Witness to suffering

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As a doctor, a lot of the care that I provide has nothing to do with prescribing medications or performing procedures. Sure, they form a significant part of my training and my day to day work. However, there are also many times where all I can provide for the patients is my presence, to be a witness to their suffering and to create space for them to grieve and mourn.

This was a huge revelation to me in the earlier stages of training – recognizing that there are many things we can’t just “fix” in medicine, and that care doesn’t end with telling a patient “I am sorry, there is nothing we can do”. I never realized how difficult it is to be truly present to witness someone’s suffering until I had to do it myself. It is so easy to give into the temptation to comfort, or to give false hope or even mislead. At the beginning, I told myself that it is because I care deeply about the patients, and it was difficult for me to watch them suffer. However, the more I did this, the more I realized I was NOT helping these patients by quickly wrapping up their suffering in a neat package to replace it with something prettier – I could see how this made them feel confused and lost. Why then, was it so hard for me to change my behavior?

Problem solving engages the prefrontal cortex of our brain – the part that allows us to reason, filter and regulate our emotions. Being forced to turn away from problem solving therefore leaves us feeling exposed, out of control and yes – vulnerable. However, in turning away from problem solving, we can truly be present and focus entirely on the suffering of the individual in front of us. In psychiatry, this is called “holding space”. Having the space to grieve without feeling pressured to go into problem solving mode can be a deeply therapeutic experience that allows one to just “be” and not be judged.

Think about our daily lives – how often do we simply listen to our friends, family or significant others and be fully present to witness their experiences? As children, how many of us had the luxury of this experience when we tried to share difficult experiences with our parents?

I tried to imagine what it would feel like to have someone fully present to witness my suffering, to have an understanding of how this could help my patients. My mind shifted to when I pray or meditate at my altar. Sometimes, I am looking for answers – but more often than not, what I desire is to have the time to sit in my grief and to let it all out, and to have someone sit WITH me in my grief. The sheer presence of my goddesses and spirit guides had always comforted me in my darkest times, and this is what I could do for my patients when there is nothing else I could offer as a doctor. Simply being present in their suffering was a service I could provide in those dark moments.

Now, when I deliver bad news, I sit with them, quietly, with a tissue box in my hand. I stay present with their grief, and in doing so I hold space for them to process their suffering.

It is true that this is much harder with family and close friends – those who we consider part of ourselves and can make us feel particularly vulnerable when they share their suffering. Practice makes perfect and I am still working on it.

Sitting with your feelings

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I was reading “Maybe you should talk to someone” by the brilliant Lori Gottlieb this morning just before work, my little morning ritual, when one message really struck me: it is horribly difficult to sit with one’s own feelings, even for psychotherapists. I am no psychotherapist, but as a doctor, I always ask patients to reflect on their actions, thoughts, and feelings, and encourage them to do mindfulness exercises where they try to notice their thoughts and body without judgement.

The practice of witchcraft also asks one to recognize their thoughts and feelings, so that they can be used to enhance one’s craft and power. An aware witch is a powerful witch – she who rules herself can rule the world.

Why then, is it SO HARD for me, to sit with my feelings? I spend most of my days reading, watching TV, scanning through Youtube, or scrolling through my phone when I am not working in a desperate effort to distance myself from my emotions. In a way, working is almost an escape, because focusing my attention entirely to my patients shifts me away from thinking about myself.

A common concept discussed in psychodynamic theory and in family therapy is that a child who grows up learning that their feelings are invalid, internalize this and grow up to be adults who cannot tolerate their own emotions. The act of noticing and acknowledging their internal processes become associated with deep shame, rejection, and feelings of being misunderstood such that they learn to cope with this by becoming avoidant, not just of their own emotions but of that of others as well.

The difficult part of this is that our thoughts and emotions influence our judgement and worldview whether we acknowledge them or not. Being able to sit with, notice, and acknowledge our internal processes help us realize why we see ourselves, others, and the world the way we do, and lovingly readjust if there are biases at play.

This of course, doesn’t come easily at all. I realized my own tendency to avoid my feelings when a supervisor pointed out how I tend to get flustered if I don’t know something I think a patient wants of me, and how I would completely shift my behavior without even noticing that I am doing this. My supervisor asked me to sit and slow down, and notice the thoughts that arise in my head when this happens. This was an EXTREMELY difficult exercise – at the end, I identified a DEEP SENSE OF SHAME that arose when I felt that I wasn’t giving the patient what she/he wanted. Because this emotion was so difficult to tolerate, I avoided it completely, not even giving myself a second to think about it – unfortunately, this did not stop shame from influencing my behavior. Once I did notice the thought, also called “hot thought” in cognitive behavioral therapy, which in my case was “I am a failure”, I was able to lovingly tell myself: it’s okay to not know everything, you are doing the best you can. In slowing myself down and lovingly readjusting myself, I was able to be more present and authentic with my patients, which in turn made them happier.

