EP 18: Getting Comfortable With Discomfort

On this week’s Hope4Med podcast episode, we feature Dr. Kemia Sarraf (Dr. K), an internal medicine physician, trauma mitigation coach, and mother. Dr. K shares the life-changing story that affected her family and what she learned from it. We discuss recognizing trauma, the illusion of control, and how we can truly bloom once we get comfortable with discomfort.

Connect with our guest, Dr. Kemia Sarraf:
Website: https://www.lodestarpc.com/
Email: kemia@lodestarpc.com

[00:00:00] Dr. JB: Ever wish for a safe place to have conversations that need to be had? A place where you could say the things that need to be said? Well, welcome to Hope4Med. This is Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med. This is Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med.

[00:00:37] Hi, everyone. Welcome back to the Hope4Med podcast with me, Dr. JB. Today’s featured guest is Dr. Kemia Sarraf, also known as Dr. K. She is an internal medicine physician and founder of Lodestar, a trauma mitigation coaching company. In its early years, Lodestar services focused primarily on healthcare professionals, but has now expanded to highly-skilled professionals in any industry. Welcome to the Hope4Med podcast, Dr. K.

[00:01:09] Dr. Sarraf: Good morning. It is so nice to be here with you this morning, Dr. JB, how are you doing today?

[00:01:14] Dr. JB: I’m doing very well, and you?

[00:01:17] Dr. Sarraf: I am doing just great. Coming at you from a very, very wet and humid central Illinois today.

[00:01:24] Dr. JB: Oh, nice. So where exactly in Illinois are you?

[00:01:30] Dr. Sarraf: I am in Springfield, well, I’m actually on a little farm just outside of Springfield. So, Springfield, Illinois, the capital of Illinois and this has been home for us for the last 18 years.

[00:01:43] Dr. JB: Oh, that’s so fantastic. You know, I used to live in Newbern, Illinois.

[00:01:49] Dr. Sarraf: You mentioned that to me before, which is, is so interesting that we were so close to each other at one point in time.

[00:01:57] Dr. JB: Right? So how long have you been in Springfield, I know you said 18 years, did you do all your training there? Tell me.

[00:02:03] Dr. Sarraf: I did not. Actually, we moved here in, let’s see, it would have been 2003 now. And, uh, but before that I was at WashU at Barnes Hospital, Washington University School of Medicine is where I did my internal medicine residency. And then before that, I had spent a decade at, in Salt Lake City, Utah at the University of Utah, where I did medical school and also did a master’s degree in public health. Which adds up to make me really, really old, now that I put all those years together. Geez.

[00:02:35] Dr. JB: Who’s counting?

[00:02:39] So are you a professional skier?

[00:02:41] Dr. Sarraf: Well, no, I am a, I’m a lifelong skier and I used to be a pretty aggressive skier, I did love to ski. In fact, funny enough, it was the view from the top of the mountain one day when I was skiing as an undergraduate student and trying to make my decision about where to go to medical school, because I had a couple of, um, I had a couple of opportunities in front of me, one of which was Chicago, which I really, really loved. I really loved Pritzker and so I was thinking about going there, and I was going up on the ski lift and I crushed it at the top of this mountain and looked out over the valley and I thought, who am I kidding? I’m staying in Utah. So that actually was the decision point for me in terms of staying at the University of Utah for medical school, which turned out to be a really good one because that’s where I met my husband, who also is a physician. He was there doing his residency training at the time.

[00:03:36] Dr. JB: Oh, wow. How beautiful is that? So perfect. And so, so I understand that that was the decision for you to go and stay in Utah for medical school, but what made you decide to become a doctor in the first place?

[00:03:49] Dr. Sarraf: That’s such a fabulous question and I wish I had a really glorious answer for you. If you asked my mama that question, she would tell you that I came out of the womb with a little stethoscope around my neck. There has never been anything else for me that I can remember in my life. And one of the things that I’ve come to notice and appreciate, and I think that many of your physician listeners probably will understand this statement when I say it, is that I always thought I wanted to be a doctor. And what I have learned over the arc of my lifetime and many decades now in public health and, and in medicine is that what I am is a healer and that was really what was always calling to me. So, yeah, I just happened to sort of come out this way and that’s how I’ve been geared my entire life.

[00:04:44] Dr. JB: And you always wanted it to be an internal medicine physician?

[00:04:48] Dr. Sarraf: Oh, heck no. I didn’t even know what internal medicine was necessarily when I started medicine, medical school. If you want to know the truth of the matter, I had a wonderful pediatrician growing up and I think that going into medical school, I, I sort of knew that there were three major routes. You became a surgeon, you became an OB-GYN, you know, became a baby doctor, or you became a doctor of tiny humans. And I didn’t really know much beyond that, but I’m, I’m enough of a bookworm, nerd, whatever, whatever term you want to put onto it, that internal medicine really appealed to me. The mystery of internal medicine really appealed to me, figuring things out.

[00:05:31] So, one of the things that happened was that in 2013, my eldest son, Joseph, who was 13 years old at the time was running through the house in his underwear, as 13-year-old boys want to do, and I noticed that he had this profound bruising all up and down one side of his body. And so, called him over and started really taking a look at this and sort of knew in my gut, the way we sometimes do when we make a diagnosis, that sort of sinking feeling, that what I was looking at in my child was leukemia. And it really came out of nowhere and he had had no symptoms, there was nothing else unusual, it was just happening to notice that bruising that day. And so, for those of your listeners who are familiar, childhood leukemia is a medical emergency, so within a couple of hours we had blood drawn, got a CBC back and had a confirmatory, preliminary confirmatory diagnosis and went from being a, a family with healthy, rambunctious boys to a family with a child who had a leukemia diagnosis and, and who was in the ICU. And so, it was a very, very quick disorienting experience and Joseph went from being a normal eighth grader to being a leukemia patient in a in, a matter of just a few hours.

