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Submitted July 2024
by Dr. Brian Sayers

Kinship, Tenderness, and Being Rescued

Gregory Boyle is a Catholic priest who from scratch built what has become the largest gang rehabilitation and recovery program in the world, born in the toughest neighborhoods of Los Angeles in the turbulence of 90’s urban violence. He has written a series of three books starting with Tattoos on the Heart that tell the story of the program and teaches us much about how people come to be in gangs. More importantly, the books tell incredible, heart wrenching, uplifting stories of how change is possible, even when it seems impossible ─ but only within a certain kind of community. The magic of his program is that he takes hardened gang members and finds a way to access the tender places in their hearts, places that exist in all of us, even those we would least expect it in. With hearts open, a sense of kinship soon develops, even among young men from rival gangs who work side by side in the programs at Homeboy Industries.

Boyle describes kinship as “not serving the other, but rather being one with the other.” As physicians, we all learn about this when we or a loved one becomes seriously ill. We quickly learn what it’s like to be a patient or a family looking to our doctors for their skill, but also for hope and a sense of kinship. For most, these experiences forever after breed a kinship with our now fellow patients that changes not just the way we practice, but more importantly, how we see patients when they come to us in need of both curing and healing. Like the men and women at Homeboy Industries, when we as colleagues let our guard down and create a safe space to care for and about our colleagues, both kinship and tenderness emerge, something I have seen often in our work with physicians in distress. While it won’t make our EMR perform any better, or call any easier, that kinship ─ going arm in arm into our shared work and our lives in general, in good times and bad, can make all the difference.

For a decade after seminary, I was part of a small team that spent an evening a week with a group of men at Ministry of Challenge, a residential recovery center for unhoused men deep in East Austin, in the days when gentrification of this area was unimaginable. Overlapping with that I met weekly with the men of Matthew House, a place of transitional housing for men just released from the prison at Huntsville. Ostensibly, these were Bible studies, but what they really were was an evening a week to explore the hidden recesses of our lives, both them and me, and as different as we were in so many ways, the exploration in safe surroundings invariably revealed the kinship that Fr. Boyle describes. From this sense of kinship comes a certain kind of tenderness from people who to the world look hardened, or dangerous, or hopeless ─ people I would never have expected it from when I started. I’ve learned then and since, just as Boyle describes, that those places in the heart that allow kinship and tenderness, the ingredients of rescue, are potentially discoverable in everyone ─ even doctors, who in their own way can find themselves on the margins of life ─ if it can just be uncovered and if someone cares enough to make the effort.

Most of you have at least some experience with medical or religious mission work, so you know well that spiritual gifts pass to all involved, not just those that the mission targets. Pema Chodron, an ordained Buddhist nun, describes it well writing of love and compassion suggesting that “it's truest measure lies not in our service to those on the margin, but in our willingness to see ourselves in kinship with them.” At that certain point in my life, I needed those desperate men at least as much as they needed me. A few years behind me now, I still think of some of them, even looking for them at busy intersections and underpasses, hoping I will not see them. They were trying to reenter an often-unforgiving world, and while I told them every week just how proud of them I was, I’m not sure I ever explained to them that we were, in those hours and years, really rescuing each other.

Brian Sayers, MD
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Submitted by Dr. Robina Poonawala
June 2024

"The Kill"

When we were picked up at the private safari sanctuary in Botswana, our guide, Professor Ice (Professor of the Bush- as they call the forest) asked us if we had any specific requests. My reply right away was, “I do NOT want to see a kill!” I had seen “a kill” about 20 years ago on a Tanzanian safari trip and was repulsed by it.

The next morning, we set out bright and early for our safari in a Toyota Land Cruiser. Professor Ice sniffed the air and looked at the pattern of footsteps on the path. He stopped by some footstep markings and told us that these looked like a wild buffalo had just crossed by and decided to follow the direction the hoofs were pointing. Lo and behold we did see a wild buffalo grazing nearby. Our guide decided to follow him— that led us to a large group of wild buffaloes on a remote patch of grassland. He told us to look through binoculars at a spot on a distant mound and we noticed two pair of triangular ears poking up. Lions like to sit on a mound to stake out their prey. Ahead of us was a small calf teetering behind the large herd of wild buffaloes. That was their prize! There was one large buffalo that would walk ahead but kept looking back on the calf following him every few feet.

Within a few minutes, we saw the two lionesses get up and walk toward the herd, eyeing the calf. Two more lionesses showed up to join the hunt from another direction. They started chasing and closing in on their target, the little calf. They would come close enough to pull the little calf down from behind and make it fall. The large buffalo noticed them and would quickly chase them away. This went on for quite some time. The one wild buffalo fending off the 4 lionesses!

A group of six or seven wild buffaloes from the large herd did come closer to the action but did not help. They just stood around and grazed and watched. One finally came closer and licked the face and nose of the calf, but walked away, as if giving it blessings or last rites. Suddenly, we noticed another group of six lions coming from the opposite side, two lionesses and 4 cubs. They all joined the chase. The large buffalo tried his best chasing them away but ultimately could not fight these six lionesses and four cubs coming from all sides. He finally decided this was a lost fight and walked away along with the rest of the large herd... leaving this calf to its fate.

By this time the calf was injured and could not get up. It sat bleating and looking for help. The first group of four lions came and started gnawing on the injured calf. Then came forward the other pride of two lions to steal the calf for their 4 cubs.

It was interesting then to see the fight between the two prides of lions. The first group of four had hunted the prey, but the maternal instinct of feeding the four cubs was stronger for the other pride of just two lions.   They managed to chase the other pride away and settled down to keep watch in either direction while their cubs were busy eating the calf. The mothers did not touch the prey while the babies were eating. The calf’s bleating slowly stopped. We decided to leave the lions to their meal.  We came back to this spot later and noticed that the almost eaten carcass had been dragged under a tree and the same pride of lions was still there. Sitting above on a branch now were four vultures awaiting their turn.

Just as we diagnose based on signs and symptoms, Prof. Ice would smell the air, look at the size, shape and direction of the footprints and determine which animal was going in which direction and how recently the footprint was laid. He would put his hand a little above the elephant dung to feel if it was still warm. In just two safari sessions of three hours each we saw all the “big 5!” Elephants, lions, one leopard, wild buffalo and white rhino.  There were also other animals and interesting insects like the dung beetle, all living in perfect harmony and contributing to the ecosystem.

In our day to day lives, full of routine, work, and worry, it’s easy to lose sight of how narrow and sometimes stressed our line of sight is. Travel to faraway places, seeing the rawness and beauty of the natural world right in front of us opens new horizons in our imagination, feeds our creativity, and can help us set aside our tiresome burdens of day to day lives to breathe new life and wonder into our minds and our souls. I will enjoy these memories for years to come!

Robina Poonawala, MD
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Submitted May 2024
by Dr. Brian Sayers

Extroverts, Tortured Poets, and the Long Journey

Arthur Brooks is a Harvard researcher and author who has made it his mission to help us be happier. He recently collaborated with Oprah Winfrey on his latest book, Build the Life you Want: The Art and Science of Getting Happier. It is an interesting read but after several years of reading increasingly complex research on basic concepts like happiness, gratitude, generosity, forgiveness, self-compassion, and the like, I’m starting to feel that when data driven research is applied to these basic traits of the heart, they lose some of their spiritual gravitas.

Brooks and Winfrey start by relabeling our goal as the pursuit of “happierness” rather than “happiness.” Brooks breaks down the “macronutrients of happiness” into three components: enjoyment, satisfaction, and purpose. He distinguishes enjoyment from pleasure by arguing that seeking pleasure by itself is empty, often leading to addiction. Enjoyment takes the source of pleasure and adds two elements  ̶  relationships and memories  ̶  to make it an enduring ingredient of happiness. Satisfaction is the reward you get after you struggle for something. We need struggle, sacrifice, even suffering, to feel we have earned a reward. He makes a crucial point that the formula for satisfaction is: Satisfaction = all the things you have ÷ all the things you want, i.e., the path to happierness is not obtaining more, rather it is wanting less.

Purpose is more complex but is perhaps the most important macronutrient. His discussion is familiar, but he puts a different sort of spin on it by boiling it down to whether, and how, you can answer two basic questions: What are you on earth to do? What would you be willing to die for? Our road to answering these two questions − to the discovery of purpose and meaning − is not linear or easy. It is punctuated by times of insight and times when we are completely lost, by times of joy and sorrow, rich connections or aching loneliness. All are inevitable, sacred steppingstones on that path.

Brooks also looks at personality types and happiness as it pertains to extroverts and introverts. Using metrics to categorize people into extrovert vs. introvert and happy vs. not happy, four categories emerge: Happy extroverts, unhappy extroverts, happy introverts, and unhappy introverts (tortured poets). Extroverts outnumber introverts and according to Brooks are twice as likely to be happy by most metrics, but fortunately for us introverts there are caveats. He notes that extroverts tend to have more friends, but often most of these friendships are casual or transactional with a tendency to have few close friends − the most important people in whom you confide and connect deeply. Introverts, on the other hand, are often happy because even though they have fewer friends, the relationships they gravitate to and maintain are often deeply nourishing.

The book was a timely read for me, digesting it as I attended a 50th high school reunion. My family moved when I was in high school and this year there are two reunions for me. In my first high school with childhood friends, I was an introvert, a pensive, petulant kid who spent most of those first two years daydreaming and getting in trouble. In the remote, rural high school where I spent my junior and senior years, I accidently reinvented myself (or they reinvented me), quickly developed friends, elected class president twice. True to Brook’s description, the friends I am close with to this day are those from my introvert years and I have mostly lost contact with friends from my second high school where my friendships were a mile wide and an inch deep.

Now an expert about happiness, what conclusions would I reach about my old classmates and how life, gray hair, and waning hormones has changed them? I didn’t reach any conclusions about happiness as, like deciphering other people’s marriages, the casual assessment of someone else’s happiness can be deceiving. What stood out was that the lines of high school hierarchy, the cliques, had disappeared and there was relaxed, jovial conversation and openness that crossed all those lines as if they had never existed. At one of the events, I stood outside the bar where we gathered, finishing a phone call, when someone from the old days walked up, someone I rarely interacted with even as we saw each other daily. We visited for a minute when unexpectedly they teared up and told me they had lost a sibling just a few days earlier. We stood there and hugged for a long time, something that would have been unimaginable all those years ago and yet seemed so natural now, the winding road we had each traveled leading us to a common destination. It reminded me of a line from the movie, Almost Famous, when the main character laments about being marginalized in high school and his older mentor reassures him, “You'll meet them all again on their long journey to the middle.”

Brian Sayers, MD
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Submitted May 2024
by Dr. Carsten Kampe

The Old Man and the Tree

An oak tree had been growing in our back yard since we moved into our house ten years ago. At the time it was small and unobtrusive. It never called attention to itself, and I never had occasion to consider its place in our world, either. Over the years, however, it grew—as oak trees do—to block our view of the beautiful verdant vista of the sprawling endangered golden-cheeked warbler nature preserve beyond our back fence and to rob our raised bed vegetable garden of precious sunshine. My wife and I decided it was finally time to remove our now thirty-foot tall oak tree. I had removed plenty of smaller Ashe Juniper trees effortlessly in my day. I would manage this in short order ... or so I thought.

As I began work—just me, a few hand tools, and the Tree—an interesting thing happened. I came to develop an unexpected relationship with, and respect for, the Tree in which I found myself trying to understand it better. We did not speak, for it was not to be, but I had time to ponder its size and stature, and to appreciate its greatness, its beauty, and its majesty as I worked with my hands, back, and simple tools to free it from its hold on the earth. Why did I wait so long to appreciate this wonder of Nature?

I reflected on our past together. I recalled days, as a younger man, when I stood underneath its branches benefiting from the shade it provided during the hot summer months, and observing how it provided a haven for birds, many of whom chose that tree to raise their young. It was selfless in its ways and generous in its gifts to earth’s inhabitants who shared its space.

I became interested in the significance of trees in our lives and learned that in many folk religions, the Tree represents physical and spiritual nourishment, transformation, and liberation, union, and fertility—Who was I, an arrogant human, to take the life of this majestic beast, a creation of God? But the work had begun; there was no turning back now.

I labored steadfastly, beginning by digging a trench around the base of the Tree, getting lost in an endless mass of tangled roots and severing them from their firm grip on the surrounding limestone as I progressed in stepwise fashion, taking frequent breaks to recharge my aging muscles. It was a long-drawn-out struggle. I could easily have hired a tree and stump removing crew but that didn’t feel right to me. In fact, I felt a sense of pride in not using electrical or gas-powered tools to achieve my goal. But was it still a fair fight?
The Tree proved a formidable foe. Neither it, nor the ground beneath it, yielded readily. I realized that this would be the last time I attempted such an arduous feat. I had taken on a struggle in which I would not likely prevail again. I am not young anymore. And yet, I felt I was destined to win this battle one last time. I persevered.

In the end, I was the “victor” ... or so I thought. But how proud was I really, having won? Was proving to myself that I had the willpower and stamina to complete the job meaningful? Was I, the garden (and the Tree) better off now? The golden-cheeked warblers would find other trees in which to nest, but where will I find shade when tending to my vegetable garden now? Who (or what) will be there to stand proud and provide physical and spiritual nourishment, transformation, and liberation? I collected my tools—and thoughts—together for the day and decided to put off sawing the trunk into smaller pieces to add to our firewood pile for another day." to show better respect for the beautiful tree.

I thanked the Tree for its sacrifice and what it taught me about life and our place in the world.

And then, while the sun was still hot in the sky, I planted a new tree.

… in whose shade I would never sit.

"The one who plants trees, knowing that he will never sit in their shade, has at least started to understand the meaning of life."

--Rabindranath Tagore

Carsten Kampe MD, PhD

Submitted April 2024

by Dr. Brian Sayers


I was senior medicine resident in the ICU at the VA in Albuquerque one night many years ago. There was a terrible sleet storm outside, the roads were impassable, and we were going to have to cover the unit for a second night. Miles away in a remote area to the north, a blizzard was in progress. Somehow, Life Flight got out ahead of the storm and transported Ray, who landed on my service. He arrived in cardiogenic shock with the ominous tall, wide ST elevations ─ “tombstones” ─ of a massive anterior MI, signifying what in the 80’s would likely be fatal.

The usual frenzy of activity followed, using protocols that sound primitive now, all the while knowing his chances were slim. He rallied for a while and was conversant but seemed resigned to his fate. He reminded me of my grandfather, the same age and both had served in France in the First World War. He told me about his ranch, snow covered now, but soon, in the spring, lush green pastures would re-emerge in this deep valley, snow fed streams winding through it. It was paradise for him, sacred ground, where his wife was now stranded without phone service, and where tomorrow his son would have to try and drive the pickup into the pasture, his grandson pushing square bales out into the snow for the hungry cattle. The old man’s face was pale, deeply creased, sun damaged, at times with tears. Things were quiet for a while, and I sat with him, and he became unresponsive.

In a long career it's surprising how certain patients, even from the distant past, can stick in your mind. I remember those hours vividly, watching life slowly ebb from him as his heart failed, checking on him almost constantly, sitting by his bed, drawn to him, considering the heart. Not just the pump, but his spiritual heart and what might become of that when the physical one stopped.

Virtually every major religion and non-religious spiritual discipline attach special, sacred significance to the heart, references to this even found in ancient Egyptian art, in ancient mythology, represented in timeless Native American lore and art as a transformative symbol connecting humans, nature, and the spirit world. The heart is often seen as a place where the soul resides, the center of emotions and morals, compassion and courage, wisdom and peace, the source of love. It is a place where we might encounter inner peace, even sense the presence of the transcendent. We tend to go to great lengths on outward journeys throughout life looking for wisdom and peace and love in the world around us, but the real work takes place when we go inward, into the heart.

Occasionally, medicine calls on us to share our heart with a patient in need. Daniel Sulmasy notes that, “If we are committed to healing patients as whole persons, we must understand not only what disease and injury do to their bodies but what disease and injury do to them as embodied spiritual persons...Illness raises troubling questions of a transcendent nature ─ questions about meaning, value, and relationship. These are spiritual questions. How we answer these questions for ourselves will affect the ways we help our patients struggle with these questions.” Ultimately, our inner journey to wholeness is for those around us as much as it is for us. Ethicist Paul Ramsey describes us as “a covenant people on a common pilgrimage” and when we enter into relationship with our patients, such a covenant requires that we visibly express fidelity, love, compassion, and justice ─ acknowledgment of the sanctity of life ─ as we honor that relationship.

In those hours, I felt about as close to Ray as you can with a patient, but I did not have what I sensed he needed from me. I was able to listen, to touch his shoulder, to hear his stories, and that’s something, but I was young and had not experienced enough of life, enough of my own inner journey to be able to help him deeply in those last hours. It isn’t something taught in medical school… because it can’t be taught. It has to be discovered. Only its importance can be taught.

Ray never woke up, and he died just before rounds the next morning. There was someone in his little cubicle almost every minute since his arrival but sure enough, the minute he was alone he passed away. We were just a few feet away gathering for rounds, talking about the storm. I tried his home number again and this time his wife answered. I tried to convey how he described his love of his family and the land, but I don’t think she heard anything after the first sentence. By late afternoon the roads were passable, and I went home. And slept.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted April 2024
by Dr. Cindy Lynn

Reflections on Retiring, Tiaras, and Purple Hair

I am retiring next week, and many people have asked me what I’m going to do. I tell them I plan to dye my hair pink. You see, I have always felt that I must look professional, and after next week, that no longer holds. So why not go crazy with hair color? When I came to work at St. David’s Medical Center in Austin in 1992, fresh out of neonatology fellowship, there was an unofficial dress code. Ladies wore skirts or dresses; men wore ties. If I had a belt, I had a place for my pager. We didn’t carry cell phones yet. Those younger than 50 are likely gasping now. I had a cell phone about the size and weight of a brick with a foot-long detachable antennae. That beast stayed in the car. As the years went by, the dress code eased up. Now I mostly wear cargo pants with pockets big enough to carry a cornucopia of items, including my cell phone, ophthalmoscope to see a newborn’s red reflex, multi-page patient list, pens, lip balm, hand cream, and of course reading glasses.

During the pandemic I stopped covering my gray hair. I went totally gray/silver/white, which I like to refer to as “pandemic gray.” I have found that you really are invisible if you have gray hair. Young people working at store checkouts cut you a lot of slack when you don’t know how to use the store’s app. In fact, I find they are usually surprised that I have even downloaded it. Young children call me “Grandma,” even though I am not their grandma. I went to my hairdresser yesterday for a haircut, and told her I wanted pink hair, but not yet, I still have another week before I’m retired. She said I don’t want pink, I want purple, it’s classier. I gave her a “Seriously?” look which she ignored. She explained we don’t want obnoxious, and I replied, “Maybe borderline obnoxious?” After all, I’m pretty sure this will be a one-time deal. So, I have purple hair scheduled next week.

The NICU nurses have been questioning me about my favorite foods and favorite flavor of cake, so-subtle clues that they are planning a retirement party. Being oh-so-quick to catch on, I told them that I don’t want a party, I want a retirement tiara. When I said that, I felt like I was asking for a unicorn, something that clearly didn’t exist. As soon as it left my mouth, it occurred to me that you can get almost anything on Amazon. Sure enough, there are hundreds of retirement tiaras on Amazon. Again, seriously? I don’t know why I requested a tiara. I am definitely NOT the princess type. I don’t wear high heels; I have no designer purses. I always thought that if Cinderella wanted a sports car, she should put herself through med school and buy it herself, not wait for Prince Charming. But I am now the proud owner of a retirement tiara and decided to embrace it. I had planned to wear it on my last day but couldn’t wait. I wore it to perform a circumcision today. If not now, when?

While I feel extremely fortunate to love my job, it’s time to call it quits. Neonatology has a “best-by” date, and for me, it’s now. I will miss my colleagues. I hope to run into you out and about. You may not recognize me. I’ll be the one with a tiara on obnoxious purple hair.

Dr. Cindy Lynn
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Submitted April 2024

by Dr. Brian Sayers

The Acorn

A year into the pandemic, stir crazy and probably not thinking straight, I bought a 15-acre olive grove near La Grange. Just before we bought it, it had 200 mature olive trees, a restored farmhouse, 160-year-old log cabin and, to me at least, the place seemed magical. Of course, there is a reason why Texas is not known for its olive industry and that terrible freeze in 2021 killed off the entire orchard.  In the years that have followed I’ve planted all kinds of trees in the groves ─ apples, plums, and pears ─ and only a dozen or so apple trees have survived the droughts and heat.

As I sat on the front porch of the house one breezy, quiet Saturday early last spring, the misplaced, struggling fruit trees in the distance taunting me, I realized I was looking at what just might be the perfect tree. Tall, perfectly round, deep green, it stands at the center of the property, an example of nature’s perfection for which I can claim no credit. Somehow, I had not really noticed it before.  It sounds silly, but that day a certain kind of wisdom about the land came to me: to watch and listen to the land, to learn its secrets, to honor and enjoy it rather than try to make it something it cannot be. It seems so obvious now.  It’s not that it’s “not nice to fool mother nature” as the commercial from a few years ago said ─ it’s that trying to fool mother nature is… well, just fool’s errand.

Life is full of mystery. In my work in medicine, I often come up against a diagnostic dilemma and years ago I learned that what some of my patients suffer from defies understanding in its earliest presentations no matter how hard I try to figure it out. The process sometimes must unfold over months or years before we are sure about it, something I’ve come to terms with, but something understandably so hard for most patients to accept. A mentor early in my career told a story from a national meeting where the speaker, describing a particularly vexing case, famously said, “Having failed to make a diagnosis, we proceeded with treatment…” The story sounded ridiculous at the time, but now I think I understand what he was trying to say. Even as some conditions very slowly unfold, we must still be present and engaged with the patient, all the while trying to share with them an understanding that mystery is always part of life and frequently part of medical care.  Honoring that, being honest and humble about it, all the while holding our patient’s hand is sometimes what is called for and is one of the most difficult things we do.

Accepting mystery, observing the world with curiosity and an open heart, and patiently letting life unfold is how we acquire wisdom. Accepting mystery is not easy. It requires patience and an open heart in a world that more often wants to harden our hearts. Physician wellness pioneer Rachel Remen writes of the “buddha seed” in all of us waiting to become a tree of wisdom if we will only allow it. “Life offers its wisdom generously. Everything teaches. Life asks us the same thing we have been asked in every class: ‘Stay awake.’ ‘Pay attention.’  Wisdom comes most easily to those who have the courage to embrace life without judgment and are willing to not know, sometimes for a long time... It involves a change in our basic nature, a deepening of our capacity for compassion, loving-kindness, forgiveness, harmlessness, and service. Life waters the buddha seed within us.”

Mystery is often a prelude to miracles.  Within every acorn, there is a yearning and the mysterious possibility of becoming a beautiful oak tree. Clueless for so long about this land, and now at least a little wiser and more observant through painful failure, I’ve started planting live oak trees around our little “Grove House,” the house’s name now relegated to quotation marks. A couple of years in, they are growing nicely, but slowly ─ as oak trees do. By the end of this year, I will have planted one for each of our eight grandchildren, and like so many things we do in life, ultimately, the planting is not for me. Like my grandchildren, these trees will reach maturity in an unseen future many years from now. As I sit on the front porch on this magnificent spring morning, studying nature’s perfect tree and the much younger trees planted nearby, I smile to think that one day each of my grandchildren might sit in the shade of these very trees.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted March 2024
by Dr. Brian Sayers


In a box in my office is a cherished collection of letters and cards from patients and their families ‒ touching messages sent to me during these past 35 years. There is also a list of patients who have passed away during those same years, 119 names on the list now, each written in my own hand with a single sentence describing them. Years ago, I thought that down the line I would need this prompt to remember them, but it turns out I don't. They are sacred memories from a lifetime spent in this office. Within this box lies the meaning I have found in my work, and I realize that the essence of this meaning comes from a certain kind of healing that was mutually exchanged with many of those patients. Many of my current patients have been with me for more than a quarter of a century and I realize now that no matter how much I have tried to give to patients, I have received at least as much in return.

Much has been written about physician wellness in recent years and more and more the search for meaning in our daily work has been recognized as a primary driver of physician well-being. As we dig deeper into what creates a sense of meaning in our lives as physicians, perhaps the key is healing. By this, we typically mean healing our patients, but if we're honest we often are most connected to our work when we receive healing ourselves.

What is healing? It's almost trite to talk about curing versus healing nowadays. Hopefully, we understand that when our patients are sick there are two processes present: there is disease ‒ a disruption of body function, and there is illness ‒ how patients experience disease, how it disrupts their lives. We increasingly recognize that curing or controlling disease is only part of our calling as physicians. It is incomplete if we ignore healing. Healing calls on us to give something of ourselves to others, a part of our heart, even if sometimes it’s just as simple as listening.

Authors have described healing as the “attainment of inner peace,” or, “a reclaiming of wholeness.” Saki Santorelli wrote that healing occurs when “we feel connected, whole, filled with a sense of belonging no matter what the condition of our body.” But I think it’s best described by Daniel Sulmasy who notes, “Ancient people readily understood illness as a disturbance in relationships… Illness disturbs more than relationships inside the human organism, it disrupts families and workplaces and shatters pre-existing patterns of coping.” He emphasizes that in ancient cultures, people were also keenly aware of the importance of the relationship between human beings and the cosmos. The task of the ancient shaman was to heal by helping the ill restore these disrupted relationships. Perhaps that is our task as well, both within, and beyond, our work as physicians.
In the long lineage of medicine, only recently has the application of science almost entirely displaced the practice of healing in our “encounters” with patients. Curing takes less effort, less time, less thought and patience than healing, but this emphasis was not always the norm. The roots of our proud history saw healing provided through shamans, curanderos, mystics, and ancient priests who with limited scientific tools knew that healing and curing are inextricably linked rather than two separate processes. Later, care by physicians, hospitals, and other organizations was often led by religious and charitable organizations that saw the need for healing of the heart as critical as the need for curing the body. This heritage of healing is becoming less and less recognizable in an era when the economics of healthcare hijacks the agenda, an agenda that too often sets aside the urgent call for healing. Anyone who really works with patients knows intuitively that we derive meaning from the healing process, both as givers and recipients, and when that is lost, so too is our sense of fulfillment and calling.

In that box in my office, on that list of patients who have passed away lies the name of patient #76. She was one of the first patients who trusted me when I opened my little practice all those years ago, and we were about the same age, just kids, back then. We grew older together along with her lupus in those next two decades before she unexpectedly died. She was a friend as well as a patient and I pray that in those years I offered her some help with healing. I know that like so many other patients, she gave me many gifts, one of which was a certain kind of healing that comes when we as physicians come to terms with our own humanity and mortality, with the limitations and imperfections that are part of our work. Healing is always possible. Even for us.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted March 2024
by Dr. Matthew Masters

Groundhog Day

In the 1993 film, Groundhog Day, Bill Murray plays “Phil,” a local weatherman who is obnoxious, self-centered, and entitled. It’s February 2nd and he must cover the Groundhog Day celebration in Punxsutawney, PA. “Punxsutawney Phil,” the groundhog, will predict how long winter will remain. Phil and his crew get stranded there by a winter storm and must spend the night. He wakes up the next morning and it's “Groundhog Day” all over again. In fact, every day from there on out is Groundhog Day. He meets the same people, the same things happen, and so begins a slow descent into desperation.

At first, it's kind of fun. He eats too much, he drinks too much, he seduces women, he takes all kinds of physical risks with no consequences. He wakes up the next morning and it’s Groundhog Day all over again. Over time he notices that there is no continuity in his interactions with others—he is not connected to them. Each day he must go through extraordinary efforts to re-establish his connection to them, but always with the goal of self-gratification. He sets his sights on seducing his producer, played by Andie McDowell, and fails repeatedly. He soon wearies of the endless boredom and desperate sameness of his life. He becomes suicidal and tries to take his life several times. No matter what he does he cannot kill himself. He awakens the next morning and it starts all over again.

One of his ploys in attempting to seduce his producer is to learn about everything she is interested in. This also fails, but it changes his course somewhat and he begins to study music and ice sculpture for his own edification. He experiments with service to others, and he is very moved by the death of a homeless man that he has tried to support and nourish that day. He recognizes the impermanence of life and the inevitability of death for everyone—except himself. He begins to use his talents to perform selfless acts of service and this eventually breaks the spell of Groundhog Day. He is returned to the status of mortal man and, of course, he gets the girl.

He has had a spiritual awakening which resulted in liberation. A series of experiences created a moment of clarity which put him on a path toward a different view of life. This is precisely the goal of 12 step recovery as it is contained in the 12th step: “Having had a spiritual awakening as a result of these steps, we tried to carry this message to others and to practice these principles in all of our affairs.” Addiction Medicine is one of the few areas in medicine where a “spiritual awakening” is an indicated form of treatment.

Alcoholism and addiction are real examples of “Groundhog Day.” The disease progresses through 3 phases: fun, fun with some problems, and just problems. Some patients begin to seek treatment in phase 2 if they are lucky, but most don’t come into treatment until they are solidly in phase 3. By then, their lives are a daily round of: chasing booze or dope, lying, cheating, stealing, manipulating, and committing criminal acts to get the money to do the dope. The first thing they lose is their dignity and self-respect. As the disease progresses, they have increasing problems in one or more of the following areas: romance, finance, health, family, work, or the legal system. They become increasingly isolated by: their use of the substance—they definitely don’t drink or drug like other people; their shame; and their increasing isolation from those who have been hurt by their conduct. They become desperate.

The antidote to their desperation is hope and hope is an acronym, it stands for: Hearing Other People’s Experiences. Their profound loneliness is transformed into connection with those in the 12 step program who have shared their experiences. Their sober peers now lead functional lives—free from the domination of alcohol and drugs. There is a cost, however, and that is hard work. They must work the 12 steps.

The 12 steps can be arbitrarily divided into 4 phases: the recognition that their “drug of no choice” is a malignant higher power, and they define a benign higher power that can displace it and restore them to sanity; confession; helping others by continuing to practice the tenets of the program. These steps are the action steps, and they require hard work. Steps 6 and 7, however, are the mystical steps of the program which only require the patient to become willing to have the higher power remove his defects of character.

For the most part, alcoholics and addicts don’t get a lot of good press, stories often ignoring the potential for recovery. Drinking and drugging can lead to wholesale destruction, but a lot of people don’t get to see what I get to witness with recovery: peace of mind, a functional life, restoration of family ties, and a release from “Groundhog Day,” all contingent on maintaining this spiritual awakening.

Special thanks to my mentor, Bob F., for suggesting that I watch “Groundhog Day” again as he feels it is the most spiritual movie he has ever seen.

Matthew Masters, MD
Dr. Masters is an Addiction Medicine specialist.
He serves on the TCMS Physician Health and Rehabilitation Committee.
Contact Dr. Masters here.

Submitted February 2024
by Dr. Brian Sayers

The Dump Truck

It doesn’t sound very compassionate, so don’t tell anyone, but I go a little bit crazy sitting with a loved one in the hospital. I get restless and irritable, even when everything is going well. It’s ironic because I spent so many years caring for patients in hospitals and only occasionally felt impatient then. Maybe it’s a complete loss of control in an environment where I used to be able to pretend I had at least a little bit of control as a physician. It’s hard to watch someone you love struggle, but also, if I’m honest, it’s... really boring. It’s sort of like the opposite of dog years ─ instead of time being accelerated, it comes to a crawl, at times seemingly to a complete stop, at least relative to the speed my anxious mind is racing. And so, I’ve been thinking about patience lately.

Patience is, “the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.” Impatience is, to paraphrase psychologist Tara Brach, to be at war with yourself. It is to react to loss of control, lack of acceptance, to be unable to slow down. Patience has three domains: patience for life circumstances, patience for challenges in relationships, and patience for the countless trivial hassles of daily life. Studies teach us that patience has measurable benefits for our mental and physical health, yet it’s a virtue that too few of us successfully cultivate.

Our world does not encourage patience. Almost everything around us is designed for efficiency and speed. There aren’t enough hours in the day for all we think we need to do and being trapped in a line, or on hold, waiting for test results, or a patient to be ready in the OR, or a child to finish eating breakfast before school ─ anything that makes us wait ─ are reminders that we are not always in control. When busy days depend on the speed needed to keep up with our expectations, as one author notes, “…very soon we cannot recognize anything or anyone who is not traveling at the same velocity as we are.” Sailing past them, we leave these people and moments in our dust.

There are ways to cultivate patience. Even rudimentary mindfulness techniques can be helpful. Specifically, when you feel yourself getting impatient, simply stopping and realizing that you are being impatient ─ naming it ─ helps neutralizes it, but also reminds you to follow practices that help you through those moments. Breathing exercises are an essential ingredient to cultivating patience. Breathing exercises, as an independent practice or as an integral component of meditation and yoga and other practices, is a simple strategy used through the centuries. Cultivating practices like yoga, meditation, journaling, prayer, time in nature, that you can regularly practice, requires a certain discipline that most of us lack, but are pathways to cultivating patience and given a chance, also sets us on a pathway to slowing down and becoming more connected with the fullness of life ─ the people and the world around us.

When my 2-year-old grandson comes to visit, with just a look and a point that is familiar to both of us, we immediately embark on our routine. There are several stops ─ the castle, the cars, the cookies that we sneak in the pantry. Our next stop is the far corner of the den and the antique wooden toy box. He directs me to sit in a tiny toddler’s chair just inches away while one by one he pulls out dump trucks, cars, nerf balls, transformers, and Barbies one at a time, showing me each before he deposits them in a nearby brass trash can. After going through the many toys, he waits for me to tell him to move the things back to the box. He could do this forever and strangely, while I can’t sit in a hospital room for more than 30 minutes without going nuts, so could I. Suddenly anything more than 10 feet away from us disappears. I am entirely focused on him and the dump truck he holds in his hand, and, for the moment at least... I am patient and at peace.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted February 2024
by Dr. Brian Sayers


If you are a child of the 60s, chances are your mother or grandmother made some of your clothes from scratch. They would go to a fabric store, look through the hundreds of small packets of printed sewing patterns and select their next project. The patterns were sheets of thin tissue paper containing outlines of how the fabric should be cut, with instructions on how to piece them together. My mother dabbled in this when I was young and while she is an accomplished woman, sewing was definitely not her forte. I remember some of the shirts that she made ‒ buttons often not quite lining up, sleeves not quite the same length, too short in length, too loose
across my small shoulders. But one piece she sewed is part of my origin story in medicine.

Around the time I was in first grade I watched the melodramatic medical show, Dr. Kildare, each week, watching the dashing young intern look deeply into the eyes of his patients, hold their hands and in less than an hour elicit miraculous cures. More importantly he was an inquisitive, sensitive, healing presence, and watching that show caused the six-year-old version of me to know that I would be a doctor.

My mother sensed this and found a pattern, Simplicity pattern number 4714, a themed set of pajamas, and made me an intern's smock, even stitching a crude caduceus over the left breast. I shamelessly wore this to school more times than I can remember during first grade. At that point in my life, it wasn't that I wanted to be like Dr. Kildare, I actually was Dr. Kildare. Looking back, it was pure, innocent, naive and, yes, it was figuratively and literally simplicity. Such was my pathway into medicine.

I’ve been thinking about this origin story lately. More than three decades into practice, a few missteps along the way, I still love my work, look forward to going to my small private practice each day to see my patients, our staff, and my office partner, but more and more lately I wonder why things have gotten so hard, so complicated. My career in rheumatology has seen almost indescribable advances for which I am grateful and in awe. So how is it possible that the same system that makes it possible to cure diseased bodies can create so many obstacles to our ability to bring healing to the souls who inhabit those bodies…and to keep the healers whole? You know exactly the obstacles I’m referring to, frustrations and hurdles that we endure ‒ and seemingly accept ‒ most every day in our work even as we try our best to care for our patients and maintain passion for our work.

As a profession, we are lost if we do not continually reexamine foundational things that make us and our profession what it is at its best, foundational things that we hold dear that called us to make the sacrifices it took to become physicians ‒ core beliefs and longings that enable us to treat patients with dignity and great care. Calling, values, the need for meaning ‒ the sort of things that we must discern and honor as individuals and as a profession, even as the importance of these is so seldom tangibly emphasized and modeled by powerful forces that increasingly control our workplace. What if we refused to work for organizations that don’t share, or let us honor, what we hold as precious, if we refused to be spread too thin to be able to properly care for our patients and ourselves, if we refused to work with that insurer that forces us to compromise care? The fact that we are often reluctant to make those hard choices threatens us as a profession and as individuals.

In his seminal work, Crossing the Unknown Sea: Work as a Pilgrimage of Identity, David Whyte writes, “We have our work now, a work that was formed in the growing imagination of the child we once were, but the work itself has changed and made us, formed us, into something different, something perhaps good but also disturbing at the same time… distant now from all other voices that crowded our childhood, try to imagine what that dreaming young self would think of the strange adult we have become.”

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted January 2024
by Dr. Richard DeBehnke

The Calculus of Giving

Over the las few weeks, due to an unexpected illness, I‘ve had to move to the other side of the exam table. Things are moving along, and I am doing well. But a lot of weird things start to happen when a doctor becomes a patient. The paradigm shifts as if a mirror is being held in front of you. All those patient-doctor relations we are so familiar with: developing trust, how to frame your message, body language, flip and the whole encounter starts to lend itself to some interesting introspection. I also realized I truly missed the interaction with my patients and tried to better understand why. What I decided I was missing was what I call the calculus of giving.

We find ourselves in the Christmas season but all through the year, and in all of our faiths, there is the tenet of “the giving hand is better than the receiving hand.” Generosity, charity, giving freely without the expectation of return is lauded.
In our profession we are called caregivers, and we are daily asked to give─give our time, give our expertise, share our compassion. Demands are high, hours are long and what we miss in the lives of those that surround us subtracts further. Burnout is common and efficiencies promised are years away from being actualized. But being forced to step away from the daily fray has helped me realize the wonderful gift we are presented with every day: the opportunity to help.
Think of yourself. How often do we avoid, decline, or ignore when help is offered, even if it is by someone near who perceives us as needy. That word implies fragility or weakness. Ask for help? How reluctant are we to “impose”? The reply is usually “I’ve got this!” “No thanks.” “I don’t want to be a bother.”

But they are, every day, our patients. Many in number, frustrating at times and perplexing in others, all lined up, an unlikely assortment of Magi waiting outside your exam room rather than outside a manger, waiting patiently to fill up your emotional needs of having purpose and making a difference. Voluntarily opening up with their secrets, exposing their fears, allowing invasion of their personal space, and for our surgeons, their very bodies. Trusting us and listening to us. When was the last time someone at home really listened to you, or were they just waiting to talk?
At the end of the day who, in this calculus of care, has benefited the most? What we do is important, we are good at it, but it is exhausting, and it can be overwhelming. But as givers ─ caregivers ─ we need to be thankful as well. Thankful that we are given a chance to help. Thankful that, for whatever reason, they have placed their trust in us.

By nature, humans are needy, and I now believe that our exchanges with our patients leave us much the richer as they fulfill our needs. I knew I needed to recognize these gifts and ask for the humility and grace to appreciate them. At the end of a visit, it is not unusual for our patient to stop at the door of the exam room and thank us. Maybe we should be thanking them.

Take it from me as someone who had to ask for a lot of help from a lot of people recently…. YOU’RE WELCOME. Welcome to my gratitude, welcome to my trust. As doctors we work hard to earn these gifts. Give yourself time to appreciate them.

