In this powerful episode of Read. Talk. Grow., host Dr. Denise Milstine is joined by author and anesthesiologist Dr. Maggie North and fellow author and psychiatrist Dr. Jesse Gold to explore the emotional and systemic roots of physician burnout through the lens of North’s romance novel “The Ripple Effect.” The conversation dives into the hidden grief of leaving medicine, the gendered realities of burnout, and the importance of reclaiming humanity in healthcare — and offers a deeply resonant look at what it means to care for others while learning to care for yourself.
In this powerful episode of Read. Talk. Grow., host Dr. Denise Milstine is joined by author and anesthesiologist Dr. Maggie North and fellow author and psychiatrist Dr. Jesse Gold to explore the emotional and systemic roots of physician burnout through the lens of North’s romance novel “The Ripple Effect.” The conversation dives into the hidden grief of leaving medicine, the gendered realities of burnout, and the importance of reclaiming humanity in healthcare — and offers a deeply resonant look at what it means to care for others while learning to care for yourself.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine: Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. Our topic is professional burnout, specifically among physicians. We will discuss “The Ripple Effect” by Maggie North.
I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where, as you know, I practice women's health, internal medicine, and integrative medicine. But listeners may not know I'm the medical director for the Arizona Office of Joy and Well-Being.
My guests today are Dr. Maggie North, who's a doctor by day and an author by night. She lives in Ottawa, Canada, with the man she met in ninth grade, their kid, and a rotating cast of hypoallergenic aquarium friends. She enjoys being autistic a lot more since she received her diagnosis as an adult. “The Ripple Effect” is her second book.
Maggie, welcome to the show.
Maggie North: Thanks so much for having me, Denise.
Dr. Denise Millstine: Dr. Jessi Gold is the inaugural Chief Wellness Officer for the University of Tennessee System and an Associate Professor in the Department of Psychiatry at the University of Tennessee Health Science Center. Dr. Gold works clinically as an outpatient psychiatrist and focuses her work on students, faculty, and healthcare workers. She is also an author. She wrote the national bestseller, “How Do You Feel? One Doctor’s Search for Humanity in Medicine.”
Jessi, welcome to the show.
Dr. Jessi Gold: Thanks for having me. I'm now sad that I didn't talk about like, pets and relationships. That’s a much better bio than me, but you know.
Dr. Denise Millstine: We can try to work in any aquarium friends that you have. We'll give it a go and see what happens. “The Ripple Effect” is a modern romance between an unlikely pair. Stellar J Byrd has left her career in emergency medicine and found her way to being the program doctor at an innovative whitewater rafting couples therapy adventure run by Lyle “McHuge” McHugh. While leading a motley crew of participants, Stellar contemplates her career and what led to her burnout, which is the topic of today's show. And she very likely falls in love, this being a romance after all.
Okay, you both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. In this case, we'll be discussing professional burnout, especially among physicians, which we know is prevalent and we know is a risk to the whole healthcare industry.
Maggie, I can only imagine, you had some professional inspiration for writing this book. Are you willing to share it?
Maggie North: Of course. I am. Well, let me launch. So I'm an anesthesiologist by training. So I was working in critical care when the pandemic hit. And I've actually I've listened to a number of podcasts that Dr. Gold that Jessi was on. And her message was that medicine and physicians in particular kind of weren't fine when the pandemic started and then there was this unique stressor that led to kind of a wave of, let's just call it burnout, but also, you know, edging up to the definition of burnout without quite crossing over into it. And I think now the healthcare system is in this unique spot where many physicians, nurses and other healthcare providers have left or are functioning well below their optimal function, just because this burnout is affecting their lives so deeply. So I've seen this happening in the hospital where I worked with my colleagues and my friends. You know, at one point, my friends kept giving me their stethoscopes when they were leaving medicine. And so I would hang them in my locker. And at one point I had four. It kind of gives the picture of how we felt where you open your locker and you see your friends, you know, the ghosts of your friends there. It was a pretty emotional experience, very affecting, and you know, really inspired this book.
Dr. Denise Millstine: That's really moving. And what a picture to open your locker and see those rattle on the door.
