sword, but I don't know that I could have disentangled myself from my anxiety without this exposure and without my overarching goal of becoming a doctor.

Rachel Davis:

A classmate of mine wrote in our school's humanities journal about his struggle with depression. I reached out to him. He was kind and this gave me the courage to ask for help, but not right away. I told my parents that I thought I might be depressed and they told me I probably wasn't. They would not, or perhaps could not, accept that their daughter was struggling. When I did finally allow myself to see a therapist, I only felt comfortable seeing a Christian therapist. This therapist asked me to sit and listen to God, so I spent hour after hour sitting in silence wondering what was wrong with me, because God certainly wasn't speaking to me. This only made things worse. So I eventually surrendered and saw a secular psychiatrist. She prescribed medication and we met weekly for therapy. This was the beginning of a new life.

Rachel Davis:

I began to have room to breathe and the strength and space to interact with other people. It was also when I was diagnosed with obsessive compulsive disorder, or OCD. Fortunately, despite OCD and thanks to meds and therapy, I enjoyed my clinical rotations. I provided good care and my patients, residents and attending liked me. It was nice to be liked, since I didn't have to direct all my energy towards survival. I had more room for the nuances of human interaction. I felt more normal and a little less alienated from the category of human. However, even with treatment, I still had religious and other obsessions. On the obstetrics gynecology service, I couldn't bring myself to participate in abortions and some other procedures, not because I wanted or needed to make a political statement, nor because I felt judgmental. Rather, it was because I was still afraid of going to hell, a remnant of scrupulosity carried over from growing up as a child with OCD in a very conservative Southern Baptist family in rural Colorado. It was because, while I had figured out how to do well in medical school, I still had severe OCD, a diagnosis I wish I had known sooner. I have compassion for myself now. Back then I just felt shame.

Rachel Davis:

Now, a doctor for 13 years, I am privileged to serve as the medical director of student and resident mental health on a health professions campus. I am passionate about helping my student and resident patients discover how to thrive, not just survive. I am moved when I have the opportunity to help someone change their perspective from desperately avoiding failure to pursuing meaning and joy. It is my mission to help my patients remember they are indeed resilient. I strive to reduce stigma and combat the fear that seeking help for mental health issues will interfere with being a physician. Last year, as president of the Colorado Psychiatric Society, I collaborated with key stakeholders to work with the Colorado Department of Regulatory Agencies to eliminate the mental illness screening questions that stigmatize and marginalize mental health problems and discourage students, residents and practicing physicians from seeking the treatment they need.

Rachel Davis:

I still have OCD. I'm a doctor with OCD. A couple of years ago one of my supervisors remarked you come in here every week looking like you've done something wrong. I was embarrassed that he picked up on that, but he was right. I still live with the perpetual feeling that I have done or will soon do something terribly wrong. I have learned to live and practice effectively despite that feeling, but I guess I don't soon do something terribly wrong. I have learned to live and practice effectively despite that feeling, but I guess I don't always succeed at hiding it. It resonated with me one time when a particularly articulate patient with OCD shared how exasperated she is of being told she has a resting bitch face. She said an OCD sufferer is fighting a war with a brain that randomly gets hijacked by horrifying images and thoughts, and sometimes this secret war makes its way out of our tortured brains and furrows our brows, making us look bitchy. I'm aware I still sometimes come off as standoffish and overachieving. This is because I'm trying not to let my OCD show through and I'm doing my best to make sure bad things don't happen.

Rachel Davis:

My desire to be a doctor is what helped me overcome my extreme anxiety, and my desire to continue to be the best possible doctor helps me navigate each day. I feel very fortunate that I seem to have been born with a purpose. I have also come to realize it is not only in spite of my OCD that I am a physician, but also because of it. I was driven to do hard things at a young age, in part because I needed a distraction and a sense of meaning outside of the chaos in my brain. My OCD leads me to be extremely conscientious, very honest, empathetic and perfectionistic characteristics that, when reined in, contribute to being a good physician. I like working with very ill patients, especially in the emergency department, because bad things are expected to happen and I am prepared to manage bad things. I feel comfortable working with suicidal patients and panicked patients and desperate patients because I am good at managing crises and bringing calm to chaos.

Rachel Davis:

I've learned how to take a lifelong struggle and utilize certain aspects of it for good. This doesn't mean everything is perfect. I still do not often feel calm. I have learned that my brain is rarely capable of feeling capable, so I just move forward. I still take medication and I see a cognitive behavioral therapist. I incorporate exposure and response, prevention, erp principles into my daily life All day, every day, I make conscious decisions to resist the OCD and make choices that lead to effective functioning both for me and my patients.