Dr. Richard DeBehnke
Contact the author with comments here.

Submitted January 2024
by Dr. Brian Sayers

The Fourfold Path: Telling the Story

Each time one of our colleagues accesses our Safe Harbor Counseling program we ask them to fill out an anonymous evaluation form. We get a lot of feedback, but near the end of last year we got one remarkable testimonial that in part read, “My sessions are incredible. I started therapy because I felt lost and frustrated... now I find that the anxiety and fear that held me back are rooted in past experiences that I was never able to unpack.... Talking about these parts of my life reveals patterns in my behavior. I feel like a massive transformation is taking place...”

Among other things, what I believe our colleagues often describe involves both discovering and telling an untold, difficult story, naming the hurts that lay within that story and, in the end, writing an entirely new story. It was a great blessing to read this testimonial and coincidentally came at a time that I was reading the Archbishop Desmond Tutu’s “The Book of Forgiving.” In this book, which contains life changing lessons, Tutu describes the path to forgiveness using the “Fourfold Path.” In the often long, complicated, and liberating road to forgiveness of self or others, of recovering from trauma, the four components described are: telling the story, naming the hurt, granting forgiveness, and renewing or releasing the relationship.

Telling the story is a critical first step on the road to forgiveness or recovery from trauma. Not just telling yourself the story, but literally telling it out loud to others, to trusted friends, colleagues, family members, or a counselor. Importantly, it involves telling the story several times as retelling the story gradually reveals detail and perspective, clarifies facts, and makes feelings related to the event more tangible, easier to deal with. Tutu notes “Even if I intellectually know that it is through my story and its telling I will begin to heal from trauma, it is not always easy emotionally to take the first step… But when we lock our stories inside of us, the initial injury is often compounded.”
One of the most important things we can do for each other is to be approachable and available to hear these stories, even when they are difficult to tell and to hear. Since early in the PWP counseling program, I have been approached by colleagues facing challenges, sometimes even trauma, in their professional or personal lives. Many have carried the weight for months, even years, afraid or ashamed to share their very personal story. Whether they knew it or not, their soul cried out for a chance to tell their story, to name the hurt, and to begin the process towards healing, the process of releasing the past. Our job as a community that cares about each other is to make sure they have a safe, trusted outlet to tell their story, with us or a counselor. Tutu notes that we cannot avoid suffering and trauma in life but what we can choose is how we will respond, “…whether we will let this suffering embitter us or ennoble us. How do we allow our suffering to ennoble us? We make meaning out of it and make it matter.”

In each of our lives there are times of great joy, of love, family, friendships, and meaning. Just as surely, life inevitably brings challenges and times of suffering, times that require us to tell our story in order to reclaim wholeness. When I was too young to understand, my father and our family suffered with his alcoholism and his untimely death caused by it. Looking back, I can see how it negatively influenced my life until I finally realized while in medical school what had happened to him, and to us, and much later, through telling the story of my adolescence I was able to forgive him and those around him who I assumed had failed him. My college roommate, on the brink of a promising life, was lost to suicide, and it was not until well into middle age, having finally told the story during my years in seminary, that I was able to forgive myself and forgive him. As Tutu notes, “We are not responsible for what breaks us, but we can be responsible for what puts us back together again…how we begin to repair our broken parts.” So much wasted suffering in those years until I was able to release the past, finally able tell a new story, to turn it into something with meaning, to find a place for it in my heart. For those of you who are in need, I wish the same for you.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted December 2023
by Dr. Brian Sayers

A Train in the Distance

In preparation for a class I’m leading, I reread The Book of Joy: Lasting Happiness in a Changing World, a wonderful collaboration between the Dalai Lama and Archbishop Desmond Tutu. One section in the book focuses on the “eight pillars of joy.” The first four qualities are the pillars of the mind: perspective, humility, humor, and acceptance. The other four are the pillars of the heart: forgiveness, gratitude, compassion, and generosity. All eight pillars are important but as I thought about it, I realized that acceptance is the very gateway to forgiveness, as well as recovery from trauma, grief, and addiction.

Acceptance is surprisingly hard to fully define, harder still to describe how to achieve. The narrator notes that in describing acceptance, “the Dalai Lama had told us that stress and anxiety come from our expectations of how life should be. When we are able to accept that life is how it is, not as we think it should be, we are able to ease the ride…with all its suffering, stress, anxiety, and dissatisfaction…” Acceptance means fully acknowledging the facts of a current situation or circumstance and not fixating why it should not be that way. He goes on to note, “much of traditional Buddhist practice is directed towards the ability to see life accurately, beyond all the expectations, projections, and distortions that we typically bring to it.” Acceptance, as a practice, allows us to thoughtfully respond, rather than impulsively react.

Two critical concepts about acceptance should be noted. First, “the kind of acceptance that the Dalai Lama and the Archbishop were advocating is not passive. It is powerful. It does not deny the importance of taking life seriously and working hard to change what needs changing, to redeem what needs redemption.” At the same time, many things we accept cannot be changed. Twelve step recovery programs hold both acceptance and thoughtful response for change as core concepts. The very first of the twelve steps is acceptance of being powerless over alcohol. The Serenity Prayer, often evoked at AA meetings, includes: “…grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Second, acceptance allows us to release the past, to set down disappointments, mistakes, or things beyond our control that led us to our current circumstances and turns our focus to the present, to response where needed, to looking forward.

Psychotherapist Amy Morin suggests a four-step approach to acceptance in tough situations: 1) Accept how you feel about a situation. Name the feelings. 2) Accept what is happening right now as a fixed reality. This does not preclude a thoughtful response. 3) Stick to the facts. Try to distinguish the situation from all the emotions that might swirl around it. 4)Acknowledge that you can still have a good life even knowing there will be challenges and suffering along the way. Therapists often use a variety of behavioral therapy techniques to help clients who struggle with acceptance.

Each morning at 4 o’clock, my wife and I are up. She’s had serious health challenges for a number of years, and we reposition and do some other sleepy tasks before dozing off again. We live a little less than a mile from Mo-Pac and there’s a train that goes by every morning right at 4 AM, the faint hum of the train and 3 long, mournful bellows from its whistle as it passes through town, disappearing into the night. It’s close enough to be heard in the quiet, but far enough away that it is deep in the background. I am comforted when I hear it. It always reminds me of a Paul Simon song, Train in the Distance, and a line near the end of the song: “Everybody loves the sound of a train in the distance. Everybody thinks it’s true….the thought that life could be better is woven indelibly into our hearts and our brains.” Simon once explained that he used trains as a metaphor for a hopeful future because they are always looking forward, moving on, leaving the past behind. Acceptance can be elusive. And so, I try to remind myself, each day (or night) that acceptance of current circumstance, the past set aside, is what keeps us grounded and grateful in the present, allowing us to look forward to the future… with hope.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted December 2023
by Dr. Brian Sayers

The Imposter

My first job in Austin, longer ago than I’d like to admit, was with a multispecialty clinic where most of the best internal medicine specialists practiced. It was an intimidating place for a rookie, and I was nervous and self-conscious those first few months. Late one Friday afternoon, I got a call from one of our internists on their way out the door, asking me to see one of their patients before I signed out. It was a difficult problem, the referring doctor was unreachable, and in the end I had to find a surgeon to assess the patient in the ER, this being an era when a good doctor didn’t just send a patient to the ER without arranging care at the other end. The next week we were gathered at Seton for a quarterly staff meeting, and in front of a dozen of my new colleagues, the referring partner berated me for referring their patient to a surgeon they didn’t usually work with. I tried to explain, but they cut me off and repeated the warning, angry and dismissive. I had been scolded like a child and there was an awkward silence as I was revealed to be a fraud, an imposter, who didn’t know how things were supposed to be done. It sounds silly, even trivial now, but at the time it seemed devastating.

Imposter syndrome was originally described in the ’70s as an “internal experience of intellectual phoniness…It is usually witnessed in individuals who seem successful to others, but on the inside, they feel incompetent.” A 2022 study from Stanford surveyed 3000 physicians and found that 1 in 4 experienced frequent or intense impostor syndrome symptoms. The study author, Tait Shanafelt, notes that U.S. physicians are at an 80% increased risk for the syndrome relative to people with a doctoral or professional degree in another field. He notes that in its worst forms, impostor syndrome carries a greater risk of occupational burnout, profound work dissatisfaction, depression, even suicidal thoughts, resulting in loss of effectiveness, personal and professional distress, and loss of meaning in their work.  

While it is prevalent across the demographic spectrum, imposter syndrome was originally described as a syndrome primarily affecting women, and though it can profoundly affect either sex, it may do so in different ways. Dr. Valerie Young, author of The Secret Lives of Successful Women, notes that gender differences that are present in this syndrome are often created by persistent differences in the way society judges men and women, and how they react to it. She notes that while society has often “forced fit” men into a certain definition of success generally measured in terms of money, power, and status, measuring success is often more complex in professional women, especially those with children where there are several success domains at play simultaneously. She describes that women often “have a more layered definition of success… that also includes meaning, balance and relationships.”

There are many strategies for managing imposter syndrome. Dr. Young notes that at the core of them is humility − making peace with imperfections and limitations while recognizing and reinforcing the intelligence, talent, and love that we work so hard to bring to work with us. “I think that’s one of the most important parts of recovering from this…saying ‘I don’t know’ and being OK with uncertainty, which is especially difficult in medicine.” One simple exercise is to put a Post-It note in a prominent spot at our desk that reminds us of the strength, sacrifice, accomplishments, and caring we bring to our patients, even with imperfections. Being honest about self-doubt with close colleagues can be helpful. For some, counseling can be a lifeline that provides much needed insight, perspective, and effective strategies.
I composed this sitting in a church waiting for a funeral to start, my third funeral this year, two earlier ones being close friends who lost long, difficult battles with cancer. For each, there were a couple of weeks at the end in hospice care − in transition − lucidity fading, briefly inhabiting what Celtic tradition calls a “thin place,” a liminal space where Heaven and Earth very nearly merge into one. Ironically, even as I considered death, I was also able to give a prayer of thanks, for in just a few weeks our eighth grandchild will be born. Birth and death − the very bookends of our lives in this world. At each of these extremes, life is distilled to its simplest, most essential elements, our souls laid bare − pure, loved, forgiven. How do all those years in between become so complicated, our expectations of ourselves so distorted, that feeling like an imposter is even possible?

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted November 2023
by Dr. Brian Sayers


Several years ago, I was leading a PWP small group when someone mentioned a study about friendship.  As I recall, it said something about the average number of friends people claimed in a survey. We found this problematic for several reasons, in part because people have all kinds of friends. Commonly listed categories include acquaintances, casual friends, close friends, and intimate friends. That last category, the ones we know and who know us inside and out, are the ones that make all the difference. In his latest book, How to Know a Person: The Art of Seeing Others Deeply and Being Seen Deeply by Others, David Brooks examines what it takes to come to know and be known in this way.

Brooks shares scary statistics that lend urgency to learning these skills: 54% of adults say no one knows them well, and the percentage of people who have no close friends has quadrupled in recent decades. Brook’s thesis is that individually and as a society we have lost our ability to form “deep” relationships in which we know each other on a level that humans need to feel connected and heard. This type of relationship is not achieved without intentional and informed effort ̶ generous listening, curiosity, “accompaniment,” and other skills he outlines. There is equal and reciprocal benefit of knowing and being known deeply that can be life changing: “Seeing someone well is a powerfully creative act, no one can fully appreciate their own beauty and strengths unless those things are mirrored back to them in the mind of another.”

Brooks writes about two distinct types of people--diminishers and illuminators. Illuminators are capable, even equipped, to see through the superficial ̶ to listen, inquire and accompany people in a way that leads to deep understanding, encouragement, and illumination, that they in turn mirror back. Illuminators come to understand the depth of your pain and challenges, but also to see and celebrate your unique humanity and worth, your triumphs, and the gifts that you bring to the world around you that others, perhaps even you, may not recognize. As Brooks describes, “they are people who are just curious about you, and they make you feel lit up."

Of diminishers, he notes, "My theory is that in any group of people, there are some people [who] are diminishers. They make you feel invisible, unseen…. They’re not curious about you. They stereotype you. They label you.” He holds that recipients of this treatment who lack close connection with others often lash out against people around them in violent or otherwise viscous ways that are all too common in our society today.

Brooks notes that the skills evident from the first time you meet illuminators is eye contact that you can tell sees into you rather than through you. They listen, ̶ “lean-in listening” he calls it.  Importantly, they are instantly curious about you and ask you questions. With nurturing, this leads to a relationship of accompaniment−in a sense just hanging out with an ongoing curiosity that may evolve into a sense of journey together, and a deep sense of understanding and connection.

It was not until well into adulthood, even middle age, that I discovered the power of this and the stark contrast that exists between one kind of friendship and another. Three seminal events in my life ̶ time in seminary, a chance leadership training program in a remote village in Ohio as we launched PWP, and a recent pilgrimage ̶ all showed me the power of seeing and being seen deeply, gifted me with new, unexpected, and life changing friendships, but also with new perspective or direction in other relationships. I’m a slow learner, but better late than never. This unique sense of connection and interconnection is among the most powerful things we can hope for in life, an antidote for much of what ails far too many people. It is, in essence, the way to find ourselves truly accompanied by fellow travelers on our uncertain and winding pilgrimage through life.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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* “The training of one’s heart to see the humanity in another.”

Submitted October 2023
by Dr. Brian Sayers


Frederic Hudson championed a theory of cyclic change that recurs throughout adult life. These are life transitions, and some are seismic, deeply desired, and visibly change our life trajectory. More often though, change is subtle, and we don’t always recognize when or where we might be residing on Hudson’s cycle of change at any given time, sometimes creating an uneasiness that we can’t quite put our finger on. Hudson describes four phases in the cycle of change: go for it, the doldrums, cocooning, and getting ready. In the “go for it” phase life seems to be working, there is a sense of purpose, of being on course. At some point though, a certain stagnation inevitably emerges in work, relationships, recreation, or particularly, in spiritual health. Such feelings are inevitable and are the gateway to the doldrums.

The doldrums is an ancient mariner’s term for what is now referred to as the “inter-tropical convergence zone,” a wandering area around the equator where the northern and southern trade winds collide, creating an area where there may be eerily calm seas and no wind for weeks at a time. It was the bane of ancient explorers, whalers, and merchant ships that could be stuck there indefinitely−bored, restless, irritable, anxious. Coleridge famously described it in The Rime of the Ancient Mariner:

Day after day, day after day,
We stuck, nor breath, nor motion:
As idle as a painted ship
Upon a painted ocean.

Sound familiar? In the cycle of change, the doldrums are downtime, a period of decline and malaise, but also as Patrick Williams notes, “The doldrums are meant to serve as a wake-up call, an invitation to restructure or reinvent life so it works again.” So, while the doldrums can be boring, it serves a purpose and is the gateway to the next phase, cocooning.

In cocooning, we enter a phase of transformation. Williams calls it an “emotional time-out to heal, reflect and discover new directions in life.” It may be a long period of sabbatical, or a series of short breaks where we explore what form the process of renewal will take for us and where it might lead. Like the butterfly in a cocoon, it may not look like much, but within the cocoon there is deep work occurring, and with time and patience something new will emerge.

In the days after my father died when I was 12, someone sent us a beautiful letter that I still remember the essence of, though not the exact wording: that with death we enter a cocoon that allows us, like the butterfly, to transform into something more beautiful, eternal, and free of the worries of this life. As a child, it was comforting enough that all these years later I still remember it, and I still think of it whenever I see a cocoon. As an adult, I think it sticks with me because I realize now that, with grieving, a transformation was occurring, as the adolescent version of me prepared for a life altered by that loss. Even then, there were cycles of change.

Significant change is seldom easy, even when urgently needed or forced upon us, let alone when it must be discerned and unfold with uncertainty. The process, even with defined stages, often involves a certain mystery, and gaining something new always requires giving up something old, something that no longer quite works. Indeed, our mental well-being and happiness depend on our perpetual capacity for change, on allowing the process to unfold with humility and patience, on living in the present while imagining a future…on letting the past be the past. The reward is Hudson’s “go for it” phase, where change is realized, acted on, becomes fully visible.

I recently spent a couple of weeks walking the last stages of the Camino de Santiago thru Galacia in northern Spain. It’s an ancient religious/spiritual pilgrimage that ends at the Cathedral in Santiago de Compestelo where relics of St. James rest near the altar. For many, the pilgrimage continues from there westward another 60 miles to Finisterre, where Spain meets the ocean, a place the ancients believed to be the “end of the world.” As you begin your Camino, you’re told to carry a stone, wherein you place your “ghosts,” the things or people you mourn, regrets, things lost along the way, trauma, whatever you need to set down on an inward journey to wholeness, and somewhere along the Camino you leave the stone behind. Discovering your ghosts is an integral part of the pilgrimage. All along the Camino at wayfinding markers you see stones that fellow peregrinos have set down, making room for something new. Finding discernment slow, I held mine all the way to Finisterre, where I went to the edge of the tall cliff below the lighthouse and threw my stone into the sea. What that will lead to remains to be seen…but I am hopeful.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted October 2023
by Dr. Tyler Jorgensen

Lifting Carts

We lived that summer in a tiny A frame house in the shadow of the Teton mountains. It had a front porch, a gravel yard, and an electric stove. I couldn’t have guessed the lilliputian square footage if I’d had to, but I can tell you I could hardly avoid hitting my head on the ceiling of the upstairs loft I shared with two strangers. Trey had the palatial downstairs bedroom to himself…he should’ve, he paid a greater percentage of the five-hundred-dollar-a-month rent. Not only that, Trey had been the catalyst for this whole operation.

A lot of us didn’t really have much direction in life right after college, but Trey had always had one very clear direction—west. To the mountains. That’s where we could find him, and where he was going to stay. By the first winter after college graduation, while Trey was thriving out west, thyroid problems had disrupted my east coast post-college plans. I found myself convalescing in my parent’s home in Houston and working part-time as a substitute teacher, and I was struggling again to find direction. What was I doing with my life? What do I do now? I dreamt often of mountains and gave Trey a call.

Trey must have lied about my wilderness bona fides to his employers at the outdoor school because he landed me a job working alongside him for the summer. What a dream! I had a job, in the mountains, living in a nasty old A Frame with one of my best pals.

There really is nothing quite like driving through the great American West in your twenties. I don’t know that I’ve ever felt more carefree, even though I really had no business working at that outdoor school. I knew far less than our students about surviving for a month in the woods. I didn’t know how to repair boots or backpacks. I could barely handle the stick shift F-350 truck with a trailer full of gear as I transported students across mountain passes in Montana and into the Owyhee Desert of Southwestern Idaho. This was not imposter syndrome—I was actually an imposter!

When we weren’t working, Trey and I would rock climb or hike up into the Tetons or fly fish. He was better at all of these than I was, but he coached me up as best he could. When good bands came through town we’d go see them. Most nights were pretty quiet, though. Actually, really quiet. I would try to get some conversation going, but it often didn’t work. Trey didn’t talk unnecessarily nor betray much emotion. He really was a Western man, cut straight from some tough Clint Eastwood cloth. Trey would sit in his chair after a day of outworking me, outclimbing me, read twenty pages or so of the unabridged Les Miserables, and fall asleep.

Over the summer months my physical and mental health steadily improved, I grew in confidence and outdoor savvy, and I figured out what I was doing at work. I think I even got decent at handling the F-350. As summer turned to fall and the aspen leaves began to yellow, I made a tough decision to move back to Texas to pursue some other opportunities. A number of us were leaving at the end of the summer, but Trey would stay behind. He had always known his direction, and that wasn’t changing now. We shook hands and parted. I couldn’t swear to it, but I think I saw a little moisture in his eyes as he said to me, “It’s been good, friend. Who knows? Maybe next time I’ll be the one under the cart.”

What a strange thing to say. I asked him to clarify.

“You know…in Les Miserables… Jean Valjean rescues the old man from getting crushed under the weight of the cart. He lifts it off of him. Maybe I’ll be under the cart next time.”

I drove off south and east, watching the A Frame and the Tetons fade in my rearview mirror, thinking about Trey’s surprisingly profound farewell. I hadn’t realized just how low I’d been a few months back, and how much my buddy had done to help me out from under that cart of illness and disappointment. I’ve been thinking about his words for two decades now. I am grateful for friends who’ve helped me over the years, especially physician friends who’ve been with me through tough times. I am thankful that in Travis County we have the Physician Wellness Program, a cart-lifting enterprise. If you find yourself under too much weight, please reach out to a friend, a colleague, a loved one, or the Physician Wellness Program. And keep your eyes peeled for opportunities to help lift a cart for someone else.

Tyler Jorgensen, MD
Please send comment to the author here.

Submitted September 2023
by Dr. Michelle Owens

Let go, with grace

the relationships that continue to take more than they give;
the failed ideals of where I should be right now;
imposter syndrome;
And the unrealistic expectations of motherhood in 2023.

Let go, with grace

the judgement from others;
the dreams of an organized Home Edit worthy playroom;
the idea of my kids willingly eating vegetables;
And the societal pressures of what my life should look like. 

Let go, with grace

keeping up with the Jones’;
achieving FIRE (financial independence, retire early) in this decade; 
being the perfect parent;
And all of the things I have no control over. 

Let go, with grace

rocking my youngest to sleep;
the dream of sleeping in late;
the pressures of needing to be resilient;
And the harsh comments of my inner critic.

Let go, with grace

the hurt and trauma of the past;
the grief of what might have been;
the wrong words said;
And the words left unspoken.

Now, let us go gracefully into the future,
holding on to who and what matters most,
all that brings us joy;

And the knowledge that our time is finite so we should choose wisely how we spend it. 

Michelle Owens, DO
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Submitted September 2023
by Dr. John Hellerstedt

Nobody Cares How Much You Know Until…

The recent piece, “Hippocrates Shrugged” brought to mind Theodore Roosevelt's memorable saying, "Nobody cares how much you know until they know how much you care." Now that I am a patient and no longer an active clinician, Roosevelt's observation has become especially cogent. With advancing age, my wife of 41 years and I are shouldering our share of America’s disease burden.

Some of the burden was predictable, some others – the worst parts – came as bolts from the blue. When the news is truly bad, the first thing you want to know is how much your physician cares. You believe they know their craft, or you would not have walked through the door. But now that you are in the exam room, baring whatever needs bared, you need to know if this person’s heart is in the right place.

As I have reached retirement, so have many of the physicians I had been seeing over the past decades. I knew I respected them, I knew I liked them, but I guess I didn’t realize I loved them, for only having to end a relationship with someone you love could explain the aching I feel when I now have to smile and try to make a good impression on a new, typically decades younger doc. I know, stereotyping is a two-way street. I do my best to not to come off as an old coot.

There are great, amazing, truly caring docs out there for sure and I have great optimism about getting to fully appreciate my new physicians. But what saddens and humbles me is that the difference between signaling indifference versus caring requires a mere modicum of clinical technique.
Rational patients—still the majority, one hopes—do not expect to gush forth their inmost souls, but rather, would be set at ease with some simple expressions of empathy, questions about their general life circumstances, and their reaction to those circumstances. We should be teaching the essence of caring made visible to every new generation of physicians, for without that skill, they will fail to reach their full potential as healers, and, I dare say, will not optimally flourish in their chosen career.

Only that personal connection truly satisfies—only that soul satisfaction can make up for all the sweat and anxiety that defines clinical practice.

I am humbled because when I think back to my early years in practice, I remember my faults more clearly than I remember my virtues. To the degree that I improved, many of those lessons were learned the hard way.

I used to be reluctant to engage the patient emotionally, if you will, believing incorrectly that to do so would turn every visit into a Jungian psychotherapy session. I now know nothing could be further than the truth.

There are (professional) shortcuts to empathy: eye contact, handshake, “how’s your day going,” “I’m here to help you through this.” Science tells us that the majority of our message is conveyed without words—primarily through body language. I am proud to say that I never wore a wristwatch in practice, and still don’t. While I was fully cognizant of the time, I didn’t want the patient to see me looking at my watch, which I know I would have done without thinking.

St. Thomas Aquinas said that love is an act of will, not an emotion: to love is to will and act to bring about the highest and best good of another. Honestly, I can’t think of a better definition of what our goal should be in treating patients.
In light of that definition, it is not only possible to love your patients, it is the very practical aim of each encounter. This definition gives me great solace in every dimension of my life, for I truly believe that we are called to love one another without exception. But how can I love someone I don’t even like?
The answer is that when you “will” and “act” to bring about the highest and best good in another person—perhaps especially one for whom you feel no emotional affection—you are obeying the commandment to love. If love were merely an emotion, fulfilling this ethical imperative would be humanly impossible.

Next time you care for a patient in this way, pause and be grateful that human connection is a shared gift in your work. Next time as a patient, when your caregiver expresses their love in this way, express your gratitude for their seeing the humanity in the patient before them. You will have helped each other heal.

John Hellerstedt, MD
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Submitted  September 2023
By Dr. Tyler Jorgensen

Bad Weather

I can’t take it anymore—this heat. It’s making me crazy. My beloved creek is dry. My lawn is brown and crunchy. My grass smells like a harvest festival haybale. Every plant in my yard sags, withered and crispy. Even the cicadas seem desiccated and brittle—they sound like cornhusks in flight! Twice when it has rained recently, the rain has somehow smelled seared coming up off the grass or the pavement.

“There’s no such thing as bad weather, only unsuitable clothing.” Or so Aunt Judy taught me. Judy was always getting us outdoors — paddling down the Brazos River, camping in the great Piney Woods, or even just strolling through Houston’s Arboretum. Summer heat, winter rain, it didn’t matter. Just get outside. I’ve been telling my kids the same thing for about 16 years now, and I generally believe it’s true. Jog in the snow, run in the rain, stay acclimated to the summer heat, journey to extreme environments. Just get outside.

Alfred Wainwright, a British writer, first penned the line about “no such thing as bad weather.” (I don’t think he’d ever been to Central Texas.) Wainwright fell in love with hiking in England’s Lake District in the middle of the 20th century and wrote several books about the region and the pleasures of walking outside. He developed a 190-mile coast-to-coast trail across northern England and inspired other people to get outdoors and enjoy the beauty of the world around them.

One of the benefits of practicing medicine in central Texas has always been our incredible access to beautiful outdoor spaces. We may not have the grandeur of the Colorado mountains, or the perfect temperature of southern California, or the spectacle of the Northeast’s fall leaves. But we have easily accessible canyons and creeks, bountiful greenery and natural springs, varied terrain, rocks for climbing, rivers for paddling. And that’s all within the city! In addition, we are all just a short drive from beautiful state parks and natural areas that help us reset and clear our minds after hard days and nights of clinical work. Had a rough shift? A bad day at clinic? Get outside.

Well, Mr. Record-Setting-Texas-Summer, you have just about beaten Wainwright’s wisdom out of me. My son’s football practices are moved to 6:30 in the morning to avoid the superheated turf, my daughter’s getting heat illness during soccer games, and even the panacea of pool water feels warm and syrupy by late afternoon. We had a deal, Texas Summer. You keep it around 95 to 100, and we’ll stay active and not complain. You broke your promise.
Kudos to all of our colleagues who have stayed active and outdoors this summer. I haven’t. I recently realized that over the past couple of months I have been hiding in air-conditioned spaces whenever I can, and my aunt Judy wouldn't like that. This past week I decided to reclaim Wainwright's philosophy and get back out there. I’ve been on a couple casual hikes this week so far, and I realized two things: 1) There really is a such a thing as bad weather. 2) It may not be as wet and cool as I’d like, but it is still restorative to get outside. And it’s not sooo hot on a shaded trail in the morning.

This week I found another Wainwright quote worth sharing:

“Oh, how can I put into words the joys of a walk over country such as this; the scenes that delight the eyes, the blessed peace of mind, the sheer exuberance which fills your soul as you tread the firm turf? This is something to be lived, not read about. On these breezy heights, a transformation is wondrously wrought within you. Your thoughts are simple, in tune with your surroundings; the complicated problems you brought with you from the town are smoothed away. Up here, you are near to your Creator; you are conscious of the infinite; you gain new perspectives; thoughts run in new strange channels; there are stirrings in your soul which are quite beyond the power of my pen to describe…No man ever came down from the hills without feeling in some way refreshed, and the better for his experience.”

I recognize that he is referring to the green hills of northern England and not to Central Texas in the summer, but I think a lot of what he is saying still applies to us in Travis County. When you are ready, and with water and shade, get outside again. It can be restorative. Just make sure you have suitable clothing!

Tyler Jorgensen, MD
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Submitted August 2023
By Dr. Brian Sayers

Hippocrates Shrugged

I came across an article not long ago about the Hippocratic Oath. Hippocrates was the true pioneer of ancient medicine, and original fragments of the oath attributed to him date back to the 3rd century. Both timeless and a product of his times, the earliest versions of the oath begin by swearing to a variety of Greek gods and goddesses that as a practitioner of the medical arts certain standards would be honored. There have been revisions through the centuries, and the modern version still used in graduation ceremonies dates to 1964. It is long, and if your memory is no better than mine, you probably mostly just remember that it says something about doing no harm.

I recently read the modern version of the Oath again after all these years. I was impressed by the fact that while the importance of scientific gains are emphasized at the very top, the Oath primarily lists the many ways that we hold our patients’ holistic wellness and dignity first and foremost, and how both our service to humanity as well as the meaning and joy we find in our work are derived from being healers. It is equally striking how the current medical environment that we work in, usually controlled by people who have never taken this Oath, makes the things that are of paramount importance in the Oath almost impossible to fulfill at times.

In a busy, overbooked clinic seasoned liberally with meaningless administrative tasks and onerous charting, just how easy is it to honor “…that there is art to medicine as well as science and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemists drug”? How often do the pressures of efficiency make it difficult to "...remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick”? Hippocrates was describing healing here, and it is embarrassing to try and explain to anyone outside of medicine, or to ourselves, how it is that honoring the Oath was allowed to become so difficult, how economics has been allowed to trump values, creating what we now call moral distress.

There was a popular book in the 1950s, Atlas Shrugged. The author, Ayn Rand, derived the book’s title from a reference to Atlas, a titan in Greek mythology who is remembered in myth and imagery as the giant who held the world on his shoulders. In the book, two characters have a conversation in which one asks the other what advice he would give to Atlas if the greater his effort, “the heavier the world bore down on his shoulders.” The other character replied that the advice he would give would be “To shrug.” Though the title is intriguing, I never read the book and It’s unclear whether to shrug means for him to express indifference or defeat to a hopeless situation, or if it means to not give up and to force his shoulders upward against the immovable force. This book title came to mind when I was considering the load that we physicians carry on our shoulders these days trying to honor the Hippocratic Oath that we all swore to in a more innocent time and how even Hippocrates himself might respond.

There is a story about a Zen master teaching someone about Zen over a cup of tea. As he was serving his guest tea, the Zen master holds the teapot over his guest’s cup and begins pouring. The cup fills, then overflows, but the Zen master continues to pour tea into the overflowing cup. Finally, he sets down the teapot and asks, “Now, can you put more tea into the cup?” The horrified guest replies, “No! It’s overflowing.” The Zen master replies by emptying the cup and placing it back in front of his guest. “Now the cup has been emptied and is ready for you to fill it with something new.”

Our lives in medicine are often overflowing, both with things critically important and with things that are utter nonsense. It’s the world we live in and the way we allow ourselves to live in it. Only when we realize this and can empty our cup just enough to make room for things that are essential and true and lasting, things that we swore an oath to, that our lives in medicine might change. As Hippocrates promised, if we act to preserve the finest traditions of our calling we may “long experience the joy of healing those who seek our help.”

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
Send comments to Dr. Sayers here.

Submitted August 2023
By Dr. Lisa Doggett

My transformation from doctor to patient

I woke up dizzy. It was November 2, 2009, two days before my daughter Clara's second birthday. I thought I was getting a cold, and I did my best to ignore it. I struggled to keep up with my usual schedule, seeing patients and teaching students at my small family medicine clinic near downtown Austin. I tried to take care of my kids, preparing snacks, reading bedtime stories, driving them to school. They were two and four years old – not exactly independent.

The dizziness – an unpleasant buzz combined with something akin to motion sickness – was relentless. I kept expecting it to turn into a respiratory infection or the flu, but then I started noticing diplopia and taste changes.
By the end of the week, I was convinced I had a brain tumor. Nothing else could explain my symptoms.

But my MRI didn’t indicate a tumor. Instead, it showed probable multiple sclerosis.

A chronic disease of the central nervous system and a leading cause of neurologic disability in young adults, MS hadn’t even been on my radar (I’m embarrassed to admit). Common symptoms include fatigue, impaired mobility and balance, visual and sensory changes, cognitive dysfunction, mood disturbances, and bowel and bladder problems.

Even though it wasn’t a brain tumor, MS was a shocking – and infuriating – diagnosis. I was 36 years old, and I couldn’t understand why I’d gotten sick. I had no family history, and I practiced all the healthy habits I preached to my patients: daily exercise, a healthy diet, no substance use.
I remembered my first encounter with MS. As a medical student in the mid-1990s, I met a man with progressive MS who was admitted with an intestinal obstruction. He was in excruciating pain and severely debilitated – barely able to move. He must have required round-the-clock nursing care even before he came to the hospital.

I realized that I could end up like that patient. And after I got a lumbar puncture, which confirmed my diagnosis, that's exactly what I thought was going to happen. Two days after the LP, when I should have been better, I got so sick I couldn't get out of bed. I still had dizziness, and I started vomiting. I was weak, exhausted, and so depressed. Unlike many of my patients, I had a supportive family and health insurance – the means to get good care. Yet I felt like my future had just been stolen.

An MS diagnosis can be devastating – physically, financially, emotionally. It often strikes people who are young and healthy. It doesn't discriminate, affecting nearly 1 million people in the US. Its course is unpredictable and random. Overcoming my symptoms and learning to live with the uncertainty that MS created have been among the biggest challenges of my life.

But nearly 14 years post-diagnosis, I’m doing well. My early pessimism was unwarranted. Thanks to advances in MS treatment – and a big dose of luck – I have bounced back after exacerbations. I’ve now been relapse-free for almost seven years. This spring, I finished my first half Ironman triathlon and biked the Texas MS150 for the fourth time.

My memoir, Up the Down Escalator: Medicine, Motherhood, and Multiple Sclerosis, will be published on August 15, by Health Communications, Inc. The book chronicles my transformation from doctor to patient while directing a clinic for people without private insurance. Writing it was fun and therapeutic – an outlet for my frustrations with MS and with the inequities of our dysfunctional health care system. But finding an agent and publisher was arduous – and took nearly eight years. After so much time, I am extra excited to be able to share this story with the world.  
I still resent MS, but I’ve emerged wise, stronger, and more grateful because of my illness.

And I’ve realized that MS – or nearly any chronic condition – isn’t an excuse to stay home and cancel plans. Instead, MS is my launchpad to achieve big dreams: getting scuba-certified, hiking the Inca Trail in Peru, publishing my book. I’ve learned to focus on my abilities and strengths – and to push my limits, embracing a new mantra: Do more – more of what brings joy, adventure, magic, novelty, meaning, connection. And do it now.

Lisa Doggett, MD
Contact the author here.

Submitted July 2023
By Dr. Brian Sayers


A story, or perhaps a legend, about Ubuntu: An anthropologist passing through a village proposed a game for children in an African tribe. He put a basket full of delicious fruit near a tree and told them that whoever got there first won the sweet fruit. When he told them to run, instead, they took each other’s hands and ran together, then sat and passed the basket around for all to share. When he asked them why they had refused to race ahead of each to claim the prize, they said: “Ubuntu. How can one of us be happy if others are sad?”

Ubuntu, a Zulu term, concept and philosophy with a long history, was championed by Archbishop Desmond Tutu and Nelson Mandela during and beyond the years of struggle in South Africa. Mandela once summarized the many interpretations of Ubuntu as, “the profound sense that we are human only through the humanity of others; that if we are to accomplish anything in this world, it will in equal measure be due to the work and achievements of others.” It is a concept worthy of each of us considering.

Medical societies from the national level, all the way down to the local level, have struggled in recent years to maintain membership, to convey their relevance to members in tangible ways that must evolve with our profession and the challenges we each face. In many ways, TCMS like other medical societies, claims relevance by what we do together, not just for our profession, but also for each other. This week, as we do each quarter, we celebrate what you have all done to help each other through the Physician Wellness Program and its Safe Harbor Counseling Program. Each of you reading this is part of this project, by financially supporting the program, contributing to our Sunday emails, by referring colleagues to the program, or checking in with them or supporting them in other ways. Your TCMS membership makes you a part of this.

Take a minute to study the second quarter donor list and the program statistics and feel proud of what we do for each other. As Ubuntu is sometimes translated, “I am, because we are.”

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted July 2023
By Dr. Brian Sayers

The Crawlspace, the Junk Drawer and Other Scary Things

It started as a simple repair job. A couple of wooden planks of siding showed signs of rot outside of our kitchen. I called a trusted contractor. Replace a couple of planks, match the paint and a couple hundred bucks later all should be fine.

Right? Well, it’s a 90-year-old house and it is never that simple. The three-month odyssey that ensued involved lifting that whole side of the house, replacing major support beams which in turn stressed our entire kitchen, cracked granite counters, affected plumbing, etc. etc. In the end, what started as a simple carpentry job ended with major renovations. I finally had to bar the contractor from exploring the crawlspace any further. There is just no logical end to what additional horrors he might find. Most of these painful repairs and improvements are entirely invisible unless one were to extensively army-crawl under the house to inspect the magnificent new beams that adorn the crawlspace.

Weeks later, most of the nightmare and clutter are behind us but for one very visible remnant. Purposely placed in a room we seldom inhabit, it sits on an ottoman in the living room, far enough away that I don’t have to deal with it but still catching my eye as I pass by, taunting me. Yes, it is the kitchen junk drawer, displaced during the renovation, its mother cabinet now resting in demo heaven. It is an orphan now, wanting attention, and it is no longer easy to ignore.

Every household has at least one “junk drawer,” and I’m betting you have more than one. This is where we toss the things that were once necessary, but now we don’t quite know what do to with them. I mean, they might be necessary, perhaps even essential someday, but in my heart, I know…probably not. But maybe.  I’ve glanced several times, even discarded about half of it late one night, but it’s a bottomless pit. Batteries (used?), a dozen keys to locks that probably don’t still exist…but might. Hair clips we used to put in our daughters’ hair as they ate breakfast or as we hurried out the door almost late for school. Bread wrapper twisties, super glue in various states of decay, and on and on. A drawer full of things I don’t want to deal with.

Why am I still thinking, even writing, about this? My preoccupation with what still lurks in the crawlspace is well founded, I think. But also, I’m reminded of past readings about Carl Jung and our shadow−that archetypal figure that lives in the unconscious and possesses “everything about ourselves we find shameful or scary and not ready to face,” something writers often describe as lurking in our subconscious basement or under the bed. Perhaps, but in this case, I think it has more to do with 90-year-old wiring I don’t want to confront rather than my shadow, though both could probably use some attention.

The junk drawer? Just google the psychology of that. There are countless articles, blogs, images, videos, even entire books exploring this.  As author Jeremy Berg notes of junk drawers, “We do something similar with our spiritual life. We are constantly accumulating feelings, experiences, wounds, doubts, conflicts, and questions, and we don’t quite know where to put them. Many of these don’t fit into our preferred life script, and so they begin piling up in some deep and hidden place in our soul.” For this, maybe some honest help from spouse or friend, or a week on a beach, a weekend in Vegas, or perhaps, time with a therapist to reclaim some insight, perspective, and peace.

