This new album, all of it, is beautiful. I’ve connected with every song on it in a different way. Today as I was listening on my walk, the song Capsize Me really struck me as a personal anthem and an encapsulation of what I’m trying to do here with From the Ashes.

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I’m overwhelmed.

Monday, I woke up and discovered that our rescue pup Pipkin got anxious when I left and had reverted on her potty habits when I was out of town. She peed alllllll over my big rug in my dining room. We have had to return to strict crate training. And I will have to get the rug cleaned, and am crossing my fingers it’s salvageable. It seems like she only pees outside when I’m here.

Then one of my kids was being needy and not feeling great this week. It’s fine. It’s nothing huge. But being the only parent and having them need me when I’m neck deep in patients in the middle of a busy clinic morning is a very helpless feeling.

And Monday (and all week at work) was cuckoo-banana puffs. I’m the only physician in office this week, so I’m seeing my (again overbooked) schedule and working with our nurses and NDs on their schedules too. I haven’t tallied the number of charts for the week… but it’s going to make me feel simultaneously proud and depressed when I’m done. And to be clear, I’m not done. I’m caught up to Tuesday on Thursday night.

And I’m writing instead of charting. And I took a 20 minute nap when I got home, because damn I just needed it to do something just for me tonight.

So I’m overwhelmed. I get this way from time to time, as do we all. On the How Overwhelmed am I? scale - Monday - I was solidly a 10/10 at some points throughout the day. On the verge of tears not because of one big thing, but a million little things that all felt like I was the only answer to each problem. After work on Monday, I got it down to 7 or so with some cranked out productivity, and it’s basically lived there all week. I’m so fortunate that I have tomorrow off. Just the knowledge I won’t get more in the hole at work has it down to a 5 tonight. That’s the only reason I think I even have the space to write at the moment. I’ll spend tomorrow morning making a huge to-do list/strategy for the day, weekend and the coming weeks. That, combined with a few days to get shit done, and I’ll be back to my baseline 3/10 by Monday.

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My 3/10 baseline has me thinking. Is this universal? Is it a mom thing? Physician thing? Solo parent thing? I think yes to all and a combo thereof? As a solo parent in a helping profession that the feeling of being needed is often overwhelming to me. I think that’s what keeps me somewhere in the middle of the scale most days. That feeling of “it’s on me.” There just isn’t anyone who can ever share the responsibility/burden of what I do. I outsource what I can. I take help (which is new for me, but I do) when it’s offered and possible. I try and drop the bullshit that doesn’t matter. I engage my kids to be helpful around the house, and they are. But there is just so much that I just “have” to do.

I need to get the rug cleaned. I need to call the IRS and the CRA. I need an oil change, I need to clear out my 100+ non-spam emails I’ve been putting off for 3 weeks. I need to catch up on my Coaching homework. I need time to write all the ideas rumbling around in my head. I need to treat and pull the weeds. I need to buy school uniforms. I need to do my CME. I need to schedule a therapy session… obviously. (This just started my to-do list for tomorrow, so thanks for that.)

I do realize I could NOT do some of these things, and the world wouldn’t end. Could l leave the pee stained rug? I could, but it stinks and it makes me mad, so doing something about it feels better than not, even if doing it feels overwhelming. I also realize that my list of things I need to do all place me squarely in a place of privilege. None of these stressors involve basic needs for me or my kids, and I also choose to do many of them (like my coaching education) So sometimes I feel a bit like I’m playing a tiny violin.

I don’t know. I may have lost the plot here. This isn’t shiny or poetic, and there’s no deep life lesson. Definitely don’t follow me for more tips on an easy-breezy life of no stress. But do know that if you live in overwhelm, anywhere on the scale most days, you’re not alone. If you need to know you have company here, reach out. I’d love to connect if you need someone who knows this life and understands it from the inside.

From the ashes,

Andrea

We spent our 4 years at OU living together. Living together during our most formative years, we felt like we raised each other. To the point where we still affectionately call each other “mom.” We have cheered each other on, wiped each other’s tears, and held each other up as we navigated young adulthood, early marriages, career building and shifting, child rearing, loss of parents, now a spouse, and the trials of launching our kids out into the world.

We often borrow The Chicks phrasing that we are “redeye midnight flight” friends. They all proved this to me when Blake died. They just came. They didn’t ask. They showed up in every way I needed. They took care of me, my kids, threw Wiley a birthday party, and held us all during that time. They made phone calls, did a first draft of Blake’s obituary, and one day literally spoon fed me when I couldn’t eat. They have been with me every step of my grief without ever asking me to be anything other than I was. They stayed and leaned way in during my shitty friend phase, doing the heavy lifting in our friendship when I couldn’t carry my share.

Our brains often still work as one. We finish each others sentences, chime in with the same inside jokes, and even find ourselves unknowingly coordinating outfits more often than not, as we did this weekend. The “work” of making food, drinks, cleaning up, etc all seems to just seamlessly happen on these trips. We all just pitch in, take turns, see the need and do the thing. It’s such an easy way of being.