Jessi, tell us your reaction to the book and what it's like to be a Chief Wellness Officer for a major medical system.
Dr. Jessi Gold: Yeah, I mean, that story was really powerful. I think it's sad but true that a lot of us have stories like that, whether it's our own or our peers or our patients. I see healthcare workers. So I have a sort of weird perspective where I see healthcare workers who are struggling in my clinical work. Then I see myself struggling by doing the clinical work in a very meta way. I burned out pretty significantly over the pandemic myself too. And then in sort of system roles have been looking at, well, what can we be doing better from a systems perspective and structurally, from prevention to intervention, to do better for folks, make the system better, even though a lot of system change takes a long time.
I'm a big fan of trying to fix culture too, so like simply having these conversations is not something we did very often. The pandemic, for better or worse, made that a little bit easier for us because we kind of looked around and everyone looked miserable. So it was a little bit easier to acknowledge that it was affecting us. And I think that that maybe made some of the silence go away a little bit. And that's been nice, at least in my role as a clinician and system wise.
When I looked at the book, I was really excited that it was mentioned as a topic without it being this sort of heavy central thing. Like it's there. It's a reason she's had stress and like is and the reason she is sort of in between work. But it's not like every second of every day of every conversation is about that, which I think is important, because I think that's how a lot of us are.
I liked how much it talked about the role of kind of us caring for other people and our emotions, but also gender. So I don't know that we talk enough about burnout’s much higher in women, not surprisingly. If you look at a study that was done over COVID of like male physicians and female physicians, like a dual physician household, the women were more likely to cut back hours, do the childcare, and then subsequently be burnt out, which should surprise absolutely no one on this call. But I think is an important thing for us to be talking about, because women physicians have different stressors that are compounding their existing stressors in medicine. And one of the stressors that's discussed in this book, I don't want to, like, give it all away. But there's more about sort of inequity in the workplace, but also harassment and not like a lack of safety in the workplace. And I think those are really important topics that nurses face, that doctors face, that other people in healthcare face. That sometimes are worse based on your gender and it's a really important conversation.
Dr. Denise Millstine: You brought up a lot of the points that we're going to talk about through this episode. So thank you so much for that.
But before we get to Stellar's burnout, Maggie, she's already left medicine. But in the early chapters, we see her describe her love for medicine, particularly for it fitting her skill set of being smart and strategic. Knowing how to read a situation, she states, knowing I could trust my judgment. Would you describe her as heartbroken for her professional life at the beginning of the book?
Maggie North: I really think you've hit the nail on the head here, and I think it's an interesting topic, like it's an interesting theme to explore in the setting of a romance, because this romance is a second chance between Stellar and McHuge. And again she is presented with a second chance to rediscover her love for medicine, which is a troubled love story, like a lot of the ones you might see.
And yeah, so she loved medicine. She loved who she was as a doctor. And when you leave medicine in a very important way, you lose your identity. There are not many professions in the world that have the power to change you as deeply as medicine. When you graduate from medical school, it changes your name. So I think she is, yes, heartbroken that she has lost this. She, you know, grieves and pines and yearns for both the practice of medicine and who she understood herself to be as a physician.
Dr. Denise Millstine: I love how you called it a troubled love story. It's such a powerful way to frame it. And probably many of the health care professionals listening to this episode, that will resonate with them.
Jessi, Stellar's got a complicated background, and she's in many ways looking for stability as she decides to study medicine because of some of the issues in the family that raised her, she sees it as a reliable career, a legitimate career that she can attach to. But then she says that she realizes her calling came little by little until one day I realized that every time I told a patient I would take good care of them, I was doing it because I wanted to. Would you agree that medicine is seductive in this way, that it pulls you in?
Dr. Jessi Gold: Yeah. I mean, I think it's probably one of the few careers where people have this, like, high hope of what it is to like when you write these essays. Like, I just want to help people. I'm going to like, save everyone by doing this. Like, we have really big like plans by doing the career. And I think when you have that and it actually satisfies that in some capacity, it's even more of a thing where you're like, oh, I actually fit this really well.
