EP 70: You Are Not Alone

Did you know that the physician suicide rate is the highest of any profession? Physician deaths by suicide are nearly double the national average. We must do more to support our physicians, physicians in training, and fellow healthcare professionals, and it starts with making it okay to talk about it and having a conversation.

Episode 70 of the Hope4Med podcast features Dr. Boyce Fish, an emergency medicine physician living in Idaho who currently serves as a life coach, helping physicians regain control of their life. Dr. Fish shares how a series of unfortunate events and the built-up pressures he faced as a physician brought him to a breaking point. He now shares his story to reach others who may be in a similar circumstance, to show them that they are NOT alone. We discuss the importance of having a space to release and talk about these issues to prevent others from reaching that breaking point.

Connect with our guest:
Website: https://www.thelifecoachphysician.com/

[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:03] Hi everyone. Welcome back to the Hope4Med podcast. I am your host, Dr. JB and today’s featured guest is Dr. Boyce Fish. He is an emergency medicine physician living in Idaho, and currently serves as a life coach, helping physicians take back control of their life. Welcome to the show, Dr. Fish.

[00:00:25] Dr. Fish: Thank you. Thank you for having me. How are you doing today?

[00:00:29] Dr. JB: I am well, how are you?

[00:00:31] Dr. Fish: It’s an amazing day. Amazing day to be alive indeed.

[00:00:36] Dr. JB: So, Dr. Fish, can we please start from the beginning? Can you share with my audience, your origin story?

[00:00:43] Dr. Fish: Yeah. So, board-certified in emergency medicine, but I guess it started, I had a nontraditional route into medical school. I had finished a bunch of core sciences and I had a family during my, during my entire undergraduate. And I’d work and I’d go to school and then I’d work kind of dad. So I had four kids actually when we enrolled in medical school, took me a couple of rounds of applications, ’cause I had to go in and get a master’s and show that I could get a good GPA, ’cause I wasn’t really super focused on that prior to that, but then I just felt called to be a physician and took the road less travel for sure. I went to medical school with four kids.

[00:01:20] Dr. JB: Wow. Wow. How old were your kids when you started medical school?

[00:01:24] Dr. Fish: Uh, start of medical school, they were three to thirteen.

[00:01:29] Dr. JB: Oh, that’s a spread.

[00:01:31] Dr. Fish: Yeah. Yeah. So yeah, all the way up to the preteen, so teenager, yeah. So life was good, it was, that was my outlet during medical school. Everybody else liked to party after tests, I would go hang out with my family. It’s pretty cool. So yeah, medical school, non-traditional was obviously different for me than other people. It was, was good. I found my, my learning methods and zoomed right into it. I’d been serving as a, a med tech before that. So I worked in the ER as an ER tech and then throughout the hospital as a CNA. So I scrubbed into operating cases, all kinds of cool stuff, so I had a really nice medical background by the time I went to school. Following school, did my audition rotations around the country and ended up at Grandview emergency medicine and Dayton, Ohio. Amazing program. It’s a very small osteopathic program that really was the right fit for me. And I enjoyed my time there. In fact, I ended up staying on as faculty. I was assistant program director for emergency medicine for a while. When I left that position, I also was clinical faculty for the Wright State Boonshoft School of Medicine emergency medicine residency and medical students there as well. Enjoyed teaching, love teaching. That’s been my jam from the very beginning. But yeah, after that, we ended up moving out to Idaho and where that’s, where I’m currently at now.

[00:03:00] Dr. JB: Mm-hmm. So why Idaho and where are you from originally?

[00:03:04] Dr. Fish: Well that’s, yeah, so I guess started out, I, I grew up in California. I took a swim scholarship to University of Wyoming, met my wife there. We got married during my sophomore, her freshman year. Kids, we went all the way through school with kids, both of us we finished with multiple degrees, but, so started in California, went to Wyoming. I’ve lived in multiple states at this point, but why Idaho? Well, out west was where her family was from. My brother-in-law’s also emergency medicine, so I came out here to work with him and settled my family where we’d be near relatives cuz when we were in Ohio, we were near nobody. So it’s kinda nice to be around family.

[00:03:47] Dr. JB: Okay. Perfect. So how has Idaho been?