This trip was nothing fancy. We went on walks, drank coffee on the porch, snuggled on the couch, did a puzzle (1000 pieces in 5 hours of work thank you very much), shared readers, gave space for a bit of work when it was needed, ate charcuterie, enjoyed cocktails, diet cokes, and but of course all our water - because we are responsible adults now. As always, we talked … a lot…until 2 and 3 am a few nights.

We spend parts of these weekends in intense conversation, baring our souls to those who we know they are safe with. These are women who are forever on my side. And it’s not to say that we don’t challenge each other, we do. But when they hold me accountable- they are never the devil’s advocate. They are forever MY advocate, as I am theirs. They make me better, but have never made me feel like I was less than, even when I have made mistakes. The love in our friendship is unconditional, and has been foundational to me as I’ve parented my children.

And might I add how freaking proud I am of them all? They are successful, powerful, thoughtful women in this world. They are strong, loving mothers. They have continually evolved in an intentional way, doing the work to be healthy in mind and body. They continue to be an inspiration for me, and a mentor to many others.

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My female friendships are my anchor. I am so fortunate to not only have these girls but also other friends I have made along the way that I love deeply and wholly. I truly believe I have about a dozen soulmates, and they’re all my best friends. So I leave this weekend with my heart full and my belly sore from laughing. Longing for the next trip, and ultimately the Golden Girls compound where we all will live together again one day. Here’s to us!!

In the Bonds and From the Ashes,

Andrea

Hot flashes, mood changes, brain fog - those are easy fixes. Thank goodness for estrogen and her magical properties. But the remaining complaint is always weight gain. And I want to focus my thoughts today on the 90% of these women are doing all the right things. I don’t have the time in my day to day schedule to get into this conversation, but it’s been rattling in my head and so I’m putting it out here.

The women I talk to are all doing the “right” things. They are counting macros, lifting weights, getting their steps, sleeping (thanks again HRT), supplementing and are still unsatisfied with their bodies. Most of them are living 10-15ish pounds above their “normal” and are healthy, but unhappy. And let me be honest, I’ve struggled with this myself.

My body and I have a complicated relationship throughout my life, as is true for most women. Until recently, I’ve never really loved my body. I grew up a skinny rail of a kid. All limbs and lanky, with coordination that didn’t come until my late teens, and boobs that never came at all (minus the fleeting time of pregnancy and breastfeeding). I endured being called “board” as a middle and high schooler, and yearning for breast implants I never got. After I had kids and had money, I debated implants, but wanted my kids to know they were perfect in the way they were made. I couldn’t reconcile the complicated feelings around it. So I never did it, but to be clear I don’t begrudge or judge those who have.

I don’t want to think of how many photos I have deleted because I didn’t like how my body looked in them. I could think of dozens off hand that I kept for the memory, but did not post on social media for the world to see. The FIRST thing I check in a picture: my belly, then my chin, then my arms and legs, then finally my smile. That seems really back-asswards doesn’t it? I’m sure we all do this. The era of iPhones and instagram filters allows us to be able to curate the perfect shot, minimizing our realness. Optimizing our image for the rest of the world to consume.

And I’d like to acknowledge that I am fortunate. I’m tall. I have a body type that absorbs extra pounds reasonably. I have fluctuated around a size that I’m comfortable with most of my adult life outside of pregnancy and postpartum. Sometimes the pants are tight, sometimes they’re loose, and occasionally I’ve upsized or downsized, but through my younger adult years, I was mostly able to maintain with a reasonable effort of healthy-ish eating and moderate exercise. In my 40’s - perimenopause coinciding with the pandemic… everything changed. 10-15 lbs came on and I did everything short of medication to lose them, all with success until I stopped. I’ve done the fad diets. I did Keto, I’ve counted macros, I’ve logged everything that went in my mouth. I’ve done programs - all in search of 10-15 lbs of weight loss.

I have to admit that at this junction - I actually have not a clue exactly what I weigh. I stopped weighing about 2 years ago after I let a number on the scale take me from “wow, I’m feeling strong, hot, and fit today. I bet my weight is ###” to despondent when the 10’s place on the scale was one higher than I though it should or would be. My mood, outlook, and self worth all changed due to a fucking number on the scale in 2.2 seconds, and that is stupid. So I stopped.

But if I were betting, it’s probably 10 lbs more than I would “want” it to be.

And I’m sure I could get those 10 lbs off. I could easily access a GLP-1. I could return to restrictive plans I’ve used (and, hell, even coached other’s on) in the past. But that’s not what feels right for me right now. I’m not here to say that’s not the right path for some, it’s just not for me in this phase of me. I’m trying to appreciate my body for what she has done, can do and will do for me, without punishing or starving it. I’m trying to acknowledge that my body isn’t the same body I had when I was 25, and that’s ok. I’m not the same woman I was then either, and thank goodness for that. I’m also trying to recognize the bias that I’ve been conditioned to think that thin = healthy.

Growing up as a teen in the 90s- the height of phen-phen use and the “heroin chic” aesthetic, and evolving into an adult body in the era of low rise jeans and rail thin celebrities has been a real mind-fuck for my generation. For awhile, it seemed like strong was making a comeback. Body positivity was on trend. Now with GLP1’s, it feels like extreme thinness is once again being lauded as the goal.