[00:07:07] And as you well know, childhood, childhood, leukemia’s no joke. He was in the ICU within a couple of hours and started on all of the medications and, and poked and prodded with all the things, and that sort of became the focus of the next several years of our lives, and mine in particular because I was fortunate and privileged and educated enough that I was able to step away from everything instantly, hand all of the things off to two wonderful people who immediately stepped in to fill the gaps, and devote myself to taking care of my sick son, as well as his three little brothers. And that was, he had a high risk ALL diagnosis and it consumed about three years of daily treatment for him. And he’s doing great, he is now 20-years-old and he is in Canada, I think right now, which is a funny thing to say about your child, that you’re not entirely sure, but he is, he’s a Middlebury junior next year in Vermont and spent his summer off in Montana getting his wilderness EMT. He also is very interested in, in becoming a physician and then drove up to Canada to visit well, his girl. So, that’s what he’s up to. So he’s doing really well.

[00:08:39] Dr. JB: I’m so happy to hear that your son is well.

[00:08:41] Dr. Sarraf: Thank you. It’s a, it’s a life-changing, life-altering experience as a parent, obviously also as a physician parent, and I am immensely proud of how he moved through that time. He learned a lot and he taught us a lot, and we learned a lot from trying to figure out how to navigate that time without allowing him to wallow in it. So, there is a, there’s some, sometimes there’s a bit of a desire when you see your child hurting and harmed to think well, we’ll give into all the things, and so, lots and lots of parenting discussions about he will survive this. And, and I remember actually having this conversation with him, looking him in the face one day very, very early on, I think he was a little short with one of the nurses. And of course, there’s all kinds of ways to explain it away, right? I mean, he’s a young boy, he’s 13, he’s, he’s being poked and prodded, he’s sick, he’s scared. He’s all of the things, he’s on massive doses of steroids. And it occurred to me in that moment that I needed to really put those guard rails up around him, to let him know what the rules of engagement were going to look like. And so, I remember very clearly climbing in at the end of his bed and telling him, as I have always told my children, they know when I’m serious, I say look at my face. Look at my eyes, look at my face. I said, Joseph, you are going to survive this. This is a hard time, it’s not going to be easy, but you will survive this, and my job is to make sure that the man who comes out on the other side is someone I want to know. And so you will not, you will not be allowed to treat people disrespectfully, I don’t care how badly you feel. And so when this nurse comes back in, you will apologize for your behavior and you will learn to control your emotions. I get that you’re on steroids kiddo, you will learn how to do this, we will learn together.

[00:11:06] So ultimately what that turned into is a running joke in our family that cancer does not excuse assholery, and I actually had, I actually had a t-shirt made for him that said that. So somewhere I have this, this picture of my very puffy-faced bald, skinny, skinny, little cancer-ridden 13, 14-year- old, and he’s sporting a shirt that says “cancer does not excuse assholery.” And, that applies to most, most things, frankly. If you stop and think about it, I don’t know that there’s much that really excuses assholery. So, humor helps, humor always helps. That’s worth, it’s worth remembering.

[00:11:47] Dr. JB: Wow. Wow. You know, like so many questions I have about, about what you said in terms of, like you said, it’s so easy for you to feel so bad and, and want to give your child the world, especially when they’re going through something like this, and for you to be able to be like, no, you know there’s certain behavior that’s acceptable and certain behavior that’s unacceptable. I mean, I just love that.

[00:12:17] Dr. Sarraf: It’s not easy, you know, because there’s a lot of terror that accompanies this, and I, I am fortunate in that I was well-resourced in a lot of different ways. I mean, that’s a, that’s a, a place of tremendous privilege just to step into a critical illness, right? I was well-resourced educationally, I really could understand what was happening, and I was actually able to do a lot of his treatment at home so that he was in the hospital far less than many children would have been with his diagnosis. We have a children’s hospital right here where I live, we did not have to leave in order for him to receive excellent care and so he was able to be with his brothers and his friends and his family. We are rich in friends and those friends stepped in to help carry pieces of the burden, particularly when I remembered to ask, cause that’s a hard thing to remember to do. And then finally, I was very fortunate that our insurance did not depend on my continuing to work. You know, we talk a lot about the ways in which healthcare in this country is not just broken, but actively harming people. And I, I can remember thinking many times through this process, how on earth would I do this if I had to work in order to keep my son alive? Not just, not just in order to pay the bills, not just in order to keep a roof over my head, but to keep my son alive because that was the only way I could access the care that he needed, because I had to work to keep my insurance. Such a terrifying– even now it sort of calls up a little fear in my chest, it’s such a terrifying prospect.

[00:14:18] So it really deepened my, not just my understanding, the breadth of my understanding, it really deepened my well of empathy for what families faced when it comes to accessing healthcare. And other thing I began noticing at this time was just how truly– even at the time, this was now seven, eight years, seven years ago– how truly exhausted my colleagues are. My physician colleagues, my nursing colleagues. I was at the bedside in a different way and I could see the fatigue and that was how coaching got called into my life, honestly. Because, as is so often the case, sometimes our best friends know what we need before we do, and one of my besties, I like to joke she tricked me, she tricked me into going away for a weekend.

