Dr. Tarane Sondoozi discusses the emotional toll caring for patients can take on one’s health and provides strategies to avoid burnout and combat compassion fatigue.
Back to Symposium Page » Okay, I will go ahead and introduce our first speaker that we have this morning. A dear colleague of mine that I've worked with in the past has been a guiding light to me personally. Doctor Turaani Sandhu Z has over 30 years of extensive experience in clinical and organizational settings. As an executive coach and organizational development consultant and educator, she has served as an internal and external consultant or nonprofit healthcare organizations worked in 250 companies, manufacturing, retail and educational institutions. Dr. Sandhu Z is an author, a competent teacher and master storyteller who teaches and applies an integrative approach to personal wellness, leadership, effectiveness, services excellence and organizational success. She presents on a vast range of topics as professional conferences, symposiums and seminars. Nationally, Dr Sandhu Z is a dedicated teacher and avid learner who views strong and healthy relationships as the key to personal and professional success. She supports leaders and teams to achieve exceptional results there enhanced personal awareness, collaborative practice and meaningful leadership, and today she's going to speak to us about 2020 the year of the nurse and the importance of self care for health care providers. Welcome Dr sun doozy. It's lovely to see you again, and I forgot to mention it in the behind the scenes section that we had before we started. I love your new haircut. I have the last time I saw your hair was much longer. It looks beautiful on you. So thank you for that warm welcome. Let's push all the academia aside. I'm 62 years old. I'm a former scripts employees. I spent about almost two decades at scripts, and I'm a mother of three. My Elvis is 36. I have been a 25 year old and a 22 year old, so not quite out of the Tino Pause, um, forest, but almost almost at the at least in age, they're no longer teenagers, will. The rest remains. I'm humbled to be here. This is not the first time that I'm presenting at this symposium. I'm like the hair club guy. I now I'm a former employee of scripts, but and I am also a current patient and a former cancer patient, Um, at scripts, both myself and my father. So I have, ah, pretty wide a range of angles that I can look at everything that you're doing. And when I was invited to speak to you when I put the presentation together, Laura's guidance was, you know, spend the first half of the presentation talking about self care and then the last talking about the year, the nurse. And last night, at about two AM, I thought, You know what? That this whole nursing business began with Florence. 19. Yell, didn't it? And it is her 22/100 anniversary this year to 2020 and I waas thinking about the image that I grew up with. This Florence Nightingale. You know, the lady with the lantern that would show up with the sick and the dying and the injured in the battlefields and help. And I thought, What a beautiful metaphor for self care Because Florence, 19 Gail, is you, whether you're a nurse or ah, physician or a tech, no matter what it is that you do in healthcare, Florence Nightingale is you now. And instead of shedding the light over the patient that you're dealing with, I'm going to ask you to imagine Florence Nightingale, you yourself shedding light over yourself as a care provider and taking a look at and assessing Where is it that you need self care? Where is it that you could, um, use some additional attention to whatever is going on. So with that intention, I'd like to take you through this brief presentation that I put together for you. It is really an invitation for you to give yourself permission to care for yourself. Many of us in health care, you know, we have the healthcare bug. It's in our DNA, so to speak. And we've been bandaging dolls and animals and what have you is Children? And here we are as adults in this field. And so it comes. So naturally we run to emergencies and we run to people, and we try and help them. And quite often it's at the expense of ourselves and eventually at the expense of our families. And if we continue that path, unfortunately at the expense of our patients is well, so this is an invitation to give yourself permission to shed light on you to assess and figure out where my life where my career do I need some self care And can I bring that in? So I have nothing to disclose. There's the faculty disclosure to sayings that are pretty popular in medicine. One is the Hippocratic Oath. First, you know no harm and the other one is the saying of physician Heal thyself. And I'm struck by the meaning of these two statements because, you know, the second one is about physicians. But it's really nurse, nurse, nurse thyself, right? Take care of yourself and the harm we're not supposed to do first. I think it's not just to our patients, but it's also to ourselves. If in the process of serving our patients, I am harming me, I'm really not going to be that good to the patient in the long run. So that is the presentation in its entirety summarized into statements. But obviously, if I did that, then you'd be free to go and I wouldn't have the privilege of your attention. So let's move forward with the rest of the information I have to share with you. So burnout and compassion, fatigue and stress. Those are all. A lot of people use those terms synonymous. Lee. They're very different. Burnout is the emotional component of the role that you play, um, in health care, whether you're a position, whether you're a nurse, whether you're a nurse practitioner, no matter what role you play, the emotional component of the role is what burn out. Um, has got to. I think this is I'm sorry. This is reversed. Burnout is the environmental factors. I don't know why this is reversed, but imagine the words air turned around compassion. Fatigue is the emotional component of the role. And when you get burnout plus vicarious trauma, that's what creates