Rachel Davis:

I have learned to set aside, on most days, the constant feeling that something is dreadfully wrong, but sometimes I still listen to my fears, like when my patient misses an appointment and I find myself on Google trying to find her obituary. I see so many students and residents afraid to be seen as weak, afraid to be human, so full of shame that they might need help or possibly even have an illness. The classmate of mine who wrote about depression, gave me a gift in his story and this allowed a sliver of light to penetrate the suffocating shame. I hope my story offers the same to other students, residents and practicing physicians. I also hope my experiences help faculty and other educators consider that it may be exquisitely difficult for high-functioning students and residents to seek help because they are able to hide behind their performance. Yet they can have mental illness, receive treatment and be successful physicians.

Gabe Nathan:

Thank you, Rachel. Thank you for reading that, Of course.

Rachel Davis:

What was it like to look back at the essay, I'm assuming as you were preparing for the show and probably for the first time in a while as I was preparing for this show, but I have had many students and residents and practicing physicians actually from across the world reach out to me after finding this article, and so I have been brought back to it fairly often, actually because people find it and reach out, which has been very meaningful and made me. It's really helped me continue to be transparent about what goes on in my brain as a physician with OCD, because of the feedback I've gotten from people about how much hope it's given them, and so you know it's interesting to read it out loud. It is often hard for me to express my emotions or feelings and so it's easier for me to write it, so sometimes reading what I've written always feels a little awkward.

Gabe Nathan:

Well, I think you did it beautifully and I want to say I wasn't expecting the reply about you receiving contact from people all over the world, and I just want to tell you, as executive director of this organization that puts stories out there you never know how or where they're going to land and it's incredibly gratifying to me to know that people are reaching out to you with affection and gratitude and shared experience, so thank you for sharing that with me.

Rachel Davis:

Yeah, yeah. I've even been able to mentor some of them as they've gone through residency or as they're applying to medical school and whatnot.

Gabe Nathan:

That's wonderful. I'm curious about something In your piece. You wrote about being the president of the Colorado Psychiatric Society and eliminating these screening questions, helping make it easier for physicians and physicians in training to seek help without negative repercussions. And we did this film series about first responder mental health, police, fire, ems dispatch and of course, as I'm sure you know and can imagine, there's myriad issues that prevent first responders from seeking help, particularly law enforcement, this fear that I'm going to lose my gun and my badge and they're going to take me off the street and destroy my career and all of that.

Gabe Nathan:

And I think there's also a fair amount of paranoia about that. Are confidential sources really confidential and is my commanding officer going to know and all of that. And I'm very curious in the medical profession. I mean, I know approximately 400 physicians die by suicide in America every year and that's probably underreported, as most suicide stats are, I think. Can you talk to me about the landscape now in 2024, about being a physician or a physician in training and seeking help? What is that like about being a physician or a physician in training?

Rachel Davis:

and seeking help. What is that like? I mean, there's still a lot of stigma, I do think, compared to other professions. So, for example, pilots or, as you mentioned, law enforcement, we've come a long way. I've certainly had patients who are law enforcement or pilots, and the options they have are so limited I mean, I could go off on a tangent about that. It makes zero sense why you wouldn't want a pilot or a law enforcement person to get treatment and obviously, if they're not allowed to have mental illness, they're just going to hide it right and not get treatment. So it's not quite that way in medical school. You know, in Colorado, at least, we did get rid of the stigmatizing questions. That said, there are still states that ask people if they've ever had a history of mental illness and you know, unfortunately that does dissuade people from seeking help, because then they have to talk to the board about what this was and does the board think they're competent? Because then they have to talk to the board about what this was and does the board think they're competent? And just a lot of things that people shouldn't have to go through if they're functioning well and practicing well.

Rachel Davis:

I was medical director of student and resident mental health from 2013 to 2021.

Rachel Davis:

And even over the course of those few years, I saw that students were able to talk more openly about mental illness and mental health and we have done a lot of outreach, at least at University of Colorado, and being proactive about encouraging people to come in even before there's a problem.

Rachel Davis:

But there's still people who come from families where there's stigma and it's not okay to have mental illness. People come from cultures or towns. So it's definitely still there and it still is there in medicine too, and a lot of states have what are called peer monitoring agencies where you can self-refer if you know that you have any sort of diagnosis it could be a mental diagnosis or a physical diagnosis that has the potential of ever interfering and then, as long as you follow their recommendations which usually if you're doing well, it just means you're staying engaged in treatment you don't have to self-report to the board. You only have to self-report to the board if you are impaired or if you face some sort of consequence because of an illness, and that can be mental illness or physical illness. There's just a lot of stigma around mental illness. So that's a very long-winded answer of saying stigma is there, but it's not as bad as some other professions. Definitely still there, though, okay.