[00:15:24] So we were about a year into Joseph’s diagnosis and as you know, that is absolutely brutal. I mean, it’s just absolutely brutal with high-risk ALL, which is what he had, multiple chemotherapeutic agents, it’s high dose steroids, it’s monthly lumbar punctures, it’s recurrent bone marrow biopsies, I mean, it’s all the things. So it was a pretty brutal year and I don’t know that I did much sleeping, and she liked to joke that I had set up an ICU in our house, which wasn’t quite true, but some days certainly felt like it. And as we came out of the far side of that, she said, “well, you know, things are settling down, he’s stable, he’s, we’re, we’re through the worst of it. You need to leave.” And it occurred to me that I hadn’t done anything. I hadn’t left. I hadn’t left the kids, I hadn’t gone out to dinner, I hadn’t done really anything that year because I was so focused on making sure that everything stayed afloat. She said, “we’re going, we’re going to go do a, a conference together in Baltimore.” Really Baltimore, we can’t go to Maui? She said, “we’re going to Baltimore for a conference.” Well, what it turned out that she was taking me to was a coaching intensive, and it was very small, it was very intimate. There were nine of us in attendance and we spent three days learning the skills and the language of professional coaching. And it was really transformative in some very, very profound ways. And I’m so grateful for that time because I think, number one, I think had I known fully, had I been fully aware of what I was doing and what I was going to, I might not have done it because I think that there are some ideas, erroneous ideas, that physicians have around what it means to be a coach, and they’re diminishing, there’s some diminishing language about it. At least, there was in my head at the time. And what I discovered was this was an enormous missing piece, not just in my life as a human, but also really in the way that I interacted as a healer.

[00:17:50] You know, in medicine, we’re really taught that we are to have the answers. We are the bearers of solution and there is a degree to which that is appropriate, but it becomes so heavily weighted. And I think it also becomes very heavily carried by us and ends up coloring almost every interaction that we have, and that’s an unhealthy imbalance that is fostered by medical training. And so, learning through coaching that I could hold the space for people to discuss and talk about and offload their pain and their trauma without needing to have the solution for them, because they will find their own solutions, was such an interesting perspective shift, paradigm shift, to a degree or two. And it has allowed me to become a lot more expansive in how I interact in every way. And so, when I came home, I, I spent the next year not only finishing up my training and doing all the things one does to become certified as a coach and practicing the craft, because that is one thing that we’re really trained to do in medicine is learn to practice your, practice your craft and keep getting better, be a lifelong learner.

[00:19:17] And so I did that and as I did, one of the things that really clearly emerged was that there was so much space for trauma awareness and trauma-informed practices and principles to be implemented in the coaching process because colleagues that I was working with were coming in with, with burnout– and I’m putting big air quotes that you can’t see around that– coming in with burnout. And what was really showing up was the, the sort of cumulative, compounding impact of years and years and years of secondary trauma, vicarious trauma, primary trauma, toxic work environments, toxic stress, and it showed up as trauma symptoms. And as they began naming this, as they began noticing this, as they began noticing their trauma reactions and naming their trauma reactions, and then stepping into choice about responses they might have instead, it became really clear that there was a, there was such space and opportunity for this paradigm. And so, while coaching is not therapy, and I’m always very, very clear about what the scope of practice is in coaching and I’m a very big fan of therapy for folks, I’m a big fan of all of the modalities, coaching can be very, very therapeutic. And not everyone who is carrying trauma from their job, secondary, vicarious trauma, not everyone needs therapy, sometimes people just need a therapeutic coaching engagement. And so, I got very serious about this paradigm and about putting it to paper and putting some guardrails up around it and then beginning to train others in this.

[00:21:19] And so speaking of knowing your limits, while I am very well-schooled in and comfortable with trauma, trauma-informed practices, trauma mitigation, trauma responsiveness, what I wasn’t well-schooled in is how you train coaches. And so I reached out to some folks who have many decades in coach training and said, here’s what I’m doing, what do you think? And Dr. Ann Deaton and Antoinette Ires, both of whom have two plus, three plus decades as professional coaches and coach trainers, said, “oh yeah, this is something, let’s work on this together.” And so– program, that is, it’s a masterclass for coaches in trauma mitigation and how you do that, how you navigate that, and is now an ICF-certified. So, one of the biggest and most well-known international coaching regulatory bodies has accredited our course. So proud of that. That’s a lot of years of work.

[00:22:31] Dr. JB: That’s amazing! And it’s crazy how it started off with your friend saying, “hey, let’s take a trip.”

[00:22:39] Dr. Sarraf: It’s amazing what happens when you say yes.

[00:22:42] Dr. JB: When you lean in.

[00:22:44] Dr. Sarraf: And lean in. Yeah, when you say yes and you lean in, even when you don’t know what the outcome is going to be. Which is again, really hard for us as clinicians, right? Because we want to be able to control the outcome.

[00:22:58] Dr. JB: Yes.

[00:22:58] Dr. Sarraf: That probably, now that you say that, is a learning from, also a learning from my time with my son and his illness. You have to unclench your fist. I had to learn to unclench my fist a little bit and accept that there were going to be periods of time where the outcome was opaque and just to be present in that time. And so it was a tough balance between mom and doctor and doctor, mom, and I don’t know that I ever got it quite right. But boy, we sure were intentional about moving through it. And, you know, one of the things I want to say about that time also in reflection is that that was the time of obviously of very, very high toxic stress for my child, right? So this is something that could have become embodied as trauma for him. Significant childhood illness, life-threatening illness, multiple medical procedures. All of these things are, are not named in the original ACEs study, but have, have since been sort of recognized in the trauma literature as things that land as trauma, as traumatic experiences for children. And going into the time with Joseph, one of the things that I was very clear about was my job is to mitigate this for him. That’s, that was really the entirety of the job. Was as much as possible, I have to mitigate the way that this lands with him, not by diminishing it, not by making it, by using language that turns it into less than it is, but simply by acknowledging it and being honest with him about it and being very transparent, uh, with him around things. And by ensuring that he knows that mom’s in charge, dad’s in charge, his, his pediatric oncologist, whose name I will forever say with reverence in my town, Dr. Greg Brandt, is in charge. There are grownups in charge, we are going to take care of you and here are the things that you are expected to do. You are expected to nourish your body with good foods, not, not Cheetos and Skittles, which would have been his preference. You are expected to stay hydrated. You are expected to move every day. You’re expected to walk every day. You’re expected to continue to do these things every day. And putting those guardrails up was really good.