compassion, Fatigue. Burnout are the environmental factors, the workload, the space designed, the cutie of the patients that you have, the scheduling challenges. Those are things that are environmental, and many times we can change them. And if we are stuck in that situation over time, it can lead to burn out. And when you take burnout and you add by carriers trauma of taking care of people, it can turn into compassion. Fatigue eventually. Okay, next line risk factors. Here's some risk factors that if you have these risk factors, you might be more inclined to experience compassion, fatigue and burnout. So age is a factor. The younger you are. If you're single s 01 of the benefits of getting married. Those of you who are. I know that at least one person on this call who maybe getting married tomorrow. So that's gonna help reduce your risk of compassion, fatigue and burnout. Your work experience If you're within the 1st 10 years of your career, the likelihood of experiencing compassion, fatigue and burnout increases personality factors. If you're a type a personality, if your perfectionist if you have inadequate coping skills. If you have had a history of burnout in your previous jobs, extremely high expectations of yourself, of your colleagues of your patients not being well versed in communication and lacking support these air the risk factors that can lead to compassion, fatigue and thio challenges in your career the signs you want to pay attention to so if you, yourself or anyone that you know is your in your colleagues. If you're somebody who has a very high stress tolerance, the reason that's important is that we don't say out right. We just continue plowing through full force ahead without shedding light on what's going on. If you have a chaotic, department chaotic practice, if there's a lot of different things that are happening, if there's disagreement with your leadership, in terms of how things are done or values if you are the emotional buffer of the environment that you work in. If you have your family life being constantly interrupted by events at work, if you you know, When I was at scripts I used to carry, there was a point that I carried three cell phones when I first started, and it it never got less than two. So carrying two cell phones, one for work and one for personal. And you know the work phone always got answered. Um, if you have a lack of control over your work and over your schedule on your over your free time, it will lead to a lack of self care. And if you have all of these compiling together, then it's time to pay attention and do something about it. Here's some common misconceptions for people that end up with compassion, fatigue. They tend to have these statements, these conceptions as part of their self talk. You know, they have the sort of the Superman superwoman syndrome. I can fix it. What happens? The outcome is my responsibility. If I care enough, it will be okay. Somebody is going to be grateful. The patients, the family members, you know, my boss, my organization, I have I will have enough resource is and my time investment is supported by my family. They know how much, Um, the work that I do is a value to me and to others, and they support me, and I know what I'm getting into. And for God's sakes, I don't need any help. I can do this. And I wish I could see everybody that's on this call, because I would ask you to put your hand up if you have at least said one of these things to yourself in your career in health care. And I'm sure every hand will go up in the room because it's very, very common. So when we get when we are burned out, that's when we are exposed to the environmental factors. The what makes our job our job. What happens is taking some time off. Taking some PTO, you can recharge the batteries. That's one of the tell tale signs. There's a downward spiral of symptoms physically and emotionally. You feel absolutely exhausted. There's depersonalization, you feel burdened. You can become cynical, sarcastic, and there's a reduced sense of personal accomplishment. And, you know, we become a bit of a Scrooge on a daily basis with ourselves with each other and with our patients. Unfortunately, so there's some burnout signs for you and compassion. Fatigue is the deep emotional and physical exhaustion, but it includes now emotional pain and the symptoms can resemble symptoms of depression and PTSD. And there's a shift and optimism. Um, people who are a compassionately fatigue lose their hope for the future, for work and the value that they bring to the table. And it could be really, really subtle. But you might be the first one that notices it. You might be the last person that notices it, just inviting you to bring attention to it. Compassion, fatigue. I put physical twice because I wanted to make sure that you're paying attention. Um, just joking. It's a It's a type of, uh, it's physical physical, this physiological symptoms of compassion, fatigue, their psychological, cognitive, interpersonal and spiritual exhaustion. So you can have, um, compassion, fatigue impact you at all these levels. Physical symptoms. I know. I'm preaching to the choir. Your every system in your body is going to be impacted your cardiovascular system, Your G I You know your stomach is your second brain. Your respiration, your muscles, your skeletons, your bones, your neurological system, your immune system and you may begin to have some inflammation. And inflammation does not just have to be physiological. You can have psychological inflammation. You can be quick to erupt or you can recoil. And those air some of the symptoms of compassion fatigue in the physical arena in the behavioral arena. Sometimes we tend to go to, uh, you know, different outlets for dealing with our challenges, dealing with our stress, dealing with our fatigue. We may start using food or alcohol or, God forbid, illicit drugs to take the edge off. And quite often this seemingly adaptive approach can become maladaptive over time because we end up abusing those things and the very medicine that we're using to deal with