When practicing magick, we ourselves form as much of the spell as the ingredients, incantations, and the spiritual forces that we summon to help us. When dark thoughts reside behind the spells that we cast without our knowledge, these thoughts can cause the spell to be weakened or even backfire. See the parallel here?

I still find sitting with my emotions extremely challenging, but I consider it an important part of my journey as a physician and a witch to become more self aware. I will be sure to keep you updated on that journey – wish me luck!

Angels in our lives

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I was having my biannual review of competency today when my evaluator told me, “I am sure you are tired of people cheerleading you all the time but I just want to cheerlead you again, to keep up with your good work”.

I wish I could tell him how much his words meant to me. The thing is, at least in medicine where I work at, I do not get much cheerleading, if at all, for my successes. If anything, disclosing my research work or records of my other accomplishments have resulted in hostile behavior from supervisors and bias them to think that I am not invested in learning from them or that I think less of them because of my accomplishments. This is why I don’t offer up this information unless asked directly – even then, it is often met with, “Oh really? I guess you must be really bored here then”, or “Oh really? We need to make sure this becomes a good *learning opportunity* for you”.

This is a biproduct of an education system that thinks pointing out an individual’s flaws, instead of celebrating their accomplishments, is going to get them to learn more effectively. To this opinion, I would like to ask what evidence they are basing this on. Education theory 101 taught in teaching school states that for students who are internally motivated, strength-based teaching approaches work much better than criticism-based approaches. This is where the sandwich model of delivering feedback was developed, where teachers are coached to provide one constructive feedback in the middle of two positive feedbacks. Focusing only or mostly on short comings does NOT motivate a leaner to do better – it gets them to be comfortable with failing. One can call that developing resilience. Well, most residents would prefer to call it “learned helplessness”, which is one of the core dimensions of depression. If no matter what we do, all we can expect is criticism, then why should we try at all?

Of course, we are learners and there is MUCH we need to learn, and evaluations of those necessary skills make a lot of sense. However, evaluation for the sake of evaluation, not producing competent health care providers, discourages cheerleading and breeds and selects for educators who “get off” of criticizing learners to boost their own ego. The system that I am in even penalizes educators who give favorable evaluations to learners – someone please tell me how this makes sense. If we can’t count on our educators be our cheerleaders, in this harsh society where medicine and doctors are more demonized than ever, who can we depend on?

When I teach medical students, my first priority is to make sure that they are treating patients in a safe way and if they can’t, that they feel comfortable enough to come tell me. My second job after that is to make sure their learning goals are met in the context of what field they want to specialize in. If their field of interest does not relate to my field at all, then I make it a priority to get them home in time so they have the time to devote to self care and studying for their area of interest. Evaluations that I provide are always strength based, because more often than not, medical students are more than WELL AWARE of their short comings. I learned to do this from the many wonderful teachers I met in my life who have done this for me. My very own cheerleaders that taught me the joy of cheerleading for others and how rewarding that experience can be.

Cheerleading is not something to be taken for granted – many people, even in education, are not capable of this or know what it feels like. While this post was largely a rant of my frustrations towards the education system that I am in, I also wanted to take a moment to express my gratitude for the cheerleaders in my life – my husband, mentors, and of course my goddesses and spirit guides. May their lives be three fold as blessed as the light they have shone in my life.

Until it happens to you

No, this blog post is not about Lady Gaga’s timeless song, “Til it happens to you”, although I would encourage any soul to check it out.

I feel that we, as humans, are motivated by our survival instincts to engage in victim blaming. Aligning or identifying with the victim feels like admitting our own vulnerability, because if the victim was “victimized”, and we are like the victim, then we are also vulnerable to being victimized.

To cope with this fear, one points out the victim’s flaws, whether it be regarding the victim’s character or behavior, trying to make the victim as unappealing of a human being as possible, one who we can’t possibly be similar to. In short, we dehumanize the victim so that we can feel safe.

I have certainly been guilty of this myself. I did not come from money or anything special, really, and my academic achievements used to be the only thing that made me stand out from the herd and gave me a sense of belonging and identity. Because of this, I had absolute faith in my ability to tolerate whatever hardship my research or academic career otherwise would throw at me. Unconsciously, I was TERRIFIED of ever admitting that I could face a situation that I couldn’t tolerate in academia. Therefore, when I heard about other trainees leave their abusive supervisors, I used to immediately go into victim blaming mode for my own survival, thinking that the abused student/ trainee was “weak”, “useless”, and probably deserved the bad treatment anyway.