[00:25:39] And the other thing that really was useful was he found purpose. Find something that is meaningful to you. And so, I really credit the Make-A-Wish foundation for planting a seed with him. They came to him very, very early on, we didn’t know they were coming. I didn’t know they were coming, I assume Dr. Brandt did, but none of us knew. And this, this delightful, I like to tease that she was Tinkerbell because she was just this tiny, adorable little pocket-sized woman who, who came in with all kinds of energy and joy, and while Joseph was getting chemotherapy one day very early on, and said, “I’m from Make-A-Wish and guess what Joseph, you get to making wish, you could to wish for anything.” I believe, at least that’s how I remember her saying it. And she went on to tell him that, you know, kids wished for trips or they wished for swimming pools, or they wished for ponies, at which point I started banging my head against the wall. Or they wish for, she said we just helped someone rebuild a car, and I thought he’s 13! So, she sort of dangled all of these wonderful ideas in front of him and asked him if he knew what he might want. And he was so taken aback by this idea, that, that he said, “well, I, I’d like to think about it.” And so, as we were driving home that day from, from infusion, all of a sudden he, he, there’s just sort of this gasp from the passenger side, which is exactly what you want to hear from your kid who just got chemotherapy, right? And I’m pretty sure I hit the brakes and swerved the car and so forth, and I looked at him and he’s like, “I know what I want to wish for.” So I’m bracing myself, I am really bracing because this is going to be something, this is a, this is a smart and imaginative kid, and I’m thinking, okay, where are we going? One of the first things he says, “well, I’d really like to go to the North Pole.” My kids are very big, we’re very big outdoors men and my kids are really, really adventurous, and at this point in his life, he had already traveled across the, the polar ice in Svalbard for a couple of weeks by dog sled, and had spent two weeks in Greenland, in Western Greenland. He and his second brother Jacob and their dad had gone and spent two weeks traversing by dog sled with the Inuits, uh, Inuit hunters in Greenland, so he, he is a very, very adventurous, outdoorsy kid. And one of the things he had said right away was, “oh, man, I want to go to the North Pole,” so I’m thinking this is going to be some sort of craziness like that. And he looked at me, he said, “mama, I want to wish to stop the proposed copper mine in Minnesota on the edge of the Boundary Waters wilderness, that will poison the wilderness.”

[00:28:40] Dr. JB: Oh my goodness, 13?

[00:28:44] Dr. Sarraf: 13. And I looked at him and I said, wow, Joseph, that is a brilliant wish. And he looked at me and said, “I know, right? Who’s going to say ‘no’ to a kid with cancer?” Well, it turns out a lot of people, a lot of people would say no, but he was right. There was a– so, sulfite or copper mining is an extremely, extremely environmentally toxic, damaging, destructive form of mining. It has never been done anywhere in the world without lasting, extreme multi-generational harm to the environment. And it had been proposed and they were just gearing up for the fight against it. It’s a large company out of Chile called the Antofagasta, who has a horrible environmental track record, and had just been proposed and we were just starting to hear about it. And the Boundary Waters Wilderness is one of our favorite places in the world. We’ve been taking our children there since they were itty bitty babies, and it’s 1.1 million acres of pristine, and by that I really mean pristine, untouched wilderness. Should be on everyone’s bucket list, it’s in Northern Minnesota along the Canadian border, and you can only get in under your own steam. You’ve got to paddle in and then portage, hike the same paths between lakes that have been utilized by native Americans and, and French Canadian travelers for hundreds of years, and there, they’re only a few permits. We just got back from a trip actually, in which for three days, we didn’t see anyone. You can’t fly overhead. There are no airline jets fly overhead. So when I say it is remote and pristine, I really mean that. I just dip my cup in the lake and drink straight out of the lake, it’s that clean. So though the mine would have poisoned the groundwater and the waters run north into the lakes there, so it would have ultimately– and there’s no buffering capacity in those waters– would have ultimately really poisoned and destroyed this wilderness. So he decided that was what he was going to work on. And when the Make-A-Wish Foundation logged his wish and began trying to help him, they began running up against people who said, “well, this is political, you can’t do political things.” And they kept coming back and back and back to him saying, “okay, pick something else, are you sure you don’t want a pony?” And he said, “no, you know what? This is my wish and if you can’t do it, that’s okay, I’ll do it.”

[00:31:38] And so, I’m not even kidding, and so he got to work. He wrote, he wrote to the president of the time, it was president of Barack Obama, and then he began writing to, he wrote to Senator Dick Durbin. He wrote to, I cannot remember who was the other Senator, it was before senator Duckworth, wrote to our other Illinois state Senator at the time. Began writing to our congressmen. And then decided that the one one-week break that he got in his first year, so there was, it was daily chemo except for one week, he wanted to go to Washington DC and start meeting with these folks. And so, because he was not safe to get on an airplane, I packed him into my car and we drove to Washington DC, and he spent a solid week meeting with people in Washington, DC, one after another, after another. The secretary of the interior, Sally Jewell at the time, met with him. He met with the head of DNR. He met with the head of the Center for Environmental Quality inside the, not inside the white house, but inside the fence, and many, many, many representatives, not just from our state, but from other states that would be interested in this. So, he told his story and he asked them to help him and he really started a movement. And then ultimately ended up starting a nonprofit called Kids For the Boundary Waters and began recruiting other kids who care about wild places to that. And now he leads yearly, sometimes bi-yearly fly-ins where children from all 50 states, almost, I think he’s had most of the states represented at one point, fly in and he teaches them how to be effective and respectful lobbyists, and they go and they lobby for a solid week. And they talk about why this is important and why our representatives should help protect it.

[00:33:46] Dr. JB: Your son is so amazing.

[00:33:49] Dr. Sarraf: He’s pretty cool.

[00:33:50] Dr. JB: Oh my goodness,

[00:33:50] Dr. Sarraf: He’s a pretty cool kid. And you know, that that I credit with how well he did through his chemo as much as anything, he had a purpose.

[00:34:00] Dr. JB: Yeah. He found his purpose. Yeah. Wow. 13. I’m still taken aback.