Gabe Nathan:

And I guess related to that. What changes would you like to see in medical schools nationwide to address that?

Rachel Davis:

Which part.

Gabe Nathan:

I guess what I'm asking is culture change in terms of you know you have to be the leader in all situations and you have to have your shit together 24 hours a day because everybody's looking to you. And I guess, changing that kind of culture how?

Rachel Davis:

do you go about?

Gabe Nathan:

that.

Rachel Davis:

Well, this is interesting. I was actually just talking to a Medscape reporter about this yesterday because there was the annual report in Medscape about medical student lifestyle in medical school and really highlighted that depression and suicidal ideation and maladaptive coping skills are still very prevalent, very prevalent. But schools have done some things and there are some things nationally. So, as a medical student, you have to take three steps of the board. You take step one, which is basic sciences, and it's a full day exam. You take step two, which is more clinical, and then step three, which is entirely clinical, and they have changed step one to pass-fail, whereas it used to get a score and people weighed those scores very heavily in considering you for residency. So now that's pass-fail, so all you have to do is pass.

Rachel Davis:

Many medical schools, including here at University of Colorado, have changed to a pass-fail system instead of a graded system, which I think is huge, instead of a graded system, which I think is huge, because in medical school you know we're all a bunch of high-achieving people who are used to being at the top of everything, and then you come in and like you're kind of in the middle or at the bottom because everybody's super smart. That's really difficult, and so I think changing to pass-fail is a huge improvement. They've also changed the curriculum. So when I was in medical school, we basically had lecture all day long, five days a week, and then I had to go find time to like memorize everything after hours or on the weekend, which meant zero free time. And so now they've incorporated a lot more clinical stuff in the early years, which I think gives people more of a sense of what they're doing for a purpose. You know, learning biochemistry in my first year of medical school, it's like this has nothing to do with being a doctor. So now there's hopefully more sense of purpose, but I think also just maybe more acknowledgement about.

Rachel Davis:

You know, being a doctor is hard. It's really hard, and we deal with very difficult situations and it's normal for people to have a hard time with that. So I think normalizing that you know what we do is hard. You're going to struggle, and that's normal, and you should seek support and you know having avenues of talking about that more rather than just oh, this is what you signed up for, you just need to suck it up and deal. You need to be. You know it's hard, it's hard.

Gabe Nathan:

Yeah, and that at the end of the day, you're a human being and you know if you don't like it. I think actually one of the first responder mental health films there was a paramedic who was talking about how it used to be in the old days. If someone was having a hard time, we would say well, you know, this probably isn't for you, cupcake, and it's like no, this can still be for you and you can still be having a hard time. The two are not mutually exclusive and I think just understanding that that's huge too.

Rachel Davis:

Right, Like I want my own doctor to be human and to care if something bad happens to me, I don't want them to be robotic and not you know, care at all.

Gabe Nathan:

Same with your pilot, same with your law enforcement officer.

Rachel Davis:

Yes.

Gabe Nathan:

Same down the line. Um, rachel Davis, I'm so, so grateful to you for making time. I can't fathom the fact that you had an hour to sit and talk with me, but here we are and I just I'm very grateful for you. Thank you.

Rachel Davis:

Well, I appreciate this opportunity. Thank you for inviting me.

Gabe Nathan:

Before you go. Where can people find your podcast and perhaps other writing of yours?

Rachel Davis:

Oh, thank you. So it's Transplant Talks. So it's on YouTube and Apple Podcasts and Spotify, but the YouTube channel is Transplant Talks-Podcast and yeah, it's all about has a strong focus on living donation, but it's about many aspects of transplant. We interview a lot of people who've had transplants. We interview living donors, things like that. I mean, I've written academic articles. You can go to PubMed and just put in my name although Rachel Davis is kind of a common name, I think if you put in Rachel Davis MD into Google, you can find stuff I've written.

Gabe Nathan:

Yeah, awesome. Well, thank you again for spending some time with us, really appreciate it.

Rachel Davis:

Of course. Thank you so much.

Gabe Nathan:

Thank you again for joining us in conversation today. It's beautiful to see the progression of our contributors. Thank you so much to our guest, dr Rachel A Davis. She's a psychiatrist and medical director in Aurora, colorado. She's doing so much to help diminish the stigma of mental health challenges among physicians and physicians in training. I'm so grateful to her for helping us learn all about how she manages her OCD as a surviving and thriving physician. Before we leave you, we want to remind you to check out our website, recoverydiariesorg. There, like this podcast, you'll find additional stories, videos and content about mental health, empowerment and change. We look forward to continuing to grow our community. Thank you so much for being a part of it. We wouldn't be here without you. Be sure to join our mailing list so you never miss a podcast episode, essay or film. I'm Gabe Nathan. Until next time, take good care.

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