And also because of the way that the career is, I think it attracts certain personality types, whether it's because you're coming from a place where you liked the structure or you liked helping people in your life, or you're looking for something different that gives you that. And yeah, it's a complicated job, but it is stable. I think that's one of the things that's true. We will always have work. It might not be the work we want to be doing or in this setting we want to have it, but we can find work. And I think that that is an important thing for people.
I also really liked that Maggie mentioned grief as a thing for people who are leaving a career, because I don't think we call enough stuff “grief”. Like we only think about it around death and loss, but there's so much grief. I mean, the pandemic’s like full of grief. And it's not just death, but it's if you think a career is going to look one way and it is entirely different, but you loved what you thought it was going to be. There's grief there. And I think that's really important for people to recognize as a clear emotion that they’re experiencing and probably not naming.
Dr. Denise Millstine: You know, there's a psychiatrist in the room now. I love that you brought up grief. I wholeheartedly agree that we need to use that term for loss of relationships, for many different life experiences. Thank you, Jessi.
Maggie, what about medicine aging us? So Stellar makes a comment that she says, maybe it's that I feel older than 33. I once read a study showing that doctors DNA ages six years during their first year of training. Too much stress and too little sleep. Do you think that's true? That we are aged from these idealistic young students, then doctors, and it really physically changes who we are as well.
Maggie North: I graduated from residency 18 years ago now, so I think I've, I maybe don't have a good enough perspective on how I aged during my residency, but I can tell you that I aged during the pandemic. You know, when I see photos of myself in early 2020 and then in late 2020, you can tell. And I think also you become an old soul. Like I also, I'm married to a physician as well, and after doing our ICU rotations, started talking about our end of life wishes with each other in our 20s. You just have this accelerated pattern of understanding how your life is going to go because you have seen, you have had the privilege, but also the burden of witnessing the most difficult parts of a lot of patients’ lives and understanding that you as a human, you are frail, you are fallible, you will age, you will get sick, you will die. And maybe we know that better than others, and it makes you into an old soul.
Dr. Denise Millstine: That's really powerful. And for those who've listened to “Read. Talk. Grow.” for a long time, we talked to Catherine Newman about her book, “We All Want Impossible Things” with a palliative medicine doctor. And while you called yourself out on being in your 20s and looking at your advanced directives, all listeners should have advanced directives. You're a critical care doctor, and you know how much smoother it goes when people have, left their wishes. So thanks for that note as well.
Maggie North: I always tell my patients; any day is a good day to talk about advance directives.
Dr. Denise Millstine: So true. Well and if you wait till you want to talk about it, either something's gone terribly wrong or that day never comes. So absolutely, it's something we all should have in place whether you're 20, 40 or older.
Jessi, Stellar is in her head a lot, right? So we see her working in the program. She's often out on the water or getting things prepared for the participants. And as she's reflecting, she thinks about a lot of mistakes that she made. I was struck by this comment that actually harkens back to some of the points you made at the beginning that she said, “At the hospital, I did tons of work for free, thinking it was earning me something respect, gratitude, collegiality, whatever. But actually, I was convincing everyone, I had no idea of the value of my time, so they shouldn't value it either.” What do you think about that?
Dr. Jessi Gold: You know there's some real heavy bits where if you just sit with them, it resonates real deeply. I mean, I think that a lot of people in medicine would say they don't feel valued in their jobs. We're not told it very often. Sometimes patients say thank you and you can feel valued, like on a one-on-one situation encounter with a patient. But I think sort of globally, we feel devalued in what we do. Often because there's a push for money over time with patients. And we really care about that often because women especially are voluntold to do so many things. I mean, it's that that sort of time thing is we sign up for a lot and we get praised for signing up for a lot and then being, doing so much stuff can burn us out, but then also doing so much stuff without compensation, etc. at least if you're doing a lot and getting compensated, there's something else for that, I think.