our pain becomes a problem in and of itself. We can have excessive concern about our patients. Even when we're time off. We never really switch off dread going to work, lack of joy at home or at work over reactivity to situations kind of flying off the handle road rage desk, rage, zoom, rage, thes days, feeling isolated and isolating. Having poor boundaries and overextending yourselves are some of the behavioral symptoms of compassion, fatigue, their psychosocial symptoms, depression, anxiety, our primary within the Depression and the anxiety as well as outside of the Depression and the anxiety There could be some agitation. You can feel helpless, confused, apathetic, have mood swings, can't concentrate very angry and irritable. Sometimes as parents who are compassionately fatigued in our jobs. At health care, we can become overly protective, overly demanding. Sometimes we can become neglectful. We kind of tune out. There's interpersonal conflict, withdraw, lack of intimacy for folks and poor self esteem. So here are some of the psychosocial symptoms. And of course, you know, we have to add This'll Cove it element to all of this before the before the presentation. As I was talking to my wonderful team here, I was saying, You know, prior to Cove it we had the same challenges as people who offer services in in the world of oncology, but at least we could hug each other. At least we could hug a patient or hug a patient family member, and we had so many tools in terms of our physical presence and having, you know, family members support us. Now we can bring family members to the appointment, right? They have to wait in their cars or wait in the different waiting areas. So many of the tools that we had accessible to us to combat compassion, fatigue because we shared the compassion with other people. Now we're not able to do that. And our hands and feet in many ways are tied in terms of behaving compassionately. Not that were not compassionate. We can't show it to the ways in the way that we used to show it. And that can create a challenge. Pardon me. There are also, um Okay, let's move this again. Here we go. The spiritual symptoms, compassion, fatigue can make you feel disconnected from your higher power. You could become become angry at your higher power. You may wonder, why am I doing this? What's the purpose of all this? We are going to die anyways. A sort of a sense of hopelessness, especially. I think when you're working in oncology, you're not just giving information to people. You're not just treating them, but you are truly, um, coaches of hope, right? Your merchants of hope You bring hope and you coach people with hope and you are juggling medical hope from professional hope. Personal hope from from that, you know, juggling item, you're moving on to the families, hopeful the outcome. So you're here. You are just juggling all these different ways of being hopeful. And you have to maintain that. And it can impact you when you become compassionately fatigue. Just exhausted from that juggling when we leave compassion, fatigue and burnout unaddressed. Suffering takes place for everyone you know, burn out. We can become negatively charged in terms of our self concept. We have negative attitude about our job. There's a loss of concern for how patients feel. If this is if burnout is left unaddressed. If we don't address compassion, fatigue, your personal health suffers your personal life and relationships suffers your work. Performance suffers and ultimately our patient and our world suffers, right? Our community suffers on the provider here some of the impacts of compassion fatigue on the provider. We talked about maladaptive coping. That was the food, drugs and alcohol, the exhaustion, the irritability, the absenteeism and the present is, um, if I spell that correctly, absenteeism is you're not work. Present is, um is your your body's at work, but your mind isn't at work. You're not fully engaged. Which leads to detachment, apathy, negativity. And eventually we can can even become task avoidant or become obsessed with the details and become too perfectionist. ICS. Christine F. Is a wonderful person who writes about self compassion, and I love this quote from her, she says. The biggest reason people are not more self compassion. It is that they're afraid they'll become self indulgent. So for many of us, Thio self care means to be selfish. And if I'm selfish, I'm self indulgent and I'm not taking care about the people. And I wanted to share this quote with you so that after the presentation you have some time to think about it. You know, what is your personal view of self care? How do you view other people that take care of themselves? Right? The prioritize self care. I know. When I was at scripts, it was many scenarios, you know, challenges between nurses. They would they would come to me. I was an e a P providers so they would come and say, You know, here I am working my tail off and there she or he sits in the break room, dipping the tea bag really, really slowly into the mug, and I don't know how she can do that. How could he possibly sit there when I'm running around with my hair on fire? Right. And so there's within that question is hidden that approach to self care a self indulgent. So if you're sitting there and if you're taking five minutes to drink that cup of tea mindfully, you are self indulging, and you shouldn't as my colleague be self indulgent. And if I don't allow you, you better believe I'm not going to allow myself. So again, another invitation to bring attention to that for you when you have some time to reflect. So you know I'm not telling you anything that you don't know. You already know this stuff, and we already know how to combat. Um, compassion, fatigue. We already know how to take care of ourselves. You cannot go to any magazine, any online resource on how to deal with self care and how how to combat stress and compassion fatigue and not get a list of, you know, sleep hygiene, good, healthy diet, exercise and as providers, we know this and we preach this. So how is it that we don't do what