If you read my previous blogs, you will know that the goddess eventually decided to teach me a lesson and gave me an obstacle that I could not overcome. I, for once, could not tolerate the abuse that was thrown at me and had to leave that position, the learning opportunities that came with it, and the possibility of a good evaluation in that rotation. When I shared this story with my colleagues, some were sympathetic and offered me words of support and advice. Others however, looked at me with judgmental eyes veiled by fear, almost wanting to scream at me “You deserved what happened to you, that would NEVER happen to a normal resident”. They interrogated me to find out what I had done wrong to deserve this outcome, so that they could be reassured that it was my fault, and that it would never happen to them. It did not escape me that I had also felt the same urge to judge when other colleagues would confide their struggles to me – I was being taught an important lesson that would stay with me forever.

My work in providing compassionate care to my patients as a physician DEPENDS on my ability to identify with them. If a patient with an extensive substance use history walks in the door with yet another overdose – I cannot hope to provide empathy and support that the patient needs in that moment unless I feel a kinship with them. The patient was likely living in highly marginalized conditions with multiple social stressors – the substance use was a way of coping when they had no other resources. I have also been at the end of my rope at the mercy of strangers for my next meal or a roof over my head. This person could be my brother, sister, mother, father, or even me.

What do I do though, when that survival instinct to feel safe is so deeply engrained into my biology? This is when I dig into my identity as a witch and ask for the help of my goddesses and spirit guides – to allow me to transcend beyond my human nature to recognize that we are all children of mother Gaia. Spiritual leaders in witchcraft and other paths often come from dark pasts – I deeply believe that this is no mistake. I believe that these individuals are angels sent to earth to learn a lesson, so that they can alchemize their suffering into healing light.

At the end, brothers and sisters, we are ALL human. We are ALL vulnerable to the same misfortunes and follies, to the same depths of sorrow and loss. This was one of the many lessons the goddess had planned for me when I came to this earth, and I hope to share it with you today.

Have a blessed new moon, child of Gaia. I embrace you.

Embracing the Other

Working in a hospital as a doctor is an interesting experience because while you are working on a team, you are often the only doctor on the floor, especially if it is overnight and you are on call.

The responsibility of being the only doctor feels HUGE the first few nights any resident does call by themselves, and it never really goes away as staff physicians often tell me. Once in awhile, a physician from a different specialty will work on the floor with you as a part of a “buddy system” to be an extra pair of hands on the floor, which is always greatly appreciated. The downside of being that “off specialty” doc is that they are often othered by the team, seen as less competent, and treated as such as well.

I was having yet another overnight shift at the ED where my staff happened to be this off specialty doc. However, he had been working as a ED physician for many years and considered himself (perhaps accurately) a specialist in the area. Unfortunately, the night went very poorly for him. Several resuscitation cases came in that he could not manage on his own – he had to call the help of another ED doc but alas, it was not enough to save the patients. I was not involved in those cases so I did not know of the details of what happened in that resuscitation room.

The rest of the night marched on with a heavy mood. I could hear whispers from all corners of the hospital talking about how these cases did not go as they should have, that another physician would have been able to save them. It was hard to control myself from not thinking what they were thinking. Would the outcomes have been different had it been a different doctor? Someone who was trained in ED from residency?

When it came time to review some of the patients with this physician, I could see the worn and defeated look on his face. As soon as I started presenting, he abruptly cut me off and without giving me a chance to finish, he started to ask basic questions, insinuating that I basically did not know what I was doing. When I showed him my documentation proving that the information was all there, he LOUDLY told me that residents are not to be trusted and that because of this, I must follow a way of presenting as per his preferred style to demonstrate that I “am not making stuff up”. I was dumbfounded by this experience. Immediately my mind went to what I was going to put on this supervisor’s evaluation for treating his residents this way. Then, the goddess whispered in my ear, “no, Embrace the Other”.

He was alone in this entire ED, managing a highly acute floor by himself in a truly difficult night. He was further othered by the staff here due to the failed resuscitation cases. I imagined what I would have felt in his shoes, and my heart immediately broke for him. The thing is many resuscitation cases are not “salvageable” when they come into the hospital. Patients often have the wrong idea of what a resuscitation is like from TV shows – miraculous recovery is extremely rare. Even if a person’s heart is to start beating again, the chance of them regaining much of their baseline level of functioning is even smaller. With his years of experience working at the ED, I am sure he knew this too, and so did the rest of the ED team who were judging him. However, amidst all this background information, his identity as the “other” is what shifted their view into judgement and criticism instead of understanding and empathy. His harsh criticism of my work, increasing his voice so that everyone else could hear, was probably an unconscious effort on his part to re-exert his power and sense of control on this floor. Yes, it came at my expense, but what I had to endure was far less than his suffering.

Gritting my teeth and controlling my breath, I told him “Thank you so much for teaching me this, it is very helpful.” He nodded and sent me on my way to see more patients. At the end of the night, when he was doing my evaluation, he said “I was so glad you were here, it would have been a rotten night without you”. It was in this moment when the teaching of the goddess became apparent. Had I not shown understanding and patience in that moment, I would have pushed him further into the darkness. In choosing to set my ego aside to embrace the Other when nobody would, I accompanied another physician, another human being, in his journey from darkness back to the world of light.