Or maybe it really is just an old house and a junk drawer.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
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Submitted June, 2023
By Dr. Brian Sayers

The Bear

In a recent episode of the TV show Lucky Hank, Hank and his wife are entertaining his not-so-beloved academic coworkers. Table talk is degenerating, and to change the tone of the conversation Hank's wife suggests a table game. She asks each person to give their two “happiness numbers,” the first one being their “percent happiness,” the second number asking how low that happiness number would have to get before they would make real change in their lives. The game was a terrible idea for a party, but it made me think: these last few years, the threshold for change for many of us has changed, often, but not always, for the better.

We have seen many versions of change around us, and you likely went through some version of the process yourself these last few years. Many of these transitions were admirable and involved careful discernment and often no small amount of sacrifice and courage. Reimagining work and changing an unhappy practice situation or career direction, taking a sabbatical from practice to catch your breath, cutting back days or hours to be more present with family, shedding a bad habit or bad relationship are frequent examples.

For many, there were other changes, often for the better but sometimes not as well thought out − pandemic pets, retiring early, or the greener pastures of a vacation home or moving far away. Many, if not most, share something in common − leaving something that makes us sad, or anxious, or unfulfilled in search of something better. Like some of you, over the years I have made my share of missteps in seeking change. But in the moment, in real time, how do we tell the difference between necessary change and just running away? We are, after all, hardwired to run away from things that threaten us.

In his cautionary essay, Wherever You Go, There You Are, Jon Kabat-Zinn explores the human tendency to run away. “The romantic notion is that if it's no good over here, you only have to go over there and things will be different... Change the location, change the circumstances, and everything will fall into place; you can start over and have a new beginning.” But he points out “you cannot escape yourself, try as you might...” He calls on us to consider that true change comes from the inside rather than from changing things on the outside, even when it is easier to run. Sometimes, that means standing our ground.

David Whyte describes it in another way: “Wanting to run is necessary, actual running can save our lives at crucial times but can also be extremely dangerous and unwise, especially in the presence of animals that are bigger, faster and more agile... In the wild, the best response to dangerous circumstances is often not to run but to assume a profoundly attentive identity, to pay attention... and not to assume the identity of victim.” Standing our ground, confronting perceived threats, resisting the urge to flee, is sometimes the hardest work we face as adults. But when it is time to run, the key, I think, is to make sure that we are running towards something and not just away from something.

Restless in that first year after the shutdown, I found myself in Colorado for a few days of hiking, hoping in vain to briefly forget the pandemic. One gorgeous fall afternoon, a few miles from the trailhead I came around a bend and found myself not more than 20 feet from a black bear. Both of us froze. I tried immediately to recall the recommended response to this situation, and based on that highly flawed recollection, I stood very still, made eye contact with the bear and… sang. Somehow, I thought there was supposed to be talking or quiet singing, though where I got that notion, I have no idea. There was a Bob Dylan song, Don’t Think Twice, It’s All Right, that I couldn't get out of my head that day, so I quietly sang to the bear… or maybe to myself. The bear stared at me for a solid minute, then turned and trotted off. Perhaps the defining moments in our lives are when we make a stand and when we run away. Admittedly, it was more paralysis than bravery, but in that moment, I was just fed up enough with bears and pandemics that I continued my hike, even with the sure knowledge that there are more bears in my future.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program
Send comments to Dr. Sayers here.


Submitted June, 2023
By Dr. Tyler Jorgensen

Jerry’s Place

During my fellowship in palliative medicine I have learned the value of home visits. I learn more about my patients’ lives in two minutes of seeing their homes than I could in a lifetime of clinic visits. During home visits, I get to pet dogs, touch quilts, study photos, and admire charming heirlooms that would fetch only a few dollars in a garage sale, but that in these homes are priceless mementos. Just as often, I bear witness to the mess, the filth, the foul smells, the poverty, and even the loneliness and despair. Regardless of whether I like what I find in a home, at least it’s honest, and it always helps me understand how to best care for a patient.

Driving out to Jerry’s place west of town for a home visit was an ordeal. We wove along roads that progressively narrowed—paved, then gravel, then dirt—dodging dogs and loose livestock all along the way. Jerry’s friend met us and walked us down a path to the old aluminum shell of a trailer where Jerry was staying as he battled lung cancer. I’ll be honest, I wasn’t too surprised to see an old confederate flag on the wall in this sad, stuffy space. Confederate flags are still fairly common in small town Texas. Mixed in with the flag I saw some more artful tapestries, but the faded colors of Dixie still popped.

As my eyes further adjusted to the dark inside of his hot trailer, I scanned the clutter and found jumbles of pill bottles, half-consumed bottles of Ensure, flies feasting on food that Jerry hadn’t touched. Then I saw Jerry himself, a specter lying in the dark, and his body revealed instant clues to the severity of his disease—labored breathing, gaunt features, the exaggerated convexity of his chest, each rib so distinct with no muscle or fat left to cover them. Sweat dripped off his pale body as he cried in pain.  

We got him some of his pain medication and quickly made the decision to call 9-1-1. He clearly needed immediate attention and was not yet ready to embrace the finality of hospice at home. He was among the sickest patients I’ve ever seen outside of a hospital. I caught myself staring.
After some long spellbound moments I forced my gaze away. As my eyes drifted up from his ribcage, I saw something equally as sick as Jerry’s lungs—a full-size swastika flag on the wall right above his bed. I had missed it at first, but there it was. Crisp and clean. A freshly made, recently purchased SS swastika flag. This was no historical artifact—this was an endorsement. Now I started to feel sick.

In 2023 we still hear some who defend flying the Confederacy’s Stars and Bars, as hurtful as the flag is to so many, but there’s no debate that a swastika represents hate, antisemitism, evil, and white supremacy. The ceiling of this nasty old trailer had just gotten a whole lot lower; I felt as if the walls were closing in.

A question has echoed in my head ever since that day. How should I handle the tears of a Nazi? I had recently been reading some of the essays of the Trappist monk Thomas Merton who dealt regularly with questions like this. Merton wrote that, for him, empathy came from an understanding that his own faults and shortcomings were as great as anyone else’s. He believed that, deep down, he was capable of any of the monstrous depravities he saw in his society and in the world at large. To Merton, the fact that he had not traveled down certain dark paths was merely a reflection of God’s grace, not his own superiority. He must therefore extend love to all persons.

Beyond that, Merton felt a responsibility to engage with the societal problems of his times. He didn’t like that he had to deal with the realities of Auschwitz, Hiroshima, and Vietnam—all of which happened during his lifetime—but he felt he had no choice. These were the times into which he was born. He didn’t get a pass, and neither do I. I have to find my role in the midst of this messy society. On that particular day, in my capacity as this man’s physician, my role was easing the pain of a neo-Nazi.

EMS arrived, and we escaped from this rectangle of sadness back into the bright Central Texas sunlight. How should I handle the tears of a Nazi? As his physician, I should handle them the same way I handle the tears of anyone else. I should wipe them, and I should do my best to alleviate his suffering. Even when I’d rather keep my distance.

Tyler Jorgensen, MD
Send comments to the author here.
A previous version of this essay appeared in the author’s Substack newsletter, which you can find, along with other stories and essays, at Crash Cart Campfire.

Submitted May, 2023
By Dr. Thomas Vetter

Dead Horse Point: A Dandy Spot to Rest in Peace

The Grand Canyon of the Colorado is a magnificent place. Words struggle to do the aptly named chasm justice. If my experience is an indicator, the conjoint human eye and brain cannot fathom its magnitude. I recall upon first entering the rustic, timbered lobby of the Grand Canyon Lodge, perched atop Bright Angel Point on the North Rim, I mistook its south-facing, floor-to-ceiling windows to be a triptych of trompe l'oeil paintings. I had to walk outside, onto the lodge’s sun-drenched, Kaibab limestone terrace, to convince myself to the contrary. It is ten miles across—as lucky golden eagles get to soar—from rim to rim.

Like the Grand Canyon, Dead Horse Point State Park in Utah is one of the most sublime places on Earth. It sits on a windswept, polychromatic desert mesa, 2,000 feet above the Colorado River. From its dizzying verge, easily reached via Utah State Route 313, aka Dead Horse Point Mesa Scenic Byway, you look down on a huge bend—geological gooseneck, incised meander—carved out by the same erosive force of the Colorado River.

The vista from Dead Horse Point comprises an area the size of Massachusetts. The photographs I captured one splendid autumn midday confirmed that from its highest vantage point, you can see the curvature of the Earth. This sight and perspective might have prevented Christopher Columbus’ pre-performance anxiety, plus his oceanic navigational “yips” and “twisties”—but would not have spared the indigenous peoples of the Americas from genocide.

Traveling to Dead Horse Point feels like a journey to the ends of the Earth. Dead Horse Point is one spot where I am thinking of having my ashes dispersed after I die—my end of days. Other options for my final resting place include the medieval castle ruins in Najac, France, and clothing optional Anse du Gouverneur on Saint Barthélemy in the French West Indies.

I never really thought about it—until just now—how apropos it would be to have my ashes dispersed in the far reaches of a place called Dead Horse Point State Park. I envision my three beloved daughters driving a high ground clearance, 4x4 SUV from the adjacent Canyonlands National Park, by way of an old uranium road, into the lower level of the state park. Or perhaps instead, departing one fine October morning from the boat ramp located at the end of Potash Road on the outskirts of nearby Moab, and meandering under azure skies, along the Colorado River, lined with golden cottonwoods, until the three sisters reach the monumental gooseneck in the river.

Oh! One last father’s favor. My darlings, besides avoiding any forecasted rainy day, while you are at it, lay me to rest far above the river water’s edge. I do not want to end up, the following week, floating down river, through the Grand Canyon, and into the Gulf of California—or far worse, ending up as filtered sediment in a water treatment tank managed by the Las Vegas Valley Water District.

“Earth to Earth, Ashes to Ashes, Dust to Dust”
(Nikon F3HP, Nikkor 28-50mm f/3.5 AI-s, FUJICHROME Velvia 50, circa year 2000)
Essay and Image © Thomas R. Vetter, 2023
Thomas R. Vetter, MD, MPH, MFA
To contact Dr. Vetter  

Submitted by Dr. Michelle Owens
May 2023

Mental Health Care is Self-Care

May is Mental Health Awareness Month, an important month to destigmatize taking care of our minds as an act of weakness, and rather as an act of self-care.

The last 3 years have only highlighted the need for mental health awareness and normalization of caring for our minds with as much intention as we care for our bodies. The most recent survey from Medscape this year again highlighted that 25% of U.S. physicians identify as feeling depressed. Approximately 10% of U.S. physicians continue to report suicidal ideation and we sadly lose 350-400 physicians each year to suicide. This data has remained consistent over the last 3 years, which further highlights the need to focus on our mental health. After all, mental health care is self-care.  

Athletes, celebrities, and fan-favorite TV shows, like Ted Lasso, have emphasized the importance of focusing on mental health as non-negotiable for being human. In the medical community, the Dr. Lorna Breen Healthcare Provider Protection Act, has written into law that healthcare workers are protected from any retaliation for seeking mental health treatment. This is huge, as it has been such a barrier in the past to many physicians needing treatment.

The amount of grief many of us have carried these last 3 years alone may warrant help from a therapist for processing and moving forward. We have all experienced tremendous loss - whether that of a loved one, loss of a dream job, loss of a pet, loss of a co-worker due to attrition, loss of childcare, loss of innocence for the world we live in, loss of trust in our government, mistrust from patients, and the list goes on. These losses are often experienced as disenfranchised grief - a grief that is not honored in the same way a “traditional loss” would be. It is often not openly acknowledged as legitimate by society and has been noted as a contributing factor to physician burnout both pre- and post-pandemic. It’s important for us to recognize the need to process all we have been through and normalize the reality that we cannot do it alone. Trained mental health counselors are crucial in caring for our minds.

As a reminder to us all, me included, you are not weak for seeking mental health treatment. All human beings benefit from therapy. Connection is paramount to our well-being, especially connection that allows us to process our emotions. We are experts at caring for others yet often do not tend to our own emotional needs.

Giving ourselves self-compassion and grace as we start to navigate and process these last 3 years is important. This is our call to action - for ourselves.

Utilize the resources available to you including some that are anonymous and free, like our own TCMS Safe Harbor Counseling program. Take what you need from where you need it. Remember we are not superheroes, we are human beings, and we need to care for ourselves as such.

Take good care of your mental health - your life depends on it.

Michelle Owens, DO
Co-chair TCMS Physician Wellness Program

Submitted by Dr. Tyler Jorgensen
April 2023

Looking Up

At age 18, my buddy, David, and I scaled the outside stucco of a hotel in Cancun, Mexico and soon found ourselves ten stories up, lying on our backs on the hotel roof, looking at the night sky. It was a terribly stupid idea—one of many we had back in those days. But once we were up there, David taught me the major stars and constellations of the summer sky. Cassiopeia, Draco, the Little Dipper, and of course, Polaris, the North Star.

Back in Houston after our trip, I was determined to remember what David had taught me. Every night after dark I would crawl out my window (sorry, Mom and Dad!), onto the roof of our house and look up. Despite the weird purple hue from the Houston skyline and the overwhelming light pollution, I found I could still make out most of the major stars of the summer constellations. I studied my hometown stars like a textbook, and I stared at them long enough that the pattern became forever etched in my mind.

When I went off to college in rural Virginia a few months later, I found the night sky looked quite a bit different—much less light pollution, way more stars. In fact, the brightness of all these stars now visible made it harder for me to pick out the constellations. I also noticed the constellations were a bit out of position relative to the horizon at this higher latitude. But as I took time to find the north star and re-orient myself, I was soon able to match this new night sky to the one I had looked at on my roof back home so many times. Far away from home, I found a great comfort in being able to look up at the night sky and see some old familiar “friends.”

For two and a half decades now, I’ve been a stargazer. When I find myself in new places, I look up. I look for the north star. Oddly, looking up always grounds me. I remember a night backpacking in the Redwoods when a chance glimpse of part of Corona Borealis through an otherwise cloudy sky revealed to me and my same buddy, David, just which way we had been traveling.

Looking at the stars in Argentina a few years ago really threw me. There were a few familiar celestial faces to the north, but up above me and down to the south were constellations I had never seen before (nor since!). Another time outside Rome, far away from home, I remember the great reassurance I felt looking up and seeing the same old Sagittarius I knew from home.

William Cullen Bryant wrote about it this way in 1832 in his Hymn to the North Star:

On thy unaltering blaze
The half-wrecked mariner, his compass lost,
Fixes his steady gaze,
And steers, undoubting, to the friendly coast;

The metaphors from all this star talk come easily. When we feel lost in life, when we feel far from home, when we seem to have lost some of our supports or to have wandered off course, it’s important to re-orient ourselves to our north star. What is it in life that has pointed you in the right direction? Is it friends? Maybe family? Is it your home? Maybe it’s a faith tradition? Maybe it’s your personal core values, or your sense of calling or mission?

The same can be true in medicine. Do you remember your north star in medicine? What inspired you to pursue this path back in the day? What did you write about in your medical school application? Sometimes it’s hard to even think back that far! In what ways can you get back to that old north star?

I have felt lost in life and in medicine many times. I imagine we all have. Look up from where you are, re-orient yourself to your north star and get grounded again. Then move forward in the direction that calls for you.

Tyler Jorgensen, MD

Comments can be directed to
Other works by Dr. Jorgensen can be seen at Crash Cart Campfire

Submitted by Dr. Brian Sayers
April 2023


This week, Holy Week, grace has been on my mind. The upstairs of our house is now a vast wasteland of empty bedrooms long since abandoned by our adult children, but on a mirror in my youngest daughter's bathroom there is still a Post-it note that says “Grace: Undeserved favor.” It only takes a few dots to connect grace with gratitude. Like grace, gratitude is the recognition of things that we have been given ̶ given to us by people we love, by strangers, by luck, by a higher power, or from the vapors. From sincere gratitude, humility naturally flows. It's just unavoidable. To recognize things have been given to us ̶ to really appreciate them as gifts  ̶  is humbling. And, as so many have written more eloquently than this, and as so much research has shown, as a practice, gratitude helps make us whole, appreciative of the world and the people around us.

Each quarter, we recognize the financial donors that have helped make your PWP Safe Harbor Counseling Program possible because we do not derive funds from TCMS dues, but rather every penny of the $300,000 it has taken to operate the program had to be raised, sometimes begged for. We are indeed very grateful to our financial donors. Now five years and 1700 counseling visits in, I realize that all too often I thank the people who give money but have neglected to thank the people who have supported this program in other ways.

Belinda Clare, our TCMS CEO came to me proposing this project back in 2017 and with her passion and hard work the program has thrived. But there are so many more to thank. Those dozens of colleagues who are writers, or photographers, or poets who have contributed to our Sunday morning emails. Speakers at our symposia, small group leaders, our TCMS board of directors, and those who encourage, suggest, and even those who criticize (and not always kindly)  ̶  you have all made the program what it is. I’m grateful to our counselors, Charlotte and Blaine, Claire and Josh, who have dedicated themselves to getting used to the quirks of working with physicians and their loved ones, patiently and with great skill taking good care of us. For Maryann and Chantel, for Claire and Tyler, for Michelle, and for Jenny, and for all those I will kick myself for not naming, thanks to each of you for your unique gifts and support. My heart is full of love and gratitude for all of you who care enough about our colleagues and their families to have made this program possible. We are a family, and I am grateful.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Submitted by Dr. Cindy Lynn
April 2023

My Almost Photo with the Bluebonnets

Yesterday I went for a bike ride with my husband at McKinney Falls State Park. If you haven’t been there, it is located only a short drive from Austin. It is a beautiful little state park, with hiking and biking trails, waterfalls, and camping. We exercise outdoors most days, for both cardiovascular and mental benefits. I agree with the studies that show that being out in the woods decreases blood pressure and improves mood. I have tried meditation, and find it is a great time to plan what’s for dinner, wonder when our next vacation is, wonder why it isn’t sooner, ponder world problems, etc. I concede I may not be doing it right. For me, being in a beautiful, peaceful outdoor setting is better than any antihypertensive medicine. And yesterday did not disappoint. The bluebonnets and other wildflowers were spectacular. I consider myself an amateur photographer and stopped frequently to snap yet another photo of
a different angle of a patch of wildflowers. To be clear, I’m very amateur, we are talking iPhone level. Thankfully, my husband is extremely patient, a great quality for a spouse of a physician.

By the time we were nearly done with the ride, I decided I wanted a picture of me amongst wildflowers. I had talked myself out of it earlier, because I thought it seemed rather silly for a 60+ year old. I think it’s great for small kids and even dogs, but old gray hair adults? So after deciding game on, I didn’t want to sit in a patch and damage any flowers. And my knees are also 60+ years old and not great at kneeling, so I got creative and decided to sit on a rock wall and have succulents and flowers in the foreground. I spotted the perfect site, handed off my phone to my husband with instructions on the shot I had in mind, and carefully tip-toed into position without damaging a single flower. I looked down, and there was a snake coiled on a rock about one foot from my foot. My first instinct was panic. But my son who has a degree in wildlife biology has told me multiple times not to freak out, most snakes are not poisonous. So I took a deep breath, and considered staying for the photo. The snake started to move, and I realized it could be a coral snake. I’m not saying it was; I’m saying I’m not knowledgeable enough to say it wasn’t. Then I realized how ridiculous I would sound explaining to the ER physician that this 60+ year old was trying to get a picture in the bluebonnet. So I hightailed it out of there faster than the Easter Bunny. I would like to say that I didn’t stomp on any wildflowers, but I can’t swear to that.

After my blood pressure came back down to pre outdoor levels, I realized how grateful we are to live in this beautiful area, and have such a spectacular wildflower display. I will continue to appreciate the flowers. I hope you get a chance to experience this splendor of nature. Just watch out for the snakes. And if I learn new skills, I might Photoshop me onto that rock wall

Submitted by Dr. Michelle Owens
March 2023

Grace & Flexibility

In reflecting back on the last few years, I am struck by an unusual theme that transcends both my personal and professional lives.

I met two new friends along this journey, although it wasn’t so clear at first.

Grace met me at a time that was dark, heavy, and dripping with overwhelm. Navigating caring for patients at the end of their lives in the midst of a pandemic involving a virus we were still learning about with two babies at home and bumbling through learning what the term “sandwich caregiver” meant as someone close to me slowly revealed that she needed more support than she’d like to admit.

Grace gently tapped me on my shoulder when I found myself drowning in the juggles and struggles of it all. She whispered, “Be kind to yourself, you’re doing your best in an unimaginable situation.” I didn’t listen at first. I had always been able to handle whatever came my way with a smile on my face  ̶  many never knew of some of the struggles I had faced and overcome in my life. However, Grace persisted. She showed up daily at the most difficult of times. She felt like a warm embrace in the midst of a cold and cruel world. Why was all of this happening? A question that often echoed in my mind. She quietly shushed those thoughts and offered a safe space to reflect and validate that I was not alone in my experience.  

Grace reminded me that I had been through tough times before and persevered. She reminded me of my strength, my resilience, and my ability to work through whatever came my way. She encouraged me to treat myself the way I treated my children. For I too am a child still learning life and all its complexities. I listened intently. I found myself longing for more and so deeply appreciative for what she had shown me. I asked her to stay, and she reminded me that she had always been with me.

Flexibility crept in when I least expected  ̶  during the joys (and stresses) of parenthood. I never imagined how much uncertainty came with having a baby. As a physician couple, we figured we knew what we were getting ourselves into (enter Grace once again). Flexibility arrived with the energy of a toddler learning how to climb and jump on the couch for the first time. To be honest, I wasn’t a fan at first. I’ve always been a planner  ̶  thinking of the 6th and 7th step ahead at times. Children have a way of keeping you in the present moment, a beautiful gift. So, when Flexibility showed up, I was not as welcoming. Why now? I pondered. My plans have worked so well up until this point, or so I thought.  

Flexibility leaned in with curiosity and posited, “But imagine if you just allowed what is meant for you to be?” Without any control of my own? I replied. Nah, I’ll pass. I admit Flexibility remained flexible – shape shifting into various forms with the best of intentions. Bravery, vulnerability, and hope were a few of his disguises. I began to listen over time like a child who is now interested in learning how to read. Realizing that we have always been flexible and yet somehow flexibility seems to get locked away the older we become. I started searching for flexibility in the little things and normalizing its existence in my life. No longer a threat to my plan, but rather a welcomed friend on the journey. I began to imagine rewriting my narrative to be one that reads of both haphazard plans and amazing surprises with flexibility interwoven throughout.

These unexpected friends met me at a time when I needed them most, yet had no idea myself. Grace continues to lighten my days, warm my heart, and keep me from falling into the dark. Flexibility encourages my growth in accepting the uncertainty of life and propagates peace of mind that I’ll be okay no matter what comes ahead.

I am looking forward to more new friends in the years ahead. Grace and Flexibility have certainly been some of my favorites.

Michelle Owens, DO
Co-chair TCMS Physician Wellness Program

Submitted by Dr. Brian Sayers
March 2023

Hospital Meatloaf, Yoda and Letting Go

Not too long ago I was struggling over a plate of meatloaf in the doctor's dining room. Fortunately, the table conversation was better than the food. Somehow it turned to how early career doctors tend to mirror the culture and clinical habits from their training program and how it often takes years to unlearn habits that don't serve us well in the long run, particularly habits related to work-life integration. Training programs are more sensitive to this now, but the economics of medicine are an inescapable reality we must navigate, and in our counseling program I hear of the struggles that some physicians experience to sustain meaning and joy in their work and healthy relationships and peace away from work. Students are now referred to as “learners,” and I pray that most of what they learn will serve them well after training, but it makes me wonder if we should all eventually progress from learner to “unlearner” and whether both states aren’t valuable in their own way.

There is much in popular psychology literature about unlearning. J.R. Rim famously noted, “Intelligence is what we learn, wisdom is what we unlearn.” Even the icon of pop culture wisdom, Yoda, of Star Wars fame, advised Luke that in his spiritual path forward, “You must unlearn what you have learned.” Ask any therapist – unlearning is foundational to new beginnings.

I revisited Richard Rohr’s, Falling Upward, recalling that a theme in much of his writing is about unlearning. As he puts it, “All mature spirituality in one sense or another is about letting go and unlearning.” Rohr holds that life really consists of two phases. The first phase is the egocentric phase, what he calls the “survival dance,” wherein the emphasis is on developing identity, success, security, and image cultivating. This is not to say this phase is bad – it is all necessary, and though there are many struggles, most often great good comes with it along with important learning, experience, love, and joy. Rohr holds that the ultimate task of this stage of life is building what he calls “a proper container” that will be needed in the second phase of life.

In the second phase of life, those learned survival and identity tasks fall into the background, habits that supported them are questioned – unlearned – and the container created earlier is emptied then filled with awareness and appreciation for deeper meaning. Things that the soul thirsts for, that were missing earlier, can now be fully discovered. It is a time of “letting go.” Rohr calls this the “soul dance,” Zen masters call it seeking the face you had before you were born. Some religious traditions call it being reborn. Some note parallels with the common literary structure of the hero’s journey. In any sense, it is a shedding of baggage accumulated earlier for something better. It can occur subtly or abruptly and depending on your early life experience it may show itself at any age, or in some, it may never become evident.

There's no good story, nor anything profound in all this, just an observation made over a half-eaten piece of meatloaf. The thing that we call our life journey may be a journey to the true self, to spiritual wholeness, or to God, but like any hero’s journey, it is always a journey home, the home your soul longs for. At some point, young or old, most will find themselves as lost as Dante: “Midway on our life’s journey I found myself in a dark wood, for the right way was lost.” It will be wise to remember at that point the importance of unlearning, of letting go. It is in the homeward part of that journey where rather than paddling furiously, we might just drift in the current and finally look up to enjoy the scenery that was there all along. And on the long journey home, as Mary Oliver urges, “If you suddenly and unexpectedly feel joy, don’t hesitate. Give in to it.”

Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Submitted by Dr. Brian Sayers
January 2023


Last week in this space Dr. Prentice wrote of the last few years with ALS in a courageous and inspiring essay. As it happens, in the weeks leading up to that I had been with two longtime friends who are both fighting health challenges against great odds, each in the two-front battle of resistance and acceptance. Their courage has made me reconsider courage in all the forms that we see it and what an admirable quality it is. As much as I admire their courage, it occurred to me that more often there is courage that is less grand and often hidden, but it is there nonetheless, and how in many ways it takes courage − daily courage − to practice medicine.
There are many forms of courage. There’s the kind we usually think about, that involves soldiers or first responders. Courage that involves protesting injustice or discrimination, or calling out those in power who misuse their office. Courage that goes into danger to help the poor, the hungry or those with no voice. Courage we have recently seen our colleagues exhibit on the front lines of a deadly pandemic. This is obvious courage. But far more commonly there is a silent, hidden kind of courage that each and every one of you reading this exhibit, most likely in ways that even you are not aware. There is great courage in caring for patients, in opening every exam room door, every operating room door. Courage in caring for people with complex diseases when the risks are high and the outcome far from certain. Courage even in the most casual, seemingly simple medical encounter where we all know things can unexpectedly go terribly wrong. It is a kind of courage that is just assumed we carry with us, and carry it we must, even when it often goes hand-in-hand with self-doubt, even fear, fear that even the courageous should admit to as they face it down. Brené Brown calls on us to redefine courage, arguing that, “vulnerability is our most accurate measure of courage… it is willingness to show up and be seen when you can't control the outcome or what other people think.”
We don’t leave courage at the door when we go home at night. Few things require more courage than parenting, where the stakes are high and where too often uncertainty exceeds even that which we experience at work. Uncertainty about how we parent and the things we do, things seemingly insignificant at the time that can intentionally or unintentionally change the trajectory of our childrens’ lives, for better or worse, in ways only seen and realized years later when we know them as fully formed adults. There is courage in long-term relationships, in being seen and loved then giving it back through the years, in seeing loved ones not just in joy but also through life’s inevitable struggles. As David White noted, “Courage is what love looks like when tested by the simple everyday necessities of being alive…From the inside, it can feel like confusion, only slowly do we learn what we really care about, and allow our outer life realigned in that gravitational pull…On the inside we come to know who and what and how we love and what we can do to deepen that love; only from the outside and only by looking back, does it look like courage.”
Yes, I have greatly admired the courage I have seen in my dear friends facing mortal challenges recently, and I’m inspired by it, but I am also inspired by less conspicuous acts of courage that I am coming to realize surround me as I go through my days at work and with my family. Courage is not the absence of fear, it is perseverance, even passion, in the face of it. Look around at the fearless way you and your colleagues go through your days, even when there is doubt, and all the good you bring into the world as you do it. Appreciate it for what it is. Courage is inspired by, fueled by, made fearless by, our love for the people and calling we hold in our hearts, for the love of life itself.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Submitted by Dr. James A. Prentice
January 2023

When a Delayed Diagnosis was a Blessing

In early 2014, I began to have muscle twitches, which by spring were severe enough to awaken me at night. These were mainly in my thighs, and I associated them at first as occurring after doing yard work at our one-acre property on Lake LBJ. In May 2014, I made an appointment with an old friend, a neurologist who had cared for my parents and my brother-in-law and my wife, and whom I had known for more than thirty years. After a neurological exam, it seemed most likely that at 77 what I was experiencing was not too uncommon for my age. A couple of years later, after 2016, another consultation took place when twitches, or “fasciculations” had become more common and were sometimes accompanied by muscle cramps. Again, I was carefully examined and it was felt that at age 79, I was likely experiencing symptoms of an aging neurological system. A couple of more years passed, and in September 2018 I again made an appointment with my friend as I was having trouble buttoning my clothes and doing other simple tasks with my hands. Another thorough neurological examination was performed. At this point it was not felt to be ALS, but the diagnosis was unclear, and we decided I should return for an EMG of my upper extremities, which I did in the following month. A diagnosis of bilateral ulnar neuropathy was made and I was referred to an orthopedist, who transposed my ulnar nerves at the elbow in November and December 2018. About the first of February 2019, the hand therapist who had been working with me told me that I was getting worse rather than better, and I should return to my neurologist.
A consult with a neuromuscular neurologist in February 2019 gave the diagnosis of ALS, a devastating diagnosis which has no cure and invariably ends in death. The prognosis is a lifespan of two to five years after diagnosis, and the course of the disease is constant loss of motor function and independence. Because of this, the patient usually begins to curtail activities in which he or she is involved. A trip in March to Mayo Clinic, where I had served on the staff in the 1970s, confirmed the diagnosis.
If I had known in 2014 that I had the early signs of ALS, I am sure I would have sold our lake house several years before I did, and I would have resigned from several boards on which I was still very active, including the Texas Medical Association Foundation, where I served as Treasurer, St. David’s Foundation, University of Texas Foundation, on which I served as President, Austin Symphony, where I served as Vice President for Individual Gifts, and the University of Texas College of Natural Sciences Advisory Council, on whose Executive Committee I served, all of this during the five years after I was symptomatic but undiagnosed. By being ignorant of my diagnosis I continued to enjoy those activities for several years that I otherwise would have been denied by early resignation.
Early on, ALS can be very difficult to diagnose, and like many complex diseases that develop gradually, only time and hindsight bring clarity. In my case the diagnosis of ALS was not made for at least five years after symptoms developed. Since there is no treatment available, timing of the diagnosis did not affect the course of the disease and the blessing was that I had five years of worry-free time. In those years, we took a cruise to Scandinavia and St. Petersburg, Russia, went on a Danube River cruise from Budapest to Germany, we visited England again, and traveled to Spain for the first time in forty years. The delay in arriving at this elusive diagnosis allowed me to continue to enjoy community activities, time with grandchildren at our lake house, and other activities I probably would have curtailed. I am grateful that my old friend the neurologist did not make the diagnosis early on. It allowed me those extra years of normal activity.
James A. Prentice, MD
TCMS President, 1996
Transcribed by Alexandra Saenz, November 28, 2022

Submitted by Dr. Christopher Chenault
January 2023

Joy in Community

I am reminded, as this new year starts and 2022 has passed, how quickly it all seems to march right on by. As I see time passing, I am reminded of all the events that I have participated in and all of that which will not come again. I realize that most of what I remember are the people. Yes, I remember kindergarten and elementary school but mostly I remember my teachers and some of the students. I remember some things about high school including some sports and band but mostly I remember my fellow students, the ones I played with, and ran with, and dated. Some of those I am still in contact with through our organization of periodic reunions. There was college with little remembered glimmers of some of the classes but the friends who enlivened and enlightened my days are most important memories. Time has passed and so have some of them and I miss their stories of family and activities. Medical school, which I enjoyed more that most events of my life, left little time for more than a couple of friends from the class, yet enough to find my love that has tolerated me now for 58 years.
In Austin for 51 years, I found that I had grown some and entered into more relationship building. I had a great group with which to practice and exchange ideas and was involved with the community of physicians through many committees and governance appointments. The exchange of ideas, including moral musings, has enriched my path along the way. In retirement, I have come to understand the necessity of replacing relationships of office staff, hospital nurses, and administrative friends. I have actually purposefully engaged in lunch outings, church small groups, and choir activities to add to my community. In that way, I believe I have been enclosed in the community with new ideas, opinions, understanding, and feelings that stand as guideposts for a life enriched. They help me up when things seem down and keep me close with their warmth.
In this era of senior isolation and public loneliness it probably should not be surprising that there is physician angst as well. Being a relative top dog in the hierarchy of social positioning as they say, “It can be lonely at the top.” Not to mention other stresses of the profession. A lot of times there is disappointment, the distance between what we expect or hope for and what life really is. Where our dreams are crushed by reality. As purposeful as we have been to get into this profession, we should also work actively to create community that is not just social but supportive. I don’t believe that is a passive phenomenon. Certainly, in my case, it has been an active adventure. That is where I find joy.
If you look up the definition of joy it invariably includes happiness. But joy is not just happiness that you got a new puppy. Joy is entwined with purpose. The purpose to be involved in the world. The purpose to understand your position in making the world better and your patients healthy. And, knowing that your purpose is also rapped up in appreciating your community and knowing its value. That you know that you have the talent to meet the challenges and overcome them. And that you are involved in a life that is lived somewhere between unrealistic expectations and disappointment. That you will, absolutely, work to know your purpose in life and find valuable relationships and joy.
Dr. Christopher Chenault

Submitted by Dr. Brian Sayers
December 2022

Lost in Translation

How often has someone told you that they are lonely? If it's ever happened, I'm guessing it hasn't been very often. Admitting to someone else that you're lonely rarely happens because of shame, and for the very fact that if you have someone you can confide in, you're less likely to be lonely in the first place. Studies show loneliness is ubiquitous ̶ in surveys a fourth of Americans admit to some degree of loneliness, a third of those over age 45. An Athenahealth survey closely links feelings of loneliness with symptoms of burnout. Studies have linked loneliness with health risks essentially equivalent to smoking 15 cigarettes a day and higher than obesity or lack of exercise. Yet as prevalent and destructive as loneliness is, we rarely talk about it.
Loneliness carries with it the baggage of shame. We hide loneliness because, like the middle schooler sitting alone at a lunch table, all the world might see that we lack meaningful relationships that we assume others have. We tend to hide our shame by withdrawing, isolating, often developing social anxiety or depression, leading to more withdrawal, isolation, and shame. It's a self-perpetuating cycle that can have devastating consequences.
Humans are social animals. A sense of connectedness is deeply imprinted in our DNA. As a species we have survived through connectedness that in an evolutionary sense optimized mutual protection, hunting, gathering and procreation. It’s no wonder then that loneliness can cause anxiety, depression, burnout or just a vague aching that we can't quite put our finger on. Joseph Conrad described it this way: “To the lonely themselves, loneliness wears a mask.”
Loneliness often creates a sense of shame. You can be lonely surrounded by people, even within a circle of friends and colleagues. At its core, loneliness is a lack of meaningful relationships, relationships that make us feel safe, make us feel heard and understood. Developing these relationships becomes harder when our days are full of work and logistics, harder as we get older, harder for physicians rushing from room to room, rushing home to get kids to practice and homework and dinner and bed, then charting into the night. Loneliness can emerge in retirement when the daily hum of activity and relationships must be redefined.
As I was putting together this series, I watched a movie from a few years ago, Lost in Translation. It's a Bill Murray and Scarlett Johansson film about loneliness. Bill Murray plays an aging movie star spending time in Japan being paid a fortune to simply pose with a glass of whiskey. He doesn't understand the language or culture but more importantly has lost touch with friends, family and even a sense of his own identity. He tells his wife by phone that he wants to “get healthy” but doesn't seem to realize that the source of his discomfort is loneliness. He meets another American, there with her husband who is off on photography assignments, she too drifting, disconnected from her husband and friends and though she finds herself shoulder to shoulder with millions of people in Tokyo, she is ironically entirely isolated. The two meet and form a community of sorts, pulling themselves, through connectedness, at least temporarily from their loneliness and detachment. I wondered when the movie was over what became of them when they left Japan and went their separate ways. The title of the movie is a play on words and what I came to think it really referred to is the basic translation that we all must make between our need for connectedness and actually achieving it – something so foundational to our sense of happiness and fulfillment.
Most of us have gone through periods of loneliness, long or short, often brought about by circumstances that punctuate any lifetime, though during these periods we may or may not fully recognized what aches within us, and we would almost never admit it to someone else. Like our primordial ancestors, to not just survive, but to evolve, we must somehow find our way to a seat around the warmth of the communal fire, and having found our way there, we are called on to move over and make room for someone else coming in from the cold.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Submitted by Dr. Brian Sayers
November 2022

Thanksgiving, Grace, Gratitude and the Cosmic Dance

Joseph Campbell was a writer best known for The Hero with a Thousand Faces, which describes the literary theory of the hero’s journey, shared by world mythologies and often found in contemporary works of literature and film. He famously conducted a workshop in which physicians were shown the classic “Dancing Shiva” statue. In the statue, Shiva, the Hindu God, is dancing in a ring of flames. The hands of his many arms are shown holding symbols signifying the abundance of spiritual life. As he dances, one leg is lifted high and the other is standing on the back of a man crouched in the dirt, typically depicted as staring at a leaf that he holds in his hand. Rachel Remen quotes Campbell as asking his audience, “What is that little guy down there doing?” After giving physicians in the room time to ponder the question, he answered it himself: “That’s a little man who is so caught up in the study of the material world that he does not notice that the living God is dancing on his back.”
It’s a fitting story to consider around Thanksgiving, a tradition that calls on us to look up from our daily routines and give thanks, which requires that we have an awareness − a presence − to recognize just how miraculous our blessings really are. Like many of you, we gather family around our Thanksgiving table, and before we offer our prayer of thanks, we go around the table and ask each person, old and young, to tell us what they are thankful for. The responses are usually somewhat predictable, even if heartfelt. Once when our children were very young, one of our daughters, everyone staring at her in anticipation, nervously paused then blurted out that she was thankful for “Life!” It has stuck with me through the years as simultaneously being a simple yet all-encompassing expression of thanksgiving, given through the lips of a child.
In its purest form, gratitude helps us, at least for the moment, to set aside the things that make us anxious or sad or wanting, and look at the essence of joy, at what makes our lives rich and worthy of living. It reboots our fearfully overloaded hard drives and propels us into the world of chaos with a smile and courage, knowing full well that it is a process that we must repeat frequently to remain sane, perhaps even joyful. Gratitude helps us to shed what Thomas Merton calls the “awful solemnity” of life and to dance into something that our lives are intended to be:
“The more we persist in misunderstanding the phenomena of life, the more we analyze them out into strange finalities and complex purposes of our own, the more we involve ourselves in sadness, absurdity and despair. But it does not matter much, because no despair of ours can alter the reality of things, or stain the joy of the cosmic dance which is always there. Indeed, we are in the midst of it, and it is in the midst of us, for it beats in our very blood, whether we want it to or not…. the fact remains that we are invited to forget ourselves on purpose, cast our awful solemnity to the winds and join in the general dance.”

Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Submitted by Dr. Brian Sayers
November 2022

Mending Wall

At a volunteer clinic years ago, past our usual quitting time they kept letting patients check in. It’s an evening clinic and after a long day I was getting grumpy about staying late. A colleague and fellow Methodist set me straight (or was he just messing with me?) by reminding me of a quote often attributed to John Wesley, “Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, for all the people you can, as long as ever you can.” Thanks to that night, I often remember this call to infinite service ‒ and not with fondness. While it’s low hanging fruit for a sermon, it would likely elicit groans in a doctor’s dining room. Physician wellness today focuses on recognizing healthy boundaries.
It’s been on my mind again as I read Melissa Urban’s book, The Book of Boundaries: Set the Limits That Will Set You Free. Urban’s theme is that setting boundaries in all phases of our lives leads to peace and happiness in relationships, work, and with ourselves. Many of us go through life unhappy in one or all of these domains because we fail to declare boundaries, instead assuming those around us will read our minds then honor these invisible lines. She notes three stages of setting boundaries: discerning what boundaries are important to us, then clearly, kindly, and verbally informing those affected, and lastly by enforcing them. She emphasizes that setting boundaries is an act of love ‒ it ultimately strengthens relationships and makes us more effective in the workplace. Defining boundaries should come from a place of love ‒ the point of them should never be to control or change those around us, rather to define behaviors and actions we will or won’t tolerate in our own lives.
Some boundaries for doctors are obvious: unprofessional relationships with a patient or employee ‒ anyone with whom we have an unequal power dynamic ‒ or treating those with whom we have a relationship that might cloud our medical judgement. But Urban goes far beyond these obvious examples. At work, many, if not most, of our colleagues are asked to see too many patients, do too much work at home, and have too little control over their schedule, often at great cost to loved ones and themselves. Ironically, while we are confident and clear with our patients, we may feel strangely powerless to set boundaries for how we navigate our workday, or fail to enforce boundaries we do set, then wonder why we are miserable at work.
Setting boundaries with friends and family can take many forms ‒ anything that puts us repeatedly in situations we find awkward or against our values. Toxic relationships with family or friends (“vampire friends”) are just not worth the effort if they perpetually ignore boundaries. We hear all too often from marriages, especially those with young children, the laments of unequal parenting duties, unequal “me” time, too little “we” time, complaints of dissatisfaction with all kinds of issues related to physical and emotional intimacy. Our experience in the PWP counseling program speaks strongly to the fact that physicians seek help related to relationships as much or more than issues solely related to their work, issues that Urban argues are by and large related to important but undeclared boundaries.
Perhaps most important are the boundaries that we should set for ourselves. It can be simple things related to diet, exercise, how much time we spend at work, or how much time we gift ourselves and loved ones ‒ boundaries we need to keep mentally and physically healthy. The inability to say no is a common personal boundary we often neglect. Urban points out that if we take on too much from all that people ask of us, it is not their fault. It is our fault for not setting personal boundaries and then following them. As Urban points out, if you never say no, “…they are never going to stop asking. Why should they?”
Robert Frost’s 1914 poem, “Mending Wall,” contains one of the most frequently quoted lines in American poetry: “Good fences make good neighbors.” The poem’s interpretations are nuanced and evolved in the era of world wars that followed its writing, but the line itself is timeless. Perhaps boundaries, like good fences, when brought with love help us live in harmony and peace. Boundary setting is a sign of maturity and respect for the important relationships with ourselves and others. As Urban notes, “...Boundaries produce the shiniest version of ourselves. They say, ‘I am worth protecting.’”
Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Submitted by Dr. Brian Sayers
October 2022

The 109th Bead

My longtime call partner, Walter Chase, passed away last month. I first met him while interviewing for a job with his group as I finished my fellowship, catching him in the middle of a busy clinic day. As he politely asked me a few questions, I leaned against an exam room door, actually, against a plastic chart holder, and with a crack as loud as a gunshot broke the thing in half. Horrified, I tried to continue talking as if nothing had happened, Walt deadpanning a quizzical look. At some point I just couldn't hold it back anymore and I started laughing hysterically. Walt didn't think it was all that funny and, in the end, my goofball interview did not end with me working there.
Despite that rocky start, a few years later Walt and I began many years of sharing call together and thinking back, I realize now how many things I learned from him in those years. There have been so many others — colleagues, mentors and teachers — who unknowingly gave me gifts that I still call on, gifts that hopefully have made me a better doctor, perhaps a better man, gifts I may in turn pass along as well. What Rachel Remen calls the “lineage of medicine” is an unending circle in which we both receive and pass on our common and unique experiences in medicine, a conversation that connects us with our heritage as well as with the unseen future.
One night, while I was a senior resident on ICU rotation, I was checking on a patient dying of heart failure. His elderly wife was holding vigil at the bedside, all 80 pounds of her, her skin wrinkled and brown as leather from years of hard work in the New Mexico sun, rosary always in hand, standing up with respect whenever we entered his room. In the days before computers or cell phones, our white coats had enormous pockets, big enough to hold the spiralbound Washington Manual, cheat notes, “code cards,” stethoscopes, reflex hammers — all kinds of crap that we thought we needed, and I suppose actually did need. She came close and put a tiny metal crucifix in one of my pockets without explanation. It is a great metaphor for all the wisdom that patients and colleagues have figuratively put in my pockets over the years, most of whom had no idea they had placed things there, but they did, and I carry them all.
In the introduction to Eat, Pray, Love, Elizabeth Gilbert makes reference to japamala beads, used for centuries to assist devout Hindus and Buddhists to focus during prayerful meditation. It is a string of 108 beads (from which the Catholic rosary was derived after the Crusades) that is held by the faithful as they meditate, their mantra repeated as they finger each bead in sequence. Japamala beads have a special, extra bead, the 109th bead, that dangles separate from the rest like a pendant. As they reach the 109th bead, they are to pause from their absorption in meditation and thank their teachers and mentors. And so, now I too pause at that 109th bead.
I am writing this as I sit in the surgical waiting room at Dell Seton awaiting news from my wife’s surgeons. Somewhere down the hall, two neurosurgeons who I have come to trust and admire are drawing upon their years of training and experience, compassion for my wife, and most certainly, from the many things dropped in their pockets by patients and colleagues through the years. And the circle continues, unbroken.
Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Editors note: What follows is a reprint from the Journal of Clinical Oncology submitted by our colleague Dr. Russell Hoverman. It is a special piece of writing, and I hope you will spend a few minutes with it. A link to a related podcast is found below. Thanks Russ…

- Brian

A Life and a Death in Haiku

My brother, Jim, was diagnosed at age 73 years with colon cancer metastatic to the liver, lymph nodes, and lungs. He and his wife were avid hikers and after retirement had hoped to visit as many national parks as possible. Big Bend National Park in Texas, along the Rio Grande River bordering Mexico, at over 800,000 acres, is one of the largest and least-visited parks in the country. The park has vast expanses of desert and high mountain islands, with some peaks over 6,000 feet. We had hoped to have Jim visit us in 2020, but both cancer and COVID-19 interfered until this past spring when we were finally able to arrange a trip to the park. It had been a few years since I had last seen Jim at our most recent family wedding. When he arrived in Austin, he appeared gaunt and frail. He had lost his taste, and many foods burned his mouth. He had lost weight and was weaker. He barely felt his feet. He struggled to just get through the day. Even so, he hiked up to a promontory overlooking the Rio Grande one day and into a canyon the next and seemed to get stronger as the week went on.
While in Big Bend, we talked about how he wanted to be remembered. Neither of our parents left tangible markers of their deaths. There were no gravesites, only scattered ashes in places without names. We discussed having a marker, a plaque, a touchstone, or maybe a bench at a favorite park, a place that could be visited by family and friends. This loss of continuity is likely a result of our culture—urbanization and the fragmentation of families. This is in contrast to The Day of the Dead (Dia de los Muertos) celebrated in Mexico and much of the American Southwest, where families decorate cemeteries and have annual gatherings to remember deceased relatives and friends. We forget, or perhaps never knew, how important this can be.
As an oncologist, I saw the wide variety of ways in which people died. A few years after I finished training, I joined a practice in a small town in Oregon with a large Mennonite community. One of my first patients was a church member with metastatic ovarian cancer that was no longer responsive to treatment. She required near constant attention for pain control, and the nursing facility associated with the Mennonite Church, primarily staffed by fellow church members, was her best option. My patient knew all her caregivers, and they knew her. It was as if she was receiving terminal care for her cancer by her sisters. This may have been the first time I attended the death of a patient outside of a hospital. Given that experience, I became an ardent supporter of hospice organizations, many of which were just starting. I knew that Jim was not far from the end of his life and that he wanted to be able to make his own choices, even to the point of getting it over with. We both also knew the impact of sudden, unforeseen, untimely deaths in our own family. I had hoped that Jim could be comfortable and able to participate with us until the very end. This most likely meant involving hospice care.
By summer, less than a year after his diagnosis, chemotherapy no longer controlled his disease, and there were no treatment options available. His oncologist offered a menu of possible treatments including radionuclide embolization of two liver lesions and radiation treatment of lung lesions. As Jim's discomfort was primarily in the region of his largest liver lesion, he and his wife decided to pursue the liver embolization for pain relief, but while recovering from his chemotherapy, Jim lost more weight and became weaker.
At the time of the scheduled procedure, the interventional radiologist discussed his concern that Jim's change in status would make the procedure highly risky and could result in hospitalization and death. He allowed that if Jim wanted to swing for the fences, they could proceed but he did not recommend it. More than anything, Jim wanted to be in control of his faculties, and the risks were too great. He and his family decided to return home and enroll in hospice care.
Jim was an English major in college, writing his senior thesis on the poet Wordsworth and taught high school English for 17 years. Throughout his career, he wrote poetry and was especially fond of the haiku. Haiku is a centuries old Japanese poetry format composed of 17 syllables in three unrhymed lines with the first line of five syllables, seven in the second, and five in the third. The subject is often an observation (usually of nature) or an event that is tied to or elicits an emotion. Over the years, a haiku would come to Jim, often unbidden, stimulated by a perception or an event.
While in Big Bend, we discussed adding a haiku to whatever memorial he considered. Once the decision was made to enroll in hospice care, Jim chose, from his life experiences, 17 haikus to post on social media, one daily beginning August 1. A few are included here:
Day 1: The Waterhole
Like the circumspect
Gazelle, I have waited long
before drinking deep.

Day 2: At Field's Pond
At Field's Pond today
a rude clique of frogs gave me
the silent treatment.

Day 7: Mt. Sugarloaf
On Mount Sugarloaf, we
met a youthful choir of pines
dressed in white robes.

By day 9, Jim was too weak to post his work. Jim's wife continued his mission and reported the responses to him each day.
Day 11: Ripples
From shore a teacher
casts a stone. Endless ripples
roll and roll away.

Day 13: The Chase
Like a leaf that runs
from an October wind, the
cat escapes my son.

Jim died on the morning of day 16, shortly after this haiku was posted.
New Year's Eve
Tonight, New Year's Eve,
is so still and cold, the trees
crack like popping corks.

At the end of life, it may not be clear who is providing the narrative for care. It may be the physician offering treatment choices, another line of therapy, a new drug, a different modality of therapy, palliative care, or hospice care. The patient may never gain control of the narrative. Aggressive treatment may lead to hospitalization and a lonely death in the Intensive Care Unit.
Jim was empowered to take control of the narrative by opting for hospice care and posting his haikus. He no longer posted details to his social network about his doctor visits, daily physical challenges, and symptoms; it was about sharing his life and the wonder he found in it. The changes in responses on his social network were profound as it became less about expressing empathy and more about remembering the person he was. Just as Jim's visit to Big Bend and the surrounding wildness and beauty of the park energized him, Jim's satisfaction with the responses made him more comfortable, looking forward to each day's reaction and, perhaps, making it easier for him to go.
A patient's journey with cancer is a story told by family and friends. The satisfaction with the story depends on how the story ends. The physician's role in the story begins when the cancer is evaluated and a treatment strategy proposed and provided. At a point in the care of everyone with incurable disease, the cancer is no longer the main issue and the patient and family take center stage. When the physician is unable to cure or prolong life, his or her role becomes that of a guide attempting to lead the patient and family to an ending that comforts all. This requires an understanding of the patient's narrative and depends on accurate information about how the narrative will be affected by treatment choices.
The combination of hospice care with the assurance of dying at home surrounded by family coupled with the ability to connect with his extended family and friends through social media was truly transformative for Jim and for me. Jim's control over the narrative and the direction that action gave to the care team made it easier to allow his death. Our role was to comfort and support and be present. There was no regret and no guilt with how things went. I could not have hoped for more.
A few months after Jim's death, his family and friends gathered to celebrate his life. We met in a grove of trees in a protected forested area where he often hiked. The centerpiece of the gathering was a bench marked by a plaque with his name on it. There was also a plaque with his favorite haiku.
Dawn on the Appalachian Trail
Light slips in along
the eastern edge. I am still,
startled by beauty.

Jim's ashes were scatted nearby.
Always the teacher, the ripples roll and roll ….

© 2022 by American Society of Clinical Oncology
J. Russell Hoverman, M.D., Ph.D.

Submitted by Dr. Brian Sayers
August 2022

Medicine as a Spiritual Practice

A true pioneer in the physician wellness movement is Rachel Remen. In an interview I recently listened to, she tells of her grandfather, who she describes as a Jewish mystic, telling her the story when she was very young of the birth of the world, and the great lesson from it. She recalls hearing the story:
“So, this is the story of the birthday of the world. In the beginning there was only the holy darkness, the Eyn Sof, the source of life. And then in the course of history, at a moment in time, this world, the world of a thousand, thousand things, emerged from the heart of the holy darkness as a great ray of light. And then, perhaps because this is a Jewish story, there was an accident, and the vessel containing the light of the world−the wholeness of the world−broke and the wholeness of the world, the light of the world, was scattered into a thousand, thousand fragments of light and they fell into all events and all people where they remain deeply hidden until this very day. Now, according to my grandfather, the whole human race is a response to this accident. We are here because we are born with the capacity to find the hidden light in all events and all people, to lift it up and make it visible once again and thereby to restore the innate wholeness of the world. That’s a very important story for our times−that we heal the world one heart at a time. And this task is called Tikkun Olam in Hebrew−the restoration of the world…and this is of course a collective task. It involves all people…We are all healers of the world.”
As physicians, we are in a unique position to be part of this calling, to heal one heart at a time. To do so in our professional lives, we must practice at the intersection of science and spirituality, more often described as the intersection between curing and healing. We have the privilege and responsibility of being witness to our patients’ physical and spiritual challenges laid bare before us, and some would argue that one of our most frequent failings is to focus wholly on science, paying little attention to the spiritual needs of our patients.
Spirituality might be looked at as “those beliefs, practices and stories that respond to a shared human need for meaning,” or “a worldview and a way of life based on the belief that there is more to life than what meets the senses, more to the universe than what is seen in this world.” It is admittedly delicate landscape to explore with patients, especially as we first come to know them.
There are thousands of Medline citations about spirituality and medicine. Numerous studies demonstrate patients’ longing for physicians to inquire about their spiritual beliefs and needs, just as surely as studies demonstrate just how seldom we respond to this. We know that a patient’s engagement with their own unique spirituality has demonstrable benefits to health and wholeness that complement the science we bring to the bedside. And yet, far too often we simply ignore its power, leaving it tragically unattended. A British study that examined reasons physicians so often ignore patients’ spiritual needs noted one representative response from a GP, “Everyone says ‘this only takes a few minutes.’ If you keep adding that up it's more than the 10 minutes you have with your patients.” How have we descended into a system that allows barely enough time to get the science part done, the curing, making it near impossible to adequately address the spiritual, the healing?
Later in the same interview, Remen recalls the early days of her career. Plagued with chronic health problems herself, she developed a kind of compassion, a keen awareness of the spiritual needs of her patients that launched a career providing a unique kind of care for cancer patients. “I began to realize how I had been healed by these people with cancer, how I had moved from a person focused on curing and coming to understand that we are all healers of one another. That people have been healing each other since the beginning, and that my power to cure was only a small part of my power to help people.”
Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Submitted by Dr. Brian Sayers
August 2022

A Flight to Nowhere

Evolved as we are, perhaps the ancients have something on us when it comes to the importance of time set apart. They seemed to recognize that rest and reflection need to be part of the normal cycle of life. Through the millennia, virtually all faith traditions recognized the need to regularly set aside time to catch our breath, get a little perspective, perhaps even a little peace. Religious Sabbath tends to be less faithfully followed these days, and though the roots of the word itself have deeply religious context, “secular sabbath” is written about more and more, its importance in spiritual health is no less vital than for those who practice religious Sabbath. The unbroken frenzy of our lives creates an unrelenting stew of stress hormones that we know is measurably unhealthy, yet we often seem powerless to find rest, even for a moment.
What sets this kind of rest apart from the occasional vacation or a few random hours of leisure now and then? Most importantly, sabbath is a planned and intentional part of our lives and as a practice carries with it enough importance and commitment to become permanently woven into the fabric of our lives. It is “time set apart” from our daily lives—lives that while full of joy are also full of problems and urgency. It can take many forms, but sabbath certainly means being away from work, problems laid aside for the moment, hopefully time to be unplugged, to think and reboot. But as a regular, intentional practice, what is the common thread?
Perhaps the real benefit of sabbath comes down to relationships. When we find time to intentionally, regularly step back from work and the electronic hum that has become the unfortunate music of our lives, what we come home to is relationships. In whatever form it takes for you, sabbath should be time and space to reconnect with people you care about and who care about you, or time and space that allows us to renew and re-explore our relationship with ourselves and, perhaps in looking inward, have a chance to connect with something beyond ourselves.
Sabbath is about finding times of stillness and being open to what that stillness might reveal. Things to be grateful for and cherish and things to let go of. Pico Iyer writes of this in The Art of Stillness and describes this type of time set apart as “the adventure of going nowhere.” In his short book, Iyer, a travel author, ironically makes the case for the importance and accessibility of traveling into your own soul as a preferred destination: “In an age of speed, I began to think, nothing could be more invigorating than going slow. In an age of distraction nothing can feel more luxurious than paying attention. And in an age of constant motion, nothing is more urgent than sitting still. You can go on vacation to Paris or Hawaii... and you'll have a tremendous time, I'm sure. But if you want to come back feeling new—alive and full of fresh hope and in love with the world—I think the place to visit may be nowhere.”
It is worth the effort. You are worth the effort. There is still time. This is your final boarding call… for your flight to nowhere.
Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Submitted by Dr. Brian Sayers
July 2022

Turning into the Storm: Love

The last in our series examining things that help us through the storms of life could have been any number of topics ─ values, fidelity, generosity, and compassion ─ but the list has no logical end and it occurred to me that all of these are covered with this one topic. It’s surprising how little is written about love in physician wellness literature.
Defining love is hard. Just try. However you define it, I doubt that your words come anywhere near a satisfactory description. Part of the problem is that there are so many kinds of love. Philosophers of antiquity described distinct types. Eros, philia, storge, agape, and platonic love are just some of them. Ultimately, love is foundational in our lives and yet hard to really wrap words around ─ but we know it when we feel it.
Perhaps love in the sense that I'm using here is the kind of love that is universal and unconditional ─ the hardest of all to define, describe, or even comprehend fully. This ultimate kind of love connects us with each other and with the universe or higher powers beyond ourselves ─ concepts which we can scarcely pretend to understand. This kind of love is messy, it calls on us to share love equally with all of those around us, even those who are seemingly unlovable. An attending on rounds one day when I was an intern pointed this out in a way I still remember decades later. We saw a patient who was in custody, restrained, and in the throes of withdrawal, the room full of the overwhelming and unmistakable smell of steatorrhea, the squirming, delirious man suffering greatly. The patient we had seen immediately before him, Mrs. Turner I’ll call her, was a delightful, entertaining elderly woman who we had all come to love in the week she had spent with us. Out in the hallway, our attending, the department chair, commented something to the effect that, “The most important thing to learn today is that we have to care for, and about, this man just as we do for Mrs. Turner.”
When you try to remember why you went into medicine, some of you might remember that it was interest in science, a doctor you admired growing up, you wanted to be wealthy and not have a boss (oops!), or any number of other reasons, but I can assure you that for virtually all of you, the real reason you spent your youth studying all those hours, being on call, missing sleep, getting frustrated, exhausted ─ was love. Love makes all of that, then and now, worthwhile. Love propels you into the next exam room or operating room or to carefully examine the next scan or slide. It fills in the gaps where science leaves off. Love, not RVU’s or a brilliant diagnosis or the perfect EMR note, is the source of healing, for your patient ─ and for you.
One night almost exactly 29 years ago, I sat with the MRI tech at Seton and looked at images of my wife’s lumbar spine as they came up. A neuroradiologist who I was familiar with, but not friends with, came in and looked at the images with me. Tumor filled the spinal canal, wrapped around the spinal cord and caudal nerves. I didn't know exactly what I was looking at, but I knew it was bad. I don't remember what he said, but I do remember that he put his hand on my shoulder, and I recall how that simple act was a pure and spontaneous expression of love given by a relative stranger on that awful night.
There is an unwavering, unending love that is around us and within us as we move through our days caring for patients and colleagues. Our job is to stay connected to it ─ to ponder it, embrace it and share it. As you pause at the doorway to the next patient, don’t just take a breath, take a breath and think… “love.”
Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee

Submitted by Dr. Brian Sayers
July 2022

Turning into the Storm: Humility

In an address to a group of medical students in 1906, William Osler made this plea: “In these days of aggressive self-assertion, when the stress of competition is so keen and the desire to make the most of oneself so universal, it may seem a little old-fashioned to preach the necessity of humility, but I insist . . . that humility should take the place of honor on your list [of virtues].”
What is humility? Some define it as the opposite of a sense of self-importance or infallibility. Humility is about understanding, admitting, and responding to the limits of our knowledge, understanding, and abilities. As one author described, “Humility is an attitude of spiritual modesty that comes from understanding our place in the larger order of things. It entails not taking our desires, successes, or failings too seriously.” Most of all, humility is about recognizing the inherent dignity, equality, and shared humanity with those around us as we all go through life on a common journey. We are no better and no worse than any of our colleagues or patients. Humility is not a sad legacy of failure. It is not surrender. It is a source of strength.
In the context of medical practice, why is humility so valuable?
•    Humility helps us admit our limitations so that we can ask for help when we need it.
•    Humility allows us to admit the limits of our knowledge, makes us more curious, more eager to learn.
•    As one author notes, “Genuine empathy requires humility.”
•    Humility helps us to recognize the limits of technology and science and allows for the potential to fill those gaps with humanity and compassion in the care of patients.
•    Humility helps us see that―along with successes―failure, mistakes, and other storms are inevitable. This acceptance keeps us prepared and ready to deal with setbacks and the unexpected. They become an expected
visitor and we are prepared for their occasional, often painful visits. We recognize that these visits are part of life for everyone.
•    Perhaps most important of all, humility connects us more fully, more intimately, with those around us. While patients have high expectations from their doctors, there is research that shows patient satisfaction and
outcomes are better when they perceive physician humility. The sweet spot might be something referred to as “confident humility.” Likewise, one of the most important domains of physicians’ professional satisfaction
is the quality of their relationships−at home, with friends and colleagues, and with their patients. Humility is conducive to more enjoyable, meaningful, and fulfilling relationships. When you think about the
relationships you value the most, you are probably thinking of people in whom you easily can recognize humility.

Where does humility come from? There is a push in medical education to try and teach it, to instill humility in physicians-in-training. I hope they are successful. Some people just seem to be born with it. It’s an integral teaching of religions and spiritual disciplines. But perhaps its real lessons are forced upon us more often than not, inside and outside of our medical practices, learned the hard way, often with a short half-life, soon overwhelmed by pride or shame. Regardless of the source, sometimes humility sticks and is a seed that can grow, open our eyes, even be passed along and I have seen and considered it in people I have greatly admired. Some of them are even doctors.
Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee


Submitted by Dr. Lamia Kadir
June 2022

Turning into the Storm: Faith

I look forward to your words every time I receive a TCMS newsletter. There are so many things I wish to share, and all have an "Anchor" in common, God, aka Allah. 
Your talk of "weathering the storm" hit very close to home. I have been a Family Medicine Physician for 20 years, the majority of which have been here, in Austin/Round Rock, Texas. 
I opened a solo Primary Care Practice in 2014, along with an MA who I thought was one of the best assistants I'd ever had. I had known her and most of her family for ten years. In late 2018, I found out my MA—turned Clinic Manager - had embezzled over $150,000 in cash and took out a significant bank loan in my name. I couldn't believe it! My heart broke when I discovered her email containing the loan application. This was an employee that had no check signing privileges but managed to apply for an ATM card in my name and steadily withdrew cash on a weekly basis. Of course, I terminated her immediately. What made it even more devastating was that she was inextricably linked to day-to-day operations, as most clinic managers are. Her departure affected clinic morale causing disorganization and "chaos" at the office. Needless to say, 2019 was the most difficult year of my life, both professionally and personally. 
The stress of the theft, as well as the guilt of not watching the books, was such a great burden, it seemed insurmountable at the time. It even affected my marriage. My husband was upset that I had not given him more access to clinic finances, I should have. He had always offered, but I had vehemently refused for no other reason than I thought I COULD DO IT ALL myself. I couldn't. I can't. As they say, "Hindsight is always 20/20." 
My mental health suffered greatly. The Unrelenting stress contributed to me gaining 30 pounds, and I've developed long-term health complications as a result. I'm always amazed by how significantly the mind controls the body. It's both terrifying and humbling. Once my husband (yep, he saved it) and I stabilized the clinic, we took advantage of marital therapy, initially offered at no charge, by TCMS. Thank you so much, TCMS, for helping take care of THIS caretaker. By the Grace of God, I am still married, and I love my husband more now than ever. 
I share this to illustrate how I COPED with one of life's "storms." If I hadn't had a strong faith in God as a practicing Muslim, I feel I would've suffered far worse, mentally and emotionally. My conviction is a source of strength and healing. In the midst of the storm, I suffered an exorbitant amount of trauma, knowing that someone I trusted betrayed me, jeopardized my entire business which could have affected thousands of patients, and wounded my family financially, and emotionally. But in the end, as a Muslim, I believe in destiny. Our lives are essentially mapped out—blueprinted—before we emerge into this world. Yet, we are equipped with a WILL and a CONSCIENCE that determines how we react to life's turbulence. It has taken me years to get over the pain, far too long. I even cried as I wrote this to you. But, in retrospect, the ordeal made my marriage stronger, drew my family closer, and I've become more cognizant of business relationships and contracts. Checks and balances must be ensured at all times. 
I'm eternally grateful that I didn't become jaded. I continue to take pride and find joy in what I do. I still value and trust my employees. I don’t have to head face-first into imminent storms alone, I'm blessed with an anchor—God—during turbulent times. I pray all of you have an anchor as well. 
With Warmest Regards, 
Lamia Kadir, MD
Family Physician
Austin, Texas
Send comments about Dr. Kadir’s letter to



Submitted by Michelle Owens, DO
June 2022


Turning into the Storm: Embracing Change 

Change is a mysterious creature. It can be both welcomed and unwelcome at the same time. It can make us grow in ways we’ve never imagined, and yet bring us to our knees. Ironically, it is one of the few things we are promised.
Learning how to navigate change with some grace has been one of the silver linings of living during a pandemic. We were quickly reminded of how little control we have in this life and how things can change in the blink of an eye.
The enormous amount of change we have all experienced in the last two years is unfathomable. From the loss of loved ones, jobs, a sense of normalcy, and parts of ourselves, the world is barely recognizable as it once was. We have learned how to juggle closed daycares, unrelenting short staffing, and the ever changing COVID treatment protocols (and variants), as well as navigating misinformation, war and unimaginable suffering in our world. The changes around us have undoubtedly changed each and every one of us. 
Resiliency is aplenty. Exhaustion is rampant. Compassion and grace have infiltrated like ninjas in the night for some, and slipped away from others like the day fades into the starry night. 
Our mortality has been emphasized, as well as our humanity. We have grown in amazing ways we never could have imagined. Things we once took for granted are cherished and clung to tightly. 
Change has imparted the wisdom that time is our most precious resource. Our energy is finite and we must choose to change the things we can that do not serve us well. We are one decision away from changing our lives each day. 
Change doesn’t have to be such a threatening intruder; it can instead be a hopeful reminder of what else is out there waiting for us to explore.
Michelle Owens, DO
Co-chair, TCMS Physician Wellness Program



Submitted June 2022
by Dr. Brian Sayers

Turning into the Storm: Calling 

A familiar story attributed to Italian psychiatrist Roberto Assagioli is a good starting point to look at differences between job, career, and vocation:
Three stonecutters are working on a great cathedral. You approach the first man and ask him what he’s doing. Angrily he turns to you and says, “Idiot! Use your eyes! They bring me a rock, I cut it into a block, they take it away, and they bring me another rock. I’ve been doing this since I was old enough to work, and I’m going to be doing it until the day that I die.”
Quickly you go to the next man, and ask him the same question. He smiles at you warmly and tells you, “I’m earning a living for my beloved family. With my wages I have built a home, there is food on our table, the children are growing strong.” 
Moving on, you approach the third man with this same question. Pausing, he gives you a look of fulfillment and says, “I am building a great cathedral, a holy lighthouse where people lost in the dark can find their strength and remember their way. And it will stand for a thousand years!”

One reason we might struggle in our professional lives is the separation that can develop between our calling and our job, a separation that we may be unaware of, or feel powerless to reconcile. A sense of calling is a basic human need and translating it into visible work (vocation), is fundamental to a life of meaning and contentment. Without realizing our calling, or worse, recognizing it and ignoring it in our professional or personal lives, sets us adrift, lost in day-to-day routines that are ultimately unfulfilling. We might assume by dedicating ourselves to a career in medicine that our work and our calling would be the same. I hope it is for you, but depending on our individual calling and exactly what our workday looks like, it might not be.
For simplicity, let’s define a job as how we make a living and career as years of dedicated work that offers opportunities for growth, stability, and pride. Calling and vocation may or may not be part of either of these, even for a physician. In fact, sometimes the job we find ourselves in can actually work to separate us from our calling. Parker Palmer explains, “We arrive in this world with birthright gifts – then spend the first half of our lives abandoning them or letting others disabuse us of them. Our original shape is deformed beyond recognition; and we ourselves, driven by fear, too often betray our true self to gain the approval of others.” 
Finding our calling involves discerning our unique gifts and passions as well as our own vision of what the people and world around us cry out for. For some, calling and vocation aren’t fully realized in our workday, perhaps by the nature of our practice situation or because our unique calling involves something beyond our work in medicine. If so, then our lives beyond the boundaries of our job must express our calling to fully realize what we are meant to be in this world. The process of discovering our calling is not easy and is never fully completed. It is the work of a lifetime. The realization of our calling is ultimately our search for meaning and wholeness. Joan Chittister sums it up well: 
“The path to wholeness of the self commonly leads through a labyrinth of possibilities, a maze of gifts. It is a matter of listening to the call−to the magnet of the heart within us−to assess our own gifts, to follow our own passions, and to find, through them, the happiness that flows from the fit between passion and purpose…It requires that we make long range choices at the very moment it seems that short term choices will do. It means that we discover who we are and what we are called to do with our lives, and having discovered that, we must set our hearts to doing it…otherwise, what is life about?”

Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee 


Submitted June 2022
by Dr. Brian Sayers

Turning into the Storm 

I recently had a conversation with a retired naval officer who did several tours on aircraft carriers years ago. Somehow the conversation turned to storms at sea during those years and how crews prepare a carrier to meet them. Storms are not always avoidable and sometimes taking refuge in a harbor is riskier than being on the open sea. The captain and their crew must be ready to take action long before a storm is actually present. This readiness involves practice, skill, and leadership. In addition to the work of the crew, part of the preparation lies in the construction of the carrier itself. The front, or bow, of the ship has a highly reinforced frame and on open sea captains are trained to turn the carrier directly into the storm as the bow is constructed to withstand the assault better than the sides, protecting crew and cargo. Although most ships of that size are usually safer at sea than in a harbor during a storm, he did tell me something about anchor systems on carriers. Anchors on the older carriers he served on weigh 60,000 pounds, connected by up to ¼ mile of chain, each link weighing around 150 pounds. Anchors are important, but as I thought about it, so too is the courage it takes for the captain to turn the ship and its crew directly into potentially catastrophic storms.
I’ve spent very little time in my life on boats any bigger than a bass boat, but I’m still a sucker for nautical metaphors and it struck me as we were speaking that there are similarities between what he described and our lives in medicine. Specifically, day-to-day practice is hard enough, but predictably we all face times of crisis caring for patients, navigating our practice environment or within our personal lives. As David Whyte describes it, our times of crisis can be like “the meeting of two immense storm fronts, the squally vulnerable edge between what overwhelms human beings from the inside and what overpowers them from the outside.” How well we weather storms depends on how we prepare ourselves as we go through our days, the mindset and inner resources we equip ourselves with, in essence, what guides and anchors us through good times and bad. These anchors require discernment, attention, and practice. As basic as they are, they do not necessarily maintain themselves. In this past decade of meeting with physicians individually, in small and large groups, coordinating counseling visits and observing recovery programs, it’s become pretty clear that without certain anchors in place we are set adrift, and are especially vulnerable to storms at sea.
This summer, we will write a little about some of those anchors that may help keep us grounded and ever mindful of true north while also helping us to courageously turn into the storms we encounter. Values, calling, connection, spirituality/faith, vocation, and humor are some that come to mind. No doubt, I’m leaving out others and I will look forward to hearing from you about your own ideas, possibly passing along a few words you might want to contribute for your colleagues. 
Smooth sailing to you all with wishes for a summer of family, friends, and some time away from work. You deserve it.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee 

Anonymously submitted
May 2022

On the Other Side
I much prefer to be called Doctor, to be on the side listening and examining and hopefully to help find a solution. Finding myself on the converse side; trying to explain my perspective and trying to find an explanation and solution to my own medical issue has been an illuminating experience. 
Recently I crossed over to the other side as a patient. As I waited for my health issue to go away or get better, it not only stayed but continued to get worse. When I could no longer ignore it, I scheduled an appointment with a new doctor as my original physician had left the practice.
I found out that this doctor would also be leaving the practice shortly. I scheduled follow up appointments to pursue answers and a solution. A long-time diagnosis was called into question. I requested labs and was unable to get a clear grasp on the situation. 
I then scheduled an appointment with a second doctor, and the conclusion was that surgery would be the definitive solution. The second doctor told me she would call to discuss the surgery and next steps. I waited for the call and finally sent a message through the online portal. I spoke with a nurse and the surgery scheduler without receiving answers. Finally, I received the doctor’s message through the online portal; it had journeyed through circuitous routes, gotten lost in a mire of messages then eventually found its way to me. The message instructed me to schedule the surgery if I wanted to proceed. As our written correspondence was hurried, I still had questions and doubts and did not feel confident enough to schedule the surgery. 
I had to accept that my unwelcome medical issue was here to stay, so I scheduled another visit with a third doctor. I told my story and enumerated every question and concern. The third doctor deftly perused my chart to immediately confirm an elusive diagnosis that had gotten lost in the shuffle between doctors. She explained the criteria for this diagnosis and the profound implications of a previously proposed additional procedure. During our visit, she ruefully mentioned comments about patient wait times but said that she could not change how she cared for her patients. As she clearly and carefully presented all the information to me, I realized that I was the grateful beneficiary of her time and expertise. I could confidently move forward with the surgery having had this discussion and having understood the details and implications of the surgery. I decided against an additional, optional procedure which would have profound and irreversible consequences. She checked labs and sent me results that evening. I felt seen and heard and acknowledged. 
I know that physicians are dealing with burnout under the crush of a packed, overbooked schedule and numerous patient messages and calls. I do not doubt the clinical acumen or knowledge of any of these doctors. They did their best and sincerely desired to help. How did the third doctor find the time to truly take care of me and my concerns with her voluminous work? How had she retained that primordial spark that draws us to medical school and found her vocation amid this system that inexorably churns through physicians, depleting the scarce personal resources left after work? Although I do not know the answer, I do know that we need these rare and singular physicians. 
Anonymously submitted
Comments sent to will be forwarded to the author

Submitted May 2022
by Dr. Brian Sayers


A decade and a half ago, it was time for a personal reassessment, a course correction. More than a few of you have told me about similar times in your life. My own path out went through a time at seminary, where just a few minutes into my interview the Dean of Admissions, paused, looked at me, and asked, “Which of your parents was alcoholic?”. It was a fitting beginning for my six years there, getting a two-year degree and new perspective.
I had a good childhood. My father was a politician and lobbyist. Even through a child's eyes I knew he was not like the other dads, but I didn’t understand that his drinking was the difference. He was not home much, but when he was there it was mostly good things that I remember. He loved milkshakes. He taught me to play chess and gin rummy. He let me drive the golf cart when we played golf. He took me to the Astrodome when it first opened, and one night we saw Jim Wynn hit a ninth inning homer that lit up the outfield wall. The summer I was 12 he tried to show me how to make butter like his east Texas family used to. We bought a hand cranked churn and for a whole weekend laughed and got sore hands while we tried unsuccessfully to make butter from pasteurized milk. Three months later he was gone.
A dozen years later, I was a medical student at Parkland in Dallas. Like most of you, we saw our share of patients with end-stage cirrhosis, watching helplessly the terminal phases of their awful disease, often frustrated, sometimes belittling the “choices” they had made to this end. I knew my father had been transferred to Parkland the last week of his life and late one night I scanned rolls of ancient microfilm to find his records. What I found was that he died in much the same way as those I was caring for, and on that very same floor. I don’t think anything in life has taught me more about how alike we all are−how equal−as much as we pretend differently. How fragile and flawed, and yet still beautiful.
I joined the TCMS Physician Health and Rehabilitation Committee a decade ago and have served as chair the last several years, propped up by some very wise committee members. It has been an interesting journey to see in an intimate way how alcohol affects so many of our colleagues and the people who love them. Alcoholism is sometimes described as a disease of broken relationships. What more perfect role can there be for a society of colleagues than to help restore a sense of right relationships with colleagues in need? Most of the physicians we support in their recovery are also followed by the Texas Medical Board’s Physician Health Program, a program established to help physicians through a five-year program of recovery while providing a firewall between them and TMB as long as they are in compliance. A few will self-report to us or are referred from a colleague or family member requesting monitoring or intervention. We primarily serve as an advocacy committee to help colleagues navigate recovery as they provide safe patient care. The success rate during this five-year program is impressive and while those first few months are often rocky, by the end of the five years we have generally made a new friend and they are almost always solid in their recovery. Help is there for those whose lives have been ravaged by addiction nowadays that was not available for my father. There is nothing easy about their recovery, but it is easier if surrounded with love and support.
Alcohol addiction is enough of a tragedy for the alcoholic, but by its very nature it has profound ripple effects on virtually everyone they come in contact with. Guilt, shame, and other emotions may alter the trajectory of all involved. It is a mysterious disease. There are always unanswered questions. Gregory Boyle once wrote, “Just assume that the answer to every question is compassion,” and so let there be compassion for those who have yet to face their addiction, for those who struggle bravely through recovery, for their colleagues and loved ones who have carried part of that burden, and when needed, for yourself.
Brian Sayers, MD
Chair, TCMS Physician Wellness Program and
            Physician Health and Rehabilitation Committee 
For more information about the TCMS Physician Health and Rehabilitation Committee, contact Dr. Sayers or TCMS CEO Belinda Clare


Submitted May 2022
by Dr. Michelle Owens


A Dozen Pearls from the AAFP Physician Health and Well-being Conference 

Here are 12 things I learned at the AAFP PWB:
1. You are only one decision away from a completely different life.
2. Self-care is primary care for your mind, body, and soul.
3. Acknowledging openly the grief we’ve all experienced over the past 2 years is necessary and cathartic.
4. Connection promotes joy. 
5. You do have the time; you just have to make it a priority.
6. This is a time of great reprioritization. 
7. Together we can do hard things, advocate for change, and be better.
8. Mindfulness and movement nourish the soul.
9. Nutrition is a foundation of self-care.
10. Gratitude practice can make the hardest day a little lighter. 
11. Being present is powerful.
12. You belong here. 