[00:03:51] Dr. Fish: Idaho is amazing. I love the mountains. I love the weather. I love the outdoors. That job was interesting. It was probably not a good fit for me in retrospect, but I came on as a a partner track and to get here, I worked for a major, a major medical organization who won’t be named and despite working all the extra hours that I ever work for them being one of the most flexible guys on the schedule, there was a two year sign on bonus limit and when I said I was leaving, they were pretty upset. And they said, well, well, we don’t care if you’ve worked more than the hours and unless you work the number of hours to the end of your August shift– and I was leaving in May– then you have to pay us back the sign on bonus. And truly, I probably should have just paid them back the sign on bonus, but I decided to work it out. And so I was working six and seven days a week. I think I, I went on one stretch of 38 days without a day off, 12-hour shifts, and worked my way out. But that was the very first time that emergency medicine didn’t feel right, that I felt burnt out. I had just, I’d worked myself into oblivion.

[00:05:04] Emergency medicine has always been my personality. I’m ADHD. I love the teamwork. I love, I love the change of pace, snotty nose, sprained ankle, code blue, right? That, that’s just what we do. And it fit me. I was able to juggle multiple plates and, and keep things going. When I moved out here, I had a little bit of time off trying to rest and recover. And in June I started I started my current position here in Idaho. At that time I was still like, not super excited to go back to the ER, which is really weird for me, right? This is my jam. This, I love the ER. My wife asked me when I came out here, what do you wanna do? You wanna– cause you know, it’s a, it’s an independent democratic group and they, and there’s lots of different places you could go as far as administration and education, all kinds of stuff. And it’s like, I just wanna, I just wanna be an ER doctor. It’s nice to just see patients and, and treat ’em. Then what happened there was what I would call a series of unfortunate events.

[00:06:03] The first one was like my very, very first shift. I came on and the doc that was on, not coming outta residency, he’s like, you’re a seasoned doc. You can do this. Once you take the floor, it’s nice and slow, you can take care of things. And so I jumped right in. It was this old archaic med system, so I was struggling, trying to figure out what to do. I had a scribe there trying to help me. I was having to ask him a lot of questions and then stroke comes in. And we get the call and their protocol, not having been there, I didn’t know this, I’ve never had to pick up a phone for a patient that I don’t even know anything about. They said code stroke, gave an age and a female, that’s all I knew, and they handed me the phone. I’m like, what are you doing? Like, I, I have to see the patient before I can talk to the doctor. And that turned out to be like a difficult interaction with a nurse. But you know, a couple months later I get a, I get my one month review at about three months and they’re like, yeah, you had this difficult interaction with a nurse, but she really likes you now. That’s, that’s hard to come back from. I’m like, well, it’s ’cause I’m a nice guy but the difficult interaction is ’cause I was just thrown to the wolves.

[00:07:05] There’s another shift a little while later, somebody signed out a patient who should not have been signed out and, had I known then that the new guy doesn’t have to get dumped on, I probably should have said no, you, you stay and finish this one. I ended up dispo’ing the patient with all the protocols and return precautions and all the things, she had follow up with her doctor the next morning but then that got sent to case review because she came back and if you bounce back within 36 hours. By protocol, it’s a bounce back and then your case gets reviewed. And they said, well, you didn’t actually contact her doctor, so we’re reviewing you as insufficient. I’m like, what? Even though I did everything right? And like, here’s the literature, this is what you, how you treat this kind of patient. And they say, yep. I was like, oh, that’s awkward.

[00:07:54] And then, I helped them bring up their, the new med system, Epic, and we go on and there’s a cardiac alert that comes in and it’s a poor weather thing. The helicopter flies around towards sun valley, we’re in the Boise area, and picks up this patient and it’s bad, and she’s hypotensive bradycardic, when she comes in, we’re like, oh, this is not good. They send us the report, it’s a, it’s an NSTEMI, it didn’t transmit, so we didn’t get that until we got there, but we knew it was cardiac alert. They’d called– or not an NSTEMI, but a STEMI. And they, so they called the STEMI and so I’m treating the patient and I’m like getting her fluids, thinking about pressors started, started the anticoagulants, getting her ready for lab, I’m like, why haven’t I talked to the doctor? They’re like, well, we didn’t page them. It was again, the new EMR, the tech didn’t know how to do that.