Shadow Work and Projection

Lately, I have been noticing that “Shadow Work”, a concept originating from psychoanalytic theory, has been appearing more than ever in mainstream media. I often hear it in the context of Wicca, a modern religion combining witchcraft practices and psychological principles, as well as many other spiritual paths.

In psychology, the Shadow is an analytic principle that identifies the part of one self that has been split from one’s conscious identity. While it is hidden from one’s conscious mind, this Shadow forms a significant part of one’s personality and how they relate to the world. While different branches of psychoanalysis calls the Shadow by different names, they generally agree that identifying the shadow is an important part of psychotherapy as it brings into awareness one’s behavioral patterns, in particular in relationships with others, that has been hidden from their conscious mind. For example, imagine a girl who has been raised by an unpredictable mother who would swing from being verbally and physically abusive to the most loving creature in the world within a split second. A belief forms in her that adults, or authority figures in general, are dangerous and not trust worthy, and that she is not worthy of receiving unconditional love and care. This belief, this way of seeing the world is so painful for her that she represses it deep into her unconsciousness – it becomes her shadow. As an adult, she has recurring issues in her life resulting from rejection of authority figures and accepting love or care from others, particularly from those that remind her of her mother. Unconsciously, she projects her belief that authority figures cannot be trusted and that she is unworthy of love and support whenever she meets a person or a situation that triggers this shadow to reappear, lifting her away from reality and making her see the world through the veil of her shadow.

Shadow work as a Wiccan principle centers around identifying one’s shadows and bringing them into consciousness, so that one can ask for help from spirits, gods and goddesses of the highest good to integrate the shadow into one’s true self. Working through one’s shadow is thought to allow for the emergence of a more whole, and integrated self, which makes them more aligned with the Universe and their magick more powerful.

The concept of the shadow has existed far before modern psychology and Wicca. Many spiritual paths dating back thousands of years and religious teachings have identified the role of the unconscious mind in how we see the world. Many meditation practices, in particular, focuses on making room for one’s shadows to appear into the conscious mind so that they can perceive the world as it is without the cover of the shadow. In Buddhism, it is said that when Buddha was born, he looked up at the sky, down at the earth, and said “Between the earth and the sky, only I exist”. There are a number of different interpretations for this saying. My favorite one is that Buddha understood that he himself, was most responsible for how he sees and relates to the world; that he understood that only himself is the true builder of his Universe.

What can we do then, once we become aware of this shadow? Freudian psychoanalytic theory states that bringing the shadow into one’s awareness, also known as “insight” is enough of a treatment in itself to alleviate the impact of one’s unconscious influences in their psychopathology. Internal family systems talk about making space for the shadow in one’s mind by accepting it and allowing it to co-exist peacefully with the other parts of one’s identity, so that they can be integrated into a more mature and resourced part of themselves. Dialectic behavioral therapy, which incorporates a significant amount of its techniques from Zen principles, suggests that one should mindfully notice, without judgment, one’s shadows as they emerge, accept and honor them, AND at the same time, make an active effort to see the world without the influence of their shadow. In Gabrielle Berstein’s “Universe has your back”, she shares a mantra/ prayer where she beautifully demonstrates this principle of honoring one’s shadow while a making a commitment to see the world without it.

In ancient witchcraft or paganism, the influece of the Shadow or the unconscious was at times descirbed as being “posessed” by the evil spirits and energies from one’s past. For example, exorcims or banishing spells were often targeted at expelling the evil spirits hunting a person’s mind that originated from a traumatic event(s) from their past, such as war or rape, producing anxiety, depression, and even psychosis.

As a physician and a practicing witch, I find myself adopting both approaches. As you have probably already guessed, the above example of the abused and neglected girl is my own story, my own shadow. Using the psychoanalytic theory, I recognize that unconscious beliefs originating from my childhood trauma influences how I relate to others and the world. I try to keep this in mind when I find myself suddenly spiraling into fear-based decisions and judgements of others so that my world is not always covered by my shadows. I embrace my younger self and tell her, Of course you had to guard yourself from trusting authority figures, because trusting them was not SAFE. I understand and honor you, and I also recognize that we are at a safer place now where we are surrounded by wonderful mentors and have the resources to defend ourselves. I also recognize that I am still hunted by the evil spirits of my past, the spirits that hunted my mother, and hunted her mother. I ask for strength from my goddesses and higher spirits to help me see the world in its truth, and to shine light in my path to banish the evil spirits of my past. I used to struggle with consolidating magick and medicine especially with matters of the mind, seated in the brain which we understand so little about. Now, I understand that they are in fact two slightly different paths that ultimately aim to get us to one shared destination – moving us closer to peace and love.