I would highly recommend checking this conference out for yourself. It was the first conference I’ve attended where I actually felt rested upon returning to work.
I hope to see y’all there next year! 
Yours in wellness,
Michelle Owens, DO
Co-chair, TCMS Physician Wellness Program


The Art of the Deal, the Four Noble Truths of Buddhism, and the Untimely Death of Virgil Sollozzo

This past year my small practice has been involved in negotiations related to contracts or dispute resolutions with several insurance carriers. Some of these negotiations were settled amicably and involved people who were courteous and fair, but at least one was more frustrating and involved people invested in neither fairness nor courtesy. In any negotiation, both parties need to feel like the other has given them something for a negotiation to succeed and for everyone to walk away reasonably satisfied. Unfortunately, the days when the bargaining power of a small practice could match up against a large insurance carrier are long gone, and often along with it so too is a sense of common purpose. 
During one especially frustrating exchange, having given up any hope of reciprocal generosity, I prayed for patience and perspective and remembered a podcast about considering the Four Noble Truths of Buddhism while navigating the world of business, truths that transcend all facets of our existence. Stepping back and reflecting on the nature of suffering, of attachment to things that are impermeant, transitory, was a helpful pause. There is great wisdom, even liberation in these timeless truths, and pondering them again gave me some much-needed perspective on the smallness of these problems in the grand scheme of things. 
From the timeless wisdom of the Buddha, I descended to the “wisdom” of Michael Corleone. A famous scene in The Godfather has Michael planning the murder of Virgil “The Turk” Sollozzo in response to this rival mob boss’s near fatal shooting of Michael’s father. Previously avoiding the family crime business, Michael finds himself bent on revenge, accused by his brother of having his judgment clouded by vengeance. Michael’s response, “It’s not personal…it’s strictly business,” is one of the most memorable quotes from the movie, and in the years since has been widely quoted in the business world. I consciously tried detaching from personal feelings after a particularly testy exchange, but instead found distain for Corleone’s well-known philosophy. 
Like many of you, I have spent my adult life nurturing a medical practice that I’m proud of, trying my best to deliver compassionate and competent care to patients I care about while working with coworkers and colleagues who I also care about. Changes imposed by industry and regulators that devalue or impair my ability to provide that care is, as I came to realize, absolutely personal. While our practices must be carefully managed to thrive, as is true of any business, our profession is decidedly more than a business. It is the years and sweat and tears we give to be able to bring our love and talents to a world in need of healing. Our “business” is a reflection of all we bring to the exam room or the operating room or the bedside. In the end, the chasm that divides us from non-medical professionals whose control over health care dominates our practice environment is deeply rooted in the reality that while for them it might be strictly business, for us it is…personal.


Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program

Submitted April 2022
by Dr. Quintin Smith


I recently participated in my second Zoom session with third and fourth-year medical students at UTMB, now the John Sealy School of Medicine. It is a Practice of Medicine seminar provided by the school to help give them insight into what specialties they might wish to go. Alumni are asked to answer commonly asked questions as well as offer advice from their perspective, provided from colleagues ranging from early career to retired. Having retired in 2013 after forty-two years in Ophthalmology, you will easily see which category I fit into. In thinking about answers to the “most frequently asked questions” from each year, I am struck by how sincerely the students seek insight and perspective from those who have preceded them. I have been thinking about how this observation relates to the future of Medicine both for these future doctors and those physicians still in the “trenches.” 
When I acquired my practice from a retiring colleague, I told him he was retiring at the end of the “Golden Age” of Medicine. Little did I dream of the changes which were to occur in the ensuing years! These future doctors are concerned with many issues but I think “Work-Life Balance” is a priority. At a time when Medicine is struggling with physician “burn-out” and “resilience,” perhaps their concern is well founded. Their training seems to be orienting them toward more teamwork in patient care which may reduce stress. Medical care itself may ultimately be largely provided by paramedical personnel with the role of the physician quite different from what it is today. Perhaps at this time, currently practicing physicians’ “Golden Age” is coming to an end and they will have to accept new paradigms if they are to reach happy retirements. The question is, can today’s physician make the necessary changes? Many practices employ paramedical assistants who deliver significant quantities of care. Undoubtedly, adjustments in lifestyle have been made by physicians as reimbursement levels have changed. Those who have been able to retire have done so and others are considering retirement. 
Perhaps the bigger question is whether today’s physicians can accept the inevitable changes, adjust to them and derive pleasure from the remainder of their medical careers? Without doubt, the efforts by our professional organizations to reduce the administrative chaos will help enormously. Physicians still practicing a traditional style of medicine will need to evolve with the times if they are to survive, much like retail businesses faced with the efficiencies and conveniences of their online competition. Hopefully, in the midst of this evolution, they will be able to maintain our traditions of healing. One day most of us may be able to look back at our own “Golden Age,” and for those future doctors, it may be yet ahead.
Quintin J. Smith, MD 

Submitted April 2022
by Dr. Michelle Owens

The Mama Bear Instinct
As a mother of 2 little ones, I’m starting to understand what the mama bear mentality is. Protecting them, advocating for them and doing whatever I can to ensure they have what they need to thrive, survive and enjoy this life.
I started to think about what if we were not only mama bears for our children, but also for ourselves? Imagine - empowering and supporting yourself to be the best that you can be, nurturing yourself and showing compassion and grace in the face of disappointment, advocating for and protecting yourself against toxic situations, people and environments? 
This sounds like it could be called fierce self-care. 
And all the while we would be modeling these healthy and important behaviors for our children, our partners, our friends, our colleagues, our communities and our world. 
If we don’t advocate for ourselves, who else will? 
We have to be willing to take care of ourselves, in order to be able to continue to care for others, in whatever capacity that may be.
You have to be a mama bear for yourself. ❤️
Michelle Owens, DO
Physician Wellness Program Co-chair




Submitted, March 2022
Brian S. Sayers, MD
An Officer of the Court
Tony (not his real name) was one of those patients who came to be a friend. I was his doctor for 11 years, guiding him through some very difficult times with a chronic autoimmune disease. He was a handyman, a fly fisherman, husband, father and a man of deep faith. His condition was difficult to control but he always offered a smile as he patiently and hopefully waded through a series of treatments through the years. I’m a terrible fisherman, neither of the two necessary traits (patience and reading the water) coming naturally to me, but it didn’t keep him from giving me flies that he had tied himself, even giving me a handmade bamboo fly rod that to this day sits in my study unused but treasured.
One afternoon my receptionist urgently pulled me out of an exam room, concerned. “There’s a man in the waiting room, a deputy or something, and he wants to see you… he has some papers.” To this day I’m not sure who or what he was other than a messenger of misery. I suppose he was a constable. He handed me the papers, and I vaguely remember a badge, a gun that seemed entirely unnecessary and a decidedly unsympathetic look, a preview of the stress and self-doubt that the coming months would bring.
I hadn’t seen Tony for quite a while and it turned out that he had been diagnosed and quickly passed away with an aggressive malignancy that a plaintiff’s attorney seemed pretty sure several of my colleagues and I should have divined, even in the absence of any signs of it when last seen. This was some years back, in the era before tort reform in Texas, an era where hardly anyone knew a physician who had not been sued at least once. Now it was my turn.
If you haven’t been through it, it’s hard to understand the emotions you go through during malpractice litigation. In some ways it attacks the very core of who you are as a physician, an accusation that you are doing exactly the opposite of what you swore an oath to do and spent all those years training to do well. There was a strong sense of injustice, as I knew I had really done nothing wrong. I was forbidden by counsel to discuss it with friends or colleagues, adding an unhealthy serving of isolation to a plate full of shame and anger. To complicate matters even more, I was simultaneously grieving a man who I considered a generous friend. After a year of silent anguish, second-guessing myself and being suspicious of patients I once felt at ease with, I was as unceremoniously dropped from the suit as I had frivolously been added in the first place. There was a tremendous, but profoundly incomplete, sense of relief. Now even two decades later I still recall those emotions clearly, even as I ironically still treasure the fly rod Tony gave me.
As physicians, we are called on to be many things by patients, and by ourselves. Compassionate, competent, vigilant, intelligent, patient, available, and when lives are in the balance, perhaps even perfect. Litigation, deserved and undeserved, remains a constant threat lurking behind any mistake or just bad luck, but fortunately not as much as some years back. This extreme kind of judgment against us has to some extent been replaced by 100 smaller cuts that we face from criticism from patients or their families, online reviews, peer review, insurance authorization denials, peer to peer reviews, colleagues, employers, practice managers, and at times, most damaging of all, from ourselves. Some of these criticisms are well-deserved, even constructive, and are to be carefully considered as teaching moments, while others are simply based on bureaucracy, greed, frustration or just nastiness. All of them challenge our deep and ultimate calling to bring compassion and love, along with our talents, to each and every interaction with our patients. We have to be careful, through self-reflection and support from colleagues and loved ones, that this type of criticism does not harden us over time in a way that causes us to lose the compassionate calling that a younger version of ourselves set out to pursue all those years ago. 

Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program

Submitted March 2022
by Dr. Michelle Owens

What will fill your cup and feed your soul today? 

Self-care is not one size fits all. On social media, there are a variety of memes and lists on ways to practice self-care. I’ve noticed these memes and lists seem to primarily contain yoga, meditation, massage, and candlelit baths. Between my husband and me, self-care can look very different, so I’m sure it looks different for others too. Being an Austinite, I think we need a “well-being food truck” with a menu of self-care items listed for people to choose from. Then we can ask “what will fill your cup and feed your soul today?”
Maybe it’s listening to one of your favorite old-school jams or meditating for 5-10 minutes. Maybe it’s calling a friend to say hi or sitting in silence hidden away from the world. It could be practicing gratitude, soaking in a tub with your favorite beverage and show streaming in the background. Or cuddling with your fur baby, bathing in nature, eating fresh pineapple or your favorite sushi, putting pen to paper and letting your feelings flow, or chatting with your therapist. Or maybe it’s a host of other things that aren’t mainstream, and that’s OK. Whatever speaks to you and helps you to refuel is personal; we don’t have to have the same definition of what self-care means or looks like as everyone else. And most importantly, each day and maybe even each hour, we may need something a bit different. 
Let’s share with each other what self-care looks like, and maybe we will all be able to add a little something new to our favorite self-care menu. 
Michelle Owens, DO


Submitted March 2022
by Dr. Brian Sayers

Hope Floats

These last two years have affected us all in different ways, but for some, something positive in this long ordeal has been long overdue reflection and a reimagining of our work or relationships. It’s easy to get caught up, sometimes for years at a time, in routines that deplete us, and sometimes we feel unable to make much needed steps towards change, only to feel stuck, even helpless. I hear stories about this from many of our colleagues in my work with PWP and have great admiration for so many who have made much needed life changes that often go against the institutional culture of medicine and our own bad habits. Much needed change snuck up on me when I realized that I was just terribly inefficient with telemedicine in those early days of the shutdown. Appointment slots were lengthened, something I found myself unwilling to undo once I went back to seeing patients in the office. With a lighter schedule my days are less chaotic and stressful, and I came to love my work again. I’m nearer the end than the beginning of my career, my kids are off the payroll and I’m self-employed so admittedly I am able to make changes that will make my work more sustainable in the years to come that not everyone can. Still, I have to shake my head that it took me so long to realize the trade-off is well worth the bottom-line sacrifice.
To further confound my financial planner, we bought a little farm an hour or so from town during the shutdown. It’s been a steep learning curve of wells and septic fields, irrigation systems and permits, spiders and snakes, but I fell in love with the old farmhouse and the olive grove that covers much of the property. The previous owner planted 200 olive trees years ago that flourished until the big freeze of 2021 killed off about a third of them, most of the rest severely damaged. This past year after we purchased it most of them have started growing back as shoots, four or five feet by now. It’s a metaphor for our own recovery from these last two years, but I’ll set that aside for now. Relaxing there and not worrying about patients quickly morphed into worrying about the grove, but it’s different and there is satisfaction in watching life being breathed back into the place, ever so slowly. I wander and tend to it weekends and have made each of my grandchildren adopt a couple of the struggling trees, measure and talk to them when they visit.
It’s an experience that has made me reconsider hope. I can imagine how people who farm or ranch for a living center their lives around hope each year, just as we do when we look at our children or grandchildren, or a patient, friend or family member who is struggling or ill, or when we wish our workdays would nourish rather than exhaust us. Hope is the underlying current in optimism, the wind in the sails of our lives, and without it we are set adrift. These last two years have given me a chance to reconsider what I hope for, sometimes pray for, and what I should let go of.
The drive to the grove is about the right distance to unwind and, for the moment at least, leave the worries of Austin behind. About 15 miles from my turnoff, I pass by Smithville. There is a sign on the highway announcing “Smithville, Home of Hope Floats.” It was a popular movie filmed there that most of you have seen, a story about humility, divorce, childhood trauma and death of a love one, but in the midst of it, from the ashes, a new family, happiness, wisdom and hope emerge. I watched it again recently, trying to remember the line in the movie that the title comes from. It is at the end when Sandra Bullock’s character notes, “Beginnings are scary, endings are usually sad, but it is the middle that counts the most…Just give hope a chance to float up, and it will...” The sign is badly faded and whizzing by a bit above the speed limit all I see each time is the reminder that “Hope Floats.” And that is enough.

Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program




From the Other Side

As I sit at the bedside of my grandmother, she is on her final journey out of this world and I am reminded that life goes on despite the hardships we navigate. 
Golden Girls is playing in the background – a show I grew up watching with her every time I’d visit. 
I am a hospice physician – my day job is helping to ease suffering and allowing for a peaceful death. Yet being on the other side as a family member is the hardest thing I’ve ever done.
I reflect back on my journey into medicine and how I ultimately decided on pursuing a career in hospice and palliative medicine. The experiences throughout my education colored my path to be able to navigate this exact moment. I truly feel I’ve been preparing my whole life for this moment – to truly advocate for my grandmother and know what to ask for, to comfort my family and gently deliver the news that she’s dying, to understand what terminal delirium and agitation look like and hope to give myself the compassion and grace I tell my patient’s families to give themselves when faced with a similar situation. Yet knowing all these things, I still struggle. 
I am in awe of the beauty of the gift of time. How fleeting it comes and goes. Although I am reminded daily in the work that I do that we are not promised tomorrow, this impending loss is not any easier. 
Our life experiences shape us into who we become and our losses remind us of the beauty of being human, knowing suffering, and holding love and loss in tandem. I will forever be changed after experiencing this loss. I now understand even more how devastating and debilitating loss can be.
My grandmother’s death will make me a better physician, mother, wife, daughter and friend. As they say, it’s better to have loved and lost than to never have loved at all.
Dedicated to my grandmother, Blanche Beverly Owens (1932-2022)
Michelle Owens, DO
Co-Chair, TCMS Physician Wellness Program



I watched as her face glowed with excitement as she told me her MCAT scores. Her prospects of being accepted into medical school had just increased. This was her third attempt at the MCAT. She is a patient care technician who works in my hospital. We shared the same patients on many occasions. She had made efforts to seek my company whenever I rounded. As I looked at her face in her excitement, I remembered my own. Unknowingly, she gifted me with the memories of that time when I fought to enter our profession. I immigrated to the US at the age of 8. English was my third language. Because of this language barrier, I struggled with the MCAT. It was not the only barrier. My birth country and culture did not support women in higher education. In addition, my parents were poor immigrants themselves and I had to work my way through college and medical school on my own. Yet, I was not deterred. Acceptance into medical school was one of the joyous highlights in my life because it had been such a struggle. 
Somewhere along the way, like so many of you, I forgot all of that and lost my joy as a physician. The workload, long hours, heavy responsibilities, electronic records, and attempts to meet impossible metrics squashed my love for medicine. Fresh from training, I had joined 3 other men in an internal medicine practice in Kansas. I remembered the oldest of the 3 men in his 70s said to me on my first day of practice, “I am sad for you joining medicine these days with such a broken system.” Over the next 2 decades as a hospitalist, I realized how true his words were. These past 2 years during the pandemic worsened my attitude. Going to work every day felt heavy. I vacillated between anger and sadness. 
In sharing her new MCAT scores and her excitement, my young friend suddenly brought me to a place of gratitude. I remembered the difficulties and remembered where I was and where I am now. It was as if a switch was just turned on. I remembered the excitement of scrubbing in for surgery for the first time, delivering a baby for the first time, placing a central line for the first time, intubating a patient for the first time, and being called “doctor” for the first time. My eyes were wide open. My mind had the humility of a beginner. Back then, no one could take my joy away. 
So, what happened? I could name all the things that I feel took away my joy for medicine. Trust me, it would take a whole lot more than these pages could hold. I am not so “Pollyanna” that I do not see the destruction of our health system. Nor do I deny that anger doesn’t come up when I witness the atrocity physicians must go through to care for their patients. However, I am at a place where I am sick and tired of being sick and tired. I have decided no one can take away my joy. I am no longer willing to give the power and control to another or a system. I get to reclaim it. 
I started to reclaim my joy of medicine by remembering what brought me here in the first place. For me, it is the art of medicine itself and the connection with patients and colleagues. I felt thrilled to be able to diagnose the unique unilateral hyperhidrosis and vertigo associated with a stroke. I “get to” sit down with a stage IV ovarian cancer patient who failed treatment as she taught me the art of dying. I get to brainstorm with colleagues on challenging medical problems and finding shared vulnerabilities of “I have no idea what this is.” I consciously chose facilities and hospitals that value my work. I chose practice partners that share the same philosophy in medicine and support my need for time away. I cut hours of working so I can tend to my own healing. It is in these things that I find joy while still working in a broken system. I have learned after nearly 3 decades in this profession, there is never a right time to make changes. If I don’t do it now, it may never happen. As a physician working in acute care, I learned life is fleeting. 
My young friend was accepted into the medical school of her choice. She did not have to say anything. I saw it on her face. I saw and felt joy. 
This quote by Josh Shipp summarized it all for me: “You either get bitter or you get better. It’s that simple. You either take what has been dealt to you and allow it to make you a better person, or you allow it to tear you down. The choice does not belong to fate, it belongs to you.” 
Dr. Anna Vu-Wallace

This weekend I was putting together some promotional material to introduce TCMS members to the PeerRxMed program, a buddy system to help physicians connect and support each other one-on-one on an ongoing basis. As we have tested the program, I found myself reconsidering the importance of connection in general and more specifically the nature of friendship. It’s an important topic these days and much has been written about the high percentage of doctors who feel isolated, the “Loneliness Epidemic,” and the known physical, professional, and emotional consequences of isolation that have been extensively studied recently.
Isolation from friends and colleagues is not a new problem. In fact, some authors argue that physicians by the nature of their training and work are more susceptible to it than most, and for many maintaining connections has been made worse these past two years. Maintaining, let alone nurturing or developing, new friendships and meaningful, healthy connections takes effort, time, emotional energy, and more recently, not just a little imagination. With so much at stake in having not just acquaintances, but true friends in our lives, it’s worth considering the nature of friendship and what friends should be for one another. David Whyte describes friendship and the consequences of neglecting them this way:
“…the ultimate touchstone of friendship is not improvement, neither of the other nor of the self, the ultimate touchstone is witness, the privilege of having been seen by someone and the equal privilege of being granted the sight of the essence of another, to have walked with them and to have believed in them…on a journey impossible to accomplish alone. An undercurrent of real friendship is a blessing exactly because its elemental form is rediscovered again and again through understanding and mercy.
...a diminishing circle of friends is the first terrible diagnostic of a life in deep trouble: of overwork, of too much emphasis on a professional identity, of forgetting who will be there when our armored personalities run into the inevitable natural disasters and vulnerabilities found in even the most average existence.”

We ignore our friendships and their vital importance in our lives at our own peril, both individually and as a society. Mother Teresa observed that many of the world’s ills are a result of having “forgotten that we belong to each other.” Deeply connecting and sharing not only life’s joys but also our challenges and fears is not a sign of weakness, rather a profound form of personal and collective strength.
Whether you participate in the PeerRx program or not, find ways in your busy days to connect with friends and colleagues on a regular basis. You will absolutely make a difference in their lives, but also consider, as Gregory Boyle notes in Tattoos on the Heart, that this act of friendship - of kinship - is “not serving the other but being one with the other.”
Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program

Standing on Holy Ground

One of my favorite passages from sacred writings is the story of Moses, still tending his father-in-law’s sheep, an ordinary day in an ordinary place, suddenly encountering God, the ground he stood on now consecrated into holy ground, admonished to “Take off your sandals, for the place you are standing is holy ground.” All of the world’s religions speak of holy ground. For Muslims, even the simplest prayer rug in the humblest of places becomes holy ground to commune with Allah. Buddhists may have a transcendent experience at a stupa. The concept of holy, or sacred, ground transcends religion and in a secular sense people commonly find themselves encountering a different spiritual plane in all kinds of places. The experience may sneak up on you, but requires open eyes to be receptive to it.
Some years back, my wife had an appointment with a specialist at Southwestern in Dallas where we would receive more news about a diagnosis that would forever change our lives in so many ways. While she was waiting to be seen I went back to the medical school auditorium where I spent so many transformative hours all those years ago. The room had many technology upgrades over the years but it was still much the same. I considered my own time there and the fact that the doctors Maryann was seeing next door all would have either trained or taught in this same room, and I had a sense of an almost mystical nature of this ordinary room, of all the lives changed for those who passed through its doors. Similarly, a patient of mine recently described such a feeling when visiting the military cemetery at Normandy. The se spaces can outwardly be ornate or very ordinary, ground that becomes extraordinary and carries with it a moment in which we seem to commune with something beyond ourselves – a favorite place in nature, working in a food bank, quietly nursing a baby.
So, how might we describe holy ground in ways that may be recognizable, even familiar, to all of us regardless of whether we appreciate its presence with religious, spiritual, or purely secular eyes? Some describe it as a “thin place,” something the Celtic tradition describes as a place where the space between the material and the divine becomes very small, where the concrete merges with the infinite, where our tangible, practical world is suddenly enveloped with mystery and intangible truth. Where, for a time, we feel untethered and are united with a hidden world and souls around us. As with Moses, or the prayer rug, the stupa, even an auditorium, the terrain itself may be ordinary, but what happens upon it, or what it comes to signify makes it sacred. 
In health care, presumably there was an original sense of calling to heal, a calling that you answered years ago and still follow. For all of the things that get in the way of us pursuing it well, we are still incredibly privileged to inhabit the holy ground on which we meet our patients, people on a common journey with us, who literally and figuratively bare their bodies and souls before us, with trust – with an assumption that we will come to them with humanity, compassion and fidelity, to stand on this ground, and as we do it we agree to leave behind the encumbrances and baggage that we all carry. For the moment, we leave it all at the entrance to this sacred and mysterious space.
Pause at the door, take a cleansing breath, then enter the exam room, or hospital room, ER cubicle, or operating room. Take off your sandals, you are standing on holy ground.
Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program
Photo credit: Ashley Yeaman, Focus Magazine


The Covid Chronicles…
Submitted November, 2021
by Dr. Leslie Cortes


COVID Apocalypse

Almost from the beginning of the pandemic, I have referred to it as the COVID apocalypse. I use the word apocalypse in both its secular meaning of disaster or catastrophe as well as in its original meaning from its Greek root for uncovering or revealing. With the first meaning, I refer to the toll of illness and death as well as the disruptions of societal functions and global economics that the pandemic has caused. The latter meaning refers to the unmasking of things both good and bad.
Most of the good that the pandemic has revealed has been at the individual level, I think – compassion, service, altruism, and self-revelation – a better understanding that we each have of ourselves and what is important to us. Much of the bad revealed has been at the organizational and structural level – inequity, inequality, greed, and callousness. These things have always been with us, but the apocalypse has laid them bare. It has revealed how politics taints public health decisions, how political rhetoric taints the decision-making of individuals who profess to live by the Golden Rule as well as the decisions of our public institutions that profess to serve us all. 
It has pulled back the curtain on pretenses to reveal how corporations that claim to be engaged in making us all healthier readily put profit above probity. It has revealed the hypocrisy of expressions such as “essential workers” when they are used to apply to healthcare workers and first responders but not the workers who keep our pantries stocked, our utilities on, who teach our children, and who make life seem normal despite the ongoing conflagration. These are the workers who make it possible for those of us, more privileged, to work from home, shop from home, and otherwise minimize our exposure to potential infection. 
I am among the privileged because my wife and I are retired with a secure income; many Americans are not. I am among the privileged because my wife and I are vaccinated; most of the world is not. I am among the privileged because of an accident of birth, a helping hand from many I have met in life, and an occasional fortunate decision rather than because I deserve it. For these things, I am grateful.
Leslie L. Cortes, MD

Submitted November, 2021
by Dr. Michelle Owens


“What are your goals of self-care?” 

"This graphic made me say “Yes! Yes! Yes! 1000% this!”
In hospice and palliative medicine, one of our most common interventions is a goals of care conversation – like an appendectomy for a surgeon or a tonsillectomy for an ENT. A goals of care conversation explores what patients value most in life and helps to guide their medical care in a way that meets their specific life needs.
In the 5 years I have been practicing, I’ve realized that these goals of care conversations actually translate across most areas of life – not just at the end. In fact, you could consider many of the questions asked could be part of a “goals of self-care” conversation. What better way to guide our decisions and provide a better measure of what a successful life looks like?
Think about this for a moment:
Instead of asking “what are you willing to go through to get more time?” to a person living with serious illness, we might ask ourselves, “what are you willing to go through in your work life to be able to maintain your home life balance?” Or “what are your work life and home life non-negotiables?”
The question “what do you want to do with whatever time you have left?” is appropriate for all of us at any time. 
The questions “what brings you joy?” and “what gives you strength during hard times?” are also appropriate for us to reflect on. 
The only things we are promised in life are change, taxes, and death. We are tasked with being good stewards of our energy and living this life to its fullest.
What other questions could we ask ourselves to ensure we are living the best-balanced lives that we can? 
I encourage you to start your own goals of self-care conversation.
Michelle Owens, DO

The Covid Chronicles
Submitted by Dr. James Marroquin
November, 2021

On a winter trip to New Mexico earlier this year, our family hiked to a frozen lake. My sons Elijah and Micah threw rocks at the water and watched the surface crack. They then hurled sheets of ice they created, shattering them across the lake. Even as the cold turned their hands beet red, they couldn’t get enough of this chilly activity. 
Watching their carefree sense of wonder and fun, I reflected on my very different mindset in middle age. These days I feel the need to ensure every moment of my day is purposeful. When a gap opens up in my schedule, my first thought is how it can be usefully spent. A positive way of framing this is that I’m being a good steward of my time. But there are less flattering interpretations of this quest for perpetual productivity. Am I seeking to make myself feel important? Am I distracting myself from uncomfortable realities?
To become physicians, we put in long hours, sacrificing time with friends and family. We were conditioned to make work our highest priority. For many of us in clinical practice there are always more tasks to be done. And the portability of the EMR enables us to continue the grind even after we’ve arrived home. 
It’s challenging to put limits on our work--to set apart and protect time to rest, play, connect, and savor our lives. Some doctors unfortunately don’t have control of their work schedule. But even if we do, it’s easy to view these “non-productive” parts of our lives as less worthy of our time and attention. With growing levels of burnout worsened by Covid, it’s vital physicians spend our days in ways that enable us to thrive in our lives and not just our work. 
For me that’s included around ten minutes every morning outside gazing at the sky. I notice the trees swaying, clouds shifting, birds chirping, wind chimes clanging, and the sun slowly rise. Sometimes my golden retriever Hunter even comes by for a pet.
I’ll end with a powerful exercise from the social scientist Arthur Brooks. First, imagine yourself in five years. Picture yourself as happy, whatever that means for you. Next, list five things that made you happy five years from now. Place them in order of their importance in bringing you joy. Lastly, ask yourself how to best manage the two most important priorities on your list. How can you invest in them to enable them to grow and flourish?
Dr. James Marroquin

Submitted October 27, 2021
In These Silent Days
I’ve been trying to make sense of anonymously submitted surveys that colleagues fill out when they access the TCMS Safe Harbor Counseling Program. With over 1000 counseling visits funded so far, there is a lot of data, and I am poorly equipped to analyze it. Two of the questions ask: “Please rate your satisfaction with your work,” and “Please rate your satisfaction with your relationships outside of work.” We’ve seen over 97% of respondents express satisfaction with the therapy they have received, but no convincing data that they are accessing counseling primarily because of dissatisfaction with work or relationships.
My original thesis debunked, why then do physicians access counseling? It’s a question worth considering as we’ve seen a dramatic rise in utilization of the program during the pandemic, especially starting around the first of this year and again in August after so many months of challenge.
I’ve asked psychiatry colleagues and therapists their perspective on why our colleagues seek therapy. A therapist I trust pointed out something that should have been obvious. Many of our colleagues come to therapy not just with stressors from work and relationships, but rather, in this unique and prolonged time of challenge, they come to therapy in the midst of a sort of “stalled discernment,” a sense that change is needed, but without clarity of what that should be or how to pull it off.
For most, these many months in pandemic, especially the early ones, have been times of upheaval and uncertainty, a vague anxiety and loss of balance ever present in the background of our work and family life. But more importantly, it has been a time that cries out for us to identify foundational things that make us whole and open our hearts. Intermingled with the chaos have been moments or days of reflection and reassessment. For many, it has been a time of discernment as we consider where we were in our frenzied pre-shutdown lives and how we might reimagine our future. A time to assess what is nourishing and life-affirming and what must be left behind. The results are all around us. In our own lives and those of countless colleagues there has been a realignment of family life, and in the workplace, unprecedented numbers retiring, leaving clinical practice, changing practice settings, or otherwise trying to make their work sustainable for themselves and their families.
Singer/songwriter Brandi Carlisle calls this time, “these silent days,” noting that “either way, I lose you in these silent days…” perhaps meaning we will all be different in some way or another as a result of these past months. Shedding the old is always a part of becoming new. Writing in the Annals of Internal Medicine, Dr. Ranna Anwash observed it in a similar way:
“If we are to find a way to live our values in these demoralizing conditions, we must hold on to what is nonnegotiable in ourselves—not because it will heal our patients but because that is the only path back to ourselves. And, yes, it will be a different version of ourselves that we meet on the other side of this. One that no longer believes in neat and tidy happy endings. Someone with perhaps a little less faith and who is still in need of healing, but potentially—hopefully—someone we recognize.”
Henri Nouwen described discernment as “reading the signs of daily life,” of seeing − and recognizing − ordinary and extraordinary events of life as signposts for both the present and the future. Discernment goes far beyond decision making. It is about rediscovering core beliefs and values, joyful living and the things that breathe life into us, then making them the defining movements in our lives, something at once difficult and essential. 
Brian Sayers, MD

The COVID Chronicles
Submitted by Dr. Kim Wheeler
October 2021

Small Town Covid

In March 2020 I joined a TMA Teleconference regarding a virus called COVID19 that was in China. The TMA called all members that night with an update. As I listened, I almost dropped the phone as we were notified that the virus was among us and would become “The pandemic of our lifetime.” We were also notified that PPE and testing supplies were scarce so in essence “Good Luck.” And the TMA was correct. COVID19 had arrived. Within days our small-town family medicine practice had implemented telemedicine, put strict office mask and sanitation protocols in place, obtained as many PCR swabs as possible to start curbside testing, and went to two shifts so if one shift had to quarantine the other shift could take over. We worried that we would become infected and infect our families. We went to work every day and never missed a beat. In December, we were overjoyed as we were offered vaccines. There was a sense of relief that we could do our jobs safely now. We provided hundreds of vaccines to our patients. In June, the CDC was giving a positive outlook and we were feeling hopeful. 
Then July hit. We started seeing a surge of COVID that was worse than 2020. We were tired and unprepared for seeing anything “worse.” By August we were booked a week in advance and had dozens of “COVID positive” patients calling daily for appointments and infusions. Most were unvaccinated, but we were alarmed to see vaccinated patients testing positive as well. By October 2021 we have had hundreds of patients infected with COVID19, many have been hospitalized, and unfortunately many have died. We’ve seen families lose multiple loved ones. It has become part of our lives, part of our daily discussions with patients. 
BUT . . . w e are becoming hopeful again. Vaccines are easily accessible and boosters have begun. Children under 12 will soon be able to get their vaccines. There is talk of a pill for COVID that is being developed by Merck. Many unvaccinated patients who got COVID during the surge now plan to get vaccinated. There is a faint light at the far end of this tunnel. We cannot give up. We have come too far. We care too much. This is what we do.
Kim Wheeler, MD
Lockhart Family Medicine

Submitted by Dr. Tyler Jorgensen
October, 2021


Seeking Still Waters

Whitewater paddlers make it look so easy—staying upright in raging waters, navigating huge swells, leaning and cutting hard at just the right time to avoid dangerous obstacles. And when they do flip upside down, they are able to pop themselves right back up. It’s a marvel. But no matter how expertly they paddle, they always have to respect the power of the water. The moment they let their guard down and get too comfortable, they can make a careless and costly mistake.
We physicians do the same. We take an inherently dangerous, complex, and difficult discipline and learn to practice it as an art. We learn how to navigate tricky diagnostic pathways, respond rapidly to changing clinical conditions, and try to stay emotionally upright while riding successive waves of an ongoing pandemic. On our best days, we glide through the whitewater of medicine with style and grace. But if we let our guard down and get sloppy, we can end up making a careless and costly mistake. Who of us isn’t fatigued by constantly having to be on guard in the whitewater?
I have been thinking a lot about paddling lately. Getting out on the water has remained a source of wellness and renewal for me since residency. I enjoy just about all paddle craft. Sometimes it’s sitting inside a skirted kayak at the level of the water and flipping upside down only to pop up again—a sort of natural baptism that puts us in fellowship with the ducks and the turtles. Or maybe it’s hopping on a stand-up paddleboard on Lady Bird Lake, and immediately feeling carefree, relaxed, and untethered. Other times it’s paddling a gracefully-curved canoe with a friend, such a timeless and grounding adventure of shared effort and striving, shared wonderment, and sometimes shared suffering! 
My current kayak is an unusual one—a black, open-hull, lightweight carbon-fiber downriver racing boat. At nineteen and a half feet long and twenty-one inches wide, with gunwales just a few inches off the water, it is super tippy. I have unintentionally flipped and flooded it many times. This boat was designed for racing down the San Marcos River, but I am still just trying to keep it upright in still water. To do so I am learning how to engage my core at all times and work on balance. No false or careless moves. It forces me to slow down and focus on my breathing and movements in ways no other boat has. I am enjoying the challenge.
Regardless of paddle craft, I have yet to spend a day on the water with a friend that didn’t result in fantastic conversation and deep connection. Hours on the water in nature together steadily take us to unhurried and thoughtful exchanges, along with potent periods of shared silence. Neither have I spent a day alone on the water that didn’t result in greater inner peace and calm. Meditation, gratitude, joy, wellness.
Here in Travis County, we are surrounded by waters. If you need a new wellness strategy, can I recommend getting out on the water? Whether it’s Lady Bird Lake, the San Marcos River, or a quiet section of Barton Creek, the water always buoys me up, helps me find balance, refreshes me, and draws me into deep connection. It can do the same for you. There is even growing neuroscience to show that bilateral alternating movements (like paddling) can help our brains process trauma. And we all know the countless benefits of time in nature.
As thrilling as whitewater can be, these days I find myself seeking still waters. Even while at work, in the midst of busy whitewater days, I am coming to find moments of still water. If I seek out and recognize these moments, slow myself down and work on my breathing, I re-discover the balance and form to keep me paddling downstream, staying upright in the everchanging waters of practicing medicine. I hope to see you on the water.
Tyler Jorgensen, MD

By Dr. Brian Sayers


A long time ago, I spent three years in Albuquerque doing an internal medicine residency, years spent at the county hospital, a Public Health Service facility serving the Navajo and a regional VA. Those were good years, a time of learning how to care for people − once I figured out how to keep them alive. Strange as it sounds, one of my best memories of those days was eating on the patio of the VA cafeteria. They made the most amazing green chile stew, full of chile softened by hours of simmering, with pork, vegetables and spices thrown in. I would look forward to lunch throughout morning rounds. We sat together at a communal table, sharing stories about the strange cases and people we were caring for, quirky attendings, stupid mistakes, saves and codes, turfs and lack of sleep. We were all navigating southwestern and Navajo culture with varying degrees of success. We were learning the importance of understanding people’s culture in order to care for them successfully.
I soon learned that the chile harvest was the pulse of life in New Mexico. Fall in northern New Mexico was all about hot air balloons, the chile harvest and the communal celebration of both, with morning skies full of colorful hot air balloons rising in the high desert sunrise. Throughout the state, chile farmers would proudly bring their harvest to market in tourist towns, small villages and roadside stands, ready for cooking or decoration. 
In the southern part of the state, commercial growers produced huge crops, mostly bound for Louisiana and the inside of hot sauce bottles. But in northern New Mexico, the norm was small family farms that have grown chile for many generations, the hard labor of growing chile an integral part of the culture, the rhythm of daily life and an ingredient in almost every meal. These small family farms were largely owned by folks with deep roots there, many direct descendants of Spanish colonialists with strong Native American heritage. They have worked the land and passed it and their way of living down through uncounted years, their hearts beating in rhythm with the land and the climate, with the very soil that they labor in. Deep within their culture is an identity with that soil, with its innate mystery and value, a sense of its holiness. Even a modest harvest is a great source of pride and a cause for celebration. As one chile farmer is quoted in Carmella Padilla’s The Chile Chronicles, “My mother always used to say, ‘If you plant it with joy, it will grow.’”
One day I was eating a late lunch after a night on call. Our attending was an older man who inhabited a wonderful, open hacienda style home outside of town in the foothills of Sandia Peak. At the end of each rotation, he would host his residents and students, introducing us to New Mexican wine as we looked over the lights of the city. He exuded calm, a trait much needed in those days, and one I have tried unsuccessfully to emulate in the years since. He walked onto the patio, bowl of stew in hand and sat down with me. 
One of our admissions the previous night was a poor, elderly chile farmer from Chama, his large extended family having brought him all those miles for care at the VA. It was an impressive sight, this tribe of modest laborers all gathered as a family to stand vigil. He had told me about his little farm and his family that night and I related some of it on rounds. “I’ve always admired people like him,” my attending said. “When we are at our best, we are more like them than you might think, grounded in culture and family. When you leave here, you’ll take a new culture and a new family with you.” I’ve thought about that offhanded bit of wisdom dispensed over a bowl of green and have considered its meaning in the years since. Those chile farmers were deeply rooted in the soil, the rhythm of the seasons and their heritage. It binds them together, gives them purpose and faith. Along with my own heritage of faith and family that I brought to New Mexico, I added new roots, the timeless culture of medicine and healing, and had been given a new family, just as you were on your own unique path. That sense of culture and family, that calling, will always be there, waiting for us to return even when we wander or forget, drawing us back, in some form or another, to what we were meant to do.
Brian S. Sayers, M.D.
Chair, TCMS Physician Wellness Program