[00:08:41] Well, then the doctor got freaked out called a Midas alert, which is like our Midas meeting, which means I’m meeting in front of the entire safety council for the hospital, administrators, nursing administrators cardiac team, ER team. There’s a couple of my ER guys that were there with me. They were all assuming I, I hadn’t page the doctor. I was like, I don’t know why I’m here. And then the tech stands up in the meeting, she goes, I don’t know why you’re all mad at Dr. Fish, I didn’t know how to page them because of the new EMR. So I’m off the hook, but then again, I look bad, right? And so these things are starting to stack up.

[00:09:14] I found out there’s another case in review, and I knew about that case. The patient wanted to be discharged and I’d gotten their labs somewhat normal. They were end-stage organ failure in multiple places and you fluid ’em up for the lactate, then you drop the lactate, you increase the BNP, whatever. So sent ’em home and they bounced back of course. Of course, they were placed on a DNR and they passed a little while later, but the patient was sick of being in the hospital, so I let ’em go home. So I knew I was gonna get another bad review and come November, these things have started to add up and I feel like I’m under a lot of pressure, a lot of scrutiny, and I realize this, so another well-meaning, but probably poorly informed doctor took my wife and I out to dinner and said, you had the one case review that went badly and this other one’s not likely gonna go very well, I’ve read the case. He goes, if you have one more within this calendar year, they’re gonna terminate you. And I’m like, okay. And for the first time now, like right as I started to get in my groove and Epic was something I was really familiar with and things were going well, now I feel like I’m walking on eggshells. Like what patient do I discharge that comes back, that then causes the case review that even though I do everything right, causes them to rate me poorly and then I’m out of a job?

[00:10:33] And so, I’m just walking on eight shells. January the fourth, I end up with a patient that comes in, influenza. She had been seen at an urgent care, diagnosed with influenza, given Tamiflu, that thing that works maybe not very much at all. And then, so the next day she was still feeling bad, so she went back to the same urgent care, she got a chest x-ray, she got a Z-pak and steroids, sent her home. I’m like, okay, now she has three things that don’t work, but okay. Then on the third day, she goes and she’s like, okay, this urgent care, isn’t taking care of me, I’m gonna go to the ER. She goes to the other system, the competing system’s ER, and they get the million dollar workup, CAT scans with contrast, blah, blah, blah, and labs, everything is a hundred percent stone, cold normal, including vital signs. She’s not happy with what happened there, so she comes to see me. Last patient of the day, I spend probably an hour with the patient and her mom and I, I give her some actually nebulized lidocaine, she’s complaining of painful breathing even though there’s no respiratory distress and that made her, of course, feel better, right? Took away the pain, figured out how to put the code into the computer so that it could be ordered again. I discharge her home. I said, look, it’s still influenza and you can come back now that it’s in the computer, we can treat you the same way and you’ll feel better. You can come back as many times as you need to, but your labs are normal and they felt reassured so they went home.

[00:12:02] So then our anniversary the next day, and 26th anniversary, and we’re like, I’m, I have to work that day, I’m partner track so I don’t dare ask for my anniversary off, but I’ve got the following day off. We spend that skiing. I come home from skiing and my brother-in-law, and we just live down the block from him, says, hey, can I come over? And he sounded kinda weird, I was like, yeah. He goes that girl, do you remember that 19-year-old you saw with flu? I was like, yeah, I spent a whole bunch of time with her. He’s like, she came back dead. Full cardiac arrest. She’s on a vent. It looks really bad. And I was like, what? 19-year-old girl, flu. And I was like, I was, I, I was broken. There’s all this pressures been building up. And in hindsight, if I’d been able to absorb those pressures that were building on me before, but I broke. I had a 19-year-old kid that who’s now almost finished with his masters in engineering and, grandkids on the way and kind of a thing, and, and I just was picturing her family not having any of that, and broke. Like I cried right then, like unabashedly, we reviewed the case, everything looked good, everything was done right. Of course the case is gonna get reviewed. I’m like, great, now what?

[00:13:22] So I work the next couple shifts. She’s still on life support. I go up to visit the family, probably not advisable, but at the same time, I just wanted to tell ’em how sorry I was about their daughter. So I, I go up, I see her, mom’s a little bit hysterical, she was the one I dealt with before, but she is like normal, like that’s what you’d expect. Dad is sad, but, you know, accepts my condolences. Grandparents rip me up one side and down the other, and just for the peace of the ICU, I, I go to the quiet room and let them tear me up and down. And after about 10 minutes, I’m like, I gotta go back to work. And they’re like, you’re a terrible doctor and all these things.