Manifesting and Crafting

I love crafting.

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My love of crafting is one of my regular reminders that there is something magical inside of me.

Not just crafting, I love anything where I am engaged in creating something that has not existed before. I love building things out of clay, painting, western and Chinese calligraphy art, making music, and creating digital art. This translates into research as well – my favorite part about doing a research project is at the very beginning, where I am coming up with a research question and designing a particular technique or optimizing a protocol.

Most of the time, if not all, I do not have any clue as to what the final product is going to look like. I am just captivated by the joy of creation. I put my hand on the equipment, smile, and let my intuition guide my work. I know that as long as I am having fun, the outcome will ultimately be a reflection of that joy.

This is a little statue of the goddess I made. It is of course not perfect – far from it, in fact, if you want to consider the technical aspect of it. However, when I look at it, it brings a smile on my face, and I feel the joy that I felt while creating my little goddess. It is amazing how energy translates as well – when I showed my little figurine to my husband, he immediately smiled and gave her a loving pat on the head.

As witches, we co-create our destiny and the world that we live in. The Universe becomes a product of the beautiful harmony between our intentions and the spirit. Lately, I started to wonder why then, do I not approach co-creation with the joyful wonder and curiosity that I have when I am crafting. Instead, often, I find myself approaching new situations with apprehension, and at times, even outright assumption that the outcome would be horrific.

Thinking outside of magic, self-fulfilling prophecy is a well-known and studied concept in psychology. It applies to situations as well as people. If one believes that the outcome of a situation will be horrible, and therefore there is no point in trying, the lack of effort and negative behaviors that this person exhibits as a result of these beliefs will ultimately result in a bad outcome – thereby confirming this person’s “prophecy”. Another well-studied concept in psychology is Confirmation Bias. Confirmation bias is one’s tendency to look for evidence that is confirmatory to the person’s ideas/ beliefs/ opinions, adding additional evidence that the belief was correct. For example, if I approach a new rotation with the preconceived idea that it would be a bad rotation, my mind would unconsciously look for signs that it is a bad rotation, focusing on negative incidences and remembering them instead of positive experiences that also occurred with the same or even greater frequency. Overtime, these negative experiences will be much more salient and accessible in my memory than the positive ones, making me CONFIRM my BIAS that the rotation was in fact, bad.

As a witch, I believe that the Universe returns the energy that I put out. This is a Universal notion that is echoed in many different cultures – I strongly believe that ideas that resonate and persist in multiple cultures speak to the Universal truth. Therefore, if I approach a new situation with negative energies, the future that I co-create with the Universe will reflect this negative energy, ultimately leading to a negative outcome.

Crafting and co-creation are both acts of creation. I can tell myself that I approach crafting with much more joy than I do towards entering novel situations in REAL LIFE because I have complete control over what I craft while I have very little control over my reality. However, believing this is a CHOICE that I made. In crafting, I do not have control over the weather conditions that my air dry clay is exposed to while on the balcony. I have no control over the hairs falling out of my dollar store brushes, and I certainly have very little, if not ZERO control over my tempéramental computer and its constant struggle to run my lengthy codes. What is different is that in crafting and even in research, I have unconsciously made a decision that whatever is produced at the end of it is worthy of love. This allows me the freedom to approach crafting with wonderous curiosity and without fear of the outcome.

I am very well aware that many situations in real life are not enjoyable and even painful. I will not lie to myself and say that all parts of life are joyful, even if I make significant efforts to believe that they are. However, I can make the choice that no matter what, at the beginning, end, and in every step of that journey, I will love myself and trust that I am worthy of love of the Universe. Co-creation is working with the Universe to shape my reality. The product of co-creation, therefore, is my future self.

This blog therefore is a declaration to myself and you, my brothers and sisters, that I make a commitment to believe that no matter how circumstances outside of my control tear me apart, I am, even if I am in pieces, worthy of the love of the Universe. I trust that no matter what, I work with the Universe to co-create my reality where the outcome will always be of love.

Spring, New Beginnings, and the Witch

Spring is here! Oestara was more than a week ago but today it officially feels like spring, with the temperature finally reaching above coat weather. I adorned myself in goddess jewelry, put on a flowery dress, grabbed my husband by the hand and ventured into a nearby park.

What a beautiful time it was! We found a fairy creek (with non-native plants, critters with an offering surely placed by a fellow sister/brother witch). We saw many battle scars from mother nature’s brave fight with yet another harsh winter. How glorious it was to be out in the sun, smell the fresh grass, and admire the new baby greens on the birches!

My first three posts have been particularly dark. I sensed a change coming though, perhaps for about a week or so now, feeling the spring goddess wake up inside me and my world filling up with light again as the days got longer. My astrological charts have been showing a lot of Sun energy in the tenth house, indicating a renewal of passion, hope, and spirit in my professional life and other passions.

