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Emily Silverman

Thanks for listening to The Nocturnists’ Shame in Medicine: The Lost Forest. If this is your first time tuning in, welcome! And I actually recommend you rewind and start at episode one. This is a series that builds on itself over time. So starting at the beginning will definitely lead to the richest listening experience. Enjoy the show!

Anonymous

The areas I work in, we encounter shame every day. I work on a community diabetes team. And our patients are often experiencing a lot of shame because of the kind of media around diabetes. But people carry that weight when they come. Also, I carry a lot of shame, because what my patients don't know is that I have anorexia. And I've been living with it for a long time–so, probably about thirty years, to varying degrees. So I've kind of varied between being very unwell, being probably–in the street you’d just think I was slim–to, yeah, barely able to function. And this is something that I actually have shared with my manager. He's fantastically supportive. But I am very loath to share with the rest of the team, and definitely need to protect my patients from it. So it's really complex.

Emily Silverman

What parts of yourself do you hide at work? Have you ever revealed something about yourself and then later wished you'd kept it a secret? Or maybe there's something you wish you could hide, but it's impossible to do so. As healthcare workers, what happens when we display the parts of ourselves that medicine teaches us to fix in others? What lengths will we go to, to prevent those parts of ourselves from being seen? And at what cost? In this episode, we explore the tension between the threat of being exposed and the very human desire to be seen and loved, just as one is. You're listening to Shame in Medicine: The Lost Forest, and this is “In Hiding.”

Anonymous

So often the things that I'm talking to my patients about–eliminating this idea of good and bad foods or overly focusing on weight–none of those things I understand, personally. I'm recommending food and treats that I've never eaten or haven't eaten for thirty years. I'm recommending ways of seeing yourself that I don't adopt. I'm recommending, kind of, loving yourself and taking care of yourself, which I don't do. And I think it's really important that I can continue to conceal it from my patients, because I think I need to protect them from worrying about me. But I also need to protect them much more than that–I need to, I need them to trust me. So it would be really destructive for them to know that actually I'm not comfortable around food.

So I will say things in sessions like–when we're working around, sort of, emotional eating–I will tell them lies. I will tell them, you know–just to kind of normalize, because I think it's really important to role-model as a practitioner–I will say to them, “Yeah, I often find myself eating a big chocolate pudding at the end of the day, and I don't really want it. And I know that's just a habit in front of Netflix,” you know. And I see them, kind of, respond to that, feel that sort of relief. Their shoulders go down, they're like, “Oh, she does it too.” And then I talk about how I try and manage that. But this isn't true. And I think my fear with my colleagues in the wider team is that it might be perceived that I'm not, this isn't the right role for me. But what I've come to understand is, I actually have a huge amount in common with my patients.

Basically, I wake up in the morning, and I think, “How am I going to be around food today? Am I going to be able to control myself?” I'm terrified of being in social situations with food, and feel immense shame about, you know, all of that. So, you know, patients sometimes say to me–not always, I’m not perfect–but sometimes they, you know, “You really get it.” And they don't know the reason that I get it.

For me, it's a, kind of, a really deep sense of inadequacy and separation. I think–I'm not sure with my patients, but I think definitely with my colleagues–this dissonance that I'm smashing my head against, these contradictions, would actually be really fruitful for them to know that. But there's great nervousness about disclosure. I think shame is ultimately about not being seen. It's kind of, it's odd, because you think of shame in exposure. But actually, for me, it's about not being seen for who you are. It's about being reduced. When we have to hide it, some aspects of ourselves, we… we disempower ourselves and we disempower our patients.

Annie van Beuningen

I am an attending physician in advanced heart failure and transplant cardiology. I'm also a mom. I have two daughters. I consider myself to be a tough person–tough physically, tough emotionally, and tough mentally. But even so, I had an unbelievably difficult time trying to manage new motherhood with fellowship. One of the things that was the hardest was trying to figure out how to breastfeed and pump and work and, kind of, keep all that hidden. Because it's not something that other people at work want to hear about. They don't want to hear about your boobs, and your, you know, sore, cracked nipples and all the things that go into trying to feed a human. One time, when I came back after maternity leave, I was the cath lab fellow. And in between cases, I would try and run to the pumping room and pump. It was down the hall from the cath lab. I mean, it was a shared, sort of, pumping space where there were chairs that were, like, sticky and gross. And there was, like, a little curtain you could get some sort of pseudo-privacy in. And, sort of strangely, it was also used as a surgery resident call room. There were, like, poor surgery residents passed out post-call there. And then there was this, like, social worker who had to use it as her office as well, which was insane.