[00:14:01] Well, then two days after that I get my scheduled six month review and the review, I mean, I’ve been wandering around in a fog the whole time. I’m very clearly depressed. Like there’s no question, I probably shouldn’t be at work, in a group that large with enough coverage, I should have just taken time off to recover, but that’s hindsight. I go into my review and I walk in and they are like, yeah, this and that, and this, this metric and this metric and oh, by the way, we’re really sorry about that case. How are you doing? I’m like this is what we do. We all get through this somehow, I’ll get through it somehow. And they’re like, well, we reviewed the case and actually the head of pulmonary reviewed the case, you did everything a hundred percent correct, your documentation immaculate, but you know, the families complained.

[00:14:55] And then I guess there was one more unfortunate event. I had a, a patient that had come to me at the end of September and she, she’d been seen by a couple of different doctors who had just increased her pain medication, called it sciatica, called it back pain. And then she got to me and of course that’s a bounce back, right? In the ER, we talk about bounce backs. And so I was like, well, you’re not getting outta here without something. I had ordered a CT scan, I didn’t wanna waste time on MRI at that point, but ordered a bunch of labs. First thing came back was her calcium was like 19. I was like, oh, yeah, now we’re gonna go a little bit deeper and so she had really bad cancer. Held her hand while I gave the diagnosis, said, we’re gonna transfer you to the, this other facility that has our oncology team at it. Obviously, this is really bad. It was up in her lungs, stage four, endometrial is likely the origin. She passed two weeks later. Well, her partner complained, and so I already had a complaint on file.

[00:15:50] So I’ve got a complaint, two case reviews, and now this other patient’s gonna complain. So they said, well, based on your two case reviews and the two complaints, the board’s gonna meet next week and they’re likely gonna terminate your contract. I’m like, that’s great timing. And I’m like, I’m, I’m definitely feeling a hundred percent right now. And but I thought about it. I was like, this other place, they’ll fly me back and forth to work, they’ll put me up, I can just go work a week at a time and, and, and have lots of down time. It would be great. So that was my plan, but I was, I was still just down. And when the one partner had said, Hey, they’re likely to terminate your contract. The other one had very gently said, well, that’s not exactly how it goes, cause I mean, he could probably read better in my face of just like dying on the inside right now.

[00:16:39] So the next day my, I was just sitting there. I had my computer open. There was gonna be a couple charts I was gonna polish up and had a book to read, had some soccer recorded, I was gonna watch some soccer. And my wife kissed me on the head and said, she loved me, and she’s gonna go off with her sister to buy some furniture for my niece who was gonna go to school here at Boise State, and they left. And that was like at 10 in the morning. And I, I don’t know what I did for the next four hours. I don’t, I don’t remember, but I just felt this deep, dark crushing pressure. And I just all of a sudden, the only way out was to kill myself and I just snapped. I grabbed a bottle of pills. She said, are you gonna pick up our daughter? I’m tied up here. I was like, no, you can. And then I turned off my phone and I drove up the hills or I, I sent her kind of a goodbye text, a suicide note, and then turned off my phone. I drove up the hills like literally 20 miles away up in the mountains. And I was like, well, that’s not cool, I didn’t leave anything for my kids. So I wrote a little note for my kids, loved them, etcetera, sent that, turned off my phone again. I didn’t want anybody finding me, and this is where the series of fortunate events begin.

[00:17:56] So, a city police officer drives up, but he’s out of his jurisdiction. So he is just sitting there looking at me, I’ve already done what I was gonna do. I’ve taken a big old handful of pills and I know it’s lethal. Like we’re doctors, we know what to do. And so he’s just sitting there looking at me. So I’m like, this is weird. I think he’s here for me, but I don’t know why or how so I drive away. And then my wife, despite being told to stay at the bottom of the hill, you know, I had guns, she thought I was gonna shoot myself. And of course, that’s what she’s telling police over and over again, he’s gonna kill himself. He’s got guns. And so she’s just, she’s just dying. She, she’s in a panic. Her sister’s driving her around ’cause she can’t drive. They’re both just… so they, they come driving up the dirt road and they semi try to block me and she jumps out of the car and tries to stop me. And I like I’ve already, I don’t wanna talk to her, like I’m broken on the inside, I don’t. I’m done. I’ve checked out.