While wandering the street market after our visit to the park, we ran into a street vendor selling crystals. A blindingly bright crystal point caught my eye almost immediately – a sunstone tower. What’s more? It was on sale! I took it as a sign that the Universe has intentionally put this crystal in my path, and brought it home. Sunstone is linked to good fortune, clearing all chakras and allowing one’s true self to re-emerge. It is quite literally spring cleaning delivered in crystal form.

If that was not sign enough – my paper was finally accepted for publication and my algorithm – yes, the one that has been running for the past 4 days – finally finished, delivering promising findings. What relief! I was so overwhelmed with gratitude I could almost cry. My dog, my familiar, is lovingly accompanying me as I am basking in the grace of the goddess and Universe while writing this blog.

I thank my goddesses, gods, spirits and angels of the highest good for always guiding me to the right path. I thank them for giving me the strength to emerge from the long, dark winter. I thank them for the immense happiness I feel as I embrace the elements surrounding me.

I thank the Universe for blessing me with all the opportunities that have come my way, and for always guiding me back to love. As Gabrielle Bernstein has brilliantly put, “The Universe has your back”.

Wellness, residency, and the witch

I still have flashbacks of sitting in the room in a zoom meeting with one of my previous supervisors, a couple of weeks after the death of my grandmother. She knew about this, but it didn’t stop her from calling me “lazy” for asking if we might be able to order bloodwork for a patient through her family physician instead of ordering it myself. Ordering it myself would take half an hour of administrative work due to a system issue far larger than myself. This would be on top of 16+ hours of work that I had to do that day. I remember freezing in that moment. Was it SO wrong to ask for some decrease in my administrative burden at a time when I am barely holding on and trying to cut out any corner of time to take care of my wellness? Yes, asking the patient to get her bloodwork through the family physician’s office would have taken her another trip to the lab to get it rather than getting it done at our hospital. However, this was not out of common procedure – as the consultant, it was rare, if ever, for us to order the bloodwork directly from our office. This is why the system was set up so that there were many administrative barriers for us to order it – because it was not common procedure. Thirty minutes of my time that I could dedicate to properly grieving for the loss of my grandmother vs. saving a patient a trip to the lab. The supervisor could have offered to order it herself – with her hospital privileges, it would have taken her half the time to order the bloodwork than me. However, she did not. Instead, she chose to call me “lazy”.

I later found out that this was in fact, resident abuse, only after I had disclosed this incident to a resident wellness advisor. I was happy to get a different and wonderful supervisor, who is now one of my mentors, after parting ways with her and believed that this was a one-off incident.

I was wrong.

I worked in an inpatient unit that I mentioned in a previous post. Generally, the inpatient team consists of a staff physician, a resident and a medical student. These 3 individuals, in addition to the nurses and other allied health professionals, dedicate their entire day to seeing about 6 patients. Surprising – I know. Frustrating? Absolutely. I accepted that this was just the way it is, that it is normal to spend 1.5 – 2 hours per patient per day doing daily extensive interviews, of which very few of the information went into treatment planning or administering evidence-based treatment. However, in the middle of my inpatient rotation, I met a wonderful supervisor who showed me that this was in fact, NOT good patient care. She taught me how to perform efficient patient interviews that focused on gathering pertinent information to inform treatment planning. Patients were informed of the nature of the inpatient admission – that they were in an acute care setting and our goal was to return them to a place where they can return to outpatient care. From day 1, we focused on disposition planning. We were clear of our role as physicians in the team, where the focus was to obtain enough diagnostic and past medical information to figure out which medication was going to be most suitable to treat the patients. Anything outside of that was delegated to allied health professionals. There were clear drawing of boundaries between us and the patients and us and the other teams within the inpatient unit.

I thrived in this environment. I enjoyed watching patients return to their baseline much more rapidly than I had seen before. There was regular patient turn over. Every time I had emergency shifts, the nurses would tell me how happy they were that there are enough inpatient beds available to send the patients instead of turning them away simply because there were no beds. On top of that, both my supervisor, myself, and my medical student were able to go home before 5PM. We were able to spend quality time with our families, take care of ourselves, and have energy left over to devote to our passions outside of the inpatient unit. I went to work full of purpose, with a clear goal in my head – return the patients to baseline, have them reintegrated into the community, clear the beds so we can treat more patients in need.