But I was pumping after a case once. And it's such a vulnerable position you're in, right? Like, if you haven't done it, it might not be obvious. But, you know, you'd, like, take your shirt off at work, and take your bra off, and you know, hook your boobs up to a machine. It's, like, a pretty intimate thing to do while you're at work. Anyway, so I was doing that and my pager went off and it said, you know, “Urgent! Mr. So-and-So is bleeding from his leg.” It was a patient I had just finished cathing and it was a femoral arterial abcess. So it's, you know, pretty emergent if someone's bleeding from their groin. And I was hooked up to this machine, topless. So I whipped the pumps off, like, threw my shirt on, left everything as it was, and ran down the hall. And I ran to the post side of the cath lab where this patient was, and there was a nurse there who was, you know, standing over his groin with a bloody dressing that was visibly bleeding. And so I took over and held pressure. And as I was holding pressure, I noticed the patient was staring at my chest. And I looked down and realized that, because I had left, sort of mid-pump, my breasts, which I had no control over, had continued to leak milk. And so there was milk, like pooling in my scrub top, through my bra. And it was just like the most humiliating thing to be standing there trying to seem professional, you know, as a woman in cardiology, a woman in the cath lab, a trainee, you know, to be standing there with milk leaking out of my breast. It was awful!

And after the leg stopped bleeding, I went back to try and quickly clean up in between cases, because, actually, the next patient was already on the table. And they were asking me to come in, and I lied and said I had to go to the bathroom, which is somehow more acceptable than saying, “I have to go clean up my pump parts.” Anyway, I went back to that shared call room and there was a note that someone had left on the chair that I had been in that said, “This is gross. This is a shared space, please clean up after yourself.” And I was just broken, in that moment. I just wanted to scream, “I am fucking trying so hard. And I can't win. I can't do it all.” And it was one of those moments that I think all new moms have, where you just feel like, even if it's not true, you feel like, no matter how hard you try, no matter what you do, you are just never, never enough. And it sucks. It sucks. And I am not alone in this experience. I know that every mom who tries to come, or who does come back and work, or not, after they've had a baby has story after story after story of the difficulties and struggles of new motherhood, which are mostly invisible and mostly silent.

One of my best friends was a structural interventional cardiology fellow when she had her second baby, her daughter. And so she spent most of her time in the OR. And she was also trying to breastfeed and pump and there was no space for her to pump that was close enough to the OR. She could have come back to the stinky, shared surgery call room that I was using, but it was too far and she couldn't. So she looked around. And what she found was a supply closet where they kept, like, a backup ECMO machine, which is like a, you know, heart-lung-bypass machine that's used for emergencies. And so she told me that she, in between cases, would go to the supply closet and kind of, like, clean off the top of the ECMO machine and lay her pump parts out and take her shirt off and pump. Sort of weirdly, it was also a space where people left their white coats to be laundered, like their dirty white coats. They would put them there and then someone would come and, you know, take them to the laundromat or whatever. And so while she was pumping, like, you know, kind of crouched next to this ECMO machine, surgeons would open the door and throw their dirty laundry, like, at her, kind of inadvertently. And if that's not an apt metaphor for new motherhood, I don't know what it is. You put your shirt back on, you swallow your pride, you bury your shame, and you go and you scrub for the next case.

Primary Care Physician

I am a primary care doctor somewhere west of the Mississippi River. And I'm fat. And I have so much shame around my fatness. And talking about this is incredibly fraught and I think it may also be really healing. So here goes. I've always been a fat kid. I grew up in a family where that was absolutely unacceptable. And where I was taken to a lot of doctors who told me miscellaneous things about my body and what it meant to be fat and how I could stop being fat. One thing that stands out was being told that I should stop eating apricots. And I don't think there was any context for them thinking that I was eating an excessive amount of apricots. But I was eleven years old and I was taught to avoid apricots and that that would fix my body. It did not. Any encounter I had with a doctor growing up was traumatic. And one of the ways that I decided I was going to process that trauma was by diving in headfirst and going to med school and becoming a doctor. And I think a part of me thought, and maybe even a part of me still thinks, that I could conquer it and the shame would go away. So I got into med school, and off I went.

Med School was rigorous and fun and delightful. And also a total shit show. Being the single fat person in my med school class, the single, fat young doctor or trainee, around, felt very exposed. At the end of my surgery clerkship, I sat with the clerkship director, a surgeon, who told me I had done a good job. I had rounded with my patients well, I did a great job with assessment and documentation. And he said that the thing that I needed to work on was that I needed to get bariatric surgery, and I needed to do it fast, before I applied for residency. I had never asked him to weigh in on any part of my health or my body, I had not solicited any feedback beyond what was demanded of me as a med student training with him. But he decided that the thing that I needed to work on was to lose weight and that I needed to do it surgically. And as I sobbed at him, I told him that, because it's what I could come up with, I couldn't afford that. And he told me he would pay for it.