The question to ask is - who benefits from this? Who benefits from a starved, frail female populace? The answer of course - the patriarchy. And you all probably know how I feel about the patriarchy. Taylor Swift, Barbie and I all agree. French journalist Juliette Lenrouilly writes in her book - “Idealizing thinness is a way to dominate women, teaching them to perpetually watch and restrict themselves. Compliant bodies get rewarded, while those who don’t fall in line get punished. This system appeared to have been, if not overthrown, then at least weakened over the past decade, but its recent return reminds us how deeply it remains anchored in our collective mind.” The correlation of the rise in misogyny and expectation of emaciation are parallel. Thinness is also equated with youth, glorifying the infantilization of grown women, which is a double ick for me.

So I’m trying to try and keep my body image not ideal for the male gaze, but ready for the fight or any adventure that comes my way. I’ll be strong. I’ll be fit. I will also take my pleasure from my body and the things I put in it. I’ll eat the cheese, which is the best thing on earth. I’ll have an celebratory ice cream date with my kids. I’ll drink more water than anything, but I’ll have cream in my coffee because it makes me smile in the morning. I’ll focus on foods that lower my risks of health issues and fuel my body for strength. I try not to judge myself on the fit of my clothes, or the size on the tag. I’ll forgive the curve of my belly. I’ll remember I have lived for 46 years, and I have carried in my body two separate humans that I made from scratch, pushed into this world, and breastfed for 18 combined months. I’ll try not to judge my thighs by the cellulite, but by the amazing mountains they’ve climbed, the canyons they’ve traversed, and the trails they carry me on. I’m letting my hair grey and my face wrinkle as personal decisions and badges of honor for a life well lived.

Mostly, I’m trying to love myself as I am. Trying to look in the mirror not for the flaws, but for the parts I’m proud of.

Imperfect, but learning.

Conditioned to internalized misogyny, but doing my best to deprogram.

Growing stronger so I can maintain my independence and can keep up with my own sense of adventure.

Rising as ever…

from the ashes,

Andrea

Joy, for example, feels like its counterpart, the other side of the coin. Every thing happy and wonderful that has happened since Blake died, feels different because he’s not there to experience it. I think one of the most unexpected hard things to do as a widowed mom has been to watch my kids thrive alone. I have friends and family who deeply love and cheer for my kids, but no one can replace their father in the ability to delight in their successes.

Anger also seems a natural counterpart to my grief. I get mad at Blake all the time. I think when you grieve someone who you lost to suicide, that’s a universal feeling. The anger was white-fucking-hot in the early days, and its mostly an occasional spark now. I’ve done a lot of work in therapy to understand and forgive his death, and that has helped with my anger so that it’s not the primary emotion I feel anymore. But when I do feel it, I acknowledge it and accept it for what it is.

Guilt in grief has been a more interesting experience for me, and has manifested from early on and in various ways, and not always how I anticipated.

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Today I want to talk about one simple phrase said by a yoga teacher several years ago that has become a mantra to me.

When I was on vacation, sitting on the deck and admiring the beauty of nature around me, I was able to sit and enjoy it for awhile. After I finished my coffee - I got antsy. Deprogramming the need to “do” is a constant battle. I had the thought I should be …. writing, doing actual yoga, working out, walking around, hiking, reading, etc. I had to make myself just sit and do nothing, and found it difficult. So I went to my toolbox and pulled out one of my favorite sayings from one of my many “Aha!” moments in yoga. Many years ago, near the end of a tough class in a tough pose, the teacher (If I remember right it was Crissa at Indigo in Fort Worth) said “use your breath to stay.”

Use your breath to stay.

Stay still.

Stay present.

Stay grounded.

Stay in my body

Stay regulated.

Stay alive when you think your world is ending.

Stay out of panic in times of trauma.

Stay calm when your kid flips their lid.

Stay steady in an emergency at work.

Stay committed during a tough time in your marriage.

The first time I heard those words in class, it was a tough season in my life and marriage. No marriage is perfect. It’s hard work. I don’t think anyone who’s stays married for 17 years (how long Blake and I were married) probably makes it that long without the thought that it might be easier to bail. But I used my breath that day in that class, and took that mindset and the mantra with me. I used my breath to calm myself, to be able to see the big picture, see the other side, see my own part in our rift. And when I got calm- he got calm. We survived that particular valley, repaired the rift, and came back stronger than we had been before.

The cool thing about staying regulated is the effect that it has on those around you. When I use my breath, the people around me start to use theirs too. Studies of Mirror Neurons have shown that the same areas of the brain become active during action execution and action observation. What we see can be what we feel. Emotional displays of others appear to be processed according to a similar mechanism as the physical actions of others, producing changes in the receivers brain that mirror the originator. These Mirror Neurons appear have a role in allowing humans to coordinate emotional reactions and social behaviors with those of others.

This can be helpful for anyone, in any stressful situation. I think about this all the times when I’m parenting, but also when I’m working. That one patient, who get’s everyone on edge? When I am calm, my staff is calm, the patient becomes calm. The stat c-section, post partum hemorrhage, or intra-operative complications? Everything goes more smoothly when it’s efficient, not frantic. If I’m not acting scared, the staff isn’t scared, the patient isn’t scared.