And so I think a lot of us struggle with saying no. I think that's a really common thing for people, but particularly in a profession that's competitive. And you are like very early set up to be like in competition with the person next to you for slots and spots and promotions and all of that stuff. And so if you're set up to compete, then you're going to keep saying yes, especially if people like say good things when you do. And I think it is really set up to be that way. And residency is a great example. I mean, if you look at hours worked per compensation. I mean, it's like way under minimum wage, especially for the folks that are only working 80-hour weeks or whatever, but really working like way over what duty hours would be. And so I think we learn really young that we have to work, that we're the backbone of the sort of set up, of the clinic, of the everything. And so we work and work and work and do so learning not to be compensated for it honestly.
Dr. Denise Millstine: And maybe this goes to your point about women physicians, particularly, because we're all three women physicians in this conversation. So maybe this is going to be unbalanced. But I think there's a drive that we tend to want people to like us, and we think that comes from extending ourselves into some of those areas of work that are undervalued, unpaid, throwing the coffee for the staff, having the extra session that's a journal club session, doing all these things that sort of never really check a box. Maggie, do you think burnout is different for women physicians and insights into why?
Maggie North: You know what, I would probably defer to Jessi on this one. But I can tell you as a woman that I've noticed these different practice patterns that we've been talking about, and I talk a lot about them in the book, as you've just mentioned, where Steller is signing up for all these committees and stuff that are, you know, not counted as high in promotion and not paid as well. And she's probably not getting any mentorship to tell her, like, hey, these are the opportunities you should be pursuing if you're aggressive, if you're ambitious. And, you know, we've seen that female physicians get less mentorship and fewer leadership positions and there is a pay gap, partly because female physicians are taking all these positions that maybe they don't go nowhere, but they don't go very far.
And so it's kind of awful in 2025 that we're still talking about this. And I feel like there is a general feeling that in 2025, sexism in medicine is fixed and we can move on and that makes it even easier for it to fly under the radar, because it shouldn't be happening.
Dr. Jessi Gold: Yeah. I mean, I also think it's funny, it's not funny, but funny that she proves it. Like she does the data and the research to prove the inequity, which is also what we're always doing. It's like, here's the thing, I notice no one's listening to me. If I do the research, maybe they'll listen and then who knows? Most of the time they don't. Like my best example of that is I did a study on like inbox messaging volume over COVID and like substantial increases for a psychiatrist in inbox messaging. I did it because I felt like I was spending too much time on my inbox and I was like, this seems different. What's that like? The numbers were huge, and I really did it because I felt like it was contributing to my burnout in my work.
And I was like, yay! Here's the numbers I'm going to get…and what I got back was like, oh, that's a really good publication. Congratulations. Not like, oh, those numbers like informed our decision making. And my comment back was like, oh, I kind of did this hoping that we might talk about this and it could lead to change. And all they saw was like, you got it into “JAMA.”
So, you know, I think. It's like that to me is the best example is like we're always constantly like, okay, well, they're not listening to my opinion. They're not listening to all of our opinions. If I just get the data, the data will show them that we know this and it's right and it should change. And still people don't really care or listen. And I think that's sad, but it's oftentimes who's in leadership and who's making those decisions.
Dr. Denise Millstine: That's such a fascinating perspective. Yeah. Go ahead Maggie.
Maggie North: Yeah, I was going to say anecdotally, over the course of writing this novel, I had the opportunity to talk to a lot of female physicians about things that were happening in their workplaces. And it's kind of astonishing, all the little things that keep piling up. So, I mean, for example, I knew one young, you know, new staff physician who was told by her department in no uncertain terms that she should not speak to the senior male physicians the way she was speaking to them. And if she has trouble knowing how she should address them, then she should call a colleague into the room to help her translate because they didn't like her tone.
I've spoken to some female physicians who, when they joined a group practice, were offered, you know, a greater share of like patient testing. But then when it came time to be paid for the testing, they discovered that the payment was to be split among all the members of the group. They were offered the testing, but not the pay. So there's all these little tiny things that pile up and I don't want to call them microaggressions because that's not quite right. But if we're talking about the steady drip, drip, drip of things that lead to burnout, I think there's a lot building up in that bucket.