I now have a staff position, I'm an attending physician. When interviewing for jobs, it's always something that I walk into the room knowing that people are going to see and make assumptions about. And it does not feel like something that I have the current capacity to have a conversation with them about–to say that the fact that I'm fat and a doctor is actually a pretty remarkable thing. And it also gives me this really insidery view into how a lot of our patients with larger bodies experience the medical field and their encounters. I really treasure that part. I have collected a whole lot of patients, without meaning to, who come to me because they tell each other that this is a doctor that you can see who will be respectful and kind. I think sometimes they tell each other this is a fat doctor, and they make assumptions that I will understand what they're coming to us with.

Several months ago, I had a patient who came in, covering for my, for one of my colleagues. I didn't know her before. And she came in for me to manage an abscess. So we were sitting with her in front of me facing the center of the room, me facing her back, numbing it with lidocaine. And she said to me, I hope you don't take this the wrong way. But it's really refreshing to see a doctor with a body like ours. And I said to her, “I really love that I get to be that doctor for people, and it is really fucking lonely.”

Ruta Nonacs

Every other year, I have to fill out the documents for the renewal of my medical license. And I always wait till the last minute. I don't have any malpractice claims to report, no disciplinary actions, no criminal activities. My medical license has never been restricted, denied, revoked, suspended, or surrendered. Period. But I have a problem with question twenty-three. “Do you have a medical or physical condition that currently impairs your ability to practice medicine?” Well, I do have a physical condition and it does affect my ability to practice medicine. But is that the same thing as “impair my ability to practice medicine?” No matter how I interpret the words or configure the questions, I end up feeling bad about myself.

When I was about twelve years old, I started to lose my vision. It occurred fairly gradually. It's not as if everything went dark or my field of vision suddenly narrowed. My vision wasn't blurry. I just started to lose the details, the fine print. I started having problems with reading books and seeing the blackboard. I learned to drive but after a few years I stopped driving because I was having problems seeing the traffic lights. Over the course of a few years, I saw a lot of doctors and had a lot of tests, but nobody could really figure out what was wrong with my vision.

On one level, this was incredibly frustrating. But on the other hand, I think there were some benefits to not knowing. At the age of seventeen or eighteen, If somebody had told me that I had a disability, I would have probably taken a different path. I would have chosen a college that was much less competitive. I would have chosen a career that was less demanding. But without a diagnosis, without a prognosis, I didn't know if things would get better or if they would get worse. I didn't really know what to do. So I just sort of kept moving on, moving ahead.

I finally got a diagnosis at the end of my second year of medical school. It was actually a pretty random event. I had conjunctivitis and went to the clinic. The resident who was on call that day was quite perplexed when I couldn't read beyond the fourth line of the eye chart. She asked me what was wrong with my vision, and I said, “I have no idea.” She was not willing to put up with that answer. And after a flurry of tests and visits with various consultants, I had a diagnosis. I have Stargardt's Disease, which is a form of juvenile macular degeneration. The good news was that I was not going to completely lose my vision. The bad news was that there was no treatment, no cure, nothing could be done. And I would just have to learn to deal with my vision.

Shortly after I received my diagnosis, I made an appointment to see the dean of the medical college. His office was literally in an ivory tower. When I set up the appointment, I felt so mature, so put together. I had a problem and I was going to deal with it head-on. So there I was in his office, with its dark, wood-paneled walls, the bookshelves to the ceiling, and the red velvet curtains. He leaned back in his leather bound chair as I explained my situation. I don't exactly know what I was expecting out of the meeting. Advice? Support? Well, that's not what happened. He asked only one question. “But what will you do?” he asked. “Certainly, you can't practice medicine.”

It took me a long time to recover from that meeting. And it could be said that I've never really recovered from that meeting. It would be easy for me to feel sad or angry about the things I haven't been able to do, or the opportunities that have passed me by. I definitely have certain challenges and struggles, but all in all I've been very fortunate. For the past thirty years, or almost thirty years, I've been a practicing psychiatrist. What is one of the hardest things about my situation is the loneliness. I've realized that it's often hard for me to connect with others, to let my guard down. Do I hide my disability? No. But I'm not particularly open about it, either. My disability feels like a flaw or a deficit. And in a field like medicine where perfection is so highly prized, there's always this feeling that's lurking in the background that I am not good enough, and when others find out I will lose everything that I've worked so hard to attain.

Jessica M.

I was a teenage alcoholic, and the focus of my life when I started nursing school was, was getting sober and staying sober. And I think the principles that define being a sober alcoholic really fed my trajectory in nursing school. I graduated at the top of my class. I met my partner, and my daughter was born two weeks after I took the NCLEX. I had the partner, I had the baby, I had the beautiful, perfect life. But, I retold my stories to myself, I decided that I wasn't really an alcoholic.