we know works for ourselves? We tell our patients this, but we don't do it for ourselves. There's, You know, one third of the reason is because we're not aware, right? We're just on toothy, you know, we've got the lantern and we're standing over the patient and we go from patient to patient to patient to patient. And we don't put the lantern on ourselves and take a look at what's going on with me. So I may not be aware. Another reason could be It has to do with control. You know, if I focus on the my patients, then I can control what's happening here. If I turn the attention and shed the light on myself, maybe there's things going on in my life that I cannot control. Maybe I cannot control his or her challenges his or her moodiness, and that he or she is the person that I'm living with. The person I'm related to, the person I'm taking care of And the third reason, as Christine Neff said, is self compassion. Many of us are walking around starving in our hearts, and we don't recognize that hunger. We tend to dish out what we want to receive and don't ask for help. We love helping, but we were not very comfortable in asking for help or accepting help when it shows up. If we knew, um, if we knew that if we shed the light on ourselves if we took the time to do self care assessment, here's some simple ways that you can ask yourself, You know, do I set the mood in my job? Do I set the mood at home? Is my com contagious, or is it my anxiety that's contagious When I go home on my present, Um, do I treat myself well? Do I share what's going on with me and my grateful? Do I enjoy good food or sit by the fireplace, dress comfortably or clean up thoroughly? You know, groom myself Well, um, I a nice host when and if I have people zoom over right now, we're not having too many people over our homes that we don't live with eso. Here's you can create your own self care assessment and ask yourself, you know, body physical, emotional, psychosocial, cognitive, Spiritually. Where am I in those fields? How? Well, um, I taking care of myself. Some areas that you may want to take a look at when you're looking at giving yourself permission to self care. Look at your look at your home. Start at home. Ask for feedback. Ask your Children. Has your childhood. How can I be a better parent? Ask your spouse, your partner. How am I as a partner as a spouse? How can it be better partner and spouse? Many of us don't want to ask because we don't have any room for improvement. You know, I like I said, I worked at scripts for almost 20 years, and there's a continuous I think, in health care in general, there's a continuous pressure to improve. Were always in process improvement. Right service improvement, if we didn't improve, will still be performing lobotomy to deal with depression, so improvement is part of the game. But that means you're never satisfied with what you have and your continuously asking for feedback, and we give polls and you know there's a press Ganey and everything else. The H caps, all that stuff that comes into play. So when we go home, we don't wanna ask for feedback. We're kind of feedback. Fatigue. Maybe That'll be my next presentation for for next symposium. So here I am, asking you to give yourself permission and inviting you to check in for feedback plan retreats to refuel. And the retreat could be just a walk around the block, maybe every day between two meetings. Maybe maybe refueling is not scheduling meetings back to back. Maybe giving yourself a 10 minute opportunity to walk around the block and come back and go into the next meeting at work. Are you managing your workload? Are you educating your staff? Your yourself, your colleagues about compassion, fatigue and burnout? Does your work promote creativity? Fun, humor? You see this little teddy bear back here behind me and doctor, um, we Joe, that is my wonderful colleague is going to be speaking to you shortly. Was commenting on that. I wanted to know if I'm at a nursery and I said, no, I'm not. I just have this because when I'm working and zoom working, sometimes people have their Children and they show up and they're cranky so I can reach behind me and grabbed the teddy bear and bring it and and have a conversation. So a 23 minute fun break for myself and for the parent that I'm talking to be, um, further enhanced by bringing a sense of play and a sense of fun into it. Before I left scripts, we had Zenden's and our different departments. I hope that that's and then still is, is there then then Now we are, you know, at home you can create it's and then for yourself at home. Maybe it's your car. May be your home is too chaotic, but you can make your car be yours. And then and maybe it's just two drops of lavender oil on your risk that you kind of rub your hands together and cup your hands over your face. And that is yours. And then, and that's perfectly OK. It's just creating that for yourself at work if you can. Obviously, you have your wonderful e, a p t. My my previous colleagues. I know they offer support groups. I know there's debriefing opportunities, and if you're not a script and these air not happening at the organization that you're at a encourage you to promote and ask for them and celebrating celebrating our success. Um, however small thing there may be, as far as your mind is concerned in terms of self care. Are you self aware? Do you practice mindfulness? We have wonderful Karen Southerners at scripts that teaches mindfulness based stress reduction program. I know our AP providers promote that as well and have various mindfulness practices that they offer on a regular basis. Accessing them will help you and I respond rather than react. We are in a world that we have to, you know, respond very, very quickly. We even have the rapid response team. But that sometimes comes at a price of ignoring the physiological, emotional psychological reactions that we have to situations that we intend to push those aside and say, I will feel that later on I will have that emotion later on, and that's a recipe for compassion. Fatigue is not pausing and reflecting, and