[Music]
you
[Music]
imagine that you are Luke Skywalker
Darth Vader cuts off your hand and says
no I am your father the stunning and
surprising plot twist ever someone said
when something goes wrong with her life
just yell plot twist and move on if that
actually worked in med school I would
never have stopped yelling it’s been 21
years since I finished med school and I
stand before you now with several quotes
on how I try and how I survived how to
develop resilience that you have been
assigned this mountain to show others it
can be moved after high school my mother
said you have to get into the University
of the Philippines for college if you
want to get into med school I was to be
the first doctor in my family basically
it was you pee or bust because we
couldn’t afford that tuition elsewhere
that was my mountain eventually I got
into med school and I thought my great
chasing and mountain moving days are
over but no I got assigned another
mountain another mountain and then
another there are many mountains to be
moved if you want to become a doctor
that which does not kill us makes us
stronger I heard that a lot I was told
that a lot in med school together with
this too shall pass
just go to work every day it will be
over before you know it you’re the
medical clerk on deck for endorsement
with very limited time to study you will
go up there and get a pen what doesn’t
kill you makes you stronger the patient
was okay this morning and now you’re the
intern helping run the code and the wife
is crying loudly beside you what doesn’t
kill you
makes you stronger you know that if the
patient can get dialysis he will survive
but there’s no money so you go to the
social worker and ask for help you shell
out from your salary this too shall pass
the patient dies you have to go to the
audit conference and explain what
happened what you did what you didn’t do
as the resident in charge what doesn’t
kill you makes you stronger never mind
if your family hasn’t seen you or you
haven’t slept properly for days or you
do not know when your next sit down
decent meal will be this too shall pass
what doesn’t kill you makes you stronger
perhaps but we don’t know that
physicians have high rates of anxiety
stress depression and suicide if it
doesn’t kill you will it break you the
Bambaataa bands is stronger than the
hope that resists so the bamboo has
resilience resilience is a capacity to
overcome adversity and not break to bend
and not be broken to bounce back so you
may think that resilience is a trait I
draw you’re a tough cookie or you’re not
but resilience is a process it is an
adaptive response a way to cope with
whatever passes your path and resilience
can be learned and if you look at the
literature there are many ways to
develop resilience you are not required
to set yourself on fire to keep other
people warm the long lines of patience
at the Philippine General Hospital are
as legendary as its trainees frustration
with poverty at one particularly toxic
clinic day the doctor beside me just
snapped the patient had not taken her
medicine and without even asking
why she just started berating the
patient I can see you dyed your hair you
got a manicure and a pedicure but you
did not drink your medicine how can you
be so irresponsible now your blood sugar
is high you will get complications you
might die etc etcetera etcetera and the
patient just held out a gift for the
doctor she had gone home to the province
to attend the wedding that’s why she had
her hair dyed had a manicure and a
pedicure she forgot to bring her
medicine and she had eaten at the
wedding feast that was why her blood
sugar was high the doctor bowed her head
she just murmured her thanks and excused
herself I smiled at the patient and said
you do know she cares very much about
you and the patient nodded and left
medicine is a vocation but what happens
when doctors start to care too much
about their patients when I go to work I
bring a measure of joy and I try not to
run out when it rains look for rainbows
when it’s dark look for stars I don’t
ever want to go to the point where I say
I am not even a person anymore I am just
stress and sadness we admitted that one
year old woman with a plastic anemia
holy bed blood transfusion she was very
stable all we worried about was where
we’re gonna get the blood donors one
moment she was talking the next thing
she’s collapsed on her bed our
first-year medical resident rushes in to
put a tube in her airway so she could
breathe but better English coke blade
it’s light wouldn’t light up it was
busted she couldn’t see the nurse had to
give him the spanner English scope still
it would not work so while they were
doing that we were bagging the patient
with oxygen there’s a mask but she’s
training blue so the nurse had to run to
the other world and get that working
laryngoscope we finally have the patient
stabilized but she still dies the
resident is very upset
besides to file an incident report
against the nurses its third job to make
sure laryngoscopes are working during
rounds he is silent and withdrawn the
senior medical resident taps him on the
back and says it’s no one’s fault this
is not the first station to die of a
bleed in the brain because of low
platelet count there was nothing anyone
could have done there was no further
debriefing or discussion of this case
and the next thing you know the next
morning the resident quits it’s another
case of burnout burnout is a syndrome of
depersonalization emotional exhaustion
and a diminished sense of personal