Unfortunately, this did not last. Two new supervisors came along who were very triggered by my rapid assessments, in my redirecting of patients, and focusing only on the information that would directly inform evidence-based treatment planning. After one day of working with me, one of them sat me down to tell me that I need to spend longer with the patients and in the inpatient unit in general. She felt that I was rushing the patients and rushing the allied health professionals – to her credit I am sure some of them did feel rushed by my methods. However, what she said in that meeting still hunts me to this day. “I am sure you will have good work life balance with the way you do things. BUT you are not doing good patient care – you will get complaints.” She was sending a CLEAR message that, my work life balance, MY WELLBEING was in direct conflict with being a good doctor. Mind you, this very supervisor walked out on a patient crying in her room the next day when I wasn’t present. The other supervisor who agreed with her managed to agitate a patient one day when I wasn’t there – the same patient that I was able to maintain healthy rapport and boundaries by keeping the focus on clinically relevant information only. That didn’t help though. I spent countless hours talking to my mentors, trapped in the room by myself, staying awake from sleep, running that conversation over and over again in my head asking myself: can I truly NOT be a good doctor if I value work life balance? Does taking care of my wellness, wanting to be efficient, wanting 8-10 hour work days make me a bad doctor?

During that time, I went to work everyday and wished I was dead – and I am sure this was evident in my face, in my defeated demeanor… purposelessly and meaninglessly nodding my head feeling that I was trapped here, perhaps forever, until I just wasted away and didn’t exist anymore. I felt lost. I will just touch on resident suicide here, a whole different topic that I will discuss at another time. During this time, for the first time in my residency, I truly regretted going into medicine. I truly believed that there was no way out of this – that I was not meant to be a doctor because my wellness was important to me, and not being able to tend to my wellness at a time when so many things in my life were falling apart must mean that I am just not cut out to be a doctor.

It was only after I finally had the time to tend to myself, seek the guidance of my goddesses, gods, angels, and spirits that I was able to see how flawed this was. A very wise physician who once supervised me said “The best thing we have to offer to this world is our energy. Sometimes, the only thing we can offer the world is our energy.” Pushing me to work extra hours without clinical indication (I never minded spending extra time in the hospital if it was going to affect measurable outcomes) to the point where my spirit was broken from not having the time and strength to return to myself, perhaps not shockingly, made me resent my patients. Being ridden by anxieties that arise from blurring my boundaries only resulted in a toxic accumulation of negative energies inside of me until I dissolved into that dark, dark void. During this time, my patients did not get better. We went from having regular patient turnover to having no movement in the unit at all. Nurses at ED asked me what was going on, why are there no beds available. I shrugged my shoulders and turned away, trying to hide my tears from falling out. I was not well enough to provide good care to my patients at this time. I went from happily spending Sundays going over my patient list before I start working on Monday to feeling nauseous when I saw the hospital building while going to work. I had no energy to offer to this world or my patients.

It took me weeks to recover from working with this supervisor, which happened when I was transferred to a different rotation where efficiency was a requirement, not an option. Why? Because it was shift work – everyone is capped to 7-8 hours of work in 24 hours. That gave me 8 hours to sleep, and 8 hours to work on my research, to tend to my spirituality, and to return to myself again. My energy brightened, I started looking forward to seeing patients again – and they sure felt it. This was one of those times where I truly believed that I would be lost without my spirituality, my spirit guides. To have something to hold on to in the spirit realm when my physical realm fell apart – incantations, crystals, and eventually, to my goddesses – saved me.

Many residents are not as lucky. When their life in the hospital falls apart – their entire world falls apart. They have nothing left on this world to hold on to. Our institution tells us that they will build up our resilience, so that we can “cope” when the unavoidable crap hits the fan. What they don’t understand is that there is only so much resilience one person can have, especially when we are not given the time to recover it while constantly having it chipped away bit by bit. They constantly send messages that wellness is incompatible with being a good doctor, that we must put our patients ahead of our own well being, even if it means to the detriment of ourselves.

The dark void is behind me now. Now, I once again have patients that tell me how “shocked” they are at how happy I am to see them, often telling me how they never had this experience with a doctor before. I used to be surprised to hear this – but not anymore.

Embracing the darkness

Wow, two blogs in a row! I am quite pleased with myself. Although I must be honest and admit that my algorithm (yes, the same one as yesterday) is still running on my desktop, forcing me to use my energy elsewhere while waiting for my poor computer to sort through this giant dataset.

My first dabbling in intentional magic (I was having visions and interactions – wanted or not – with spirits before this thanks to my witchy genes) came when I moved back to my country of birth after having lived years in a foreign country, attending international school. Having been, if I may say so myself, quite popular in the international school, I thought that I would enjoy the same welcoming in my hometown. I was terribly wrong – to these students, I was a spoiled, entitled brat with a stuck up nose and a funny accent. After they grew tired of asking me questions about “foreigners”, their customs and language, and having determined that I am just a big show off and there is in fact, nothing special about me, I was mercilessly bullied. Three years of bullying, in fact. In my “home” country, there is a term describing a student who is bullied by the entire class, and a separate term describing a student who is bullied by the entire school. I was the former, and my best friend was the latter, so you can imagine the kind of humiliation and painfully disfiguring abuse we went through on a daily basis. My mother, well meaning but very unwell, swung from one day, feeling motivated to help me and inviting my bullies over to try to make good with them, to making fun of me and humiliating me for being friendless, which of course, makes me “worthless”.