if you don't have the time during the day, creating that space and time for yourself at some point in your day to do that to kind of decompensate decompensate to decompress. Okay, So some simple suggestions that you could do at work and at home to kind of promote self care. Mind your lighting. Um, you know, the lights are too bright. Excuse me. Maybe around. Uh huh. Uh huh. Excuse me. One of my goals is to catch the sunset every day. There is research that says that by staring at the sun as it sets the colors that you're that you're looking at, actually get your body to produce melatonin, which we know is an important chemical for easing us into sleep. So lighting, especially now as it's getting darker, faster bringing light and playing with light to see which which kind of light promotes a small, soothing environment for you. The colors, right? Are they Are you wearing soft colors? Are you living around soft colors? Are you working around soft colors? What about your atmosphere? You know, And that could be your atmosphere can be your bubble. And this is so hard. I know now with Kobe because we have to wear masks and you know everything is covered up and our hands everything about us is covered up the work. So it's difficult to create that warm, fuzzy atmosphere when everything looks so, um so medical, you know, so procedural. Given the challenges that we're facing with cove it can you bring some nature in? Can you have a sound machine that has birds chirping in your break room? Can you have ah, plant somewhere? Can you have a photograph of a plant? I know Thea Marai, center over one of our clinics has got this beautiful skylight. When you look at it, it's all cherry blossoms and the beautiful sky. So when I had a patient when I went there, I really looked forward to seeing that nature. Although it's not riel, it brings nature in clutter. Alright, A cluttered life is a cluttered, mind cluttered spaces, oclock cluttered life. So take a look at that and see if you can de clutter. Can you declutter your thoughts? Have a conversation with your AP. Can you declutter your desk space? Can you declutter your office? Um uh, bringing aromas bringing, um, sounds into your environment that can be very soothing. Here's a whole bunch of different strategies that you can take. Um, take a look at you know that I've put here for you. Anything from separating work from home, Having it be okay to say to say no, I'm asking for and accepting help, right? Sizing your expectations, redefining success. Um, maintaining. Ah ha. Be learning to say no. I know for many of us, that's a difficult thing to do. Living mindfully, practicing regular meditation, practicing gratitude, journaling, even if it is you just saying your phone, you put it on record and you say once the one thing every day that you're grateful for just for yourself and you can listen to it at the end of the month and see what you've got going. And if I had to bring your attention to anything on this list that I think is very important, it will probably be my lower left hand corner. It may be your yes, probably your left hand corner as well. Keeping the three piece in mind. The three piece are nothing is personal. Nothing is perfect and nothing is permanent. And when you take that into consideration, it creates ah, breathing space. It does for me, and I can ease my way through whatever I'm facing because I know It's not personal, even if it is directed at me. I know it's not perfect. People are messy, relationships are messy, and life is the messy is, and medicine is the messages of it all right in more ways than one, and it's not permanent. This this patient will graduate. Hopefully, one way or the other, they will leave, and I will leave this job one way or the other. So it's not permanent, which allows me to enjoy the joys and tolerate the challenges more effectively. No, Um, I want to invite you to try a self care challenge. Give yourself permission to take care of yourself for 21 days. Research says that if we do anything for three weeks, our brain tends to create new neural pathways for those new habits. And here again are some suggestions. Can you take 21 days and do one of these things every day, you know, express your feelings, acknowledge accomplishments, play with Children and animals, engage in soothing activities. Grieve well. Oncology is lives next door to los right. It's inevitable. Yes, many people like myself can survive breast cancer or different types of cancers that they have, but eventually. And ultimately something gives that's life right. And sometimes what gives is their ability to fight off the cancer. And we lose. We lose with them and we have to go to the next patient. And sometimes we don't grieve. Well, we don't say ouch. And this is an invitation to do that. Having and creating a medicinal cabinet that has music as medicine in it. We all have songs. We you know, you have your favorite breakup song. You have your favorite Jim song. You have your favorite party song. Um, create that pharmaceutical. Uh uh, medicine cabinet with intention. Put music in there that soothes you that helps you that motivates you. That inspires you. Practice. Let's see. Here, let me move here. I don't know what I'm practice positive self talk and connect with nature for many of us. We have this negative self talk, you know, that we have internalized because we were spoken to negatively with the best of intentions on We maintain that, and it's an incredibly difficult process to go through. If you're dealing with oncology patients and yourself, talk is pretty critical. If you're never good enough for yourself, that can be really challenging. So try bringing attention and maybe speak more positively to yourself for 21 days and see, uh, what what can happen? Something as simple as lighting a candle. You're gonna think what is lighting a candle? How's that self care? Well, it changes the lighting, right It takes. It's a very mindful thing, especially if you get a candle that's hard to light, Right? So one of those candles that are deep inside a maybe a glass container or