When I relapsed, I was working as a labor and delivery nurse. My daughter was three years old. We had dinner with our neighbors every Thursday night. We alternated homes. And it had been our night to host dinner. I waited until everybody had gone home. I waited until my daughter's dad was doing bath and bedtime. And I was in the kitchen cleaning up and there were leftover bottles of wine. I decided I didn't want to be drunk, I just wanted to taste it. I hid it. I didn't tell anybody. That night I woke up in the middle of the night and I was in terror. I, it was real. I had taken a drink.

I spent the next four years in a, in a downward spiral. I never got in trouble at work. I was a really, really good functional alcoholic. But part of, of being a good nurse is your heart is in what you're doing. And in my addiction, a heart takes a backseat. It becomes a dead thing. And, and so you're faking it. So in that four-year period of time, probably I was sober for a lot longer than I was using, but I couldn't stay stopped. It was a spiral into chaos, basically. By this time, I was a single mom with three children. And I got scared of, of where my disease was heading. I asked for help from a psychiatrist that a friend of mine worked with, and he referred me to an addiction medicine specialist. I was afraid because of my career, because I was afraid of losing my license. Unfortunately, this doctor did turn me into the board. When I got that letter in the mail from the board, it was like a kick in the gut.

The nursing diversion program added a layer of complexity to my life that made it harder, instead of easier, to get sober. Suddenly, I couldn't go to work. I had to call a phone number every morning to see if I had to test or not that day. I had to show up at a meeting for a nursing group every week. I had a really difficult time, even when I got sober again, sharing in meetings, because I felt so much shame around what my job was and what my behavior had been–that I had relapsed and continued to work. Yeah, it felt like it would never be okay.

I was in the nursing diversion program for four years. I wasn't allowed to work for the first two years, I believe, of that four years. I had applied for a job about seven months before I got the phone call. They were supposed to call by five o'clock. And it was 4:30. And my phone hadn’t rung and I decided to drive to Starbucks. And on the way there, there was this double rainbow in the sky. And for the first time that day, I wasn't obsessing about work, I was, I was obsessing about this amazing rainbow. And I got out of the car. I got my coffee, I was I was sort of in this blissful place. And I got back in the car and I had a voicemail saying, “If you'd like to accept the position, it's yours.” And it was such a beautiful moment, but I hadn't told them yet about diversion. So I contacted the person who would be my manager and said, said the truth. I was terrified. I thought for sure she's gonna go with somebody else, this is not going to be my job anymore. And I got the job! It was, it was the double rainbow moment. It was pretty amazing.

So when I look at the last ten years, having been sober, having been back at work, what I learned was that I couldn't stay sober and continue to live in shame. I had to find ways to start telling the truth. And, and it started with, with one person, one woman who was my sponsor, and it, and it branched out to being able to share a little bit more and a little bit more. I had to choose not to live in shame.

Emily Silverman

Thanks for listening to The Nocturnists’ Shame in Medicine: The Lost Forest. One of the most common types of stories that we received when we put out the call for shame stories was about shame and mental illness. Tune in next week to hear stories of clinicians navigating this incredibly important topic.

To contribute your reactions and reflections to our shame series, and to access additional resources like transcripts, discussion guides, and more, please visit our website at thenocturnists-shame.org. Shame in Medicine: The Lost Forest was co-created by me, Emily Silverman, as well as Will Bynum and Luna Dolezal. Our producers are Sam Osborn and Molly Rose-Williams, with additional producing by Adelaide Papazoglou. Sam also edited and mixed the series. Thanks to medical student producers Corinne April Iolanda Conn and Nikhil Rajapuram, production coordinator Penelope Lusk, impact campaign manager and assistant producer Carly Besser, and Exeter team coordinator Alice Waterson. The Nocturnists’ executive producer is Ali Block, and our chief operating officer is Rebecca Groves. The series illustrations are by Beppe Conti, and the music comes from Blue Dot Sessions.

Shame in Medicine: The Lost Forest was made possible, in part, by the Shame in Medicine Project at the University of Exeter, funded by the Wellcome Trust. The Nocturnists is supported by the California Medical Association, a physician-led organization that works tirelessly to make sure that the doctor-patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org.

Our show is also made possible with donations from listeners like you. Thank you so much for supporting our work in storytelling. If you enjoy the show, please follow us on your favorite podcast app so you don't miss an episode. And while you're in there, you can help others find us by leaving us a rating and review. To contribute your voice to an upcoming project or to support our work with a donation, visit our website at thenocturnists.com.

I'm your host, Emily Silverman. See you next week.