accomplishment so how do we prevent
brenna
burnout hopefully by developing
resilience details of your incompetence
do not interest me so said Miranda
Priestly from The Devil Wears Prada and
I had a mentor just like her who taught
me insight and insight is a component of
resilience the awareness of one’s
limitations and errors and yet being
able to still try problem-solving online
I call myself the endocrine witch and I
call that myself in honor of dr. Miranda
that her real name one of the original
endocrine witches of the Philippine
General Hospital she always knew what I
did not prepare for for example all our
service patients should have a summary
of the blood sugar records in front of
the child not at the back in the nurses
notes so as a diligent senior resident I
made sure of that
however she shows up at rounds and she
says I don’t want to see our white
patients let’s go to the emergency room
and the first try she sees does not have
that blood sugar monitoring chart in
front so she gives me that look the look
that says earth peace swallow me now but
know every ranch brought new challenges
but it also gives me insight on how I
could improve and it helped me develop
resilience the second component of
resilience is self-care my alone time is
for your safety it has been proven by a
research that divided attention tasks
tasks that required the integration of
information across several sources is
very vulnerable vulnerable to stress
such as what happens when a physician is
managing a patient because the attention
might shift from the task at hand to the
source of the stress and so medical
students and doctors need alone time to
actually eat the stress I did this in
watercolor pens still I also draw now I
collect fountain pens I do loom band
bracelets I call it a creative
procrastination it is also possible to
have alone time together when I was in
residency we had the three o clock habit
every 2 p.m. the morning shift nurses
would endorse to the afternoon shift
nurses and we couldn’t do anything
because they held all the charts so all
my batch mates would gather in the whole
room to just chat to pause and breathe
deeply before going back to work it was
the highlight of our day the other
component of cell K another couple of
resilience is values finding meaning and
purpose in one’s life and in medicine we
often talk about work-life balance as if
the two are separate entities that are
in competition with each other the work
and the life outside work as if it is
only possible to find happiness outside
of work I prefer the term work-life
integration which implies a synergy
between the two difficult roads lead to
beautiful destinations
that’s my son Ryan he turned 11 last
yesterday and that marks 11 years since
I have stopped having Saturday clinics
not good for the
but it is a choice I have made because I
find that there are connections to be
made that to work with patients and with
colleagues that make the work fulfilling
and satisfying and I am more open to
those connections when I have my
revitalizing weekends and so every
summer I take two weeks off for vacation
I take early Christmas break and ashram
clinic after the New Year my patients
understand that this is something I need
to do in order to serve them better this
is my improves block 1996 can you find
where I am since then I have been an
interest monitor I’ve been on the
residency training committee I have been
a mentor and sadly hierarchical tension
and the hidden curriculum still exists
I trained during a time and it was
acceptable to be told at the morning
endorsements you practically killed your
patient it was objectionable to go home
even when you were not on Judy because
your patient was dying it was
unthinkable to complain even if you
suffered verbal abuse from your
superiors but what you are now is what
will continue and we should not allow
what dr. Marshall Myers calls the
damaging culture of medicine a culture
that values what Danielle Ofri refers to
as the tyranny of perfection where to
have burnout is to have a Badge of
Courage much has been said about
generational differences my oldest son
is 14
he’s a millennial every time I feel the
urge to tell a student you know during
my time I imagine my son in my head
rolling his eyes at me
so I couldn’t stop myself because when a
flower doesn’t bloom you fix the
environment at which it grows not the
flower so it has been said medical
students and doctors
need to be supported not trained in
resilience we need to push for
organizational change that has lead to
an environment that can actually nourish
resilient healers and medical educators
have found many ways to do this either
through mindfulness meditation training
peer supervision counseling all of these
activities and they have also found it
necessary to point people towards
resources that they can use when they
want to escalate concerns or when they
need support because they have been
bullied or harassed in the U P College
of Medicine every first-year medical
student is assigned a mentoring group
and I am my husband were privileged to
mentor nine such individuals and I
graduated last year we still keep in
touch with them and I feel it is our
small contribution to helping medical
students thrive in med school and beyond
I started with Darth Vader let me end
with God what we feel our plot twists
are actually part of God’s grand plan
and if we feel we are drowning let’s not
be afraid why because our lifeguard
walks on water
Matthew Freudian verse 25 thank you
[Music]
you
[Music]