In this darkness, and being inspired the Harry Potter series sweeping across the country at this time, I decided to conjure up a spell of my own. I studied runes, talismans, goddesses, elements, and sigils. Looking back, I was embarrassingly green, barely understanding the basics of the aforementioned topics. Maybe it was Karma, or maybe my spell did work, but magickally, one day, my bully became the bullied. She was a terror no more, and I was happy to be able to to hang out with my friend at school without being afraid of being sworn at or otherwise humiliated. To be completely honest, this didn’t last long, as it didn’t take long for another bully to make my life a living hell again. Looking back at my life, my magick was always the strongest in my times of darkness, and for the longest time, I resented this. There were exceptions to this, of course. I have been fortunate to have money mysteriously flow in during times of desperation, for things that seemed impossible to just “work itself out”, for people who were obstacles to somehow disappear from my life, etc. It did bother me, however, that when I had dark thoughts about someone, willingly or not, there was a high chance that something bad would happen to this person.

After becoming an adult, I declared that I will only use my magick and intentions for “good” and reject/ suppress all my negative thoughts, cleansing and purifying them with whatever method was trendy at the time. Smoke, essential oils, singing bowls, crystals, tuning fork – name it, I’ve tried them all. It is only recently, emerging from the tribulations bestowed on me during my residency, that I have begun to feel the darkness again, rising from the depths within me. One of the reasons why I switched from an entirely research-based career to medicine was that I was being consumed by this darkness – the cut throat competitiveness and general toxic personalities that research unfortunately tend to attract grew so much anger inside of me that I felt like I was losing myself in it. I thought dedicating myself to medicine, to a more stable career where the goal is to care for others, where one does not have to step on someone else (supposedly) to make an earning, would help me abandon this darkness all together. However, life has its surprises. After 3 distinct, rather catastrophic events (without exaggeration) that happened in the earlier stages of my residency, I have, yet again, started feeling the darkness consume me. At the beginning, I tried to run from it – I meditated, cleansed, and had lavender running on my diffuser 24/7. I tried reminding myself that darkness can only bring about more darkness, that I must stick to the way of the “light”.

The point of this blog is to tell myself, and you, that I have chosen to take an entirely different path. I have realized, from reflecting on my life, that my magick is in fact, the strongest in the darkest times of my life. As witches, some of us are called to the light, some to the dark, some both, and some to absolute neutrality. I have come to accept and embrace that I have been called to the dark, and that there is no escaping it. My life, as thankful for it as I am, has been, to use the words of a psychiatrist that I saw for a single consult, “mostly traumatic”. In this life that I have been given, I have learned to live and even thrive in this darkness and to reject it would be to reject my entire being. The four goddesses that I look for guidance is a good representation of this. Hekate – goddess of crossroads and guide to those heading to the underworld. Persephone – a young maiden and goddess of spring taken by Hades to the underworld by force. At the beginning, she is a victim, but she emerges from it victorious by accepting her situation, embracing the dark and emerging as the goddess of hell as an equal to Hades. Psyche – a naive young woman emerging as a goddess of the mind (psyche – psychology, see the link?) and metamorphosis after going through literal and figural hell and arising from the ashes. Isis – goddess of magick and medicine going through the grief of having her husband cruelly murdered and dismembered, but using this grief to amplify her magick and power to restore her husband to become the rightful ruler of the underworld alongside Osiris. See a theme here?

Trauma work in psychiatry has two steps – first is to learn the coping skills to manage the devastating effects trauma has on one’s mind. Coping skills in stage one includes – wait for it – grounding, mindfulness, and drawing boundaries. Sounds familiar? Yes, these are the basic skills that any good witch book will have as one of the first steps of becoming a witch. Second part of trauma therapy is actually revisiting the trauma and learning to process and even harness positive changes from it ONCE one has obtained the basic skills to be able to hold and maneuver the trauma without completely succumbing to it. I am lucky that by practicing witchcraft, I have learned how to ground myself by extending my roots into mother Gaia, and how to co-create my reality instead of being a victim to circumstance. As the author of “Initiated” has wisely put, I need to “stop looking to escape the underworld”. My next challenge is to use these skills to harness the darkness for my highest good without letting it take control over me. One of the elemental forces, fire, stands for transformation and producing light from darkness. I started the practice of harnessing my darkness by asking the element of fire to turn the darkness rising from inside of me into a bright flame, which I then used to invoke the three fold law that I mentioned in my last blog. I am hoping that this becomes a precursor to my journey in embracing and ruling the darkness instead of running away from it.

Wish me luck!