Dr. Jessi Gold: I think you want to be like, the only thing that burns us out is the things we hear and see. Right? Like it's too simple. I think it's like so many things and it's so subtle most of the time. And I think that that's part of what's hard about it is it's almost like our numbers are 50% pre-COVID. So if you look around, everyone looks burnt out. And so you'll actually sort of feel like that's just what work is supposed to be. And that's like a side effect of work as opposed to a problem at work. And I think when it's subtle or it's like this thing and then this thing and then this thing and then, oh, my life is also a thing because I have relationships or kids or whatever else, pets. Like it can get really complicated in a really fast way, almost like a shock. But it happened. But it had been like building up subtly the whole time. Like that's how my burnout was, like when it really was bad and I was sleeping every day after work for hours and like, not realizing I fell asleep or it was starting to get to, like, affecting patients.
Like, I was like, how did I get here? I've been fine. Like I've done my job well and I show up for people and what is this? And like, it was actually like subtlety building the whole time. I just ignored it as sort of like, this is how you feel when you're a psychiatrist in the middle of a pandemic taking care of healthcare workers, which is like fair to some extent, but we minimized the fact that, like, we don't have to feel that way either.
Dr. Denise Millstine: Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
Dr. Denise Millstine:Well, and there's an aspect of it that we've culturally been sort of sold on this idea that we're not allowed to not be in a good place. Maggie, I really was struck by this quote from Stellar in the book. She says, “We had this thing in the ER, for you, it's a regular day, but for the patient, it's the worst day of their life. It's supposed to help us not take bad behavior personally. Toward the end, I question that wisdom. What does it do to people to work in a place where the person who's allowed to be having their worst day is never you? What do you do when you're supposed to reset the bad behavior column to zero every day? But for you, everything just keeps adding up.”
That's so insightful. Thank you for including that in her thoughts. Do you want to add to that?
Maggie North: What I want to say is it's so special to have a physician read this book and have some of Stellar's thoughts and feelings hit home. What I was taught in medical school was…it's changing now, perhaps not fast enough…but I was taught that you weren't supposed to have feelings. You weren't supposed to really eat or drink or go to the bathroom. The more service you did, and the less you complained about it, the better doctor you were. And the better doctor you were, the more opportunities you would get. So I guess don't eat till you leave the hospital, which is 36 hours from now. Good luck.
So I think that people maybe don't realize how bad of a time physicians are having, and especially how bad of a time resident physicians are having, and how much they're expected to deny their essential humanity in order to function, especially like in the book, Stellar embraces a lot of the idea of being mechanical, a robot, and she even has tattoos that are mechanical. And I think for me, that meant that patients love to embrace physicians humanity when it's about us giving them care, holding their hand, sitting at the bedside, spending extra time with them. But they don't like to embrace our humanity when we have a need for care. So that's really where I'd like to make that point.
Dr. Denise Millstine: I think that's really interesting. We often see this in how doctors are introduced. People should listen when they hear a doctor being introduced. They're often introduced by where they went to school or the position that they hold. And we will strip away things like who their family is and their aquarium pets.
Jessi, this might be a good, good point for you to tell us if you have any pets.
Dr. Jessi Gold: Listen, I was that's why I liked her introduction so much, because it did, like, get rid of that. You know, when I was writing the back blurb for my book, I really wanted that too, because I was like, I'm writing a book about how we're not human, and I'm leading with my career and my job and everything, cause that's what I was taught to do.
And yes, I have a dog. Her name is Winnie. She's blind now. She went suddenly blind, so she's had a rough go of it. She's only eight. I have Winnie and I have a Taylor Swift problem. So that is what you know, makes me human I suppose.
Maggie North: Tell Winnie she's a good girl.
Dr. Jessi Gold: Yeah. She's wonderful. She just is having a rough go of it now. I'm sort of like a chronic illness parent at this point with her.
Dr. Denise Millstine: That's so sweet.