imagine that you are Luke Skywalker
Darth Vader cuts off your hand and says
no I am your father the stunning and
surprising plot twist ever someone said
when something goes wrong with her life
just yell plot twist and move on if that
actually worked in med school I would
never have stopped yelling it’s been 21
years since I finished med school and I
stand before you now with several quotes
on how I try and how I survived how to
develop resilience that you have been
assigned this mountain to show others it
can be moved after high school my mother
said you have to get into the University
of the Philippines for college if you
want to get into med school I was to be
the first doctor in my family basically
it was you pee or bust because we
couldn’t afford that tuition elsewhere
that was my mountain eventually I got
into med school and I thought my great
chasing and mountain moving days are
over but no I got assigned another
mountain another mountain and then
another there are many mountains to be
moved if you want to become a doctor
that which does not kill us makes us
stronger I heard that a lot I was told
that a lot in med school together with
this too shall pass
just go to work every day it will be
over before you know it you’re the
medical clerk on deck for endorsement
with very limited time to study you will
go up there and get a pen what doesn’t
kill you makes you stronger the patient
was okay this morning and now you’re the
intern helping run the code and the wife
is crying loudly beside you what doesn’t
kill you
makes you stronger you know that if the
patient can get dialysis he will survive
but there’s no money so you go to the
social worker and ask for help you shell
out from your salary this too shall pass
the patient dies you have to go to the
audit conference and explain what
happened what you did what you didn’t do
as the resident in charge what doesn’t
kill you makes you stronger never mind
if your family hasn’t seen you or you
haven’t slept properly for days or you
do not know when your next sit down
decent meal will be this too shall pass
what doesn’t kill you makes you stronger
perhaps but we don’t know that
physicians have high rates of anxiety
stress depression and suicide if it
doesn’t kill you will it break you the
Bambaataa bands is stronger than the
hope that resists so the bamboo has
resilience resilience is a capacity to
overcome adversity and not break to bend
and not be broken to bounce back so you
may think that resilience is a trait I
draw you’re a tough cookie or you’re not
but resilience is a process it is an
adaptive response a way to cope with
whatever passes your path and resilience
can be learned and if you look at the
literature there are many ways to
develop resilience you are not required
to set yourself on fire to keep other
people warm the long lines of patience
at the Philippine General Hospital are
as legendary as its trainees frustration
with poverty at one particularly toxic
clinic day the doctor beside me just
snapped the patient had not taken her
medicine and without even asking
why she just started berating the
patient I can see you dyed your hair you
got a manicure and a pedicure but you
did not drink your medicine how can you
be so irresponsible now your blood sugar
is high you will get complications you
might die etc etcetera etcetera and the
patient just held out a gift for the
doctor she had gone home to the province
to attend the wedding that’s why she had
her hair dyed had a manicure and a
pedicure she forgot to bring her
medicine and she had eaten at the
wedding feast that was why her blood
sugar was high the doctor bowed her head
she just murmured her thanks and excused
herself I smiled at the patient and said
you do know she cares very much about
you and the patient nodded and left
medicine is a vocation but what happens
when doctors start to care too much
about their patients when I go to work I
bring a measure of joy and I try not to
run out when it rains look for rainbows
when it’s dark look for stars I don’t
ever want to go to the point where I say
I am not even a person anymore I am just
stress and sadness we admitted that one
year old woman with a plastic anemia
holy bed blood transfusion she was very
stable all we worried about was where
we’re gonna get the blood donors one
moment she was talking the next thing
she’s collapsed on her bed our
first-year medical resident rushes in to
put a tube in her airway so she could
breathe but better English coke blade
it’s light wouldn’t light up it was
busted she couldn’t see the nurse had to
give him the spanner English scope still
it would not work so while they were
doing that we were bagging the patient
with oxygen there’s a mask but she’s
training blue so the nurse had to run to
the other world and get that working
laryngoscope we finally have the patient
stabilized but she still dies the
resident is very upset
besides to file an incident report
against the nurses its third job to make
sure laryngoscopes are working during
rounds he is silent and withdrawn the
senior medical resident taps him on the
back and says it’s no one’s fault this
is not the first station to die of a
bleed in the brain because of low
platelet count there was nothing anyone
could have done there was no further
debriefing or discussion of this case
and the next thing you know the next
morning the resident quits it’s another
case of burnout burnout is a syndrome of
depersonalization emotional exhaustion
and a diminished sense of personal
accomplishment so how do we prevent