Using your breath to stay “something” is a practice I use daily, and I hope you’ll find it one that you can incorporate into your life as well. If you need more tools-take a deep breath, and reach out.

From the Ashes,

Andrea

But I’m also a bit sad and a bit anxious, which I hate. But it’s true.

Blake used to love weddings. He loved white wedding cake. We both love/d champagne. He was a horrible dancer, but we had a lot of fun dancing. He’d sing off key, incorrect lyrics in my ear and I’d laugh. It was always such a great date for us. Seeing other people publicly professing their love to each other makes you remember when you did the same. We would always reminisce about our own wedding (which I don’t want to brag, but I will) was epic. It was the perfect event filled with all of our favorite people. We sang, we danced, ate, drank. All in the midst of tornadoes that turned into double rainbows. The DJ stayed until 3:00 AM (Thanks mom and dad for keeping the party going). My only regret of our wedding is that I didn’t let Blake convince me to say our own vows. I wanted the traditional “do you take this wo/man, blah blah blah.”

And those vows were true. In sickness and health, for richer or poorer, for long as we both shall live.

Fuck.

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One year later, I reflect on where we started and where we are now. And I’m proud of us. We have all grown and healed, put ourselves out there in new and vulnerable ways, and rising from the ashes . It hasn’t all been sunshine and roses… as life never is. We have had more heartache. I think at this point we are professional grievers. We had to say goodbye to my amazing mother-in-law and the kids Grandma, Celia. She lost her battle to breast cancer in November. We lost our beloved pup Rico- the dog that made me a dog person- and best boy ever in January. I reallllly thought maybe 2026 would be the year without a loss, and I was so sad to be wrong. Losing Blake has made us comfortable in loss, however, which sucks, but is true nonetheless. We can talk about it, cry about it, and know that we will survive it. Because we have survived the worst before, when I didn’t know if we could.

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But with those losses, have also come new blessings. Our friend circles are ever expanding. Our new poodle Pipkin is a joyful puppy presence that makes me smile every day. We have found and are ever cultivating our community and our people. The kids are thriving in school and activities. We are excited about University applying and campus touring.

I’ve learned a lot about myself and about Toronto in the past 365 days, and I thought I’d share some of that knowledge.

Canadians are as friendly as the stereotypes, but that’s not my favorite thing about them. It’s the total lack of pretense. They are honest, no sugar coating and no false niceties. And as my friend Carrie says… clear is kind. It’s so true.

Toronto is a beautiful, green city. There’s so much nature to be found here.

Toronto is a city of Immigrants- about 50% of the population, in fact. I love hearing the different accents and languages that I encounter in any given day.

They lied when they said we didn’t get “Buffalo amounts” of snow. Now they all swear that last year was a fluke…. I AM keeping tabs.

There’s no such things as bad weather, just bad coats.

Peace can be found sitting in 12 lanes of traffic on the busiest highway in the world.

Dogs are a sanity savor in the cold winter months. Daily walks made me get outside and socialize with the other dog owners in the park, even on the coldest, snowiest days.

Public transportation is the bomb.com. I love the independence it gives my kids (and me).

Everyone loves their neighborhood and I am no exception. My neighbors are wonderful and I’m obsessed with our park. I love our location - a short 20 minute subway to the hubbub of downtown, but far away enough that you would never know it, and close enough to suburbia that there’s a Costco 15 minutes the other direction.

I could go on and on, but it’s safe to say that this move was good. I know that nothing in life is guaranteed, nor is it going to be easy or perfect. But we will persevere and do hard things while we continue to treat ourselves with softness and grace. We are in the place we are supposed to be -content, growing, evolving, and learning - all from the ashes.

Andrea

Moving to a new country almost a year ago was an interesting experiment in social connection for me. I have friendships and connections I’ve cultivated since University days and beyond that I’ve carried through my various phases and locations of life. Moving to Toronto with just my kids, 2 dogs and a cat was a huge leap into a life with no pre-existing social connections.

I have my new little work family, which has been wonderful. I’ve been so lucky to land in yet another practice full of amazing women. I will die on the hill that you work is more fun when it’s collaborative, and I’m so lucky to again be in an office where I not only enjoy my partners, but trust and seek their counsel on clinical questions. But the GTA is so large, none of them live geographically convenient to me to grab a coffee, or drink, or go on a walk with. So for the first time I’ve had to look outside of work for a primary friend group and with older kids. Older kids don’t foster the same kind of opportunities to get to know their friends/classmates parents.

The first thing I’ve done in this process is just say “yes” to every offered connection. I have been so lucky to meet “connectors” in my neighborhood - those people who know lots of people and are good at guessing who may gel and getting them together. From these connections, I’ve found a workout group and workout friends. Workout communities have been so important to me from OKC to Fort Worth, and I had been missing this type of interaction.

The second and admittedly more nerve racking thing I did was sign up for a group of women who were looking for friends. There are several online iterations of this… Real Roots, TimeLeft etc. and it basically groups strangers together for brunch, dinner drinks or other activities and you see if you click with anyone. Think speed dating for friendship. I joined one on the premise that I needed to make friends with people who needed friends, and have met some lovely women through this endeavor. We’ve been to knitting classes, yoga classes, and on hikes and walks. It’s been a good way to see more of the city as well.