Jessi, people deal with burnout in all different ways. And actually, when people hear that statement, they might think that all those ways are not constructive, but in fact, they can be very constructive. So one of the ways that Stellar deals with her burnout and navigating what she's been through is by running. And at one point, Lyle, Maggie, I was fascinated that you called him McHuge. I thought of him as Lyle the whole time, but readers will have to decide for themselves. Okay, I digress, so Lyle asks Stellar, “Is that why you run? You literally run away from whatever's bothering you?” She says. I run back again and he says running helps. It helps keep me out of jail. Gives me the strength to control one thing in this world, even if it's only me.
Can you talk about using exercise when somebody is experiencing burnout and maybe even any other healthy strategies that you found in your role?
Dr. Jessi Gold: Yeah, I mean, here's the deal. Like any coping strategy in the moment can be fine as long as you're coping with, like actually expressing emotions at some point. When Maggie was talking about it was like, we are taught not to even pee or eat, so why would we have feelings that's not even going to register. And so we learn really to deny that part of us or even recognize that. And we might be doing these things to avoid it and have no idea. Right. Like we could be running because we like, genuinely like running, but hadn't actually thought about how we didn't name our feelings or deal with that thing that a patient told us today or anything like that. Right. And so running can be meditative for sure. Running is great if that's what you like to do to cope. But I do think that, like, you probably need a time or a space to go, oh, today was hard. Let’s think about today a little bit. Give myself space to name how I felt about it and put that away and go running. Whatever it looks like.
I think you do need that space to sort of decompress a little and acknowledge that our jobs affect us before you go do this skill. I'm not good at that either. Like when I have big feelings, like I want to go get rid of them. Like I want to go like that, like talk to someone or anything, but sit and go I feel yucky and so I think a lot of people do that.
What you choose to do as a coping skill, people like different things. I mean, one of the things I hate about coping skills as a term is, like so many of us just do, the one that's available through the workplace. They pay for mindfulness. So I have to do mindfulness. But if you hate mindfulness, like please don't do mindfulness. So I think it's really important that people figure out what that is for them. If that's running, that's great. If it's journaling, that's great. If it's different one day and another, that's also fair and true. If sometimes when you feel more overwhelmed, you have to do something different than like when you're sort of preventing it. Also true.
But like knowing that about yourself and what works and what you like is important, I think. And we don't always learn that. And we certainly didn't learn that as kids very well. And it's really important to know that, especially because when you're overwhelmed, it's hard to remember what you actually like to do or what actually is a coping skill or brings you joy.
And there's no actual bad coping in that. Like if you went running because you were avoiding it if you liked it. Still helpful. If you like to take naps and naps are somewhat avoidant, it's okay as long as you also deal with your feelings at some point.
I would say the most problematic coping skill that doctors have is substance use. I mean, I would say that without a doubt, and I think we have pretty like equivalent rates of alcohol use to the general population, but higher rates of prescriptions, which shouldn't surprise anybody. But we do that not to feel. And I think we also have a pretty work hard, party, hard training culture that we had a really hard week and now I'm off Sunday, so I'm going to go out on a Sunday and that's just what we do.
But it's not like I'm going to go out and talk about how hard my like week was. It's like I'm going to go out, not feel any of this and have quote unquote fun. And I think that, like, if we're going to think about things that we could improve upon as what we choose to do is probably the most complicated and problematic thing that a lot of us learn early in training and like really isn't good, and a lot of us do struggle with it as we age or even are younger.
Dr. Denise Millstine: I really appreciate you bringing up that topic, which is difficult and really hard to talk about, especially among healthcare professionals. We had a really amazing, enlightening conversation on episode number 19 with Dr. Anthony Chin-Quee and his book, “I Can't Save You.” So listeners who want to learn more, please do check that out.
So Maggie, we talked about running, but there's also yoga in the book. This made me so happy as an integrative physician who's recommending yoga to so many people. But what was a little different about this is that we have Lyle or McHuge, who's leading the practice and he says to the group, but it resonates with Stellar: There's never shame in deciding your body isn't ready for this pose today. Like there's no shame if today isn't your day. Today is the day of, I get you. So honor the spirit of appreciation and collaboration in this stage by knowing yourself first. Be gentle with yourself first. And after that, Stellar adjusts her downward facing dog just a little bit so she knows it wouldn't look as good to somebody looking at her, but it feels amazingly better to her body. Is yoga one of your well-being strategies and places to find wisdom?