[00:34:10] Dr. Sarraf: So if anyone is interested, you can go to Kids For the Boundary Waters, it’s all one word, K I D S, kidsfortheboundarywaters.org and you can read more and learn more and, and support them because they did not get to do their fly-in last year because of COVID. And so, they are now planning for their fly-in this fall and thus far, they have managed to stall the, this mine. The U.S. Forest Service and other organizations really do fully recognize how damaging it would be, how harmful it would be, so, it was a matter of, mostly, of really getting the right people to sit up and take a look at it. And this is not an anti-mining position of his, in fact, he will joke that one of the first things I made him do, I was not a very easy mom on him in this year of cancer, one of the first things I made him do is I made him write a position paper in favor of the mine, I made him do the research and write the position paper from that, from that posture, because I wanted him to understand why people would want it. Why people would need it. Why people would think it was a good idea. And so that was a really important learning for him, it humanized those who are on the other side of the discussion and the argument, and allowed him, I think, to deepen his understanding and his empathy, but also strengthen his arguments against, because we don’t need the resources, we’ve got plenty of copper. That’s not the issue. And there’s no shortage of jobs in the region of good paying jobs of mining. It’s not like we have a lot of miners, you know, intergenerational miners who were sitting around out of work, they’re not. So this is, this was really about corporate greed from this one particular company, they saw an opportunity to come into the United States and be exploitive, but it was a good exercise for him to go through.

[00:36:10] Dr. JB: Wow. And for you also.

[00:36:15] Dr. Sarraf: Oh gosh, my children have grown me up every bit as much as I ever grew them up. That’s for sure.

[00:36:20] Dr. JB: You know, one of the things that you mentioned in the beginning was about being present and throughout this conversation, you’ve shown time and time again how you have really embodied that in everything that you do, with your son and with your coaching practice.

[00:36:45] Dr. Sarraf: What a lovely compliment, thank you. I wish I could say that it’s, it’s who I am. It isn’t. It’s what I’ve learned to do in as many decades of intentional practice, and it’s very easy for me to forget to be present because I’m hardwired to go fast and go faster and then go faster than that. And I think that’s true for a lot of our colleagues, is we’re sort of hardwired for it in the first place and then our training amplifies that tendency and encourages that tendency and amputate any natural inclination we might have towards self care, physical awareness of our own physical needs. And then we also live in a society that denigrates the ideas of rest, of full engagement, of presence, of slowness. So again, coming back around to this idea of profound imbalance, that’s the time that we are in. We are in a time of profound imbalance. And, and we were prior to. So, you and I knew, got into the last 18 months, we were in a time societally of profound imbalance, in healthcare and in education and in a lot of areas, even before what I call the “tridemic.” Before we hit this period of COVID, that’s, that’s point one of the “tridemic,” violence, racial violence, acute on chronic racial violence, political violence, both physical and verbal, and, and just sort of this uptick in, domestic terrorism that we are seeing in our country, both in terms of mass shootings and other. And then all of that was compounded, so that’s the second leg of it, all of that was compounded by isolation, right? Homeschooling, home work– please, one of the things I learned this year, I don’t know what the big lesson for you is, but my big lesson was that I will pay teachers any, there is no limit to how much a teacher is worth.

[00:39:21] Dr. JB: Right?

[00:39:21] Dr. Sarraf: I love teaching. I mean, I really love teaching until you ask me to teach my own children.

[00:39:28] Dr. JB: Right? It takes so much patience, and I don’t have patience for my children it seems.

[00:39:33] Dr. Sarraf: Yeah. I do not want them to read to me until they’re good at it. That’s sort of the bottom line. It’s sort of the bottom line. And the other thing we know in the trauma research is that the most trauma mitigating thing that we have is us, we mitigate for one another and that was stripped from us. So those social supports, that scaffolding that allows for me to reframe from you when you’re going off the rails, or you to reframe for me when I’m going off the rails, that was stripped. And we were living in this time of incredible opacity, there was no clear– there was no clarity, we had no clarity around when it would end. And frankly, uncertainty is a well-known form of torture, it is a utilized torture device, and so we were, we were living through this time of intense uncertainty and we as humans do not do well with uncertainty. And so, we saw people racing for the binary poles, right? Very, very little communication was happening around how we exist in a period of uncertainty while caring for each other. Most of it ended up either being “this is overblown, nitwit garbage,” or “this is the worst thing and we’re all gonna die, and everyone’s killing each other, and you’re an evil human if you even think differently and aren’t locked in your home,” and neither of those two positions were healthy, and neither of those two positions were helpful, and neither of those two positions were correct. And yet, that’s where we go as humans. And I have deep empathy for why people go to those two binary poles, because fear and uncertainty are not comfortable places to exist. You’re not practiced in existing in those places.

[00:41:28] We don’t even recognize that that the fear and uncertainty is trauma. We certainly weren’t recognizing trauma symptoms in our self, nor were we recognizing and acknowledging it fully in each other. And so, I liken it to, I don’t know, I don’t know how long you’ve been on this planet, but I’ve been on this planet long enough that I remember the old-fashioned pinball machines. And one of the things that I remember is that you could pull the lever all the way back and get all the balls lined up and then send them all zinging out at the same time. And when you do that, they not only ping off of the sides, they start pinging off of each other, amplifying the speed and the rate, and that is really an apt metaphor for what I think I was witnessing over this last year, what we all were witnessing, is that we were all in this state of very, very high activation. We were all living through, as much as I hate the word, unprecedented at this point, truly unprecedented, chronic inescapable, toxic stress and it was becoming embodied as trauma symptoms in most of us. And from that highly activated state, we were amplifying the same in each other. And so, trauma mitigation, learning these techniques, learning to recognize the symptoms of trauma when they show up in others, learning to recognize trauma reactions when they show up in others, learning to recognize them first. I mean, it all begins with me. I better be able to recognize it in myself because if I can’t recognize it in myself, I sure as heck am not going to recognize it in anyone else. So, it begins with recognizing and noticing in me.