Submitted September, 2021
by Dr. Michelle Owens


During a well-being debriefing with my work family this week, the strategy of practicing gratitude was shared as a way to practice self-care to be able to navigate these continued times of uncertainty and acute on chronic stress.
This resonated with me deeply as earlier in the year I had adopted a gratitude practice with my husband. Every evening, right before bed, we take turns sharing 3 good things that happened to us during the day. Often times they would be similar and related to our young children. We found it to be a nice way to end the day and drift off to sleep with comforting feelings instead of exhausting thoughts of one of the many worries or stresses of the day. I also noticed I slept deeper and was more rested in the mornings.
I’ve heard other colleagues share similar gratitude practices - some starting their days off by reflecting on 1 good or meaningful thing that happened the day before; others reflecting on 1 meaningful interaction they had with a patient or family that day on their drive home from work; and others practicing daily gratitude journaling. They all shared how impactful their gratitude practice had been on their overall well-being, and many shared that they look forward to that practice each day.
This is not a novel idea and the field of positive psychology has focused on the impacts of practicing gratitude with happiness for years. It’s not surprising that people who routinely incorporate the practice of gratitude in their lives report feeling happier, more optimistic and with an improved well-being. Some studies have shown increased exercise and fewer visits to physicians, as an association with the practice of gratitude.
There are many ways to practice gratitude and none are superior to others - it’s truly what speaks to you and ultimately fills your cup. Gratitude is a salve for our emotional wounds. 
What ways do you incorporate the practice of gratitude in your life? 
Dr. Michelle Owens

Submitted September 2021
By Mark Rosen, M.D.
Seeing the lost and overwhelmed look on one of the new ICU nurses reminded me of my internship.
My high grades came easy to me - until medical school. Suddenly I found myself surrounded by others at least as smart as me. Most of them had a hard work ethic while I was always able to manage without much studying. I continued to enjoy the campus and city life at my prestigious medical school, with grades well in the middle of the pack.
I applied to 13 top internship programs plus two safety nets. I got into #14. I was devastated. This was in Miami, Jackson Memorial Hospital, and some of the wards were not even air conditioned. I was so naïve back then. I had no idea that to get into a top internship, you needed to get references from top academicians, and you need to have done research for at least one of them. Not me. 
My first month was ICU, where the resident just had one intern and I was protected for the most part. The second month was the Medicare ward, old and sick. My first night on call the ER doc admitted to me a patient with pulmonary edema. I went to the ER and saw a cachectic man on a Bird respirator (as if anyone reading this knows what that is), no edema, no rales. Bed, IV pole and ventilator. It was my responsibility to move him to the floor? How? Do I have to grow a third hand? You know us guys, we don’t like to ask for help or directions. But I had no choice. Turns out we were to call respiratory therapy and they move the vent. I got the patient tucked in upstairs and figured out he had decompensated COPD. Dry as a bone. My first big lesson: don’t trust what other doctors or the patient tells you about the diagnosis. It’s a good place to start but make your own decision. 
Things went downhill from there. I was sure I would kill someone from missing an obvious diagnosis (we learned thousands of them in med school) or ordering the wrong medications (ditto). I became depressed with what I now recognize as PTSD. Couldn’t sleep, no appetite. Dreaded going to work. Tachycardia whenever I was not at work and heard a siren. 
My medical school rotations, being at a tertiary referral center, gave me little chance to make decisions. I’d be the fourth or fifth doctor to see the patient, and everything was known and planned by that time. 
I told my housestaff director that I was going to have to quit. He refused to accept this and told me to take some more time. I had an elective coming up and wouldn’t be faced with decisions or night call for a month. I saw a therapist. Wasn’t given antidepressants or antianxiety meds, not sure why. I sure needed them. 
Month 4, back on general wards. Night call, asked to see one of my fellow intern’s patients with abdominal pain. He had a board like belly. First thought, call surgery. Second thought, he will ask me what does the CBC and abdominal film show? So I ordered those. Free air under the diaphragm, called surgery, off to repair a perforated peptic ulcer. 
Even now I still tear up when I tell this story. I realized that I did know what I was doing. There were only a few medications for pneumonia, not thousands. There were only a few diagnoses we had to deal with daily. The few exceptions were sent to specialists, discussed in morning report or grand rounds, and got treated appropriately. 
My symptoms resolved and I finished my training without further such problems. 
In retrospect, I was thrown into the deep end without knowing how to swim. If I had been accepted at one of those top internships, I’d still be dog-paddling. I truly believe that I am a much better clinician now having had the training at Jackson Memorial rather than elsewhere. 
Which is sort of the story of my life. Without exception every disaster, calamity, disappointment in my life has turned out to be the opening to something better. Sure, part of this is just my attitude about life. If I’m on vacation and miss a plane, so what? I’m still on vacation. Read a book in the airport instead of on the beach, who cares? 
I met my wife of 47 years in Miami. Which wouldn’t have happened elsewhere obviously.
I’ve been practicing medicine for 44 years. From the start I’ve heard my colleagues complaining about how it’s not like the “good old days.” They would tell my son not to become a doctor. He didn’t heed that advice, and last week moved to Palo Alto to start an IBD research program at Stanford. 
I prefer to look at the positive side. I love what I do and I’m good at it. I love my partners, who always want to help out. I love the hospital nursing and ancillary staff. They always seem happy to see me. I’m 74 years old but why would I retire? I’m having too much fun. Plus, every day there are at least one or two amazing patient stories that arise. 
The practice of medicine will continue to change, for the good and bad. Accept the inevitable and learn to work with it. You will be much happier than if you fight it. 
Mark Rosen, MD

Submitted August, 2021
by Dr. Anna Vu-Wallace


No One Dies of COVID

“No one dies of COVID, right?” This was one of the first questions my patient asked me in our initial encounter. My immediate thought: “What??!!” He went on to say, “It’s just another virus, like the flu, I am told.” My response: “Who told you that? Where did you get your information?” Despite the calm exterior, I felt intensely angry. Unfortunately, I didn’t get to stay in anger long. Within hours, my patient was intubated. Even before he was intubated, he couldn’t believe he was heading into respiratory failure and needed a ventilator. The following days were struggles to keep his vitals and numbers stabilized. Some days we were successful, other days we were not. He died two weeks after his intubation.
I am certain many of my hospital colleagues encountered similar patients during these past 17 months. I heard sarcasm and anger from physicians and nurses, echoing my own internal attitude towards these patients. It had been building up to this point for me since the beginning of the pandemic. Like everyone, I had my fears when the pandemic started. In the beginning, there was so much support for those of us in the hospitals. 
Then, it started to fade when misinformation surfaced. Anti-mask protestors appeared with subsequent bans on mask mandates. In a divided country, there was even more division on this point. The anti-vaccine movement seemed to end our patience the moment it started. I saw the outpouring of anger and disbelief from the medical community. By this time, it felt as if we were abandoned by the public. How can any of us not feel anger? We have every right to be. We are human, after all. Many have been overworked for years and were asked to give even more. 
Staying in anger, disappointment, and negative emotions has had its effect. Fatigue and burnout settled in. Dr. Sarah Smiley, the leader of our hospital practice, defined the state as “…haggard and stressed,” in referring to all the nurses, therapists, doctors, chaplains, and hospital staff. “Even the greeters and security guards are weary,” she recalled.
My daily calls to families, much to my surprise, became a part of my healing. The personal calls led me to understand who my patients were and what led them to believe what they believed. These daily calls allowed me a look into the person, not the “annoying, ignorant patient” as judged by this physician, but a human whose life has been rich in gifts they gave to others. I realized, when I am in judgment, that it just takes knowing the other person, really knowing them, to understand and let go of judgment. I heard the sounds of their weeping and understood how much my patients’ lives touched those who knew them. 
Dr. Elizabeth Kubler-Ross said, in so many words, to truly serve altruistically, we must understand our own biases and let them go before entering a patient’s room. These phone calls were often the only thing I could give to families to comfort them. The calls were often the pause I needed to look at my own biases and judgment, and just listen. Surprisingly, anger and frustration softened. My practice partner, Dr. Pamela Cowper, said recently, “I thought that I would have little sympathy for these patients who were not vaccinated, but I found it to be the exact opposite. I am rooting for them all. I am sure I picked the right career.”
The pause and listen seems to be key. False perspectives from my patients do arise from some element of truth. My husband, a retired business executive, life coach, and minister, reminded me, “To be open to another perspective, a person needs to first feel validated in some way that her/his own perspective has merit on some level, too.” Married to a highly educated and non-medical person, my husband also reminded me that despite his graduate studies, he knows nothing of the medical world. He said, “I don’t even know what questions to ask! I wouldn’t know who to believe if I didn’t marry a doctor. How would the public know who to trust given all the information out there?” This is a really good point. When I first met David, he didn’t know the difference between generic and brand name meds. He didn’t even know he could ask for generic medications, just as I would be clueless in his area of expertise. 
So, how do I serve during such a tumultuous time? How do I serve those I disagree with? Pausing, listening, acknowledging other perspectives, and respecting the other person provided a space for conversation that can lead to change and healing. I don’t deny my emotions when they arise. I feel them and try to express them in a more constructive way. My anger and reactivity has not changed anyone. There is so much negativity now that I am careful not to add to it. I certainly don’t want to stay in negativity. It has not served me nor anyone else so far. By pausing and truly listening, I can reach for understanding. I am still working on this. It is an art after all….this doctoring.
Dr. Anna Vu-Wallace

Submitted August 22, 2021
by Dr. Michelle Owens


I Don’t Want to be Resilient

I went to replace four hanging plants at a nursery this past weekend because they all died once the Texas heat made its appearance, despite being watered, placed in the shade and talked to by my daughter and me.
While I was looking for plants that will hopefully survive the Texas summer, I was chatting with my husband who cheekily said, “those plants weren’t resilient.” 
He of course knows my disdain for the word “resilient.” I have shared quite a few times this year why it makes me cringe so much. The term “resilient” has been thrown around so flippantly since COVID that it is a real buzzword now. 
As I have told my husband before, I do not want to be resilient. Being resilient to me means you’ve survived a dumpster fire white knuckling the whole way through at the brink of death but then manage to come out on the other side, traumatized, but still alive. Some might describe their experiences with COVID this way. 
I believe there are ways we can be more proactive to fend off having to be too resilient too often.
I challenged him and said, “I do not want resilient flowers, I want hearty flowers. In fact, I want to be hearty.”
A quick Google search provided me the Webster Dictionary definition of the two:
Hearty means “vigorous and cheerful”; “strong and healthy”; “wholesome and substantial.”
Resilient means “able to withstand or recover quickly from difficult conditions.”
Looking at the image search is even more telling - hearty images show wholesome stews and soups, while resilient images show a human figure pushing a boulder up a hill. 
I would much rather have a solid, hearty foundation than a resilient one marred with cracks, chips, and unevenness.
I worry that many organizations think “resilience training” is the answer, that if we all had a little more training in resilience, we would all be better for it. Honestly, I think resilience training is counterintuitive, exhausting and a slap in the face to the person having to complete it. Retroactive resilience training when staff are already burned out just contributes further to their burnout and feelings of failure.
The need to provide resilience training suggests that our perceived lack of resilience is the core problem, that “if only you were more resilient, you’d be happier/less burnout/ etc.” Perhaps we and our lack of resilience really isn’t the problem?
We all know watching a module on resilience, sitting in a lecture about mindfulness, being told to practice more yoga and breathing techniques does not make you feel less burnout. It’s having the support and buy-in from your workplace, to actually have the time to do the things that feed your soul and fill your cup. Adding more onto an already overflowing plate of life’s stressors only makes it heavier and more overwhelming.
I want support. I want authentic connection and compassion. I want someone invested in my well-being who prioritizes my self-care to prevent me from having to be perpetually resilient. I want someone who values my heartiness and helps to cultivate an environment that fosters continued growth for myself and others. 
Dr. Michelle Owens

Submitted August 15, 2021
by Dr. Christopher Chenault


My Journey in Medicine and Life

I have been reading Dr. Sayers’ articles on the TCMS Wellness Program page as it provides a window into other lives in this journey of medicine and life in general. We all start out on a road that would seem quite like other travelers in training and practice, but we all find a unique and special way of stepping over or around the rocks and pebbles on the way. Some of us find these obstacles more difficult to ignore or put behind us, leading to more worries. 
I do not wish to be too pollyannaish, but I have found medicine to have been a wonderful world in which to participate. Of course, medical school was a difficult goal to achieve, but when I finally got there it was exciting and challenging. We all knew it would be hard work and it lived up to its reputation. But it was grand and full of excitement and wonder. I scrubbed with Dr. DeBakey and Dr. Cooley and survived, held the artery after arteriograms, resuscitated a cardiac patient on the floor with only the respiratory therapist, delivered a lot of babies, set a few fractures, and did all the same things that all of you have accomplished and loved it. It was one of the highlights of my life. Following internship and general surgery residency, I spent two years in the Indian Health Service where I learned cert ain patient care techniques that I used the rest of my years in practice. My orthopedic residency was very much to my liking and they actually introduced me to the practice in Austin that I eventually joined. I found the group a remarkably congenial, smart, honest, and talented lot with which to practice. You just can’t find a better way to spend your days. Yes, we were in the ER a lot. One internist did the numbers and found that the general surgeons were called to Brackenridge about 110 times per month and the orthopedist around 103 per month. That’s a lot! But we had good dedicated colleagues with whom we shared that responsibility. Sure, sometimes in the middle of the night I felt a bit lonely and isolated, but I could call for help if needed. 
During my practice, I realized you couldn’t run a school without a good PTA and you can’t run a hospital without committees. So, I served on a few committees where I got to know some doctors in other areas of medicine. The credential committee at Brackenridge and later at Seton brought some real insight into the workings of other departments and the complexities of privileging certain specialties. That also allowed me to get to know some of the staff and administrators in both the hospitals and the Medical Society. The talent observed lifted my days. 
A wonderful wife and family took me on many unexpected journeys to a myriad of horse shows, band trips, uncounted band concerts, family travels, PTA live auctions, and all the crazy things that families do. The horror was losing one of our children that became the low point of our lives. With support of partners, family, friends, and our church we survived and moved on. You never completely move away from that but with support it becomes tolerable. 
I don’t know why I feel so lucky because I know that many others are blessed as much or more than we have been. The comparison doesn’t make any difference. It is the absolute of what we live that is the joy. The opportunity to make at least a few people feel better in their pain makes the trip worthwhile. And the companionship of community is a remarkable balm to help manage the bumps in the road. 
I present this story as a person who has very much enjoyed medicine as a vocation in spite of some complications and in contrast to the more difficult paths others have encountered. 
And retirement is pretty nice also. 
Christopher “Kit” Chenault, MD

Submitted August 2021


Three Trout and Wisdom from the Ordinary

Let’s be honest about something that people are notoriously dishonest about. Fishing. I am just a terrible fisherman. I’m no good at picking bait. I’m impatient. I try to set the hook too early or too late. I can’t read the water in a Colorado stream nor see redfish swirling in the bay. Some years back I decided to take up flyfishing after re-reading A River Runs Through It, thinking I might fare better. On a magnificent stream in Colorado, I managed to catch two nice trout one memorable afternoon, but I’d have to say the day ended in a draw because I also hooked my fishing hat twice. I feel pretty sure that my father-in-law, a great outdoorsman, went to his grave wondering why in the world his daughter married such a terrible fisherman.
With our adult children and six grandchildren recently in Port Aransas, I was determined to catch some fish with my eight-year-old grandson. There was a lake behind the house, and we fished it some that first day, but all we managed to catch was a very unfortunate turtle. I gave in and hired a guide for some bay fishing, but when we got to the dock that morning there was a message that he had called in sick. You don’t tell an eight-year-old that a fishing trip is called off, so on advice from a local in the bait shop we went to a spot where we could fish from a pier or wade. What followed was at once predictable and surprising. He caught a croaker, just a bit bigger than what we could buy at the bait store, but as I was about to throw it back, he wanted to look at it. He marveled at the different colors that glistened in the sunlight, the spines, the pumping gills. Over the next hour or so we caught three small trout, none of them keepers, but he was amazed at how slippery they were and laughed as they repeatedly squirmed from his grasp when he tried to throw them back. By mid-morning nothing was biting, but several dolphins joined us just a few feet away much to his amazement, and in the end fishing that I would have called a dismal failure was a great time that he talked about for days. It was only one of many times that week when ordinary things − collecting shells, letting their feet sink into sand in the surf, feeding seagulls − things I hardly notice anymore, fascinated them, and through them, became visible again to me. 
The evening before we left, I snuck out to the lake at dusk to try my luck again. It was a still evening, a full moon rising, and the lake was smooth as glass. John Buchan famously wrote, “The charm of fishing is that it is the pursuit of what is elusive but attainable, a perpetual series of occasions for hope,” a quote that fits even unsuccessful fishing well, and life in general. The casts were well placed, or so I thought, the results predictable but soothing nonetheless and I stood there in the quiet of early evening, Norman Maclean style, in the half-light where, however briefly, “all existence fades to being with my soul…and the hope that a fish will rise.” Perhaps there is more fisherman in me than I thought, seeing the essence of fishing before me, even without fish. I stood there and considered the lessons of that week: that there is wisdom in the ordinary, and with each cast, hope.
Brian S. Sayers, M.D.
PWP Chair

Submitted, July 2021
by Dr. Michelle Owens


A Heavy Load

I want to share a short story from Jon Muth’s book “Zen Shorts” titled “A Heavy Load.” I’ve read it to my daughter and this particular story really spoke to me.
“Two traveling monks reached a town where there was a young woman waiting to step out of her sedan chair. The rains had made deep puddles and she couldn’t step across without spoiling her silken robes. She stood there, looking very cross and impatient. She was scolding her attendants. They had nowhere to place the packages they held for her, so they couldn’t help her across the puddle.
The younger monk noticed the woman, said nothing, and walked by. The older monk quickly picked her up and put her on his back, transported her across the water, and put her down on the other side. She didn’t thank the older monk; she just shoved him out of the way and departed.
As they continued on their way, the young monk was brooding and preoccupied. After several hours, unable to hold his silence, he spoke out. “That woman back there was very selfish and rude, but you picked her up on your back and carried her! Then, she didn’t even thank you!”
“I set the woman down hours ago,” the older monk replied. “Why are you still carrying her?”

How many of you also struggle with holding onto things that don’t bring you joy, but rather rob you of it?
Life is too short to hold onto things that weigh you down without any potential benefit in sight. I know I have struggled with this from time to time.
Our time and energy are invaluable; we need to be good stewards of it. Much easier said than done - I know. We are so much better at offering this advice to our families and patients rather than taking it to heart ourselves.
What’s one thing you can set down this week? 
Michelle Owens, DO

Editor’s note: Our guest writer this week is Dr. Michelle Owens. Dr. Owens is a hospice and palliative medicine physician, wife, mom, native Austinite, self-care advocate, and current scholar in the AAFP Leading Physician Well-being Program. 
Brian Sayers, MD
Chair, Physician Wellness Program

Submitted July 2021

I can’t carry everything.

Knowing our limits is so important - they are critical in guiding us to set, respect and implement healthy boundaries, which in turn fosters our ability for adequate self-care. Asking for help is also crucial - and much easier said than done.
I am amazed at the self-care practices my 3-year-old daughter already has. She inspires me. She names her emotions better than most adults. She reminds my husband and I to “take a deep breath and calm our body,” and has healthier boundaries than I have ever had. 
I’d like to think that some of the language she has acquired has been from me. I’ve heard myself say - especially as of late - I can’t do everything. I have found it to be a validating mantra and almost daily affirmation that I am not superwoman, I am not immortal and I am human. 
She often times tells me this phrase, “ I can’t carry everything” at bedtime when she is trying to carry her baby doll and 2 unicorns upstairs. I always carry the 2 unicorns after she has asked for help; she always thanks me. We both feel better- her load is lighter and I’ve helped her. Win. Win.
I wanted to share this with y’all as a gentle reminder to know your limits, set healthy boundaries, don’t be afraid to ask for help and to give you hope for the future generations. ❤️
Dr. Michelle Owens

Submitted June 2021
Shame, Empathy, Connection, 
and the Sinking of the Essex

I just finished a book about the sinking of the Essex, an early ninetieth century whaler that sailed out of Nantucket only to sink after being attacked repeatedly by a huge whale on the open sea. Only a few survived after three months at sea in small lifeboats enduring exposure, thirst and cannibalism, eventually rescued 3000 miles away off the coast of Chile. The captain survived and returned to Nantucket; the fantastic story of the whale attack confirmed but still suspect. He went to sea once more, his next ship hitting a coral reef and sinking. No longer employable as a captain he lived out his days in obscurity as a night watchman. Herman Melville, who wrote Moby Dick based on these events, met the beached captain and remarked, "To the islanders he was a nobody. To me, the most impressive man, tho' w holly unassuming, even humble…" As I finished the book, I could only think of the shame he must have endured, and I wondered if anyone cared.
A decade ago, I heard Brene’ Brown speak at my daughter’s high school. It was before I was familiar with her work and a toddler on the row behind me kept kicking my chair, but a line from her talk did stick and I’ve thought about many times since, especially in interactions with physicians experiencing distress or addictive behavior. I couldn’t recall the exact wording until I came across it recently: “Everyone has a story or a struggle that will break your heart. And, if we’re really paying attention, most people have a story that will bring us to our knees.” For the most part, those struggles, often involving shame, are mostly hidden from view, even when carried by people we think we know pretty well, smoldering and informing their behavior and mental well-being. 
While guilt is a sense that “I did something bad,” shame is a sense that “I am bad,” and Brown describes it as “the swampland of the soul.” When shame is unaddressed it can cause despair that fuels destructive behavior, addiction and a variety of mental health issues. Brown points out that shame expresses itself differently in men and women. In men shame stems from the fear of being perceived as weak, in women of failing to live up to the complex web of expectations society lays on them. Beyond that, physicians in general are susceptible to shame, born of subtle indoctrination in training and early career to deny imperfections.
Brown notes that “empathy is the antidote to shame.” Like shame, empathy is a hot topic these days and has as many definitions as it does researchers. A basic definition would be “the ability to understand and share the feelings of another.” Author Sherry Turke’s slightly different view is that it means, “I have a commitment to be there for you. I don’t know how you feel, but I am here to listen.” Empathy requires connections, and while for some the pandemic strengthened our closest relationships, for others close connections with a network of friends and family normally available with empathy were lost or badly fragmented. Over time, this loss of empathetic connections has taken its toll on many, the dramatic rise in utilization of our counseling program and physicians leaving medicine only t wo of many indicators.
While empathy refers to our ability to take the perspective of, and feel the emotions of another person, compassion is when those feelings and thoughts include the desire to help. Compassion is the action that (hopefully) results from empathy. As a society of colleagues, we are meant to look out for each other. Actively. In ways that the institutions we inhabit can’t or won’t, we check in, we give space for the people we work with and care about to confide, to connect. Research has repeatedly shown that half of our colleagues are in distress from work, if not their life around it, yet we can’t fully appreciate it unless we are face to face with someone who is suffering, and take the time to recognize it. As Mother Teresa once said, “If I look at the mass, I will never act. If I look at the one, I will .” 
Brian S. Sayers, MD
Chair, Physician Wellness Program

Editor’s note: Our guest writer this week is Dr. Michelle Owens. Dr. Owens is a hospice and palliative medicine physician, wife, mom, native Austinite, self-care advocate, and current scholar in the AAFP Leading Physician Well-being Program. 
Brian Sayers, MD
Chair, Physician Wellness Program

Submitted, May 25, 2021
The Plight of the Family Rock
It only makes sense that as the doctor in the family, you would be the one that everyone goes to in times of crisis. I get it – it takes a certain type of person to persevere through all the challenges of medical education and training. But that doesn’t mean I have to like it. And that doesn’t mean I wouldn’t like to wish it away on more days than not.
The past 15 months have highlighted the plight of being the family rock. As if the global pandemic wasn’t enough to deal with, life goes on. Dealing with crisis and stress during normal times is hard, let alone having to juggle COVID-19 risk mitigation, social isolation and political extremes. So, this begs me to ask the question - Who is the rock for the family rock?
It’s exhausting to really sit down and think about it. And honestly, the best answer I can come up with is – a therapist. Paying someone to be your rock is one way to ensure you have someone to lean on when everyone else is leaning on you.
A wise mentor of mine during residency destigmatized the practice of seeing a therapist. She told me that therapy was part of her self-care. This makes so much sense to me now. I’ll admit that I was one of those people who thought seeing a therapist meant you were weak, imperfect (not an easy thing to swallow when we strive for perfection in the field of medicine), and there was something wrong with you. 
Later I realized that no one is unbreakable or perfect. In fact, I would argue that those who see a therapist regularly are stronger than those who do not; largely due to the strength it takes to be vulnerable and share imperfections and perceived weaknesses. 
Sadly, not all rocks become diamonds under pressure. Some become so damaged that they disappear. We can’t afford to lose any one of us. Consider lessening the burden with a therapist of your own – a good one is worth their weight in diamonds. 
Dr. Michelle Owens

Submitted May 2021

The Winds that Brought Me Through
At first, I thought it was my imagination. Why are so many retiring, leaving medicine or “downsizing” their practice lately? A specialist with young children finally got fed up spending evenings and predawn hours keeping up with charting on too many patients and left fulltime practice to work part time and be more present with their family. A highly skilled specialist disillusioned with the system they worked in left medicine altogether. Seasoned colleagues still at the height of their skills with time to reflect during the pandemic decided that early retirement was not only possible, but imperative. An employed colleague whose hours and practice location were abruptly changed without adequate time to make childcare adjustments, left clinical practice. All took a financial hit which, in the end, paled in comparison to the emotional toll their work was causing. All at some point felt a sense of guilt in making the change, all felt betrayed that the demands or clash of values in their work left them no choice if they were to remain whole. It’s not just here. The sudden spike in doctors leaving medicine during the pandemic is a nationwide thing .
Heather Fork, who ran her own successful dermatology practice in Austin for almost a decade, knows as well as anyone what it’s like to discover her dream job was, in the end, not what she had anticipated. Although she enjoyed caring for her patients, she felt she wanted to help people in a different way and that the brief interactions with patients scheduled back-to-back was not an ideal way to have a meaningful impact. She closed her practice and, after a time of discernment in the Hill Country, became a Master Certified Coach and founded the Doctor’s Crossing, an organization that helps physicians re-examine their career path and explore options outside of clinical medicine. Heather’s already full client list has experienced a surge during the pandemic. To the usual reasons doctors consider leaving medicine, the pandemic added new ones born of the varied experiences doctors had that made us pause and re-examine our work. For some, it was a reduction in workload or more time with family that they are not willing to give up coming out of the pandemic. For others, it was the physical and emotional toll of working harder with suffering, death and safety issues a constant part of their work for months on end. For many, it became plain during furloughs, reassignments or other unwanted changes imposed by employers that they were undervalued and had little control over their work. Dr. Fork notes these and other factors “have the result of physicians feeling that they don’t really matter, except as RVU generators. They often feel unappreciated and expendable. This is not a good feeling for anyone, but when you’ve sacrificed many years of your life for this profession and then finally arrive and find out that your satisfaction is not important, it is very hard to continue sacrificing more of one’s life and well-being. Physicians are only human, and they too need what we all want, which is to feel valued, appreciated, and have freedom to serve in a way that brings joy and meaning.”
In the best of times, it can be challenging to fully connect with the joy and meaning that our work should bring to us, and these are not the best of times. Many of us are coming out of the pandemic knowing that change is needed in our work. Lately, for some that has meant “downsizing” schedules or changing practice settings entirely. For others, it means leaving direct patient care if not medicine altogether and, for our profession and our patients, that is tragic. Life is short and all moments within it are sacred, and we all deserve to be happy. We would all do well at this pivotal moment to re-examine life’s basic question posed by poet Mary Oliver:
Tell me, what is it you plan to do
with your one wild and precious life?

Most of us find great joy in our work, but for those who do not, there is a whole world out there waiting. Either way, we will always be colleagues.
While pretending to read journals the other night, a sappy movie about country singers in various stages of their careers was on in the background. It soon caught my interest because it had many parallels with medicine: passionate origins, early career enthusiasm, overwhelming time commitment, compromises with success, disillusionment, burnout. One of the songs  had a line that reminded me of the colleagues I’ve had on my mind: 
But I can’t do those things no more,
Like the way I’ve done before.
The same winds that brought me through,
Can blow that fadin’ flame out too. 

Brian S. Sayers, MD
Chair, Physician Wellness Program

Submitted April 2021

One of the surprises in the PWP counseling program has come from the anonymous questionnaires we ask colleagues accessing the program to fill out. To protect identity, we can’t ask much, but we do ask two questions − numerical assessments about satisfaction with work and relationships. It turns out that the responses are not very different from doctors who don’t access the program. But what I have found informally with physicians experiencing distress or dissatisfaction with work, relationships or life in general is a sense of regret, often involving a particular event or situation that triggers in them a call for change.
Regret feels bad because it comes with a sense of personal failure, is often visible to those around us, and is accompanied by self-blame, shame and sometimes guilt. Studies show that regret is a common emotion, 70% of adults having a significant sense of regret. While those studies demonstrate the most common sources of regret involve education, career, romance and parenting, I’ve found with physicians who seek support that their regrets involve relationships, career choices, medical mistakes, choices related to alcohol or substance abuse, or choices that adversely impact work-life integration. Researchers point out that regret related to inaction is more difficult to navigate than regret related to choices that turned out badly because the possibilities with the former are almost limitless as opposed to the more concrete consequences of the latter. 
Regret can fester because left in isolation we often tend to dwell on it. As Amy Summerville describes “. . . we develop the reflex to chew and chew on an unfortunate turn of events, like a cow on its cud, till there is no nutrition left in it.” This can be paralyzing when major, life altering events occur that involve regret unless we reframe regret into something constructive. 
All major religions and spiritual belief systems share a common theme that author Richard Rohr describes as the order→disorder→reorder cycle. Examples abound: traditional Native American cultures use metaphoric cycles of day-night-sunrise or the order of seasons, world mythologies consistently tell stories in a journey-fall-return to a new home pattern, recovery programs explore innocence-addiction-recovery, Christianity centers around life-death-resurrection. The list is endless but the point is the same: in any life, chances are we will at some point encounter what mystics called the “dark night of the soul,” a crossroads, with regret often a prominent feature, a place from which with some effort we might emerge into a new life that has not only escaped the bonds of regret, but has acquired wisdom from it. Rohr notes that even in distress we attempt to avoid the hard work of real change, the orderly progression from dis order to reorder and we often attempt to “jump from stage I to stage III,” of this common cycle, bypassing the personal growth that comes from confronting regret. 
The liminal space between disorder and reorder is often described as a wilderness, a time of disorientation and unsure footing where the pathway out may be obscure. Discovery of that path is deeply personal and requires naming and confronting regret, openness and accepting support from family, friends, counselors, pastors, or a colleague, many of whom probably inhabited that same space at some point. It requires looking inward, self-compassion, a sense of hope and, perhaps the hardest part of all, patience. While in the wilderness, if we look closely, we may find angels that were sent to protect us, sometimes in the most unexpected places.
Author David Whyte sums it up well, “Sincere regret may in fact be a faculty for paying attention to the future, for sensing a new tide where we missed a previous one, for experiencing timelessness with a grandchild where we neglected a boy of our own. To regret fully is to appreciate how high the stakes are even in the average human life. Fully experienced, regret turns our eyes, attentive and alert to a future possibly lived better than our past.”
Brian S. Sayers, MD
Chair, Physician Wellness Program

Submitted March 2021


Stealing Fire

Lewis Mehl-Madrona is a Native American physician who believes that nothing is more powerful in medicine than storytelling. It does not replace science or technology, but it shares an equal footing for those who truly practice the healing arts. Encouraging patients to tell the story of how their illness began in their own way and on their own terms can be a powerful tool in determining their path to healing. He notes that from a patient’s perspective, “Creation stories are also important because the final story about how you or I got well must be compatible with the story about how we got sick or the treatment will never work.”
Dr. Mehl-Madrona is the author of the “Coyote Trilogy.” He is a firm believer in the importance of the blending of what he describes as the bio-psycho-social-spiritual realms of illness in medical practice. His Native American roots inform him of the importance of the creation story, storytelling that is a crucial way of defining cultures, families, individuals, and even illnesses. “Stories contain and convey the meanings and values of our lives. They tell us how to perceive the world. They give us cultural identity . . . tell us about families and lives and what it means to belong. They comfort and heal us, both in the listening and the telling. They contain the living symbols we use to make sense of our world.”
Physician distress/moral injury/burnout that many physicians suffer in some ways is an illness of the soul and Mehl-Madrona's belief in the importance of exploring creation stories to make sense of illness applies as well here as anywhere else he describes it. Creation stories change with telling and retelling, evolves, matures, and becomes more interpretable, aided by those who help us through generous listening. 
Hearing the story of others promotes healing for us as well as the storyteller. Particularly important is hearing stories of transformation, journeys from places of darkness into new life, a journey then envisioned by the listener. He notes that transformation is a logical evolution from closely explored creation stories as “Stories contain the hidden secrets of transformation, the alchemist’s formulas for turning lead into gold. If we hear enough stories about profound transformation, we find ourselves transforming, even in spite of ourselves. While we can’t command transformation, we can create an enriched environment that makes it more possible.”
While hearing a story can be healing, so too is telling our own story. “In some African cultures a woman healer tends the storytelling tree. Traumatized and suffering people come to the tree, place their hands upon it, and tell their story. Their suffering flows into the tree and away from them. Then they can walk away from that pain and trauma, because they have given it to the tree.” Telling our evolving creation story allows not only for an unburdening, but also helps us to make sense of the origins of things that trouble us, helps us understand the illness so that a path to healing can be envisioned.
Mehl-Madrona makes the point that in creation stories initial creation “leaves the people cold and unadorned. Within most cultures of North America, once created the people must steal fire to improve their lot−to keep them warm, cook their food, or give them light in the darkness. Fire is rarely just given to the people. It must be stolen or earned. Both Navajo and California natives steal fire. For the Cherokee it is given, but on top of a tall tree on an island far from shore with no obvious way to get it . . . The quest for fire also opens the door for heroic journeys towards new worlds of growth and development. Stealing fire arises from our dissatisfaction with the current state of affairs−stimulus to growth and change. Fire brings us light and warmth.”
There is little debate these days about the origins of physician distress. It is the result of difficult and often demoralizing systems that inherently caring and intelligent physicians are thrust into that has caused so much difficulty in our profession. We hope and work for change in these systems even as we do our best to function within them. In the meantime, we each have a creation story to tell about origins and the journey that brought us to the place we currently inhabit, for better or worse. Hidden within our creation story is the possibility of transformation. There is a story to be told. There is fire to steal. 
Brian S. Sayers, MD
Chair, Physician Wellness Program

Submitted February 2021

Broken Open

One of the things that defines families or lifelong friends is that while time and circumstance may cause us to drift apart, sudden tragedy or loss brings us back together, reminding us how important the connections with loved ones are, and how difficult it is to face life’s storms alone. In these last few weeks, we have witnessed our family of physicians in Austin figuratively, and often literally, reaching out to console, hug, encourage and commiserate over collective loss.

A friend who I share books with passed along Broken Open by Elizabeth Lesser recently. Lesser’s book is billed as an “inspiring guide to healing and growth…even in the face of loss and adversity.” I found myself less than fulfilled when I read the book, not that it doesn’t have profound truth in it, but rather that it seemed inadequate for the moment. In this and other times of unimaginable tragedy, people often, and rightly so, refer to the stages of grief, our search for meaning, the “hero’s journey” from mythology, the mystic’s “dark night of the soul,” scripture or other profound writings. All of these contain truth, even hope, but in the raw sadness of the moment when we feel lost, it can be difficult to find comfort or any grain of understanding in them.

These last few weeks, we have demonstrated, as colleagues with whom we have an unspoken bond of love and share much in common, how powerful it can be to come together as one, to support and be supported, to love and be loved, to remember and to look together for glimpses of comfort and hope.

A few years back, a patient of mine was telling me about a hobby of his, a passion really, called Kintsugi and I thought of him as I tried to make sense of these past few days. Kintsugi is a Japanese artistic practice and later a philosophy, with origins in the 15th century. Legend has it that the Shogun Ashikaga Yoshimasa always used his favorite bowl for the tea ceremony. The bowl was broken and sent back to China where a clumsy repair using a rusty staple was eventually returned to him. He instructed his Japanese craftsman to come up with a more aesthetic solution to repairing his cherished bowl and from that Kintsugi was born. In this practice, the tiny shards of a broken object are collected, sorted, cleaned and assembled one by one with meticulous precision. The pieces are precisely glued, then sanded, then the remaining cracks are filled in by successive layers of lacquer, then sprinkled with gold or other precious metal powder. The metal mingles with the moist lacquer to give an illusion of flowing metal. The gold “scars” are then burnished and a new work of art, meticulously created from the original, takes on new life. It is a practice that takes large measures of patience and time, for to rush the process leads to undesirable results rather than a thing of beauty.

The obvious metaphor from this is the basis of the Kintsugi philosophy of healing and hope. Even after profound damage, a healing of sorts may take place, but only over time, layer by layer, the shards of damage slowly pieced together, pieces slowly becoming part of the whole again. Though forever changed, it is eventually sealed and burnished, with patience and love, into an entirely new object, a lovely and precious piece of art that makes no attempts to hide its traumatic history, even as we marvel at its beauty.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program

Submitted January 2021

How to Save A Life

Once a year I’m asked to remind my colleagues about the work that the Physician Health and Rehabilitation Committee (PHRC) does and its availability to help our members. This time, as background, TCMS COO Belinda Clare gave me an article from 1989 written by Dr. Charles Felger about the work PHRC does. In the article, Dr. Felger notes, “We help our impaired colleagues not because we have to, but because it is the right thing to do…because we want to do so.”

For decades PHRC has been a source of support and structure to physicians in need, at any given time actively supporting 20-25 of our colleagues. Over the many decades of its existence, the Committee has helped hundreds rebuild their lives, be successful in their recovery, and safely continue caring for patients. Most of the physicians that we support are in recovery from alcohol or substance abuse and are monitored over a five-year period. Almost all are successful in their recovery, often against great odds. In my years serving on the Committee, I have seen many displays of courage and commitment from these brave physicians as they rebuild their lives and careers. On the day that we first meet with them, some of our colleagues’ very lives are at risk if profound change does not occur.