Maggie North: It really is.
Cause it's come up twice and I love talking about romance. Let's talk about McHuge’s name for one second, because romance is a place where you can have a lot of fun. You know, you can put aquarium friends in your bio and you can name characters really fun things. And so that's it's just fun to read. And he's from my first book, “Rules for Second Chances,” so we had to keep McHuge, but to me he's Lyle too.
Anyway, yes. So that point in the book, I'm so glad you brought it up right now, because we can see right before Stellar attends the yoga class led by Lyle, she was running and suddenly she finds herself not really interested in running, which she's using to control her anxiety and feelings of distress. And she decides instead to come to yoga, which is hard for her because she's pretty hard driving. It's difficult for her to slow down. Same girl. And then again, you know, picks up this different pose. And I have to say, this is where I put a lot of myself into the book, where yoga feels pretty competitive to me or did do when I was younger. You know, I'm stronger, I can do more asanas. I can, you know, do all the power poses I can this, I can that.
And I like years later, years of yoga practice later. I understand that actually every body is unique and not everybody is going to be able to do the standard poses, nor is it going to be healthy. You must embrace uniqueness and individuality, and you must be gentle with yourself, or you're going to end up with injuries that don't let you carry on. So it is a lot about trusting yourself to know what is good for you, knowing when you can depart from the quote norm, and having a teacher you can trust to back you up on that.
Dr. Jessi Gold: I think when you deny yourself like going to the bathroom, right? Like you don't even realize when you're pushing yourself too hard or you're in a pose that you shouldn't be. Like, we are so disconnected from our bodies in ways that I don't think we realize in what we do.
I am partially dissociated most of the time I'm talking to patients. Like I'm very connected. No one would say I'm not empathetic, but I'm not registering any of that because I don't want to. Like, I don't want to take that on because I'm an empath. And if I do, I may have a horrible day. And I didn't realize how dissociated I was until at a time where my previous dog was really sick and I was in residency and I hadn't been sleeping because he was sick. And I had a patient listen to the patient. And right after I just started like bawling and my best friend came in is like, what's going on with you? And I was like, the world is so dark. The world is just a terrible place. And she was like, what happened? Everything we hear is quite terrible. Why was it more terrible today?
And I realized, like, I actually couldn't dissociate because I was tired and cranky and I hadn't, like, I couldn't do it. And so I was totally present and totally listening. And I actually had no ability to hold that at all, because I also was really tired. And I think that's even just sort of mentally in some capacity. But like from our physical selves, we are so disconnected.
And I think people don't recognize, like how important it is to reestablish that connection to actually feeling good and coping and whatever that looks like for you. At its core, that's really what mindfulness is, right? Like centering on the moment. It doesn't have to be through meditation or anything like that. It could be through yoga, right? Like it's like I'm going to be with my body in space right now. Whatever's going on with me can be there, but it doesn't have to take over. But I haven't actually pay attention that this hurts or I'm not prepared for this, or I. I can have limits, which we don't at work, right. And I think all of those things people take for granted as like actual huge life, like educational opportunities to help be a better person or holistic person. I think.
Dr. Denise Millstine: Well, that dissociation is something, Maggie, that you give to Stellar as well. You say that she can't feel pain, or at least she's trained herself not to feel pain. Is that that same type of thing that Jessi's talking about with her dissociation mentally when she's with patients?
Maggie North: I think it's very much in the same vein. Yeah. As Jessi said, if you're trained not to go to the bathroom, if you're trained through your premed and your medicine studies and your residency, that working harder and trying harder equals better results. Like not listening to yourself and just throwing yourself into work gets you where you want to go, then, yeah, you're just very likely to deny your physical self in that way.
Dr. Denise Millstine: And Jessi, you said one of the strategies, whether your coping structure is around running or yoga or journaling or whatever it might be, is really coming face to face with the emotions that you're feeling and feeling them. And perhaps that's why you wrote a book called “How Do You Feel?” Can you talk about your book a bit?