[00:18:50] So I get past her, I go down the road and here’s the first mistake I made. A police officer, now a sheriff who has jurisdiction there, flips on his lights, turns his car across the road and tries to block me in well. It’s snowmageddon, we have piles of snow, more snow than we’ve had in a hundred years. And I put my big old truck in four wheel drive, take it up through a big old snow bank, go around them. That doesn’t make him very happy. He eventually gets turned around and starts following me. And so I’m just meandering through roads, I’m like looking behind me. I’m like, there’s like seven cop cars back there. So I finally, I’m like pull over. I’m like, what do you want? They’re like, we wanna talk to you. I’m like, well, I don’t want to talk. Well, do you have guns? I’m like, of course, you want ’em? Will you leave me alone if I give you my guns? No, we want you to get out of the car and talk to us. And at this point, my wife comes up and since guns are involved, I have three pistols, three nine millimeters, and two AK or, or two AR fifteens pointed at me. And now she thinks I’m trying to die by my cop. And so she’s tripping out about that and, and I don’t see her, right? I haven’t seen her since the beginning, they keep her held back and then I drive away again. But that was a big mistake ’cause now I’ve pissed off not just one guy, I’ve pissed off everybody. So they blocked me in a little while later and of course, tossed to the ground, tased, cuffed.

[00:20:10] I get a medical clearance sitting in the slushy road, literally sitting in the slush on the road. A blood pressure cuff, and are you suicidal? Yes. You wanna kill yourself? Yes. Okay. Paramedics leave. I get taken to jail and I’m like, you gotta be kidding me. You’re not gonna, I I’d asked to go to the other, the competing ER, cause I don’t wanna deal with any of my partners, or former, not partners, whatever. And I was like, they take me to jail. And supposedly I’m on suicide watch, they’re like– I was sick and unsteady, they’re like, why are you sick? I’m like, well, I’ve been up for like almost 40 hours now, how would you feel? Like, fine go over there. And I remember laying down on a concrete bench thinking this is it. And that’s, that’s the last thing I remember for a couple days, like three, four days.

[00:21:07] My wife, my sister-in-law keep calling the jail. He’s an ER doctor, he knows how to do it. Have you checked on him lately? My sister-in-law called again at 2:45 and somehow that simulated the nurse. I don’t know if I’d been checked on before that, I’ve been, I’ve been face down on a concrete bench for five hours at this point, six hours. And so, the nurse comes and checks me as I’m taking my last breath. Well you’ve been in the ER, you know what agonal breathing is, my heart was probably already stopped. They start CPR, it doesn’t come back. The paramedics arrive. I’m shocked, but I’m unresponsive. I guess I’m responsive to pain, but I’m posturing, like flexion contraction of everything to pain, but not localizing the pain. And that was my best response in the ER. They did some scans, they did some labs. I mean, my lactate was, I don’t know, 15 or 16, my BNP was jumped up. My troponin was jumped up. I was in acute renal failure, I think creatinine and BUN were like close to 4 and like 46, or something like that from a normal healthy guy just a few hours before. So I don’t know how long I’d been down, but it was, it was bad.

[00:22:24] They stick me in the ICU, but you know, like I said, as much as things were going south for me, the nurse happening in at that time, I mean, she had waited five minutes, I wouldn’t be here. They get me upstairs, I’m– things are really bad. I’m on three pressors, maxed out, nothing’s responding. And it’s really bad. My labs are getting worse, not better. They poured a bunch of fluid on me, so my, I guess, my lactate had dropped down around 12 or something like that, but they’re still expecting me to die. My wife gets a call come to the hospital, he’s had cardiac arrest, that’s where he is at now. So the family’s all there. They can’t see me because technically, I’m still arrested. In fact, I have a picture of me cuffed to the bed, completely intubated, and unresponsive without sedation. Like I’m checked out, there’s nothing left.

[00:23:13] And so they’re calling family from around the country to come in and see me, and my brother, the ER doctor’s, sitting there and he and our very courageous intensivists are looking at me and they’re like, well, he is got right heart strain on echo. Maybe he’s just got a massive PE, we’ll just give him TPA. Well, after 15 minutes of CPR, TPA is a pretty courageous thing to do. No idea what the outcome of that’s gonna be, but it worked. My daughter found what I had taken, they started doing some reversal things as far as that goes, TPA, and all of a sudden I rebound But I end up being on a vent for the better part of four days before they extubate me.