During a run recently I was listening to music and How to Save a Life came on. I had not heard it for several years and paid some attention to the lyrics. It was a well-known song a few years ago that describes someone trying to intervene with a loved one in crisis. The lyrics take us through a familiar scenario of how informal interventions tend to go when someone is brave enough to confront someone they love, with uncertain, and all too often unsuccessful, results. The refrain laments how inadequate we feel at times when we try to help someone in crisis:

“Where did I go wrong?
I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life.”

In an interview with USA Today, The Fray lead singer Isaac Slade explained that the song is about an experience he had working at a camp for troubled youths: "One of the kids I was paired up with was a musician. Here I was, a protected suburbanite, and he was just 17 and had all these problems. And no one could write a manual on how to save him.”

We all feel inadequate at times like these, when someone we care about desperately needs help that they are not inclined to accept. It takes courage to confront, even intervene, in such situations, and initial attempts are often unsuccessful, but it is no less important to try. In my years on the committee, we have seen many people - friends, family or colleagues - courageously reach out to help someone, and as difficult as it is for all involved, the eventual outcome in helping our colleagues is almost always successful. The importance of taking the first step to help someone cannot be overemphasized.

How to save a life? As important as it is, the first step, to help someone (“Step one you say we need to talk…” the song notes) sets things in motion, but ultimately only one person can save a life, something we see, in awe, time and time again in the colleagues supported by the committee. We can set things in motion that might lead to recovery for people we love, but in the end, only they can save a life. Poet Mary Oliver describes it well:

But little by little,
…there was a new voice
which you slowly
recognized as your own,
that kept you company
as you strode deeper and deeper
into the world,
determined to do
the only thing you could do –
determined to save
the only life you could save

For more information about the committee contact Dr. Sayers at or Belinda Clare at



Submitted November 2020

The Knock at the Door

I recently read a piece by David Whyte that reminded me of an item on my long-neglected and largely imaginary bucket list, walking the Camino de Santiago, an ancient network of roads that lead to the shrine of St. James at a cathedral in Santiago, Spain. Christians through the centuries traveled these roads in pilgrimage, popular in modern times as a journey of personal growth or adventure. While the roads converge at the cathedral in Santiago, many “peregrinos” continue for a few more days to Finisterre, where the road ends at the ocean. Here, among several traditions, two are that pilgrims will burn something they carried on the journey, often a letter carried or written along the way, and also leave something behind that helped them to their destination, often their boots, both traditions highly symbolic and nowadays also highly discouraged by locals. Here, the pilgrim symbolically stands at the end of one journey, the beginning of another. Whyte writes of the experience in his poem Finisterre (abridged):

The road in the end taking the path the sun had taken,
into the western sea, and the moon rising behind you

as you stood where ground turned to ocean…
no way to make sense of a world that wouldn’t let you pass

except to call an end to the way you had come,
to take out each frayed letter you had brought
and light their illumined corners; and to read

them as they drifted on the western light;
to empty your bags; to sort this and to leave that…

and to abandon the shoes that had brought you here
right at the water’s edge, not because you had given up
but because now, you would find a different way to tread,

and because, through it all, part of you would still walk on,
no matter how, over the waves.

Whyte is writing about change at life’s biggest crossroads, and the sort of careful examination and courage that we are all called on to make at a handful of times in our lives when familiar paths we have followed need to be changed. We often feel paralyzed when change is needed, standing at the water’s edge as in the poem, trying to make that first step. 2020 has for many of our colleagues been a season of change, changes of both small adjustments, but also some larger ones that may change the trajectory of our lives well beyond the pandemic with our work, our families, our relationships. There are only a few things that really define our lives – faith, love, calling, hope, fidelity are some that come to mind, but so too is change, change that we have to consciously consider in one form or another through all the seasons of our lives to stay healthy, engaged, content.

Sharon Salzberg, author and advocate of Buddhist meditation, often uses the metaphor of a house where our soul lives. Visitors come to the door frequently, and we then decide how welcoming to be. Anger, fear, jealousy, doubt and shame are among the many visitors we may want to turn away, but instead, she recommends that we let them in and get to know them a bit. They are, unavoidably, familiar figures that come around often. The key is to get to know them a little, learn from them, then show them out. Don’t let them become residents or even overnight guests. Give them audience, then send them away. More often, invite into your home generosity, patience, gratitude, and love and encourage them to become more permanent guests in your house. In this metaphor, change will visit as well, the kind of change that we all need from time to time, a call to leave a familiar path behind for a new one, the kind of change you have to choose and have the courage to make. It may come to the door disguised in any number of ways, wanting not just an audience, but to become a part of your household at a time when its presence is needed, sometimes desperately. Whether we hear the knock, and how we respond, will make all the difference.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program

Submitted September 2020


I read an essay by poet Mary Oliver recently that describes her childhood home. Dogs roamed free until the town required leashing, and a dog catcher was hired. One particular dog, Sammy, was sort of a communal pet and did not take well to leashing. He showed up repeatedly in her yard, a chewed-through leash dragging behind him, unwilling to be tied. She eventually adopted him, and after appearing before a judge for being unable to keep the dog confined, she built a fence, which he promptly learned to climb. It’s a story about natural instincts to refuse unnatural constraints.

It made me think of medicine, through the ages, in recent decades and now in a pandemic. As a profession and as healers, we have been leashed in many ways over the years even as medical science and all of its miracles have emerged. One current restraint, a pandemic, is unique in its suddenness and completeness in so many ways, not just our work, but our lives in general. We have learned to recognize and respect that most of us have a certain uneasiness, or worse, that we often can’t quite put into words, and as skilled observers of the human condition we have come to recognize its effects on our patients and our colleagues, perhaps better than we recognize it in ourselves. Author David Kessler notes, “that discomfort you’re feeling is grief.” However we describe it, like familiar constraints imposed by the systems we work within, some aspects of it threaten to pull us away from what energizes us as physicians: a sense of meaning. As a good friend pointed out as I was writing this, too often we overlook the good things, the gifts, that we have received in the pandemic, and perhaps it is also a good time to acknowledge that some of the leashes we struggle with are self-imposed, bonds broken only through self-examination and, yes, resilience.

An article from several years ago asks the question, “What do doctors find meaningful in their work?” Studying narratives written by volunteers they found three recurring themes: a fundamental change in the doctor’s perspective, connection with patients, and making a difference in someone’s life. Change of perspective typically occurred after being part of a profound emotional experience shared with a patient. Connection with patients was described as occurring over hours or decades, involving moments of emotional intimacy, the doctor’s willingness to respond personally and genuinely, “being moved by their patient’s humanity…sharing their own emotions and life experiences.” Making a difference in someone’s life was not usually from brilliant diagnostic insight or skilled therapeutic intervention, rather it involved stories occurring in the setting of chronic, incurable illness, situations in which “doctors themselves were the principal therapeutic agents…awed that their mere presence could be healing and comforting to patients.” Common to each is recognition that sickness includes both disease, a disturbance of the body that needs our technical skills, and also illness, a disturbance of the soul that requires healing – humanity and connection – and therein lies the real meaning in our work. Each of these themes requires the physician to be undistracted and present in the moment, something difficult in most day to day practice settings. When we think about meaning in those terms, it is easy to see how so many things, lately the pandemic, may obscure recognition of moments that should energize us, make us better doctors, better human beings.

As for Mary Oliver’s Sammy, eventually, as he aged, he was harmless, but no more likely to allow himself to be confined, and the town turned a blind eye to his wanderings. The dog catcher who had rounded him up so many times quit, his career outlived by Sammy’s persistence. Unencumbered, she notes, “In this way, he lived a long and happy life…” Physicians through the ages, never more so than today, have looked for ways to break free of the leashes that distract, even separate us, from finding meaning in our work, too often unsuccessfully. But meaning is still there, at times hidden, waiting to be rediscovered. One day the pandemic will subside, this latest leash broken and we will hopefully find ourselves, with gratitude, in a new landscape, appreciating the return of things so easily lost, the lessons learned, unexpected gifts received, recognizing what Mary Oliver describes as “the wonderful things that may happen if you break the ropes that are holding you.”

Brian Sayers, MD
Chair, TCMS Physician Wellness Program

Editor’s note:

Our guest blogger this month is Dr. Lauren Crawford. Dr. Crawford is a plastic surgeon and founder of Lady Docs of Austin, a Facebook community of female physicians with over 1100 members. She serves on the PWP Steering Committee.


Brian Sayers, MD
Chair, TCMS Physican Wellness Program


Submitted August 2020

Confessions of a Physician Mom

I confess. I’ve done my best. But, I chronically fail at this so called work-life balance.

I’m a plastic surgeon. I’m a mom of two. I sometimes function as a cook. I’m an occasionally lousy wife. I am not gifted at keeping plants alive.

I’ve read all about the elusive work-life balance. I think it’s like hunting unicorns for Type A folks like me.

But, over 10 years of private practice, I have gotten better.

I think it is a personal journey for any professional woman juggling a family. Physicians are unique in that a patient’s immediate care takes priority. When you are managing the health and surgical outcomes of numerous patients on a daily basis, you’ve set yourself up for some failures on the home front.

And, this causes stress. Especially for the women.

This is not a dig against the guys who are doing it all too (both doctor and domestic-duty dads). Women tend to shoulder more of the domestic work in these dual income households. In a way, the physician moms want it because we like the control. But, we take our domestic failures harder. The burdens haunt us more. We worry about our patients. We worry about our kids.  

We are often the nanny hirers, grocery shoppers, meal planners, cake makers, summer camp organizers, school snack preppers, family event creators, appliance consumer report readers, and carpool mom texters. The multi-tasking wheel running hamster wild in our brains never stops. It even invades our dreams.

With every physician at risk for ‘burnout’ or ‘compassion fatigue,’ you can understand why the female doctors are particularly at risk.

I talked with a colleague before sitting down to write this. He has known me since I started practice here in Austin. He remarked that I seem really good, better than he has ever known me to be. I reflected on that. I think he is right.

What have I learned that has made my life better? I brainstormed and this is my laundry list.

1) I picked an excellent partner in life who supports (not always loves) what I do. We talk when I am overwhelmed. We figure out how to share the family work. He is the most important person, my best decision. Every physician mom needs an ultimate helper. A second wife isn’t typically a legal option. So, you need to find your critical support.

2) If you find good childcare, hang onto that person! Pay them well. Remember every birthday and treat them well. That trust is ultimate peace of mind. Outsource and hire out what you need to survive as you can afford to do so. Please.

3) Be selfish and surround yourself with supporters. And, support them right back. Those carpools have saved me. I want to kiss the last neighbor mom who made us dinner. There are amazing helpers in your community. Find them.

4) Be honest and realistic with yourself. Don’t over plan weekends. Don’t create unlikely timelines. Overestimate the time you need to prep for that Saturday soccer game. Always feeling behind or late at both work and home is stress you don’t need.

5) Figure out what you need to SLOW THINGS DOWN. You’ve got to carve out some time for your thing. Whatever that is. You need to have consistent time carved out. For me, it’s what we call my ‘moving meditation’. Actual meditation is not my thing. Running is. My husband sees the antsy energy when it’s overdue. Adjust something in your schedule to allow a change of focus. You need it.

6) Let go of total perfectionism. Perfectionism plagues our profession. The biology of the human body does not allow for it. You’ll do better as a quasi-perfectionist. Keep the big picture, broaden your perspective, and ask yourself what really matters?

7) Relieve yourself of perpetual mom guilt. Your kids will survive an afternoon or a week of too much screen time. That laceration on the forehead will scar just fine. Eventually, your kid will not need a nighttime diaper. That dental appointment is only 3 months late. Relax! Truly.

8) Find your peer group and bounce your parenting, business ideas, grief, and concerns off on those trusted colleagues. Don’t go friendless because you are too busy. Everyone has some time to fire off a few text messages every week. Don’t let those relationships go completely dormant. Even introverts need people. Social media can have some benefits here for quick feedback from minds you trust.

9) Learn how to say no at work when it’s needed. It is a bit cliché, but people will abuse a doctor who is too available. When something is a poor use of your time, recognize it, and say no. But, also, choose your battles. A small detail in your office policy that doesn’t affect patient care may not be your hill to die on. Frequent conflict in the office setting is draining. If your work culture is bad, not fixable, and not sustainable for you, start your hunt for a new job. Be confident in your value. Invest in your happiness. Be willing to move for it.

10) To piggyback off of 9, it’s not a failure to leave a position that won’t work for you long term. You will be wiser as you research your career move and look for the things you and your family need.

I can’t overemphasize enough that I’m not a finished product. I think I’ll always be a work in progress. I’ve repeated some of the same old behaviors that have made me unhappy in the past with work. But, it seems experience and age has led me to doom myself less.

I look at my kids’ faces every night with no small electronic or work distraction. I just sit with them. We might be reading or watching a movie. Maybe a back scratch or drawing my fingers down the ski slope of their noses. Nothing big. We have some of our best conversations in those moments. And, it might just be for five minutes. But, it never fails to quiet my brain and make me feel happy.

I am so sorry for all the doctors out there dealing with additional stress in this time of COVID-19. You may have a sick family member (COVID or not). You may be worried about losing your job or you’ve already lost it. Much love to you all as you navigate this tremendously difficult time as physicians.

Lauren Crawford, MD

Submitted July 2020

Editors note:

Our guest writer this month is Dr. Anna Vu-Wallace. Anna is a Hospitalist, PWP Committee member and Director of the quarterly Stress Reduction Meditation Workshop for Healthcare Professionals.


Dear Friends,

Being in the hospital gives me a unique perspective on the current situation of the pandemic. Some of you shared with me that you don’t even look at the news anymore. That is understandable given the tumultuous period of our time. There are other ways to obtain vital information. This is a link to our statistics on COVID locally.

As hospital physicians, we are tasked with reaching everyone who may have influence as we see the sharp rise in our county and state. As I write you today, our hospitals are filling up. We are near capacity as we prepare our convention center for overflow.

Let me share with you what my typical day looks like. Shortly after awakening, I put on my scrubs and head out. Fear of taking this virus home and infecting my family takes hold as I don my N95 mask tightly to my face. Protective goggles are placed. Shoes from the day before left in the garage wait for me to put back on. As I enter the hospital, another mask is placed on me along with a shield. As I enter the COVID unit, I am covered with a gown and hair cover and 2 layers of gloves. My shoes are covered with shoe coverings. By the end of the first hour, my face and ears are painful due to the gear I must wear. The back of my ears bleed on occasion. By the time I get home, indentations mark how long I have been working. I strip off my contaminated clothes in the garage. I dare not to touch anything until I shower. Even then, I know how unpredictable this virus is. I pray my family will be ok as I have decided not to find different living arrangements isolating from them as there is no end in sight.

I attend to many. Without a definitive treatment for COVID, the sorrow of families of the dying is often overwhelming, relentless.

Today, I learned that at least 12 nurses I worked with have been infected and sick, 7 hospitalized. There have been at least 4 physicians infected. I know some will die. Our nurses are at the greatest risk. The longer we are exposed to COVID-19, the higher our chances of getting infected and sick despite PPEs. We are seeing such a steep climb in hospitalizations that Travis County becomes a topic of national news each night. What can I do? I can ask for your help. Would you make your own plea to your patients, friends, and family? These are some of the things we ask to help us control the spread of COVID-19:

-Would you wash your hands frequently, wear a mask outside of your home and physical distance for the next year?

-Would you not invite friends to come to your home for dinner/drinks until our local health departments clear to do so?

-Would you stay home when possible? We have a stay home order from Mayor Adler.

-Would you hold off on any church gatherings until we see a trend downwards for at least 2 weeks?

I know this is difficult. Community is vital to our very human journey. From my perspective, we are still in community, just in a different way. In our difficulties, there is an opportunity for growth. We can now see disparities in access to healthcare and what populations are at greatest risk. We can now see how our system is broken and can work for change.

Before sending this email, I explored my motivation. Yes, I don’t deny that I ask for me. However, I also believe I ask for all of us. What I have truly learned from this virus is how connected we all are. What we do individually will affect the collective.

In gratitude,

Anna Vu-Wallace, MD

Submitted June 2020



Like many of you, I’ve spent the last few months on a new and unpredictable schedule. Doing telemedicine from home (where I never seem to have quite what I need), then back to the office to see folks that need to be seen in person, semi-hypoxic from masking, with schedules, workstations, basic procedures all far from the routines and systems I’ve arranged in my office all these years. In medicine, if not life in general for some of us, there is an unspoken quest for perfection. Perfection that provides the kind of care for patients that we want for them, perfection that might isolate us from criticism, perfection that makes our days flow seamlessly. Of course, we know that imperfection and its twin, uncertainty, is actually what punctuates our days, and how we navigate that has much to do with our happiness. I’ve found that patients have generally been flexible and understanding about the new level of imperfection and inconvenience in medical care these days, certainly more so than me. Navigating those challenges has even formed a new kind of bond with some of my patients who have needed more help lately, and relaxing a bit and accepting imperfection and uncertainty might, perhaps, produce a new kind of wholeness described in this way by Rachel Remen:


“The marks life leaves on everything it touches transforms perfection into wholeness. Older, wiser cultures choose to claim this wholeness in the things that they create. In Japan, Zen gardeners purposefully leave a fat dandelion in the midst of the exquisite, ritually precise patterns of the meditation garden. In Iran, even the most skilled rug weavers include an intentional error, the “Persian Flaw,” in the magnificence of a Tabriz carpet. In Puritan America, master quilt makers deliberately left a drop of their own blood on every quilt they made; and Native Americans wove a broken bead, the “spirit bead,” into every beaded masterpiece. Nothing that has a soul is perfect. When life weaves a spirit bead into your very fabric, you may stumble upon a wholeness greater than you had dreamed possible before...”


In traditional Japanese culture, wabi-sabi is a world view centered on the acceptance of the transience and imperfections of life, the natural cycles of growth, decay and death, the beauty of nature, the frayed edges of existence. Derived from Buddhist teachings, it stresses simplicity, humility, intimacy, and appreciation of the natural world. Control, possessions, and predictability are notably absent. Our lives in the time of coronavirus, and beyond, are marked by existing in a magnificent but imperfect world in which we all live imperfect lives, creating a kind of kinship with all humanity. From impermanence and imperfection may come frustration, anxiety, and sadness, but also the possibility that we might find growth and acceptance, see the world through a different lens, even discover self-compassion, the very definitions of wisdom that comes to us only through living in harmony with the imperfections of life.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program

Submitted May 2020

Telemedicine and the Opening of Eyes 


Like many of you, a very short time ago I made the transition to telemedicine visits almost overnight, just as countless other changes went on within our small practice. While imperfect, telemedicine visits in the current environment offer a certain kind of safety that we just can’t pass up. I knew that there would be significant disadvantages, but I would soon learn that this strange new world of sitting in my study and suddenly finding myself inside of my patients’ homes might add an entirely new dimension to my relationship with them.

Even the simple platform that we use presents significant hurdles for many of our older patients, and our receptionist, now repurposed as our “IT Hostess,” sometimes spends more time getting them online and their mic and camera working than I do with the visit. The first week I’ll have to admit I was entirely distracted by the patients’ surroundings. Most use a laptop set below their face and I am often greeted with a perfect anatomic tour of their nostrils and popcorn ceiling. For those who position the camera at eye level, there is invariably a background nothing short of fascinating, even when entirely ordinary. On the wall behind them I have seen everything from 50 year old wedding pictures to an image of Jesus, family photos, and on memorable occasions a Grateful Dead concert poster, part of what I think was a framed rendering of “dogs playing poker,” and once, what appeared to be a varmint tail of some sort nailed to the wall. I’ve seen kitchens in the background with a concerning array of dirty dishes, but also palatial surroundings, breathtaking hill country or lake views and magnificent art. Occasionally, when the name of a certain medicine eludes them, I get a walking tour of their bathroom and medicine cabinet.

The initial fascination with my patients’ surroundings soon gave way to what it should have been for me all along: a sense of appreciation to see them in their natural surroundings, generously inviting me in. More often than not they are chatty, often much more interested in having some company in for a visit than telling me much about their medical issues. I have come to see that in these visits, if I take some time, I learn more about them and who they are than I have in 20 years or more of in-office visits. Invited into their homes, I have been given a seat on what to them is sacred ground, and with most I feel a new sense of kinship, and witness a certain vulnerability and hospitality that must have been what caused our predecessors to keep doing house calls with little complaint until not so long ago. On a good day, when I allow it, telemedicine visits help me to see my work and my patients through new eyes. Perhaps this is what physician wellness pioneer Rachel Remen had in mind when she penned these words:

“Often finding meaning is not about doing things differently; it is about seeing familiar things in new ways. When we find new eyes, the unsuspected blessing in work we have done for many years may take us completely by surprise. We can see life in many ways: with the eye, with the mind, with the intuition. But perhaps it is only by those who speak the language of meaning, who have remembered how to see with the heart, that life is ever known or served.”

Brian Sayers, MD
Chair, TCMS Physician Wellness Program

Submitted April 17, 2020

The Upside of Uncertainty


There is not much in our lives that hasn’t changed drastically in the last three months. Each of us is experiencing fallout from the pandemic in our own unique way. Each of us is writing a story that will only be fully told months or years from now when we see these events with the perspective that only time can give--hopefully from a place of relative safety, a place where it may seem like we have all collectively exhaled. Our lives are not just drastically different at this time but will just as certainly never be the same, in ways that we are only now starting to see an outline of. There is great tragedy, danger, fear and anxiety all around us, a sudden uncertainty that is at once disturbing and disorienting. But just as surely, there is emerging an unexpected upside from this time of uncertainty.

This past week, I asked members of the Physician Wellness Program Steering Committee to write a few lines for me regarding strategies and observations they have to offer during this difficult time. By far the recurring theme was that this communal “time out” of sorts has, even with stress and tragedy around us, brought us closer together as families, helped us appreciate our friends and colleagues and our work, all of which we so often take for granted. It has caused most of us to pause some work activities, volunteer commitments, our children’s overextended schedules, the frenzied pace of our lives. While some of us are busier than ever dealing with the fallout of the pandemic, many find themselves on a reduced schedule, certainly at home more, and with other commitments lessened, time to think, to reassess priorities, schedules, friendships and family. Time to realize how much we assume, how little we reflect, how much we miss. Several observed that this time of uncertainty has bred a new sort of gratitude and compassion and feel that it may just give them a second chance to bring about positive changes in lifestyle and outlook.

More of the Committee’s observations and strategies for weathering the storm, along with notes about recently enhanced PWP programs on this video.

Physician Wellness Counseling

  • Featuring our outstanding psychologists
  • Remote/telemedicine visits
  • Psychiatry volunteers

The Physician Wellness Program offers anonymous, free sessions with TCMS vetted psychologists. So far, the program has funded over 500 confidential sessions with our therapists.

As an added benefit of the program, for the next three months, TCMS has a referral list of psychiatrists who have offered to participate in the program.  If you feel you would benefit from seeing a psychiatrist in addition to, or instead of, a psychologist, let us know when you call the helpline.

The program can be easily accessed, and privacy is strictly protected. A certified Gottman Couples Therapist is now available in addition to individual counselors to help with work, personal, or marital issues.

The cost of the first four sessions is covered by the program.

Whatever the issue, this program is your safe harbor. Nothing is reported, no diagnosis made, no insurance billed.

To access the program, call the wellness line at 512-467-5165 or visit the PWP counselor page.

Submitted March 20, 2020


Confidential, free counseling program for TCMS members and spouses now offering telemedicine/remote services.

Masks, gloves, raw hands, empty store shelves, telemedicine, nosediving stock market, the very real concerns for our loved ones and ourselves. Uncertainty. Chaos. Yet in the midst of it all, our TCMS members are doing amazing things for our community. But for some, it comes at a price.
For the past two years the PWP Counseling Program has been there offering convenient, anonymous, free counseling services by our vetted doctorate level therapists. Over 500 visits have been sponsored by the program to date.
To make things even more accessible in these stress filled times, all five of our therapists offer initial visits by phone and are now offering ongoing counseling via telemedicine in the privacy of your home, office or where ever you want to access it.
Take a minute to check out your medical society’s PWP program and our therapists’ bios. Call our anonymous Helpline 512-467-5165 for assistance, or contact one of our therapists directly . Just identify yourself as a TCMS member (or spouse) and they will take it from there.
Stay safe. Stay connected.
Brian Sayers, MD
Chair, TCMS Physician Wellness Program



Submitted March, 2020

Profiles in Courage

A recent story I read about Washington politics made reference to John Kennedy’s Pulitzer Prize winning book, Profiles in Courage. Kennedy wrote the book while still a senator, a book that looked at politicians who had, at their own personal or political peril, taken courageous moral stands that were counter to party or popular opinion. I spent some time with it, hoping to see a model that might help me recognize admirable courage in modern day Washington. There is a quote in the introduction that caught my eye. “To be courageous . . . is an opportunity that sooner or later is presented to us all . . . in whatever arena of life one may meet the challenge of courage . . . each man must look into his own soul.” I gave up considering where courage might or might not be in Washington as thoughts turned to who closer to home I’d consider courageous. I did not have to think for long.

For almost a decade, I’ve served on and chaired the TCMS Physician Health and Rehabilitation Committee. PHRC advocates and assists in monitoring our colleagues who are in recovery from alcohol or drugs, its goal being to help physicians in whatever ways we can to be successful in their recovery, to protect their license and livelihood, and to see them on a path to a new and fulfilling life. The committee is made up of physicians from all kinds of practice settings and specialties, including psychiatrists and addictionologists, active and retired, some in recovery, others simply interested in helping their colleagues. My own path was as an adult child of an alcoholic, a father who died of alcoholic liver disease at age 40 as the 12 year old version of me looked on, in an era when getting help was greatly stigmatized. For recovery to be successful takes great personal courage. It also takes the help of others.

In a recent interview, Elton John made reference to the importance of community, of asking others for help, in the process of recovery. “We were all people who had made bad choices and seen the consequences, but then made the same choices despite ourselves . . . again and again and again. The truth of it all was that simple: no matter where we had come from, what we had accomplished or failed to accomplish, what our life experiences had been up to that point, we were all the same. And none of us would get better without asking others for help.” And so it is that PHRC exists, to play at least a small role in helping those in recovery.

Our colleagues who go through our five-year monitoring program all have their own story, unique origins that brought them to us, but there is a common pattern. There is usually anger and denial early on. After an extended stay in rehab which most of them agree to and are successful with, they reemerge with less anger and denial, often replaced by a period of a sort of disequilibrium, even as they see the framework of a new future emerge, as they lean into the gale force winds of early recovery. As we get to know them better over time, I invariably see a kind of raw courage and determination, mixed with a new sense of humility and vulnerability that does indeed propel them into a future of hope, often a new appreciation for things lost and regained, and a rediscovery of sacred worthiness that was there all along, but hidden. By the time their five years with us are completed, I think we usually consider ourselves to be friends, and I consider myself lucky to know these men and women of courage as they leave the program and as I have a chance to see them beyond the walls of the committee room.

Our work as physicians can be rewarding, bring great satisfaction, even joy, but it can also be frustrating and stressful, sometimes causing us to question our calling. Doctors are humans and humans are fallible, capable of terrible missteps that can alter not only our own lives but also those around us that we care for. As I’m writing this piece, I have been reading a book by Gregory Boyle, Tattoos on the Heart. In it he closes one chapter with a memorable line worth considering as we do the sometimes difficult work of caring for each other: “Just assume that the answer to every question is compassion.”

Brian Sayers, MD
Chair, TCMS Physician Wellness Program

Submitted February, 2020

Beyond Burnout: Docs Decry Moral Injury From Financial Pressures of Health Care
By Melissa Bailey

Dr. Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.


All those tests? They turned out to be unnecessary and left the patient with over $1,000 in extra charges.

The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.

“We’re just shotgunning,” Corl said.

The shingles case is one of hundreds of examples that have led to his exasperation and burnout with emergency medicine. What’s driving the burnout, he argued, is something deeper — a sense of “moral injury.”

Corl, a 42-year-old assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.

The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon, were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.

That idea resonates with clinicians across the country: Since they penned an op-ed in Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.

Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.'”

Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.

Those barriers can be particularly intense in emergency medicine.

Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care. In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.

These brief encounters may be good for business: They reduce the “door to doc” time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without “being seen,” which is another quality measure.

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for hospital-acquired delirium.

“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”

For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days as they await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”

Jarman said many emergency physicians she knows work part time to curtail burnout.

“I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”

Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they’ve identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.

Sawyer, 38, said he has suffered moral injury from treating patients like this one: A Latina had a large kidney stone and a “huge amount of pain” but could not get surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.

“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion. Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

Their work is attracting praise from a range of clinicians:

In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the private practice she worked in. She said she saw “a dramatic shift” in the culture there, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them.”

In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”

In Chambersburg, Pennsylvania, Dr. Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment — and spending nights and weekends slogging through paperwork required by insurers.

“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.” Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.

He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.

“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”

This story was originally published on the Kaiser Health News website. Illustration by Maria Fabrizio for Kaiser Health News.

Brian Sayers, MD
Chair, TCMS Physician Wellness Program

Submitted January, 2020

A River Runs Through It



During that last week of the year when I picture myself on a warm beach or by a fire in the mountains, I instead found myself, along with my loyal but somewhat annoyed staff, manually entering “Quality” and “Improvement Activities” data to satisfy my MIPS requirement to avoid Medicare penalties two years down the road. Many of you will have no idea what I am talking about, your practice managers and EMR silently taking care of this each year, but for those increasingly rare souls in small practices wary from hearing complaints about “pajama time” and the other struggles and cost of maintaining an EMR, that tedious time at the end of the year somehow seems worth it.

As I wondered if clinging to my paper charts is a reasonable strategy or if I’m just the proverbial old man hollering at kids to get off my lawn, I managed to waste even more time as I tried to find something that might explain “value based medicine” and how my time with MIPS is worth the effort. MACRA’s QPP (Quality Payment Program) is supposedly part of the pathway to value based medicine. There is, of course, nothing inherently wrong with the idea that being paid to keep people healthy is a better idea for society than primarily paying us to do things for people after they are sick. What I couldn’t get out of my mind was the repeated reference to “value.” Not surprisingly, the word “values” is never mentioned.

In fact, many argue that the very source of what is wrong with medicine, and more specifically with doctors, has everything to do with values, and not nearly as much to do with value. There are certain values that can be traced back to the origins of medicine, ideas like fidelity, compassion, competence, kindness, respect, and responsibility to name a few, that make us as a profession who we are. Many say that physician distress and burnout are the direct results of working in a system that provides little or no incentive, often even obstacles, to our honoring core values of our profession. This time of year when I am most acutely aware of distractions that distance us from honoring values sacred to our profession, I am reminded of a quote from Goethe: “Things which matter most must never be at the mercy of things that matter least.”

There is a river that connects physicians of antiquity to us in our own time, and beyond. The shores that the river endlessly passes are the ever changing shores of advancing science and evolving economics. Both surely change the façade of medicine in every age, and will continue to do so in ways we can scarcely imagine today. But the river itself carries with it certain timeless truths, values that are the same in any age, even if often hidden beneath rushing currents. The river burnishes and refines the stones in its bed, stones that carry messages that if not sought out and given homage, remain hidden at our own peril, words of timeless wisdom from our predecessors that we must both receive and pass on. My favorite line from a lifetime of reading is from Norman Maclean’s, A River Runs through It. It reminds me of being mindful of the heritage passed on through the lineage of medicine.

“Eventually, all things merge into one, and a river runs through it. The river was cut by the world’s great flood and runs over rocks from the basement of time. On some of the rocks are timeless raindrops. Under the rocks are the words and some of the words are theirs.”

Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program

Submitted, November 2019
The Man with a Gun

Tony (not his real name) was one of those patients who came to be a friend. I was his doctor for 11 years, guiding him through some very difficult times with lupus. He was a handyman, a fly fisherman, husband, father and a man of deep faith. His condition was difficult to control but he always offered a smile as he patiently and hopefully waded through a series of treatments through the years. I’m a terrible fisherman, neither of the two necessary traits (patience and reading the water) coming naturally to me, but it didn’t keep him from giving me flies that he had tied himself, even giving me a handmade bamboo fly rod that to this day sits in my study closet unused, but treasured.
One afternoon during a busy clinic my receptionist urgently pulled me out of an exam room exclaiming, “There’s a man in the waiting room with a gun and he wants to see you… He has some papers.” To this day I’m not sure who or what he was other than a messenger of misery. I suppose he was a constable, but all I remember is him handing me some papers and thinking how ginormous the gun in his holster was, reminding me of a foot long handgun that Mattie pulled out of a flour sack in True Grit, or the gun that a sneering Clint Eastwood/Dirty Harry pulled and pointed, challenging a criminal to try and resist, “Go ahead . . . make my day.”
I hadn’t seen Tony for a while and it turned out that he had been diagnosed and quickly passed away with an aggressive malignancy, which a plaintiff’s attorney seemed to think I should have suspected, even in the absence of signs or symptoms as of his last contact with me. This was the era before tort reform in Texas, an era where hardly anyone knew a single physician who had not been sued at least once. Now it was my turn.
If you haven’t been through it, it’s hard to understand the emotions you go through during malpractice litigation. In some ways it attacks the very core of who you are as a physician, an accusation that you are doing exactly the opposite of what you swore an oath to do and spent all of those years training to do well. As is often, but not always, the case there was a strong sense of injustice, as I knew I had really done nothing wrong. I was forbidden by counsel to discuss it with friends or colleagues, adding an unhealthy serving of isolation to a plate full of shame and anger. To complicate matters even more, I was simultaneously grieving a man who I considered a generous friend. After a year of silent anguish, second-guessing myself and being suspicious of patients I once felt at ease with, I was as unceremoniously dropped from the suit as I had frivolously been added in the first place. There was a tremendous, but profoundly incomplete, sense of relief. Now even two decades later I still recall those emotions clearly, even as I ironically still treasure the fly rod Tony gave me.
As physicians we are called on to be many things by patients, and by ourselves. Compassionate, competent, vigilant, intelligent, patient, available, perhaps even perfect. Litigation, deserved and undeserved, remains a constant threat lurking behind any mistake or just bad luck, but fortunately not as much as some years back. This extreme kind of judgment against us has to some extent been replaced by 100 smaller cuts that we face from criticism from patients or their families, online reviews, peer review, insurance authorization denials, peer to peer reviews, colleagues, employers, practice managers, and at times, most damaging of all, from ourselves. Some of these criticisms are well-deserved, even constructive, and are to be carefully considered as teaching moments, while others are simply based on bureaucracy, greed, frustration or just nastiness. All of them challenge our deep and ultimate calling to bring compassion and love, along with our talents, to each and every interaction with our patients.
Even Socrates noted 2500 years ago that “The unexamined life is not worth living” (though he was never “yelped”), so this is nothing new, though now it sometimes seems more personal, more public. Criticism is inevitable in our lives as physicians, as we are visibly out in the world doing things that matter, things that affect other peoples’ lives. Much has been given. Much is expected. We are not perfect. We were not designed to be. Along the way, people will surely assist us in realizing that.
Of course, we need to pay some attention to criticism, even when not kindly given. Criticism can be very valuable. Even when expressed inaccurately or with venom, there can be nuggets of truth. But there can also be a destructive element to undeserved criticism and judgment. We have to be careful, perhaps with self-reflection and support from our colleagues and loved ones, that this type of criticism does not harden us over time in a way that causes us to lose the compassionate calling that a younger version of ourselves set out to pursue all those years ago. 
Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program


National Physician Suicide Awareness Day
Tuesday September 17

Submitted September 2019
A few weeks ago we sent out a PWP blog, “My Friend Richard.” Many, if not most, of the PWP blogs sent out to 4000 or so TCMS members go mostly unnoticed. This particular one seemed to strike a nerve with some of you, and most who emailed me or stopped me in the hallway at the hospital afterward had a personal story of a friend or colleague who was lost to suicide, or came very close. 
I don’t need to repeat the statistics that you have all heard so many times about physician suicide. I will just take the opportunity on this particular day to remind you to reach out for help if you need it. Once the honest and courageous decision to get help for the sake of yourself and those you love is made, help is readily accessible through family or a colleague or a friend you trust, or through our PWP Safe Harbor Counseling Program. And please, keep an eye out for your colleagues. If you sense they are in trouble, check in with them, say something. You just might be the person who makes all the difference for them.
Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program 
Check out this video



Submitted July 2019


My Friend Richard

There is something special about that childhood friend. It’s a bond that lasts a lifetime, something we can only experience fully in our formative years. My friend was Richard. We were inseparable in school growing up, then roommates in college, growing into manhood together. When it came time for medical school, I went to Dallas, Richard to Houston where he would start his career. We drifted apart in those years, each in a different world, each of those worlds with its own all-encompassing gravitational pull. I knew he had been depressed at times as far back as high school, but he always seemed to snap out of it. We took a vacation together on a break that last summer and he just wasn’t his old self. I couldn’t quite put my finger on what had changed but he was different. Our minds and energy were so preoccupied in that pivotal time as our careers were forming. A few months later I got the call one evening from a mutual friend in Houston that he had taken his life. As I tried unsuccessfully to piece it all together in the days, then years, that followed, there were fragmented stories of those last weeks, none fitting together. To this day I have no idea if he made any attempt to get help or if anyone tried to help him.   

The current seismic movement in medicine to address physician burnout has its roots in a realization more than two decades ago that we were losing our colleagues to suicide at an alarming rate, much higher than the general population. In the last ten years there has been an explosion of research in this field, with a long overdue realization that the physician wellness crisis has little to do with the personalities we bring into medicine, and everything to do with the environment we are placed in from the day we enter medical school until the day we retire, or change occupation, or worse.   

In the years since the TCMS Physician Wellness Program launched I have heard many stories from my colleagues about frustrations, loss of meaning, even stories of suicides in our community that I was unaware of. I have seen courageous colleagues get the help they needed with counseling or a recovery program, escaping a toxic work environment, cutting hours, developing healthier habits, connecting with colleagues, reconnecting with family or leaving direct patient care. Still, we find in some of our colleagues a certain sense of cynicism or anger or hopelessness, sometimes even a sense of shame that prevents them from getting help.  

In a recent New York Times article, Clay Routledge writes about suicide as an existential crisis and notes that, “In order to keep existential anxiety at bay, we must find and maintain perceptions of our lives as meaningful.” He goes on to say, “How do we find meaning and purpose in our lives? There are many paths, but the psychological literature suggests that close relationships with other people are our greatest existential resource.”  

The point is this. We all need to pay close attention to self-care in the many forms that must take. We need to get help from professionals and lean in to our family and trusted friends when we sense trouble and listen when those around us express concern. We also need to look out for each other. Check in with colleagues, especially if you sense they are struggling. What you think might be an awkward conversation with a friend might just save someone’s career, or their marriage, perhaps even their life.   

My friend Richard may be the best friend I’ll ever have. I have many happy memories of growing up together, but also regrets. It is a difficult story even four decades later, but there is a happy ending of sorts, as his story, along with the stories of struggles of so many of our colleagues through the years, people you have seen in crisis, perhaps even your own story, are all embedded in this program and our growing desire as a community to be there for each other. 

Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program 


Submitted June 18, 2019

Editorial Note: Our guest writer this month is Claire Miner, PhD, LPC. Dr. Miner is one of our PWP therapists, specializing in couples counseling. She can be accessed through our anonymous Physician Wellness Program coaching/counseling program by calling our confidential help line at 512-467-5165 or using the contact information at the end of her article.