brenna
burnout hopefully by developing
resilience details of your incompetence
do not interest me so said Miranda
Priestly from The Devil Wears Prada and
I had a mentor just like her who taught
me insight and insight is a component of
resilience the awareness of one’s
limitations and errors and yet being
able to still try problem-solving online
I call myself the endocrine witch and I
call that myself in honor of dr. Miranda
that her real name one of the original
endocrine witches of the Philippine
General Hospital she always knew what I
did not prepare for for example all our
service patients should have a summary
of the blood sugar records in front of
the child not at the back in the nurses
notes so as a diligent senior resident I
made sure of that
however she shows up at rounds and she
says I don’t want to see our white
patients let’s go to the emergency room
and the first try she sees does not have
that blood sugar monitoring chart in
front so she gives me that look the look
that says earth peace swallow me now but
know every ranch brought new challenges
but it also gives me insight on how I
could improve and it helped me develop
resilience the second component of
resilience is self-care my alone time is
for your safety it has been proven by a
research that divided attention tasks
tasks that required the integration of
information across several sources is
very vulnerable vulnerable to stress
such as what happens when a physician is
managing a patient because the attention
might shift from the task at hand to the
source of the stress and so medical
students and doctors need alone time to
actually eat the stress I did this in
watercolor pens still I also draw now I
collect fountain pens I do loom band
bracelets I call it a creative
procrastination it is also possible to
have alone time together when I was in
residency we had the three o clock habit
every 2 p.m. the morning shift nurses
would endorse to the afternoon shift
nurses and we couldn’t do anything
because they held all the charts so all
my batch mates would gather in the whole
room to just chat to pause and breathe
deeply before going back to work it was
the highlight of our day the other
component of cell K another couple of
resilience is values finding meaning and
purpose in one’s life and in medicine we
often talk about work-life balance as if
the two are separate entities that are
in competition with each other the work
and the life outside work as if it is
only possible to find happiness outside
of work I prefer the term work-life
integration which implies a synergy
between the two difficult roads lead to
beautiful destinations
that’s my son Ryan he turned 11 last
yesterday and that marks 11 years since
I have stopped having Saturday clinics
not good for the
but it is a choice I have made because I
find that there are connections to be
made that to work with patients and with
colleagues that make the work fulfilling
and satisfying and I am more open to
those connections when I have my
revitalizing weekends and so every
summer I take two weeks off for vacation
I take early Christmas break and ashram
clinic after the New Year my patients
understand that this is something I need
to do in order to serve them better this
is my improves block 1996 can you find
where I am since then I have been an
interest monitor I’ve been on the
residency training committee I have been
a mentor and sadly hierarchical tension
and the hidden curriculum still exists
I trained during a time and it was
acceptable to be told at the morning
endorsements you practically killed your
patient it was objectionable to go home
even when you were not on Judy because
your patient was dying it was
unthinkable to complain even if you
suffered verbal abuse from your
superiors but what you are now is what
will continue and we should not allow
what dr. Marshall Myers calls the
damaging culture of medicine a culture
that values what Danielle Ofri refers to
as the tyranny of perfection where to
have burnout is to have a Badge of
Courage much has been said about
generational differences my oldest son
is 14
he’s a millennial every time I feel the
urge to tell a student you know during
my time I imagine my son in my head
rolling his eyes at me
so I couldn’t stop myself because when a
flower doesn’t bloom you fix the
environment at which it grows not the
flower so it has been said medical
students and doctors
need to be supported not trained in
resilience we need to push for
organizational change that has lead to
an environment that can actually nourish
resilient healers and medical educators
have found many ways to do this either
through mindfulness meditation training
peer supervision counseling all of these
activities and they have also found it
necessary to point people towards
resources that they can use when they
want to escalate concerns or when they
need support because they have been
bullied or harassed in the U P College
of Medicine every first-year medical
student is assigned a mentoring group
and I am my husband were privileged to
mentor nine such individuals and I
graduated last year we still keep in
touch with them and I feel it is our
small contribution to helping medical
students thrive in med school and beyond
I started with Darth Vader let me end
with God what we feel our plot twists
are actually part of God’s grand plan
and if we feel we are drowning let’s not
be afraid why because our lifeguard
walks on water
Matthew Freudian verse 25 thank you
[Music]
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