[00:43:24] And guess what? We talked about this earlier, we physicians are not tuned into our own physiology. In fact, our training teaches us not to tune in, to ignore our own physiology. How many times have you heard people say “I haven’t eaten yet today” at the end of a 14, 16, 18, 24-hour shift? “I didn’t even have time to eat.” “I haven’t had anything to drink, or to pee exactly.” Which is why we don’t drink or eat, because we know we’re not going to have time to use the bathroom. Right? We, we train out the, the natural bio rhythms. Don’t sleep, 36-hour call in the ICU. I mean, back when I trained, that was normal. You go home for 12 hours, you come back, you do another 36. So, we train ourselves to ignore our bodies and so, relearning that is really an important noticing. Where do I notice my activation? I notice it always in my throat, if I’m having a strong reaction to something, it always shows up with sort of a tightening and a closing in my throat. It took me far longer, as an intelligent woman, it took me far longer to realize that than it should have. And so, helping our colleagues to start tuning back into that because there’s a really wonderful book called “The Body Keeps the Score,” it’s written by Dr. Bessel van der Kolk, and the title alone is worth the purchase price. The body keeps the score, the body remembers. And it’s not mental health and physical health, it’s health. And so, the body remembers the traumas that we have experienced and it will show up in our bodies first. Will show up and our bodies will become activated before our prefrontal cortex comes online and we are able to step into choice. So, if we can begin retraining ourselves to notice those symptoms in our bodies, then we can also begin training ourselves to be centered, present, to deactivate, and from that space, I get to step into choice. I choose how I’m going to respond rather than reacting from a place of high stress, trauma, et cetera.

[00:45:50] And the other thing we know is that trauma primes the brain. So, I like to say it’s sort of like encountering a bear in the woods, right? This incredibly brilliant, beautiful system that is designed to do one thing and that is keep us physiologically alive. So when we encounter a bear in the woods, that amygdala hijacks us, fight, flight, flee, free, submit, save yourself, and we have no choice. I want to say this because I, I know there is some listener who needs to hear me say this, we don’t have choice in which of those four trauma reactions shows up. The hind brain chooses for us. It’s not like I say to myself, I’m going to fight the bear, the amygdala says “fight,” or the amygdala says “submit.” And then submission kind of reactions are important to know exist, and they are some of the most sticky to detangle because there’s often shame that accompanies submission trauma. That’s just as in a fight, and I don’t know why intuitively that needed to be said today but it did. So our amygdala says fight, flee, free, submit and it happens. And it’s super, super helpful if you have just encountered a face-eating bear, and most of us don’t actually encounter true face-eating bears, so this is metaphorical, but, but let’s say we encounter the face-eating bear, and now our system knows to recognize it. And then we encounter it again the next day, face-eating bear, and again, the next day, face-eating bear. Now the system is primed. Now the system is looking around everywhere in the woods, is tuning into every sound that we encounter, and we hear the sound and the system takes off, face-eating bear, face-eating bear! But it’s actually just a little chipmunk and you’re not in the woods, you’re in a boardroom with your colleagues, but you’re reacting to something that happened as if it were a face-eating bear. Then we have a problem, right? Because you are no longer utilizing your full capacity to engage with others. You’re reacting to something that isn’t actually occurring at the time. This is how trauma primes us. This is how trauma harms us over the long haul. And what we’re finally seeing societally I think is that the, the opportunity in this last year is that all of us are starting to recognize it. Okay, yeah, this really is trauma we’ve been through. We’ve all been through it. And so, we’re, we are, I am noticing that we are more willing to use the terminology.

[00:48:54] When I started doing this type of coaching five, six years ago, I was always very, very hesitant to call the word, the T word into the room, a lot of physicians have very strong reaction to it. In many people’s mind, there is a connection between trauma and victim. And now we are recognizing that we get to decouple those words, trauma’s just something that happens to us. It’s just something that happens to us that is out of our control, but it’s overwhelming and then it involves a real or perceived loss of control. And we humans really like to think that we’re in control. I think this last year showed us the control as illusory, but at least I hope it did, but that, that real or perceived loss of control. And so, all effective trauma mitigation begins with restoration of agency, even if it is something as small as “I notice that the person I am with is highly activated.” And rather than utilizing the typical interventions, shaming them, blaming them, wondering what the hell is wrong with them, telling them to calm down– which never works– asking them, would you just take a deep breath– that also never works– holding space for it. Just simply holding space for it and the discomfort that accompanies that, making sure that I am centered, that I am grounded, that I am deactivated so that I am not inadvertently retraumatizing them with my own reaction and then getting curious and offering them some control. ” I hear what you’re saying, thank you for sharing that.” “May I ask a clarifying question?” That tiny statement, that tiny phrase just gave them back choice. There’s some of restoration of control in that moment. So the old trauma involves a loss of control, trauma-responsive languaging, trauma-responsive communication begins with restoration of agency, restoration of even those small moments of control, allowing people space to offload their pain and allowing them some choice and some voice. And these are the things all of us can learn. That’s the beauty of this. This is not and these are not 15-year PhDs that you have to receive. Although the people who came up with this all studied this over the course of a lifetime and, and have those doctorates, but, but the beauty of this is that this is a way of communicating that is deeply compassionate. It taps into our empathy. It teaches us to connect with self, and then it drives us to connect with other people and it can be utilized in a 360-degree fashion. So, one of the things that has been that has been the most beautiful and revealing to me in this process has been that much like the, the work of becoming an anti-racist, it’s the work of a lifetime. There’s no finish line to it. It is something I will be working on and learning and, and expanding on my whole life, so is the work of becoming trauma-informed and trauma-responsive in how I engage with others. It is not a hat I put on and take off, it’s a way I strive to move through the world.

[00:52:34] Dr. JB: There was something that you said about holding space for it and the discomfort that accompanies that. And I thought that was so profound, because again, it shows an example of the importance of being present, being present and staying present is not comfortable.