something, It slows you down. And it is. It shows you that the flame is not permanent. At some point, the candle will burn out. So it could be a very mindful, meditative practice. If you choose to light a candle every night, maybe you light a candle for all the patients that you had the blessing of treating every night and you wish them well. Maybe you light a candle because of something that you're grateful for. Remember why you are doing what you are doing. Recognize and measure and manage compassion, fatigue? Um, ask for help. Rein stands for recognize what you're feeling, allow That's the A allow for what you're feeling. Investigate what you feel you have your lovely AP team. If you're at scripts. If you're not at scripts, reach out there. Plenty of mental health resource is available free online through your health insurance and and is nurture right nurture, which you recognize. What you allowing what you investigate. Enjoy the moment And remember, remember the three piece again? Okay, lets one of my favorite favorite quotes by a favorite artist, Vincent van Gogh, who said, Your profession is not what brings your paycheck your profession is what you were put on earth to do with such passion and such intensity that it becomes spiritually and calling. And I can't think of another profession that lives up to that quote, Um, to the degree that having a profession in the medical field does as a nurse, as a provider as a physician that what I think is doing, that's what you did. I know when I was a patient, the and I am still a patient. I know my team of providers. They did their work with such passion that it was not only spiritual for them. It was a special experience for me, and this is just a slight to remind you of that? I think that's why we all get into this. So why should we self care? What does it promote? Psychological hardiness. It makes you more resilient. It makes you feel like you're in control. It gives you a sense of purpose. It creates strong social support. It allows you to tolerate failure more realistically, and it allows you to accept and not feel responsible for outcomes. These air all evidence based that when providers promote and engage in self care activities thes air the benefits that they can enjoy. So it's the year 2000 and 20 the year of the Nurse Ondas. I started first with Florence Nightingale. Um, when I've heard that it was the year of the nurse, I don't think any of us expected this. This is not my quote. It's a quote that I found online. I don't think anybody expected, um, co bed and a global pandemic and to be delivering oncological care along with, um, pandemic in the middle of a pandemic, with all the limitations that Kobe has placed on us. And for many of us, as I was saying earlier on, it renders you not quite helpless, but it definitely challenges by taking away some of the tools that you had previously. Which is your physical presence. Your you know, your your beautiful scrubs that you could wear free and people could see you smile behind those masks. And now everything is covered. Hands face everything. And then we've got that protective face shield over everything that reflects the light. So your patient cannot see the Van Gogh, right? The van Gogh, that is your smile, The van Gogh, That is your spirit that shines through your through your face. And we do know that 30 55% of communication is the nonverbals right? And so much of that is compromised within cove it. And so my hat is off to all our nurses. My hat is off to all our providers because you are doing what you've always done really, really well with such an incredible, um, challenge, that cove it presents. So thank you for that. Um, Rosie Williams said to do what nobody else will do in a way that nobody else can do. In spite of all we go through, that's what it means to be a nurse. I think that's what it means to be a health care provider, whether your mother, your TVs, whether you are, you know, the wonderful Mr thank You at our lawyer campus, no matter who you are, when you do something that nobody else is willing to do it or nobody else is doing it in a way that nobody else can do it because it's your way right and we do it in spite of our personal lives. We put that behind us when we put on the badge and walk onto campus. No matter where you work at, that's what it means to be a health care provider. That's what it means to be a nurse, and we've been doing it for 200 years, so thank you. All right, let's So here's a summary of what I shared with you and the summary is that self awareness we leads to self regulation. So I'm encouraging you to become self aware to shed light on yourself, to do a self care assessment and say, Is there room for improvement in all these areas? Um, that I could enhance my self care. When you are aware you're able to regulate yourself, you're able to check yourself before you wreck yourself, right? We talked about intentionality right to to intentionally bring attention to the thinking. Mind to the sensing body and the feeling hard as you provide the services and to increase that awareness of compassion, fatigue and burnout professionally with your colleagues. Um, there there are re sources that are available online, where their assessment tools that you can actually question is that you can complete to see is your department compassionately fatigued? Are are you compassionately fatigue? Is there burnout? So use those things, and ultimately, the what really helps us is our ability to connect first with ourselves and then with each other. And that's what self care is about is about connecting with yourself so you can take care of yourself so you can take better care of people. One last thing. I wanna end our little conversation first with this, and then if I have time, I'll share a story with you. It's about the art of going belly up, and if you were here last year, I think I might have even used to slide. It's one of my favorite slides. No matter what presentation I give, I try to bring this in if you have been blessed with a pet, whether you have a cat or a dog, if you pay attention