Dr. Jessi Gold: Yeah, I mean, it's embarrassing sometimes to be a psychiatrist who's actually not comfortable with their own feelings, but I'm very comfortable with other people's feelings. And I think I didn't realize how uncomfortable I had become with my own. The story is about my experience being a psychiatrist during the pandemic for healthcare workers. All of the patients are healthcare workers are on the path to being healthcare workers. They're composites. So based in truth, but based on multiple people's truths, to protect their identity.
And you follow us through about six months and see kind of all along the way, the ways that we deny that part of us. That we deny our feelings or we deny our humanity. What are the factors that go into that as a resident, as a premed, as an attending, as a nurse, that might be different, but also kind of all along this path to us learning to prioritize other people over ourselves in a way that makes it so we don't even recognize ourselves or like our own emotions in that context.
And I think that it has taken a lot of work for me to get to a place that I even will say out loud that my job impacts my mental health. Or that I have negative feelings about something, because I think sometimes you think if you say you had a bad day that you're like, it means something about how you feel about that patient, or if you save a bad day, you're like criticizing a field that has so much meaning and you're so lucky to be doing anyway because it's so hard to get into and all this stuff, right.
You just learn over time, like not to say anything and not to recognize how it's impacting you. And I don't even know that I really knew that until it kind of all came to a head for me, which you see in the book as it's a memoir.
But, I'm still working on that. I think it's so embedded that it's such a work in progress for me. Like sometimes I'll be talking to my therapist and she'll be like, I know someone who wrote a book on that. And she's like, go back and read that stuff that you wrote. Because I don't always follow what I preach even though I've really worked on and reflected and processed this particular stuff to be able to explain it to somebody else and, you know, write about it. And I do like, feel like I learned a ton about myself and, and other patients and healthcare culture through that experience. But it's like a really hard thing to unlearn and maybe is not possible to completely unlearn in the setting of our workplaces because we can't just cry all the time or whatever it is. And so it's complicated, a complicated balance. Because I've definitely said to people like, you know, in talking about feelings, people are like, what makes them so sensitive now? And they're so judgy of like, residents and med students for advocating for their own mental health. Or they say, like, I don't like that. You said that it's okay if we cry or, you know, something like that. I don't mean that we should always cry all the time with every patient that's not healthy. You would need to come see me if that was what was going on. That's why I have a practice.
But we can't do never. And we do never a lot. And if you do never for years, you're very messy and neutral and numb and confused about feelings. And you don't even have words for feelings. You say you're okay, I'm fine. Because you think those are feelings, and they're not feelings, but those are the only words that you know.
Dr. Denise Millstine: So powerful. Thank you. I think this is a great pairing, “The Ripple Effect” with “How Do You Feel?” All of the healthcare professionals or those interested in healthcare professionals in the audience, should buy both books and read them both back-to-back. I think they truly speak to one another.
I want to thank you both for being here with me and talking about professional burnout. “The Ripple Effect” will come out in summer 2025, so listeners should go and get a book. And realize that this is only one thread. It is not the main plot of the book. We did not ruin that or check it out Dr. Jessi Gold's memoir, “How Do You Feel?”
Thank you both for being here with me.
Dr. Jessi Gold: Thanks for having us.
Maggie North: Thank you so much, Denise and Jessi. I feel like we're sisters in the way of writing books about burnout.
Dr. Jessi Gold: Yeah, I mean, it's so interesting because when Denise was like, I read this book and I think it would be such a good connection to yours, I was like, okay, I was like, romance. And she was like, yes, yes. And it was such a, you know, you have to be an artistic, thoughtful person like Denise to be able to have put all that together. But I really appreciate it because it's such a different angle of talking about this for me, too.
Dr. Denise Millstine: We can learn something from all genres of books, and there are a lot of romance writers or excuse me, there are a lot of romance readers out there, and one thing I love about romance, Maggie, is that it always promises to catch you at the end. So even when it goes to those dark places, you're assured that it's coming back around in some way. That you'll leave with, resolution and some type of happily ever after. So I agree, go out and read some romances and you could start with “The Ripple Effect” by Maggie North. Thank you both.
Maggie North: Thanks again.