Making friends as adults can be tricky, but it is something that’s so important for us to do. I’m also thinking about the example I wanted to set for my kids in this new environment. Being vulnerable and putting yourself out there is scary but can be so rewarding. I want them to also find friendship.

For kids and adults peer connection matters. Friendship is a known protective factor against suicide risk. Adults who’ve spent years investing in their career and their kids at the expense of friendships and connection have worse mental and physical health. Medicine is not a field that inherently fosters friendships at work - especially for male colleagues and in male dominated fields. With so many demands on physicians in and out of the office it’s easy to let social connection and friendship fall to the wayside. If that is something that you’ve noticed in your life- do you think you can find some room for it? Do you need help finding the time or drawing a boundary that would give you that space? If you need help, or just need connection - I’m here for you. Let me know how I could help.

From the ashes,

Andrea

Someone said this on a podcast I was listening to this week, and it’s been rumbling around my head since then. The things that happened to me were never about me. It’s a pretty amazing phrase. I feel the truth of this in my bones.

This thought can give you some serious distance from a lot of pain and suffering.

Imagine if we could get that kind of space from all the things that aggrieve us. Being treated unfairly by your asshole boss? It’s not about you, it’s about them. Raised by an emotionally immature parent who was/is unable to meet your needs? It’s not about you, it’s about them. Partner isn’t able to connect and support you where you need? It’s not about you, it’s about them.

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My clients all know I’m in training. They’ve all been physicians who are familiar with the concept of practicing while learning. As I hung up with my first “official” client the other day, I had the feeling like I’d not been enough - not insightful enough, not prepared enough, not “coach-y” enough. These were my feelings, not my clients. They were very appreciative of our session. They said they felt heard and validated by our session, and left with a plan in place for their issues. This was all within myself that I was having these doubts.

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My mind tried to figure out what I was feeling - was this imposter syndrome? I’m quite fortunate that I never really struggled with imposter phenomenon as a physician. Imposter syndrome/phenomenon is a huge burden in medicine. Over 50% of female and 25% of male physicians have reported symptoms and feelings consistent with the imposter phenomenon. I “knew” about it but didn’t “know” enough about it, so I’ve done some research and found there’s research! So let’s dig in…’

*all sources are linked*

Imposter syndrome was first described in 1978 by Suzanne Imes, Ph.D., and Pauline Rose Clance, Ph.D. as an observation first among successful women and other marginalized groups is “a behavioral health phenomenon described as self-doubt of intellect, skills, or accomplishments among high-achieving individuals. These individuals cannot internalize their success and subsequently experience pervasive feelings of self-doubt, anxiety, depression, and/or apprehension of being exposed as a fraud in their work, despite verifiable and objective evidence of their successfulness.”

Several inter-related characteristics are potentially seen.

Imposter Cycle

An essentially pathognomonic characteristic of imposter syndrome, that occurs when a high-achievement task is encountered and met with one of two responses: over-preparation and procrastination.

In over-preparation, those with IS feel they must work harder than others to achieve the same goal, and because of this objectively false perception that one must put in more effort, they are an imposter. In cases of procrastination, those with IS feel that they are an imposter due to hurried ‘last-minute’ preparation and will eventually be exposed as a fraud.

Upon completion of the task, there is a brief sense of success or triumph in each scenario, but there is a failure to internalize this sense of success. This leads to those with IS experiencing a spectrum of fear, anxiety, fraudulence, and other pathology leading into the next task, effectively establishing the cycle.

Perfectionism

Perfectionism occurs when we self impose practically unattainable standards and goals. These impossible-to-reach benchmarks continually drive a detrimental positive feedback loop in those needing to ‘be the best.’T his can exacerbate phenomena such as work martyrdom (sacrifice of self-interests for a falsely perceived ‘greater good’), over-generalizing mistakes that are perceived as a ‘lack of ability,’ and overly critical non-constructive self-feedback.

Super-Heroism

This manifests as a tendency to over-prepare for tasks to appear more than capable of completing them. This additional workload is detrimental to mental health.

Atychiphobia (Fear of Failure)

Individuals with IS experience anxiety, the fear of being shamed and /or humiliated if they fail or do worse than a peer on a particular task. The failure confirms they’re an imposter.

Denial of Competence and Capability

Sufferers of IS tend to discount their intelligence, experience, skills, and natural talents. They internalize failure and relate success to external influence or random chance, despite evidence that the individual accomplished a particular task without these factors.

Achievemephobia (Fear of Success)

Interalized failures become a positive feedback loop. Successes are not recognized or internalized. This all leads to higher expectations or increase pre-existing workload.

It’s a lot. I am doing a lot of self-coaching and working with my fellow coaches in training to make sure I remember I know who I am. I am in learning mode. I’m not supposed to know it all, now or ever. I will embrace my roll as novice, knowing I’ll advance with practice, and that’s the only way to do it.

If these characteristics of imposter syndrome ring true with you, and you’d like to chat about it, let me know. I’d love to coach you through it.