at some point during the day, probably not in a bathtub, because we don't have one laying around. But at some point during the day, your cat or your dog will go belly up just like this puppy is in the tub. And when when a mammal goes belly up, what it's saying is my environment is safe enough right now, then that that I can expose all my vital organs, right? There's no threat. I've been blessed enough that I have found and retained a human being that's willing to go to work and take his or her heart and money and buy me good food and toys and shelter and place with me. And you know what? They talked much nicer to me than they talk to each other. They cooing and doing over me and baby talking to me and that kind of mean with each other, isn't life great so that dog or cat will go belly up now as people we don't go belly up, especially now for some of us who are working at home like I am. We're working remotely. Were the letter C right? We're leaning into our computers. You're looking into your screen. Even when you are on campus, at your at your health care facility, we lean into computer screens. We lean into pictures, stores. We lean into patients, Um, you know, wounds and circumstances. So we're continuously in this letter c, which is curved up and we don't expose we don't go belly up. And if you look at the gentlemen that sleeping on the floor if you did nothing from the list of suggestions that I shared with you in terms of self care, if you simply committed to 21 days of 5 to 10 minutes of every day of just lying at this gentleman is lying at home, you can also put your feet up against the wall. Put your legs up against the wall. Um, you put your relax your heart in this position, it doesn't have to work as hard. And by just doing this 5 to 10 minutes every day and focusing on your on your breath, it's okay. Other thoughts come, you can take it back to your breath by focusing on that by doing this committing to do this for 21 days, you'd be amazed at the difference that it will make for you in your life. So if you have young Children, you can bring them with you and they can put the teddy bear on their bellies and take the little teddy bear for a ride with their breath. But make this be a family affair. Make to speak something that you do every day. I can't tell you enough of how beneficial this will be. Let's see what cause I have next for you. Awesome. This is the end. Um, if there are no questions, I want to see if there are any questions, any comments to what I've been sharing, so I will pause. And if there are no questions or comments, then I may share a story with you, so let's see. Oh, thank you, Dr. Sun. Doozy for your presentation. I learn something every time you speak eso Thank you for that right now. It doesn't look like we have any questions currently on DSO. If you would like to share the story that you wanted to share, we have so many stories to share. You know I can always share. Maybe I share in oncology story on def. You've shared it in the past. If I've shared it in the past, bombard Laura on the text and say, Tell her to stop sharing the story because she told that last year or or other time it's my story of pink lemonade. You know, I introduced myself as a story ologists and a professional lemonade maker. One of the most incredible big lemons that rolled my way was cancer. First, it was my father's cancer. Hey was diagnosed 40 years ago with Mucha epidermal carcinoma of the soft palate. He's an oral surgeon and dentist, retired oral surgeon and dentist. So, you know, it was very ironic that this happened when it happened and he hit it from the family. Physicians don't always make the best patients. Healthcare providers don't always make the best patients. Uh, so he left Hey, left the United States, and he went to Nepal and China and India in search of alternative medicine. This was over 40 years ago when alternative or complementary medicine, I should say, was not as popular as it is these days. And then hey came back 20 Some years later, the cancer in his mouth started to metastasize, and it grew into the size of my fist and it was choking him. So we came. I wasn't employees. Then, about 25 years ago, we went to scripts, loya and wonderful, wonderful team of providers. 18 hour surgery that rendered him without a soft palate impartial hard palate, um, protected me and a long stay in the long journey pursued and has been living with me ever since. And I've been taking care of him ever since. Eso that's my story with his, with his journey and from his journey I want to share a story and from my journey I will share a story with you. So his journey here he is at one of our hospitals. Um, Post being discharged from the surgical. I see you and this is the first day that they're allowing him to sit up and he's sitting up and he can't speak. His face is about this big, all swollen. Andi is writing whatever he wants. And so he writes on a piece of paper. I'm just doting and want to know what it is that I could do to help. He writes on a piece of paper. He says to me, I wish I had. I wish you could be in a Jacuzzi right now because he hadn't bathed. I don't know for how long with that, obviously the sponge bath, but not an actual shower. And he wanted the healing power of running water. You know, to sit in a, um, amniotic, uh, metaphorically and amniotic environment and just be contained, I think is what he was looking for. And as helpless as I felt. I said, Okay, let me see what I could do. So I left and went to one of the nurses, Andi. I asked for one of those big basins that they used the plastic base and they gave it to me. I came back into his room. I filled it up with hot water. I put a couple of pumps of hands, open it and lathered it up. And then I took a bunch of straws and I got him from their thistles before straws were bad. Eso I sat in. He's just looking at me, wondering what I'm doing. So I got on the floor and took off his hospital socks and put his feet in that hot water bubbling hot water. And I took the straws and put five or six of them in my mouth. And I started to blow in