My friend is a gardener. Her flowers respond well to her care and attention. Some plants thrive with just a bit of water and sun, while others require fertilizing, a certain climate, and weeding to assure growth. In your “life garden,” you nurture your children and community with attention and resources. But is your marriage getting consistent “tending”? Even a healthy relationship will blossom with focused care. John Gottman’s Seven Principles for Making Marriage Work can point the way:  

1. Enhance Your Understanding of Each Other 
Know your partner and keep abreast of changes in his/her life. You know all the basic stuff, but do you know your partner’s inner world, such as his/her stresses, worries, aspirations, dreams?   

2. Build Fondness and Admiration 
Friendship is the foundation for passion and romance, and affection and respect are an important basis for friendship. Communicating the areas that you appreciate in each other will increase positive feelings.   

3. Turn Towards Each Other 
Everyday moments when people connect with each other are the building blocks of all relationships. “Turning toward” with emotional support, shared conversation and humor, exchange of interests, and affection will increase the positivity in the relationship.   

4. Accept Influence from Your Partner
Being able to “yield to win” means that you won’t be a roadblock to change, and that you’ll be able to make your partner feel valued and respected. Focus on how to stay engaged and connected to your partner, rather than winning the argument.  

5. Solve Your Solvable Problems
Couples in long-term, satisfying relationships have learned skills to solve the problems that can be solved in their relationship. These skills are not innate; we can all learn them—for example, starting a conversation gently and compromising.  

6. Learn How to Talk about Perpetual Problems More Easily
Some issues between couples will never be resolved. The best that can be hoped for is to be able to find some humor in them and to be able to talk about them more gently and easily with acceptance, so that they are not great sources of pain.  

7. Create a Vision for Yourselves as a Couple
One of the tasks of couplehood is to create shared meaning. Finding a vision to work towards together will enhance your sense of “we-ness” and keep you bonded as you move through time together.  

Dr. Claire Usher Miner, PhD, LPC, Certified Gottman Couples Therapist, can be contacted at 512-689-7105.



Submitted May 10, 2019




Last month a couple of us from the medical society’s Physician Wellness Program spent a few days in Yellow Springs, Ohio at a training workshop conducted by physician wellness pioneer Rachel Remen, hoping to bring her well known Finding Meaning in Medicine small group program to TCMS. It was a transformative time spent with a collection of bright, motivated physicians mostly from prestigious institutions, who displayed exemplary humility even in the presence of a goofball like me. One of the group prompts was to bring a small object from our home or work that held some symbolic significance for our work. In one of the groups, someone had brought a small caduceus lapel pin given at medical school graduation. It reminded me of the power symbols can have, emotions they can trigger, stories or habits they can remind us of. 

The caduceus is the classic symbol of our profession, its familiar gold staff, wings at the top and two serpents wound around it, tangled and climbing upward is actually different from the simpler, ancient version, the rod of Asclepius. A number of stories as to its meaning and origin exist. As Daniel Sulmasy recounts in A Balm for Gilead, the use of caduceus is derived from a story about Asclepius, the physician hero-god of Greek mythology from whom Hippocrates claimed lineage.  

According to mythology, one day Asclepius was called to help a man who had been struck by lightning. While trying to save the man’s life, a snake came up beside him. Multitasking as physicians through the ages have, he quickly struck the serpent with a staff, killing it, then turned his attention back to his patient. Soon after another snake appeared, carrying herbs in its mouth which it promptly placed in the dead snake’s mouth. To the amazement of Asclepius, the dead snake was soon brought back to life. Taking the example, the mythological father of medicine took some of the herbs and placed them into the mouth of his own patient who was quickly healed.  

Rich in symbolism, the story makes an important point about us as physicians and mortals. In classic literature the snake is often a symbol of our imperfections. Within that context, we see one serpent coming to the aid of another wounded serpent, then together climbing up the staff and away from their worldly moorings, healer and healed becoming as one, an image worth considering. We are instilled with a yearning to be like the winged staff, strong and reaching upward, but compelled to recognize that, like the serpents, we are vulnerable and in need of each other. It is the humility and response to this commonality, this broken oneness with all around us, that can make us healers in the best traditions of our profession, our ethics, our faith.  

On the flight home, in that rare space where we might have a couple of hours to think, I considered again the trajectory of medicine in general and my own practice in particular. We all explore, in our own way, how we might become the kind of physician, the kind of healer, that occupied our dreams as our paths in medicine were being formed. Perhaps that will come from an ultimate realization that to be a great physician, rather than being the smartest person in the room, we need only be the kindest.  

Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program 


Submitted March 25, 2019  






Faith, Hope, and Transformational Leadership  

I went back to school well into middle age and in class one day during a discussion on icons and Saints, the professor recommended that in the space where we work, relax or spend creative time, along with family photos we sprinkle in a picture or two of other people who somehow inspire us. It is a practice I had discovered years earlier and in my study are pictures of Abraham Lincoln and Johnny Unitas. The picture of Lincoln is just before his assassination in 1865, haggard and dramatically aging, but with a hint of a smile as the war came to an end. The picture of Johnny Unitas, the premier quarterback of his era and my childhood, is from the 1958 NFL championship game against the New York Giants, often called “the greatest game ever played.” It was the first nationally televised pro football game, a game that brought the NFL into the modern era. In the picture Unitas is raring back in classic drop back quarterback style to launch a ball far downfield that would tie the game up and move it into overtime. It may seem strange to think that these two diverse pictures could both inspire me or have anything in common, but they do.

Like many people, I am amazed and inspired by Lincoln’s life, rising from abject poverty, loss of his mother and beloved sister at an early age, an adversarial relationship with his father that he eventually escaped. As a young lawyer he developed lifelong depression that was so bad his doctor noted, “He was within an inch of being a perfect lunatic for life.” At one point his friends hid sharp objects and guns from him and Lincoln himself noted, “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth.” In the midst of this, Lincoln suffered political defeats and all kinds of personal abuse, but found a profound sense of purpose in the antislavery issue and that sense of purpose and meaning propelled him to the presidency, and immortality, against great odds.  

I recently read Doris Kearns Goodwin’s book “Leadership in Turbulent Times,” in which she describes Lincoln’s form of leadership as “transformational leadership,” that is, leadership that focuses on future goals and purpose rather than more expedient “transactional leadership.” In the many books that I have read about Lincoln I’ve come to see that Lincoln’s transformational leadership applies not only to leading those around you towards a greater good, but, perhaps more importantly, it is an internal leadership that lifts us as individuals to lives of meaning and purpose. Martin Luther King, Jr. famously said, "The arc of the moral universe is long, but it bends toward justice," and though it would be a century before that quote was spoken, Lincoln surely felt that same certainty, in part from his faith, but also from a deep confidence that he possessed the skills and determination to make a difference, just as each of us can in our own lives. 

Johnny Unitas was from humble origins as well and early on nothing about him seemed remarkable or destined for greatness. Just three years before he played in that epic championship game, he was working construction and playing semi-pro football for six dollars a game. His sheer determination, confidence and quiet leadership were the hallmarks of his career. On that particular day, in an instant frozen in this photograph, he was poised to launch a long pass. 60,000 eyes would be pointed skyward while in the quarterback’s heart there was not only hope, but also a sense of certainty that the arc of the pass and the receiver sprinting downfield would connect in just the perfect spot, at just the perfect time. But more importantly, what inspires me when I look at the picture is the sense that there was also a certain kind of faith and resilience, a confidence that even if that particular pass fell to the ground, they would pick themselves up, huddle up and try again. There was an unspoken sense that his leadership, optimism and love of his work could make all the difference, attitudes critical in our own lives as physicians. 

Who inspires you? 

Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program 


Submitted March 12, 2019

A Surgeon’s Wellness Instruments: Empathy, Scalpel, and Music  

Music has a primal power to impact quality of life whether it creates healing, happiness, self-expression, human connection or calm. Austinites, as listeners and performers, know that as well as anyone. Most of our lives are imbued with music; in restaurants and retail shops, in our cars and trucks, our late-night watering holes. We play music and it takes us away, to re-connecting, remembering, re-energizing.  

When we are ailing, music can be soothing or pleasantly distracting and help with pain or worries. When most of us walk into a doctor’s office, our blood pressure rises about 10 points, our heart rate rises, and we feel anxious. When we are told we need surgery, that is a whole other level of stress. Music plays a big role for both my patients and me in the operating room. It can provide connection and calm.   

After I talk with a person and examine their shoulder, elbow or hand, I arrive at a diagnosis. If I feel surgery is truly the best option for them, I recommend it. And then there is a pause, a reflection and a moment of wonder. I am always moved by my patients’ sudden and extreme faith. It is as if they are saying, “I just met you like 15 minutes ago, but sure, cut open my body. Take saw blades, scalpels, drills, screwdrivers, and chisels to me as needed. Whatever you think.” I am humbled by their trust. At the same time, I see “healing with steel” as actionable empathy. As surgeons, we listen, hear, see, understand, enter and attend. With this primal connection, this precise and sensitive action, we can alter the quality of a life.   

On the day of surgery, I greet my patients on the gurney, and I can see the anxiety in their eyes. I say, “I know you’re worried, but I am confident that the surgery will go well ,and you will feel much better.” Then I say, “I always play music when I’m operating. You may not remember much of it, but what would you like to hear?” They always perk up with this. Most often, they say, “Whatever you want to listen to; I want YOU to be relaxed.” I tell them, “I like almost everything. And I’m always relaxed in the OR. It’s my happy place.” Then I might hear, “The Beatles!” or “I’m a classic rocker” or “classical” or “anything except what my 17-year-old plays these days . . .” This choice, this brief moment of control, this conversation about music, just before “going under,” has a calming effect.   

Despite being in practice for over 20 years, I am continually inspired and intrigued by people’s stories; what they do, how they live, who and what they love. In addition to diagnosing their medical concern, it is so fascinating to learn what makes someone tick or creates a lift– the Talking Heads, fly-fishing, angel hair pasta, the banjo, rock climbing. The music they love.   


O. Alton Barron, MD 
Dr. Barron is an orthopedic surgeon with ATX Orthopedics and is a 
Clinical Associate Professor of Orthopedics at Dell Medical School

Submitted January, 2019

Maybe It's Time

During the holidays I was running some errands, half listening to a rerun of some financial show on the radio. I was mostly ignoring it but then they said a couple of things that got my attention. One was that time honored disclaimer “Past performance does not necessarily predict future results,” followed by “the best way to predict the future is to create it.” Both are rich material but the second one, a well-known quote attributed to Lincoln, caught me at just the right time. 

The transition from one year to the next is often a time when we might become somewhat introspective about where we are in life, how we might improve things, and what we need to leave behind. Positive change requires careful assessment of what our current state of existence is, then the difficult task of deciding what to shed, and what form transformation might take. Sounds exhausting. You might think that the only things that need to be shed are bad habits, or things that clearly work against our happiness and success. You might be wrong. 

In the world of business and organizational development, “change management” is a critical component of success and is now a well-established discipline in that world. Large organizations have executives whose entire job is to help the organization evolve and survive by strategically planning how to take a successful organization and pump new life into it every few years. It is a critical key to long term survival. 

As I considered this, I reread Halftime by Bob Buford. A couple of the themes in the book are interesting to think about. The first is “the sigmoid curve.” Organizations that get off the ground and do well go through a fairly predictable cycle of formation, development, growth, then the pinnacle of success, but then an equally predictable decline if change is not part of the organization’s culture − if it does not, or cannot, evolve. Once that decline begins it is hard to reverse. You need look no farther than Sears, Toy R Us, shopping malls, bank lobbies, World Book Encyclopedia and other bygone successes that are failing or breathing their last gasps. The sigmoid curve holds that the time for change is during the height of growth and success − before decline − while there is still creativity, enthusiasm, and resources to bring about change that will perpetuate success. It is profoundly counterintuitive as it calls for the organization (or individual) to leave behind some of the things that actually created success in the first place in order to achieve more lasting relevance. Buford’s second point is that this constant, difficult evolution in people, is ultimately an evolution “from success to significance.” 

Most physicians are highly successful in their practice, but how many go on to achieve not just success but also significance, and not just in their work (which is no small thing), but also in something that transcends work and is all encompassing in their own lives and in the lives of those around them? This kind of change is not about giving up core values and beliefs, things that are timeless and help us weather life’s storms, but is more about defining priorities, how we go about our work, who we work with or for, and how we nurture and cherish family and friends. Ultimately, it is about how we embrace change at each unique stage in our lives, in order to fill our lives with meaning, generosity, and love that spills over into the world around us. That kind of change is the difficult work that defines our lives. 

It may seem odd to quote Bradly Cooper, and this will probably (hopefully) be the last time, but as I was writing this I happened to hear his song from A Star is Born. It’s not exactly Shakespeare but it’s a fitting thought to close with.

Maybe it's time to let the old ways die.
Maybe it's time to let the old ways die.
It takes a lot to change…
Hell, it takes a lot to try.
Maybe it's time to let the old ways die.

Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program


Submitted November, 2018

True North

My oldest child is grown now with a career and a growing family, but he used to just be a kid, and like all children, he needed a bedtime routine. All too soon he lost interest in bedtime stories but we still needed a way to wind down together at bedtime. In those days a set of encyclopedias was still on the shelf and for a while we ended the day exploring the world together in those books. We would randomly select a volume, then flip it open read about whatever was on the page we landed on. It’s surprising how many of those random facts I still remember today. One evening we read about “true north.”  

I always thought that a compass points to the North Pole. Like so many other things, I was wrong. True north is the direction along the earth's surface towards the geographic North Pole. It is almost identical to astronomical true north, calculated for centuries by ocean bound navigators. It is a static, predictable point mariners have depended on since man began to travel.  

Magnetic north is a wandering point in the northern hemisphere where the planet's magnetic field is vertically centered. It is the direction compasses point. Magnetic north varies slightly from year to year, altered by natural and man-made magnetic fields. Following magnetic north as a navigation strategy over long distances to precise points will inevitably cause us to become lost, as ancient mariners knew.  

And so all these years later, this fun fact I learned with my son one evening returns to haunt me (and now you) as a metaphor. In life's journey we are often uncertain where we stand, where we are going and what is the right path. True North is the internal compass that guides you successfully through life. It represents who you are as a human being at your deepest level. It is your point of orientation - your fixed point in a spinning world - that helps you stay on track as a leader and as a human being. Your True North is based on what is most important to you, your most cherished values and beliefs, your passions and motivations, the sources of satisfaction in your life. Ignoring or leaving True North unexamined is dangerous and can rob life of meaning. Finding and following True North is the difficult work that defines our lives.  

When it comes to vocation, we might consider True North as another way of describing our calling—how we match what is deep within our heart and the unique gifts we have been given, with what the world cries out for in need.  

I speak to physician groups frequently about burnout and wellness, and many times I have flipped through my well-worn power point slides about both. More and more it occurs to me now that most of these slides are ultimately useless unless we as individuals spend more time exploring, discovering and then tenaciously following our own unique True North.   

Most of us were in small practices when my career began, now 70% of physicians are employed. Often, our professional lives are influenced, if not controlled, by people far removed from the realities and sacredness of the exam room. To practice in an environment that ignores the importance of things like calling, relationships, values, respect and meaning, instead focusing most visibly on profit and market share, devalues the humanity in our work and its wake can land us as individuals onto a rocky shoreline before we even realize we have strayed off course. Self-examination in medicine these days requires not only examining what is deep within us, but also what we allow to go on around us. If our own values and calling are in conflict with the practice or organization we work within, we go to work each day in great personal peril. Fortunately, we have some great leaders in our medical community, many of whom support the Physician Wellness Program, who are increasingly committed to physician wellbeing. Be a voice within your organization. Watch out for your colleagues. We still have a long way to go.  


Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program


Submitted September, 2018

The Cloud of Witnesses

During my years in study at an Episcopal seminary, I came to appreciate the reverence Episcopalians have for the saints. There are hundreds of recognized saints and one semester I spent several months studying some of their life stories and the spiritual gifts they left behind. The Old Testament refers to the "cloud of witnesses," the faithful who pave the way for subsequent generations. Of course, the importance of the heritage of important figures in inspiring and giving us direction is not unique to religion. As Americans, we venerate the founding fathers, Lincoln, King, and many others. There are legendary athletes that sports fans compare modern day athletes to, as well as educators, authors, scientists, social activists. Imperfect as they were, their life stories are guideposts of inspiration. Medicine is no exception. Lister, Curie, Freud, Fleming, Jenner, Osler, DeBakey, and so many other giants along with the teachers and mentors who paved the way for us. The cloud of witnesses is sometimes likened to the crowd that cheers you on as you run a marathon or 10k. Often nameless and faceless, but full of those who care about us, want success for us, cheering us on.

For the last few years, I have had the honor to write memorials in the TCMS Journal for our departed colleagues. Some were well known to me, others I never met. Given the generation now passing, most are male, almost all served in the military, the majority trained in Texas or the south. The women of that generation who have passed serve to create a very special witness to our profession, their unique obstacles as women in medicine in that era an especially rich heritage. As I piece together their lives, not surprisingly what stands out more than the accomplishments that punctuated their lives is the heritage of compassion, accessibility, friendship, and faithfulness they imbedded in the hearts of the lives they touched. Poet David Whyte notes, "Death is not impressed by what we have done, unless what we have done leaves a legacy of life...what is remembered in all our work is what is still alive in the hearts and minds of others.” I often think of doctors who I have worked with, along with mentors and teachers who are gone now but gave me gifts that I still call on today. They likely had no idea that I would see things in them that I would carry with me that make me a better doctor and a better man.

We accomplish much in our lives as doctors. We make lives better, cure or control disease, and, on a good day, even connect with patients and bring real healing, often against great odds. We should not lose sight of the fact that connecting with colleagues, being available to listen and advise, to be an encouraging and compassionate presence, is one of our primary callings and ultimately is the most important thing we leave behind to our colleagues and our profession. 

These are difficult times to practice medicine. We know that burnout is all around us – statistically about half of us – and not just the usual irritations of work but true burnout with life altering effects that shade all phases of our lives as well as impacting patient safety. Keep an eye out for colleagues who may be struggling, check in with them, encourage them to get help or at least talk about it. Realize it or not, your life is an example to those around you and there are unseen opportunities to help your colleagues who may need help but don’t get it out of shame or denial.


Brian S. Sayers, MD
Chair, TCMS Physician Wellness Program



Submitted July, 2018

The Hero’s Journey

Since childhood, one of my favorite stories is David and Goliath, the story of the young, future king who finds himself – by a combination of chance and choice – facing the Philistine giant.  The fate of his army depends on him alone, with only his wits, faith and courage to perform a seemingly impossible feat.  We might all identify with this story, as we have all felt ourselves to be an underdog at some point in our lives.  As I was preparing a class about this story recently, I came across an essay about the “monomyth” or “The Hero’s Journey.”  Described by author Joseph Campbell and others, the Hero’s Journey is a basic story pattern throughout mythology, a pattern frequently found in other ancient writings as well as later day literature and film. 

A very brief summary of the stages of The Hero’s Journey is as follows: the hero from the ordinary world is called to adventure.  After initially refusing the call, he crosses the threshold into a supernatural region.  He descends into “the belly of the whale” and “the road of trials,” along the way meeting with helpers, mentors, a goddess, a temptress, and seemingly insurmountable challenges. There is atonement with a higher power, then receipt of the boon (treasure) and apotheosis (achievement of a higher level of existence), finally rebirth and return to the ordinary world, now possessing gifts to bestow on humanity. 

Literature is often a reflection of everyday life, and if we spend a little time thinking about it we may be able to see many small, and perhaps a few large, monomyths in our own lives.  Our lives in medicine these days is easily seen through this lens.  We pass through a certain threshold from our early lives into a life of medicine, lives that are full of mentors, challenges, temptations and perhaps dark times spent in the “belly of the whale.”  But like the heroes in many of the stories, as we navigate difficult times the treasure that we acquire may be a certain kind of knowledge, perhaps even wisdom, a boon that we are called to share with our colleagues and all of humanity, one patient at a time.  To achieve and then share the gifts that we attain on this journey is indeed heroic, anything but ordinary, but often obtained at great cost.

Different authors describe The Hero’s Journey in different terms, but all include the importance of the “mentor” or “supernatural aid” that assists in the journey.  We may find this assistance in several ways.  One is deep within our own souls, beyond ego where our deepest desires and meaning lives, a place it takes some effort to reach.  Another is found within our community of colleagues, bound together with common hopes and goals, supporting each other, sometimes going arm and arm down the “road of trials,” then hopefully beyond it.  Lastly, there is something woven within, but also beyond, both of those.  On my desk I have a fortune from a fortune cookie with a well-known saying: “Act boldly and unseen forces will come to your aid.”  The ambiguous sounding “unseen forces” is open to individual interpretation.  In my own life it means something very specific, but beyond that, the saying is significant in calling on us to whine and retreat as little as possible in the face of life’s important challenges, but rather to act boldly as we carry our gifts and dreams into a world in need, regardless of obstacles in our way, and to do so in a way that breathes life into us and those around us.


Brian S. Sayers, MD
Dr. Sayers is Chair of the TCMS Physician Wellness Program 



Submitted April 30

An Endangered Species, or an Evolving Species?

In an article from the last issue of the TCMS Journal, Dell Medical School Dean Clay Johnston, MD, PhD,  makes insightful observations about the future of practicing physicians and the mindset we will need to remain relevant. Are physicians, at least as we have traditionally considered ourselves, really an endangered species? He observes what many of us have already grudgingly concluded: that the capabilities of AI (artificial intelligence) will increasingly replace much of the data storage and problem solving tasks that physicians have traditionally seen as their own unique gifts. As this happens rapidly and predictably, what will be the role of physicians? Will that new role be an entirely new direction for us, or a return to the deepest roots of the healing profession?

Dr. Johnston notes that the way medical schools train physicians will need to undergo a sea-change to prepare the next generation of physicians: “Most allocate substantial time to memorization and analysis, tasks that will become less demanding as artificial intelligence improves. But components of the art of caring—communication, empathy, shared decision-making, leadership, and team-building—are underemphasized, when they are emphasized at all… It’s essential that medical education leaders rebalance their curricula toward these components. Doing so will help patients receive the best care that medicine and machine have to offer. It may be good for physicians as well, as they find more opportunities for meaningful patient communication and delivery of higher-quality care.” 

Dr. Johnston notes, “We know that the art of caring is central to the medical profession.” Indeed, it is one of the few things that AI cannot replace. Physicians will need to remember that curing and healing are not the same and our call as physicians in providing care is to endeavor to restore wholeness to the person, not just the body.

How do we realign this mindset as a profession? Daniel Sulsmasy, in his article, Is Medicine a Spiritual Practice?, observes that for physicians to really connect with their patients they must be willing to explore, or at the very least acknowledge, that patients struggle with “the big questions. What is the meaning of my illness? Why must I suffer? Is there anything about me that is valuable now that I am no longer ‘productive?’... Can my doctor possibly understand what I am really going through? A physician who has begun to explore these questions in his or her own life will be better prepared to help patients struggle with these questions.” 

Brian S. Sayers, MD
Dr. Sayers is Chair of the TCMS Physician Wellness program


Submitted March 28

The Medical Marriage

Medical Marriage-photo
Adam Taylor/ABC via Getty Images

First the good news.  Contradicting earlier studies with potentially flawed designs, a study out of Harvard  that looked at data from 6 million people, including 40,000 physicians, found that physicians, 27% of whom reported ever being divorced, are actually less likely to divorce than the general population of non-healthcare employed people, 35% of whom had been divorced.  Broken down into healthcare professionals, we stack up well again, less likely to have experienced divorce than dentists, healthcare executives and nurses.  

In spite of this good news, married physicians face unique challenges to be navigated.  Our work as physicians can be highly stressful and involve long hours physically (or emotionally) away from our families.  We often bring these stresses home with us.  The traits that can make us excel as physicians as often as not may make us a challenge to be married to.  Women in medicine often face an additional set of challenges balancing work and family life and are 1.5 times more likely to have been divorced than their male counterpart of similar age, with women physicians working more than 40 hours per week at particular risk.  

So what is the key to a successful medical marriage?  A number of strategies have been suggested.  One study from Mayo Clinic looking at factors that work for and against the medical marriage from the spouses vantage point demonstrated that “on multivariate analysis, minutes spent awake with their physician partners each day was the strongest predictor of relationship satisfaction, exhibiting a dose-response effect.”  Other studies have also identified time together as the key, although at least one has demonstrated that quality time is really the key with spurts of just 30-120 seconds of “caring interaction for a total of 20-30 minutes a day,” to be a key predictor of marital success (Sotile/Fraenkel).   By any measure, time with your spouse is a critical ingredient, also one very difficult to navigate when so much time and emotional energy are consumed by career and the “parenting vortex.” 

In April, the TCMS Physician Wellness Program is proud to add a Certified Gottman Couples Therapist to our coaching panel for couples in need of expert help in making their marriage the best it can be.  Here is more information about couples coaching as well as our coaching program.


Brian S. Sayers, MD
Dr. Sayers is Chair of the TCMS Physician Wellness program



Submitted March 5

When 20% is a Passing Grade, but Surprisingly Hard to Get

Last fall I attended a nationwide conference on physician burnout and resiliency in which a researcher from Mayo Clinic presented data about causes of physician burnout.  In the study, they looked at certain characteristics of physicians who fulfilled criteria for burnout and those who did not and tried see how the two groups differed in certain categories

They asked participants to identify what work related activities they find most meaningful.  Examples included direct patient care, administration, research and education activities.  They found that physicians who spend at least 20% of their time on their most personally meaningful activity have a burnout rate that is half of those who spend less than 20% of their time on favored activities.  It is, of course, both amazing and frightening to think how many physician fall short of that low percentage in their workday, but not surprising what the consequences are.

Shortly before I sat down to write this, I listened to a podcast during a run that featured Shawn Achor, an expert in positive psychology. In describing the “secrets of happiness” he notes the importance of redefining how we think of happiness.  His argument is that if we define happiness only in terms of pleasure or the final accomplishment of a goal, then happiness is never more than a fleeting moment in time.  He calls on us to see happiness as primarily being “the joy we feel while striving towards our potential.”  The potential he refers to is our ultimate capacity for optimizing relationships, vocation, and other integral aspects of our lives.  Intimately linked to realizing joy and happiness, he argues, is a sense that the things you are involved in have meaning.

As we try to navigate our professional careers towards happiness and fulfillment, an important call is to recognize what part of our work is most meaningful to us and to make sure that in the course of a normal workday that activity is consistently and proportionately represented.  

What specific activity is most meaningful to you?  How well is it represented in a typical day?                    


                                                                                   -Brian S. Sayers, MD
                                                                                     Dr. Sayers is Chair of the TCMS Physician Wellness program



Submitted Febuary 2

Healing From Within

I have been an internal medicine physician for over two decades and have traveled the world both as a missionary physician and a tourist. When I am home in the United States, I can feel a palpable and growing level of stress in our communities across America, as evidenced by the ever-increasing opioid crisis, alarming rates of obesity, rising statistics of violence, depression, and sadly, suicide. This level of stress is much higher in the United States than other countries I visited. I have felt helpless for many years, not really knowing how to treat my patients facing stress-induced diseases. How could I? Like many of my colleagues, I was practicing with burnout symptoms for many years.

Then, in 2009, I had a personal tragedy so horrific that I knew prescription medicine could not help me to heal. I had to find a different way. I was encouraged to try meditation. Despite my skepticism, I decided to put effort into the daily practice of meditation. To my surprise, it worked. It not only took away the emotional pain and burn-out symptoms but replaced it with a deep joy that is difficult to describe.

This led me into research for the next several years on why and how meditation heals. What I found was substantial research in meditation in major universities throughout the United States, particularly at the University of Massachusetts and Harvard Medical School. Meditation is offered as treatment for many conditions including hypertension, depression, anxiety, ADD/ADHD, just to name a few. Meditation reduces complications to chemotherapy, radiation therapy, AIDS treatment, surgeries, and the list goes on and on. Meditation works because it counteracts the stress response creating a relaxation response that allows the body to heal. It is now considered a significant evidence-based practice in medicine.

Meditation is currently widely used in many occupations. It is being adopted in the military for stress and resiliency. In the corporate world, companies such as Google, have incorporated meditation into the work day as it has shown to improve morale, focus, less sick days, and increased productivity. Schools are using meditation instead of detention, showing improved attention, behavior, and grades. Even in sports, professional football players and Olympians use meditation daily to help their focus.

I practice a meditation called the Centering Method, a mindfulness meditation. It is a simple method that elicits the relaxation response when practiced daily. I brought this meditation practice to physicians in 2014. We now have ongoing workshops at

Meditation has been practiced for thousands of years. However, we have only started to study its benefits. I see a future where we learn that the power of healing is truly within each of us.

Anna Vu-Wallace, MD
Dr. Vu-Wallace is a hospitalist and is founder of the Mindfulness Meditation Clinic at Seton Cove


Submitted December 31


The beginning of each new year often becomes a sort of artificial but important threshold, a time when we look back on the old, both regrets and joys, and wonder about the year to come. Some years when happiness and abundance have marked our year the transition is easy, almost entirely unexamined, while other years, recent events of loss or regret challenge us toward self-examination and change. To acknowledge and navigate significant change, a threshold, in any meaningful way requires honest reflection and courage. The late poet John O’Donohue commented on such times of challenge:

“To acknowledge and cross a new threshold is always a challenge. It demands courage and also a sense of trust in whatever is emerging. This becomes essential when a threshold opens suddenly in front of you, one for which you had no preparation. This could be illness, suffering or loss. Because we are so engaged with the world, we usually forget how fragile life can be and how vulnerable we always are. It takes only a couple of seconds for a life to change irreversibly. Suddenly you stand on completely strange ground and a new course of life has to be embraced. Especially at such times we desperately need blessing and protection. You look back at the life you have lived up to a few hours before, and it suddenly seems so far away. Think for a moment how, across the world, someone’s life has just changed – irrevocably, permanently, and not necessarily for the better – and everything that was once so steady, so reliable, must now find a new way of unfolding.”

Sometimes thresholds are abrupt and dramatic as O’Donohue describes. More often, arrival at one of life’s thresholds is more subtle, but no less profound and challenging to discern and cross. In such times, we need to call on not only the invisible strength found within us, but also the support available from those around us, to produce visible and productive change. As he goes on to note in his poem “For the Interim Time,” during such times,

“What is being transfigured here is your mind
And it is difficult and slow to become new.
The more faithfully you can endure here,
The more refined your heart will become
For your arrival in the new dawn.”

We hope the old year ended with happy memories, gratitude, and professional satisfaction and that the New Year will be full of family and friends as well a sense of purpose and meaning in your work. If you find yourself in a time of challenge and in need of help, please consider reaching out to the PWP confidential coaching program, where one of our professional counselors is only a phone call away.

                                                          -A physician

Submitted November 29

It’s the Most Wonderful Time of the Year (?)

In the midst of digging out of the colossal mess left over from our great family gathering at Thanksgiving, then bringing down the seemingly endless boxes of Christmas decorations from the attic to sort through, I convinced myself it might be therapeutic to read about survival/enjoyment during the holidays. Here’s a few of the most common tips: 

  1. Gratitude. Expressing gratitude on a daily basis and in tangible ways (verbally or in writing) is incredibly powerful. There is a whole body of literature about the measurable and life changing mental health benefits of this practice. Spend a little time reading about it or look at some links and videos about gratitude at
  2. Reconnect with your faith or spiritual practices. Plan out quiet time, walks, reading sacred texts, poetry or other inspirational writings or find time for worship and thanksgiving.
  3. Reconnect with family and friends, and not just texts and emails but something relaxed and unrushed. If they are not nearby, surprise them with an actual phone call. If they are close by, share a meal or meet for coffee or do something without a lot of time pressure.
  4. Avoid toxic people or situations. You know exactly who and what this means. Enough said.
  5. Enjoy some unscheduled, unstructured time. There is great power and rejuvenation in the fine art of “goofing off.”
  6. Unplug. Find time when someone else is on call to turn off your phone, your computer and forget the emails. You might just have a chance to get to know yourself, your family or friends with distractions missing.
  7. Go outside. Take a “nature bath.” There is surprisingly robust research about the mental health benefits of spending time in nature.
  8. Take care of yourself. Holiday food and drink is everywhere. A little moderation and some exercise won’t kill you.
  9. Forget about finding the perfect gift. It doesn’t exist. As you fret over gifts, reconsider generosity. Be generous with your time and your love.
  10. Keep a mental scorecard. Which one is leading, the “stuff” or meaning and connections? If the stuff gets too far ahead, it might be time for a coaching change. 

Can this be the most wonderful time of the year? Absolutely! It should be full of family, friends, fun, rest and meaning. It just takes the right mindset and maybe the ability to pause and take a deep breath every now and then.

If are struggling and think you might need a little help, consider calling the 24-hour confidential PWP coaching hotline 512-467-5165 and we will help you connect with one of our TCMS counselors by phone or in person.  

                                                        -Happy Holidays!

Submitted November 7

On Being Perfect

Compulsive, perfectionist. Personality traits often blamed as root causes of physician burnout. There is a part of perfection seeking that makes us better doctors, but another part that can be profoundly destructive. When we fall short of our own expectations, either through our own missteps or because of things we cannot control, with the wrong mindset it can send us into a spiral of self-doubt, hesitation or defensiveness that impairs our ability to provide good care for patients, and ourselves. 

No matter how hard we try, sometimes things go wrong. It is part of our lives in medicine, life in general for that matter, which goes against our quest for perfection, a quest we take on in equal measure for our patients and our egos. At some point we have to come to terms with imperfection, with failure, and see these events for what they are and what they teach us and at some point redefine what perfection really means.

I am a sucker for old sports movies as they study not only those who succeed, but also those who seemingly fail. My favorite scene in Friday Night Lights is the halftime pep talk that the coach, played by Billy Bob Thornton, gives during their championship game:

“…You got two more quarters and that's it. Now, ya'll have known me for a while, and for a long time now you've been hearin' me talk about being perfect…To me, being perfect is not about that scoreboard out there. It's not about winning. It's about you and your relationship to yourself and your family and your friends. Being perfect is about being able to look your friends in the eye and know that you didn't let them down, because you told them the truth. And that truth is that you did everything that you could. There wasn't one more thing that you could've done… Can you live in that moment, as best you can, with clear eyes and love in your heart? If you can do that gentlemen, then you're perfect.”

As physicians, perhaps we should learn a lesson from the coach, redefine perfection and know you can achieve it, regardless of the outcome, when you can look into the eyes of your patient, and into the mirror, and can truthfully say you did everything you could, there wasn’t one more thing you could have done, and say it with clear eyes and love in your heart.

                                                          -A physician

Submitted October 6


I was the senior resident in the ICU. It was late and I was exhausted. A sleet storm was in progress outside the hospital and miles away in a remote area in far northern New Mexico a blizzard was in progress. Somehow Life Flight had managed to get out ahead of the storm and transported Roy to County where he landed on my service. He arrived in cardiogenic shock with ominous tall, wide ST elevations that we identified as “tombstones,” signifying what in those days would as likely as not be a fatal event.

The usual frenzied dance followed, using protocols that sound primitive now, all the while knowing his chances were slim. He rallied after I had sent the interns and students off to get a little sleep, was even oriented and conversant for a while before the arrest and futile code. He told me about his ranch, snow covered now, but soon, in the spring, lush green pastures would re-emerge in a valley below two tall mountains, snow fed streams coursing through the valley. A family ranch where his wife was now stranded in the storm, and where tomorrow his son would have to try and drive the pickup into the pasture, his grandson pushing square bales out into the snow for the cattle as they went along. The old man’s face was pale, deeply creased, sun damaged, and now with tears. I think that night was the first time I held a patient’s hand for more than an instant, in this case for an hour or more, his hand clutching mine at times. By 7:00 a.m. my shift was done, and so was Roy. I called his wife then headed home, and slept.

We have talked about physician wellness a lot lately and it occurs to me that at the core of it lies compassion, of sharing the suffering of others. Burnout and compassion travel against each other with opposite trajectories, one always ahead of the other. Our lives in medicine are defined by compassion, both in giving it, but also in feeling worthy of receiving it. We might ask ourselves many times in a long career, “How do we nurture and protect it?” Without compassion, we are just technicians.

Even today I will sometimes see a cardiac monitor in the unit and think of Roy. Most years, driving to a favorite spot in Colorado I will pass by a certain wide pasture, emerald green, framed with tall mountains, dotted with cattle, and pray that I will never forget that night.

                                                           -A physician


Submitted September 5, 2017

The Inner Environment

For physicians who go through a period of dissatisfaction (or worse) with their work, there is a tendency to blame external factors. This is encouraged by countless articles and books written about physician burnout in recent years. It is hard to ignore the factors that seem to conspire against us. The systems we work in that sometimes appear to be as concerned with production as with quality, the avalanche of regulatory requirements, and the disproportionate amount of time we spend with EMRs and wrestling with insurers. All of these things, and many others, take us away from the one thing that physicians value most in reflective moments – unpressured time to have meaningful, human interaction with their patients. True as this might be, at some point we may have to realize that while there are “systems” problems in our work that we cannot control, what we can control is how we react to these potentially destructive forces, and in doing so, we just might preserve a sense of joy and meaning in our work. Controlling how we respond takes hard work, perhaps the hardest kind. It requires that we look inward. 

Ronald Epstein, author of Attending: Medicine, Mindfulness and Humanity, and our 2017 TCMS Foundation Lecturer, speaks of this in his book: “Burned-out physicians are not only alienated from patients; they are also alienated from themselves…. But changing the health care system won’t solve it all. It is important to recognize that burnout has affected clinicians for centuries, and important causes of burnout reside within clinicians themselves. For the first time in memory…some doctors are finally paying attention to their inner environment in a systematic way and finding ways to bring greater presence and resilience to the practice of medicine.”

Paying attention to what Dr. Epstein describes as the “inner environment” is a unique process, requiring skills, patience and self-examination that does not come naturally to most of us, but the rewards for us and our patients can be immense. It is work that leads to the meaning and connection in our daily lives that we always assumed awaited us when we put on that first white coat. 

                                                    -A PWP committee member 


Submitted: July 20, 2017

During the past year I have been a part of a couple of physician wellness workshops in which one of the speakers uses an exercise about our calling to be physicians as an ice breaker.  She asks members of the audience to turn to one or two people sitting next to them, preferably someone they do not know well, and tell the story of how you decided to become a doctor.  It is a little awkward telling someone you don’t know something about you that is potentially either a fairly personal story, or one that might just sound lame, or a story you can’t fully put into words.  Over the years, patients have asked me often enough why I wanted to be a doctor and I reply with something very brief and unrevealing−more of a sound bite than a real explanation.  But with a colleague, and in this type of setting, I have found that it does make me think more carefully, to recall complex feeling and events that led to the decision, and then share it with a relative stranger.  It does create an instant bond of sorts, perhaps even a new friend, something that is clearly part of the exercise.  There is also great power recalling and verbalizing the nature of that call all these years later.


The second part of the exercise is then to address the question, “Why do you continue to practice medicine today?”  If the second answer is different from the first, and it often is, that is certainly food for thought.  Is the sense of calling to medicine at our current stage of life one that energizes us, fills our work with meaning, our lives with joy even in the face of challenge, or is it now a life of perceived drudgery and annoying obstacles?  The answer may say much about how we interact with patients and loved ones, and whether strategies for change/renewal are needed.  

Considering the need for a course correction might start with a challenge described by author David Whyte:  “…try to imagine what that dreaming young self would think of the strange adult we have become.

                                                      -A late career internist