From the Ashes,

Andrea.

She, along with so many of my clients, colleagues, and friends are having what some might call a mid-life crisis. I think this crisis isn’t a personal one, it’s a crisis of the system within which she’s expected to not only function but flourish. These women are having a revelation.

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So many physicians face daily moral injury, unsupported in an environment of high demand. There are so many pressures. Of course, we have the obvious keeping people alive pressure, OBGYN, ER, Trauma, Surgical specialties and Intensivisits all deal minute to minute with potential catastrophe, then spend hours on the phone doing peer to peer calls to justify basic standards of care. Office based primary care specialties like family medicine, pediatric and internal medicine are holding our medical systems together with coffee, grit, and mountains of paperwork with paltry reimbursement for their efforts. Then there’s call, sleep deprivation, increased schedule loads, RVU expectations, Press Ganey scores, charting, billing, administrative duties, student debt to repay, and more. The list seems endless.

I think the shocking thing is honestly that we’ve all accepted it to this point.

Something is happening; there’s a rebellion at hand. Many physicians my age are facing a mid-life reckoning. For my female colleagues, we are smack dab in the throes of perimenopause, and our ability to continue to swallow the status quo has diminished. We have kept our head down and our nose to the grindstone, raising kids and advancing our careers. But now that we’ve arrived, we are looking around asking …

What is this all for? We got into medicine to help people, but that seems like the smallest part of our days. The administrative burden of our work takes the majority of our time on duty.

Who are we servicing? Certainly not ourselves, and barely the patients.

Who benefits from our back breaking labor? This is all in service of the insurance companies, and the systems that employ and profit from our labor.

What’s the cost, and am I willing to continue to pay it? The cost is burnout, depression, anxiety, decreased quality of life, time away from family and friends, and our own health and wellbeing. Female physicians have a shorter life expectancy than our non-physician cohort, this field literally sucks the life out of us. And the data is mounting that we are not, in fact willing to continue to pay this price. Women are leaving practice at all time high rates.

But change doesn’t have to mean leaving medicine. Our systems are not designed for us to flourish, so we have to draw boundaries, stand up, and demand the systems change. It’s going to have to start with us. We can not afford to wait. We need a revolution.

It is possible to make a sustainable practice. I have forged that for myself a few times over, setting small fires and rebuilding from the ashes as I’ve navigated the practices and seasons in my life. I’d love to help you do it too; this is why I’m coaching. If you need help setting a metaphorical fire, drawing boundaries, making changes, or even imaging what different could look like, let me know. Bring YOUR revelation to the revolution.

From the Ashes,

Andrea

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But those decisions weren’t all easy. I’m lucky to have had my therapist there to talk through things in an objective manner. The most powerful thing she reminded me of during these discussions is that I could still have these discussions with Blake. I have a hell of an internal dialogue, and I’m the kind of person who will have conversations in my head regardless, so this task was fairly easy. I had the benefit of making decisions with Blake for 20 years before he died, so I could predict what he would have said, how he would have reacted, what he would have thought. That was really affirming for me to know that I had his guidance even after he died. He usually made great decisions (minus the one disastrous, tragically shitty and stupid decision he made at the end) and I knew he had my back.

The other thing that helped me so much in making decisions big and small, was that I learned to listen to my body, specifically my gut. That’s where I feel anxiety. If I have a decision to make, I can now sit down, close my eyes, consider the decision and truly feel in my body how I feel about it. This skill was acquired also thanks to my therapist and the work we have done through both EMDR and IFS. I’ve talked about both of these modalities here before, but they’ve been continually helpful in my life.

When I consider doing something that is out of alignment with my values, or something I just plainly don’t want to do…. I feel a churning in between my stomach and my chest. I’ve learned to know that feeling is anxiety. When I feel excited, sure or solid in my ways, I feel an expansion in my chest, a softening of my shoulders, and a sense of being grounded to my chair or my feet. Noticing these sensations has not steered me wrong.

In my coaching course, we have learned a tool called the Body Compass which teaches you how to learn what signals your body is trying to send you. I have started working with a client using her own Body Compass as a guide as she is facing some big decisions, and it’s been really fascinating and rewarding to do. Listening to my body has bought me freedom and confidence, and I’m excited to be able to help others find the same. If you need help figuring out how to listen to your own body - I’d love to help you. Please reach out- you can always email me at andrea@andreafromtheashes.com.

From the Ashes,

Andrea

I’ve touched on this phenomenon before in my writing when I found myself having a full hour for lunch one day, and that downtime felt disconcerting. My friends and I, who are all trying to unwire this programming, catch ourself doing this all the time. We chat daily via the Marco Polo app, and when one of us mentions resting, sitting down and doing nothing, watching a show, reading a book, we all instinctively say something along the lines of “I’m glad you got to rest, you’ve earned it.” We all then correct ourselves, saying “not that you have to earn it…”

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What is it that makes us feel like rest is not a valid expenditure of our time? More importantly, why is it not a valorous investment of our time?