the water and the water started to bubble, and he started to laugh and cry At the same time, a couple of nurses were walking by and they want to know what I was doing. I said he wanted the Jacuzzi And so, um, to those nurses came in and they each grab a straw and they sat, Um, the obvious lady came and she want to know what we were doing. So she grabbed the straw. So this man had four lovely ladies at his feet blowing bubbles in the basement of water. And there was this Jacuzzi and I shared that story with you because to this day, we talked about that to this day. When ever we go Onda have a beverage that has a straw, he can't use a straw to drink because he doesn't have any, doesn't have a palate. But when we look at a straw together, it revives that story. And the wonderful team that was there that played with the patient and the patient's family member. And, um, I am grossly aware of how that may not be available right now. With Covic, I may not even be allowed to go into the room with my father, so he has to heal on his own with wonderful team that's around him without having me. Is the family member to support and assist and be part of the treatment team, because that's what family members are. So that's a story from him. My own my own story of breast cancer diagnosis. Um, December 31st, 2000 and 15. At 8 37 PM I got a call that said, You have breast cancer and, um, I want to share a story within a story. And that story is about the story of the Chinese farmer. If you're into mindfulness, you probably have heard this story before, so forgive me for the redundancy, and if you don't know it, it's an incredible story that's been very helpful for me. It's very simple, but very incredible. And the story is about a Chinese farmer who has a son and a horse and a piece of land and He plows the field and plants the seeds and he harvests and puts the goodies on top of the horse and the back of the horse. And the sun takes it to the market. And that's how they live. And one day the horse runs away. So all the Villagers come in. They're all very upset about the whole thing. And they look at him. They say, you poor unfortunate man, You're you're worldly goods. You know, your horses gone. What are you going to do? This is terrible. And he says maybe yes, maybe. No. We'll see. So little time goes by and the horse returns with four female wild horses. Everybody comes and gathers around them. The Villagers and the neighbors. They say, You lucky man. Look at this. You have the most number of horses in the village or the you're the richest. This is incredible. What good fortune. And he says, maybe yes, maybe No, we'll see. And a couple of weeks go by and his son is trying to domesticate the wild horses and he falls off of the back of one and breaks his leg. And he is in a cast. All the neighbors villages come and they say, you poor unfortunate man, your son your right hand. He can no longer help you. This is terrible. This is awful. He says maybe Yes, maybe. No. We'll see. And the Chinese revolution breaks out and the military comes into town to forcibly enlisted Remove all eligible young man and his son is spared because of the broken leg. And the Villagers come. And they say, you lucky man, whose son spared from imminent death of battle and aren't you lucky. And he says Maybe yes, maybe. No, we'll see. So when I got that call on that December 31st 8. 37 pm from my physician telling me that I had breast cancer, What I heard myself say to her, she says, This is terrible. This is awful. I am so sorry I said, Maybe yes, maybe. No, we'll see. And I think that is that some sums up medicine for me because it's maybe yes, maybe No, we'll see. And we can all times hope for yes. And at times we can hope for no. And we don't know what's going to happen. We'll have to see. And it's in that seeing It's in that, um you know, Vaz elation that that swing of the pendulum between the yes, and I know that we show up every day, put our super capes on and take care of people who are not able to take care of themselves. And, um, I'm inviting you to pay yourself back for the incredible work that you've been doing. So with that said, um, I look forward to seeing you in person. Hopefully at the next symposium or next scripts sponsored conference, my contact information will be shared with you on the slide. And please reach out to me if you like. The story that I told you can go to YouTube and you can put doctors on doozy d r s o N d o z I If you just go to YouTube, you see ah, bunch of stories that I tell the story every Sunday on its posted on YouTube and you can go in and listen to a story and reach out to me on LinkedIn. Reach out to me on Facebook and let me know what you're thinking. What you're doing, what you're learning. I love to stay connected with you with that said Thank you for the honor and the privilege of your attention and the time that you've given to me and thank you again from the bottom of my heart for everything that you do. And this is our symbol for the light, right? May the light shine upon you May the light that you shine upon others be returned to you in many, many folds And please shine the light on yourself and see where you need some care and take care of yourself. Thank you. Thank you, Dr Sandhu. Z, we did wanna let you know that during your presentation, um, some of the facilitators asked in the chat box to the participants and attendees. What kinds of self care does everyone practiced? And so just to let you know, some of the responses that they had, um they try to get outside for a walk every day, even if it's just a short walk. One person responded that they work out with the train or twice a week, virtually 30 days. They walk on the beach on Ben. Another person responded that they practiced monthly massage therapy. So some of the songs that wonderful well, consider yourselves hugged his a virtual hug, coming your way right? And here's another way to take care of yourself. You know, Pat on the back and the self hug. Your body doesn't really know that it's you. It experiences the benefits of Bath. Thank you, Laura.