[00:53:01] Dr. Sarraf: You are absolutely right. And we, we don’t, again coming back around to this idea of imbalance, I don’t want to suggest that there is anything wrong with comfort. We all need comfort and we all can and should seek ways to comfort our self and comfort others. And we have become so very, very imbalanced in thinking that we have a right to be comfortable, thinking that we should always be comfortable in every space, thinking that others should make us comfortable even if it is to their own discomfort, and that includes both emotional and physical comfort. And so, you, you mentioned something about Joseph and, and how well he did, and I, I want to attribute a little bit of that to the fact that one of the things that wilderness teaches us is how to be uncomfortable. You know, sleeping on the ground is not as comfortable as sleeping in your bed.

[00:54:09] Dr. JB: That’s true.

[00:54:10] Dr. Sarraf: You know, mosquito bites are uncomfortable, fly bites are really uncomfortable, paddling all day and feeling your arms get sore and exhausted or, or putting a canoe on your shoulders and carrying it for two miles, these are uncomfortable things and the gift of learning to be uncomfortable in, in service to your purpose. If your purpose is to commune with nature, then you are choosing to be uncomfortable in service to your purpose. And, and you learn that there’s an end to the discomfort or that the purpose outweighs the discomfort, and so you choose to step into it anyway. And I think that’s such a profound and meaningful lesson because what is in service to my purpose then with, with being willing to be uncomfortable, being willing to sit in discomfort, was in service to my purpose because holding that space for others opens up opportunity for them to heal. That’s in service to my purpose. Holding that space for others opens up opportunity for them to then turn around and do it with the next person, sort of learning that nonviolent and healing communication skill. That’s important to me. So I think it is really critical that we all learn to recognize and acknowledge that there’s nothing wrong with saying “it’s very uncomfortable for me” and that’s okay. Discomfort does not kill us. Discomfort does not kill us, and, and we can learn to be comfortable in the discomfort. That’s how we stretch, that’s how we grow. That’s actually healthy stress. That’s the stress that breaks muscle fibers and builds bigger muscles, or that’s the stress of muscle against bone that strengthened the matrix of the bone, right? That’s the kind of stress that makes us, uh, increases our capacity, makes us more resilient, increases our stamina. These are things that we should be striving for, so I think it’s really important to learn to hold that and it’s liminal space oftentimes. So liminal, I love the concept of liminality, which is, is that threshold, it’s the literal translation of it, but what it, what it signifies is that space in which you let go of what was, but you haven’t quite figured out what is. Sometimes I refer to it if the gray midst of an uncertainty. So the space where you just, it’s not clear what’s coming, you don’t know, and it can be very, very disorienting both for the person who’s in it and for those who are, are learning and practicing the discipline of holding that space for other people.

[00:57:16] When people come to you for coaching, particularly right now, many of them find themselves in that liminal space. They’re transitioning, they’re transitioning out of a career or they’re transitioning positions, or they’re transitioning in their personal lives. I mean, there’s all kinds of things that are happening and that liminality is intensely uncomfortable and it can be uncomfortable to hold it for them, particularly because again, as physicians, we are accustomed to having a crystal clear idea, here’s the diagnosis, here’s the treatment plan, here’s the outcome we are expecting. Doesn’t really work out that way.

[00:57:57] Dr. JB: That’s right, ’cause again there’s what you learn in the books and reality.

[00:58:03] Dr. Sarraf: Exactly so. Exactly so. And there’s tremendous beauty in this, and healing, and opportunity, and I think that’s where the hope lies in all of this, is not that we finally are recognizing that we all are carrying big T trauma. I mean, so we often talk about trauma as being an event, that’s how most people think about it, but trauma is also the cumulative, compounding impact of small T traumas. Microtraumas, however you want to name them is fine. That also ends up landing and, and impacting us over time, and that’s just the middle piece. So, the goal in this type of coaching is to sort of drag those unseen, unnamed, unmitigated unmetabolized, unrecognized oftentimes traumas and their impact out of the darkness. You know, kind of grab them by the ankle and drag them out, that monster out from under the bed and set it out there in the sunlight of the day and name it and step into choice around it, and name it, step into choice around it over and over again, as it diminishes, as the sunlight disinfects it, and as we normalize, because one of the things that definitely compounds trauma is disconnection and loneliness and the shame that comes with the idea that “I’m the only one.” I’m the only one who thinks this way, I’m the only one who feels this way, I’m the only one who’s experiencing this, I’m the only one who can’t, I’m the only one who hasn’t, I’m the only one who doesn’t. My goodness. The number of times I have heard that cannot be quantified. And the truth of the matter is that whatever it is that anyone is carrying and thinks they are the only one, I promise you’re not. And I promise that deep, dark, horrible secret is not going to be nearly as shocking to everyone as you think it will. And the relief that comes from saying it out loud. “I hate teaching my kids,” or whatever. Whatever. “I have had a terrible year and I find myself thinking that I can’t go on in my job.” “I don’t have what it takes.” “I don’t have the resilience to keep being a doctor,” boy I have heard that a lot. “I’m not resilient.” That’s crap.

[01:00:41] Dr. JB: That’s crap.

[01:00:42] Dr. Sarraf: That is the weaponization of resilience is what that is. Whatever that secret is, drag it out. Let’s put it in the sunlight, let’s unpack it, and then decide what you’re going to do. And then that’s where it gets fun because you start to step into choice, again you remember you have choice. Then, we move towards this, this space of healing-centered engagement. And I do want to say, just for all of the psychiatrists and the therapists and all those out there that worry because, rightly worry, because it sounds like therapy. The difference between therapy and trauma-informed or trauma-responsive interactions is that therapy is therapeutic in the sense of diagnosis, digging in, creating a treatment plan, and executing on that treatment plan. There’s no digging that happens with this type of coaching, it isn’t about come and, and sit and tell me all your things, tell me all your points of harm, and let’s dissect your points of harm. It is about just simply knowing everyone carries it and changing the ways in which I am willing to hold space because I just acknowledge every encounter someone’s bringing harm in. So, we never go digging into people’s stories, that’s not the job. That’s trauma porn is what that is, unless you’re a skilled professional. The objective is not to ask people to come and bleed their harm all over the floor, we should never do that. That’s profoundly trauma uninformed, actually. We simply acknowledge and hold space for people to tell us what they want to tell us and, and then allow opportunity for decisions.