I blame lots of things.. capitalism, the patriarchy, being raised by boomer generation, the culture of medicine and medical training, athletic “you can rest when you’re dead” ideology and hustle/girl boss culture. So many systems in our world try their best to convince us that our worth is tied to our productivity because of course, it services them.

One of the most ridiculous manifestations of glorifying this notion is “Perfect Attendance” awards for kids in school. I remember (this was pre-Covid, mind you) being at an awards assembly for my kid’s elementary school. The principal was announcing the kids who got perfect attendance, and she lauded them for likely coming to school when they didn’t feel their best. Who on earth is that serving? Not that kid. Not the other kids in their class for sure, nor the teacher. Likely it serves the employer of the parents, because it would have meant that a parent had to stay home from work to care for them. Taking a day off to care for a sick kid, or for yourself when you’re sick can be difficult for many. In the US, paid sick time is a luxury most don’t have. Fucking capitalism.

In medical training we learned early on the only bad thing about working long hard hours were the cases you missed when you were off. Sleep is less important than education, experience, and cases participated in. I was among the first cohorts to have the 80 hour work week limitations, and the disdain for this new (poorly held) standard was thick from so many attendings and upper level residents. We were given lectures over the dangers of working sleep deprived, but with few options to make that not happen. We were educated but without agency - a no brainer set up for burnout. The concern that work hour restrictions would negatively impact education were unfounded. Studies suggest that reduced work hours may even have improved the quality of training of physicians as morbidity and mortality in the academic setting decreased after work hour restrictions were implemented.

The patriarchy instills in women the notion that their value lies exclusively in serving others, while holding expectations for us to be all the things at once for everyone and thankful for the opportunity. The Barbie movie monologue is one of the most true things I’ve ever heard. Women essentially work for free 2/12 months due to the gender wage gap in addition to doing the lion’s share of the domestic labor.

My generation - raised by Boomers have an additional layer of learned expectations. “Embedded within the work ethics of Baby Boomers are their core values, which have shaped their professional lives and continue to influence how they approach work. Among these values is a strong emphasis on hard work, considering it not only a means to a financial end but also a source of personal fulfillment and self-worth.” Hard work is priority one, and rest is only appropriate after work is done.

Data shows, however that rest should be not something that is earned on the back end of over working. It necessary to maintain our humanity and our health. The cognitive, metabolic, and endocrine disruptions that occur with both acute and chronic sleep loss are well documented. Early studies do show however that rest can be helpful in reversing these effects. Along with it’s benefits from a personal and professional medical standpoint, evidence is available that rest can prevent and treat burnout.

So if you’re burnt out, like so many of us are. How can you find a way to prioritize rest in your life? For so many, it seems like an insurmountable task when you think about all that you “have” to do. If you need help structuring your life so that you can find time to rest, recover, and heal yourself, let me know. I’m here with you, trying to prioritize that for myself too. We’re all in this together.

I hope you take sit down, read a book, scroll on your phone, watch a show or take a nap soon, especially if you haven’t “earned it.”

From the Ashes,

Andrea

When I reflect back on the past 4 years, I have learned so many things. That’s what I want to focus on today.

I have learned my sister is an angel on earth. I always knew she was awesome. I’ve looked up to her my whole life. But I never knew how much I would depend on her. She has showed up for me time and time again.

I have learned my friends were before, and remain now and forever my family of choice. They have rallied to my side, loved my kids like their own, and been with me in my darkest dark and lightest light. They are a daily dose of unconditional love.

I have learned that I am not defined by my loss, but that it does inform how I move through the world. It has changed me in a way that I am grateful for and proud of. I think I am a better doctor, coach, and friend than I was before he died. I have also learned to set boundaries, which makes me better at all of those things too. I am well grounded in who I am, what I want, and what I will tolerate.

I have learned I can make big, huge decisions on my own, and it’s not scary any more. I have the benefit of Blake’s wisdom within me. I experienced making decisions with him for 20 years, and I know how he would have reacted in most situations. I can hear him playing devil’s advocate when I’m debating something in my head. It’s helpful to have that internal dialogue with him from time to time. As I have learned how to listen to myself and most importantly my body, I find I’m relying on that less. I feel confident in my own inner wisdom.

I’ve learned our kids are resilient and magical. I knew the magical part before he died. But resiliency is only earned through tragedy, and they’re unfortunate pros. But it’s pretty amazing to see them flourish when I thought none of us would ever be okay.

I’ve learned that walking has healing power for me. Putting one foot in front of the other literally and figuratively has gotten me through.

I’ve learned to find peace in solitude, and that I’m excellent company for myself.

I’ve learned being resilient is found in rest as much as work.

I’ve learned the power of an amazing therapist.

I’ve learned to love reading again.

I’ve learned sleeping in a poodle sandwich is the soundest sleep possible.

I’ve learned I’ll miss him forever. I can move forward with my life and that will never change. I’ve found missing him doesn’t hurt all the time like it used to. It gets more nostalgic. It’s turned into more of an ache than a pain.

I’ve learned that community is priceless. And I hope if you need it, you find it here.

From the Ashes,

Andrea

Although it’s been almost 4 years, this is our third Father’s Day without you.

And like all of the landmark days… there are lots of mixed feelings.

I hate that in the last picture I have of you and the kids they don’t even look like the kids that are both teenagers now. They’ve grown so much. But I love the humans they are, and that pieces of you shine through them every day.

I hate you didn’t get to parent them as teens. You would have had so much fun with this stage. I wouldn’t have had to hire math and physics tutors, you would have nailed that. You would have relished teaching them to drive. You’d still be fun dad - windows down and music up. I hate that you’re not here but I love that we can still put on Diane Young and pretend for a minute you are.

I hate that you’re not here cracking us up all the time. We miss your sense of humor. But I love that we did learn to laugh again.

I hate that I’ve had to keep myself busy all day so I don’t come apart. I even pulled weeds, dammit. I don’t love that I’m letting myself do it now, but I’m trying to let it happen anyways.

I hate you don’t know the version of us that came out on the other side of losing you. But I love who we are becoming and what we are building.

I could go on and on. But mostly I just hate you’re not here, and love you still all the same.

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She hedged around a bit about.

I could tell she was anxious.

She made a comment about not being sexually active.

I asked my new favorite question - “What do you need out of our visit today?”

“Do everything you can to make sure I’m not going to die.”

The spark of recognition was instantaneous.

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In the practice of medicine, and in all facets of life, we get acclimated to our routines, environments, and relationships. Although these may be unhealthy, we are “comfortable” with them because they are what we know. This is why attachments styles dictate our relationships. This is why people (mostly women) stay with abusive partners, and their children tend to be in abusive relationships as well. This is why couples stay in loveless marriages. This is why physicians stay practicing medicine in the systems and institutions that have burned them out, gaslit them, and told them to be more resilient.

Nothing about the practice of medicine is comfortable. I touched on that a few weeks ago - the humanity has been removed from our field. But we are used to it. The status quo is comfortable in that it is known - to the point that for many of us it is actually now hard wired.

In medicine, we are sold the idea that all we are doing is in service of our patients. This is why we went to medical school right? “Helping” is what drew so many of us to the profession. It was a calling. But that calling has been twisted. So much of the work we do now no longer serves the patients. It services the insurance companies and the corporations who employ doctors, all at the expense of the well being of physicians. Doctors are told to work harder, see more people (for less reimbursement), sleep less, chart more, be kind, patient, efficient, and of course make no medical errors. 100% perfection with a smile, that Press Ganey score can’t say you were grumpy!

So we stay, and we work, and we don’t push back because it’s what we have always done. What we were trained to do. What we are always expected to do.

And the cold hard truth is that I can’t change that.

I wouldn’t even know where to start.

Affecting change on a global scale, institutional scale, practice wide scale? Do-able if we all align and hold accountable the decision makers, but an overwhelming task to say the least.

So what can we do?

Get uncomfortable.

Start with ourselves. Make small, meaningful changes in our habits, routines, and thoughts. And bring our partners along with us. Spread boundaries like measles. Spread self care like herpes. Spread the expectation of our recognized humanity like hanta virus. We have to reclaim our own sense of self, and force our system to take note.

We can do this. One at at time, getting out of the “comfort zone”, gathering momentum, until things have no choice but to change on a system wide level.

I’ve done this before. I’m doing it now. What is one area of your life or career where you think you could start the process of reclamation? If you need help brainstorming- reach out. I’d love to coach you through it.

From the ashes,

Andrea

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When we look at this survey, it also corroborates recently published data showing female physicians leading the workplace at a higher rate than their male counterparts at all ages. 64% of the respondents in this survey were women. One of the authors from the study Dr. Sea Chen stated “The women in our study left clinical practice earlier than men, and they left due to pressures like caring for young children or other family members more often than men,” he says. “Addressing these issues—through better childcare access, flexible work policies, and equitable treatment—could help retain more women in the physician workforce.”

I have feelings about that statement.

Feeling one: That’s the bare minimum.

Feeling two: That won’t even come close to fixing the issue.

Feeling three: This isn’t a problem with female physicians. This is a problem with society, the patriarchy, and the medical establishment as we know it.

Feeling four: Dammit. (*Edited down from baseline feminist rage string of swears)

Yes. We need to support women better. Institutions where physicians practice need to support ALL of them better, in so many ways. But until we address society’s expectation that female physicians maintain their full time clinical obligations and be a full time mother, care taker, homemaker, schedule wrangler, lunch lady, short order cook, loving partner, soccer mom, and CEO of the home as well as their office practices? Big fat fucking chance anything will change. The level of expectation is unsustainable. Period.

Study after study shows that female physicians face lower earnings, more EHR burden, more patient messages, more discrimination and abusive behaviors ALL while having superior patient outcomes in both surgery and medicine. MAKE IT MAKE SENSE. You can’t right?

We can’t make it make sense. We can’t control society. We can’t control the hospital and clinical systems that employ physicians. All we as physicians can control is ourselves. We can enforce boundaries. We can refuse to do unpaid labor. We can demand our humanity be prioritized. We can change how we act and react to ensure the systems that are designed to take advantage of us can’t do it.

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So join me if you want to make the change start with you. Let me know one way that you think you can change your situation to make it more sustainable. And if you need help, please reach out. I’d be honored to do this together.