[01:02:36] Dr. JB: And to walk into options. Or walk into choice is what you’ve been saying– and I love that because so often we feel like we don’t have choice, right? This is the only thing we know how to do and this is what we’re going to have to do for the rest of our life, and then you feel stuck when it’s not fulfilling anymore, for whatever the reason is, and, and then you feel alone. You know, some of the things that you mentioned, I just wanted to just say again because you’re speaking so much truth. One of the things that really resounded a lot with the purpose of Hope4Med from what you said was being a place that allows, or being a space that allows people to off load. I call it a pop-off valve, just to release with your peers. You don’t have to explain yourself, you’re talking to people that, that are living it, have experienced it, and creating that community where we can confidently say that you are not the only one feeling this way or that way. You’re not.

[01:03:50] Dr. Sarraf: You can’t see me nodding, but I’m over here nodding, and that is exactly right. It is making space for the relational rather than transactional. And it is making space and holding space for the narrative. We all have stories and storytelling is just so profoundly important in healing. You know, a lot of the teaching I do is, is I teach through storytelling, my own stories always, never anyone else’s, but most of us have a lifetime of our own stories that we can draw from and it’s really profoundly important because we remember those stories, the stories stay with us. If I sat with you and your listeners today and just rattled off a lot of facts and figures, which I could easily do, about trauma and numbers and gone into great detail about the neuronal pathways and what it means when we’re hijacked, which is really not the correct word, but that’s okay, they might remember a bit of it, but I bet you, everybody remembers the face-eating bear. So, there’s, there’s profound opportunity for us to connect with one another around storytelling and narrative and, and good use of metaphor, and allowing for others to do that, and encouraging others to do that. Storytelling comes very naturally to me; it doesn’t come naturally to everybody else. And so, allowing them the space to make sense of their lives and how they are experiencing it, not only without judgment but without diminishing it, again, coming back to this idea of the binary, we oftentimes use the language of “yes, but,” and it’s such a killer. It’s such a conversation killer. “Yes, but,” no, no, no, no, no, no, “yes, and.” Yes, and. The truth of my lived experience can coexist with the truth of your lived experience, they don’t cancel each other out.

[01:06:10] Dr. JB: And there are so many takeaways from today’s conversation. For me, one of the biggest ones is the power of an individual, no matter what age, to really affect change, especially when they find their purpose and their passion.

[01:06:36] Dr. Sarraf: Yes. And especially when the right scaffolded supports exist around them to allow them to pursue that. And that I think is a missing piece in the narrative in sort of dominant culture right now. Joseph did some really cool things, he is doing some amazing things and he certainly did not do it in a vacuum. So, I would, if I could wave my wand in this world and, and vanquish one harmful myth, it would be the myth of the bootstraps. Did he learn along the way? Did he work hard along the way? Are the things he accomplished remarkable? Absolutely. And he had all the scaffolded supports around him that he needed in terms of people, in terms of friends, in terms of connections, in terms of food and shelter and healthcare and access, he had all of those things that allowed him to be successful in pursuing the things that he pursued. It didn’t happen in a vacuum. Does it make him less remarkable? No, I don’t think so. But it is a more truthful story than the bootstrap story. That is, it is just such a profoundly damaging narrative, and I would love for us once and for– first of all, I would love for us once and for all to recognize that the origins of that story are that it was used to describe an impossible task. You literally cannot pull yourself up by your bootstraps. So, it was meant to, to describe something impossible to accomplish and it’s morphed into something else, but it’s, it’s just such a– I am an enormous fan of individualism and, and self, and it has become again, sort of weaponized and toxic. It can become, when it’s, when we become imbalanced in it, it becomes a death cult really. The individual over the collective is a death cult. We have to have both. Your individual right to express and believe and feel and love and our collective responsibility to one another.

[01:09:17] Wow, we went all over the place today. I feel like I did not do a very good job of honing in on one point for you.

[01:09:26] Dr. JB: I don’t think we needed too though. I don’t think we needed to, I think this conversation was fantastic and it really hit on some really important areas that people just needed to hear. And that’s how my conversations go with podcasts, I just let them go because it’s a conversation I love getting to know people. I love hearing people’s stories because I think everyone’s story is important and I wish I had infinite, infinite hours of the day to listen to stories, but alas, you know?

[01:10:00] Dr. Sarraf: Alas, just the reality of, of needing to put a roof over our heads interferes but I am, I am with you. I love to collect and gather stories from others, and I am so appreciative of you providing me with so much time this morning to tell some parts of my story. And, I hope that, that someone out there who is listening to this found it to be a healing conversation that we have this morning.

[01:10:31] This was really a joy for me to spend time with you this morning and I, I thank you for being so generous with your resources and your time.

[01:10:39] Dr. JB: Thank you so much. And then lastly, Dr. K, if my listener wanted to get in touch with you, how can they do so?

[01:10:51] Dr. Sarraf: Thank you for asking that. The easiest way is to find us, find me on our website, which is a Lodestar, L O D E S T A R, P as in Peter, C as in cake, dot com, lodestarpc.com. And, there are a number of different ways from there, you can email me, kemia@lodestarpc.com, you can set up an appointment for an initial discovery call or consult, or any one of my, my partners who work with me, they’re also available to contact through that. So, we do lots of great work and, and really enjoy what we do.

[01:11:35] Dr. JB: Yeah, who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some, each one, teach one. I’m done.


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