[00:23:53] I don’t have a lot of memories, I think I met with a psychiatrist at that point. He asked if I was still suicidal and of course I said, yes. But I was really groggy and not there. And it wasn’t from sedation, although I had been sedated for a few days at that point, right? As they’re weaning me off of that, the first thing I remember is really waking up and I had several of my siblings, my father, my mother, my kids, I had two adult children that still lived in Ohio had flown out. They were in disbelief, they’re like, they get they’re told to come fly out, that I’m dying. They’re like, nah, he’s, he’s not suicidal. He did, they didn’t understand. They’re like, he’s just, maybe he just wants attention. Like that’s, that’s not dad, he’s Superman, he’s gone through everything. There’s nothing that can make him do this.

[00:24:40] Well, I wake up to non-judgmental– my wife was very, she had curated what was gonna happen very well. She’s like, everybody just love him, nobody talk about it, and there’s, she had just created this environment of kind of love and welcoming. And I started to realize, I was like, Ooh, I almost checked out all of this. And that was a good place to start. I, I knew the drill, right? Worked in the ER, I know what a 72-hour hold is. I also know that if I check in myself, then I have a little more control over my situation. So I check myself in and I stayed for a little over 72 hours, but I’m watching my wife come visit me and I’m realizing the damage that I’ve done. Right? And when I started focusing externally on what was around me, it was a clear turnaround.

[00:25:28] And I mean, I should be clear, like for people who are depressed, of course, we’re talking to you, right? And with COVID and everything happening there, that’s a lot of people. But there’s people who don’t think that they’re depressed. Well, that was me, right? I’ve seen the wellness lectures, whatever, I’m fine. I love my job. Everything’s great. The people who think that they’re not depressed and this doesn’t apply to them, it most definitely does. I’ve never been depressed. I’ve never taken medications, currently don’t take antidepressants, don’t need them. It was 100% job-related. And it was pressure on pressure and it’s the same thing that’s been happening with COVID. Like we’re looking around and the 300 to 400 docs per year has definitely accelerated. I don’t know if we’re ever gonna get a clean number from that because the way things are reported for physicians. But definitely suicide has been in the news more than it’s ever been in the past. And if that’s the case, then it has definitely gotten worse.

[00:26:31] Yeah, super happy to be here. I had anoxic brain injury I think before I checked myself out of the psych facility, they had done another MMSE on me and I, I couldn’t do serial sevens. I like, my brain just was a little bit fizzled out still after being deprived of oxygen for who knows how long. But I’m excited to be here and the message isn’t without hope, right? I mean, I really feel like people who go through things like this have a chance to bounce back. I know a lot of people don’t want to share the story. I won’t lie to you, there’s a little bit of shame involved in this. I would rather pose naked for a magazine than talk about this openly with my name attached to it, but I also know that the story needs to be told. And that if that’s my job, while I’m not letting my suicide define me, it is forever part of my story. And if I can help other people, that’s what I need to do.

[00:27:49] Dr. JB: Thank you. It takes a lot of courage to be able to share your story. And I thank you for, for sharing it here with us at Hope4Med.

[00:28:05] Dr. Fish: You’re welcome.

[00:28:06] Dr. JB: You know, suicide amongst physicians is a huge, huge problem.

[00:28:14] Dr. Fish: Yeah.

[00:28:16] Dr. JB: Yeah, it’s a problem. Mm-hmm.

[00:28:18] Dr. Fish: There’s, there’s tons of risk factors for us. We talk about, there’s a great book, “Why Physicians Die by Suicide,” from Dr. Michael Myers and he’s worked with suicidal physicians, he’s talked to survivors, and he has some risk factors out there. Perfection, holding ourself to some sort of almost unholy standard, unattainable standard, right? Us physicians we look around, it’s not the hundreds that we’ve saved. It’s the one that we lost. Right? We have this kind of standout personality. We’ve always excelled and done things well, and then when things start caving in, that starts to crush, right? There’s the sensitive physician. Most, most surviving family members would describe their lost ones as very sensitive. I spent an hour with a patient, like literally talking them down from anxiety and stress and worry. I think physicians in general, one another risk factor is like the narcissist, which I don’t think fits the average physician. There’s healthy narcissism, right? You can’t, you can’t even step in and take your board exam without a little bit of like, okay, I’ve studied, I’m ready, I’m gonna, I’m gonna do this, right? You can’t send a patient home ever, unless you believe in yourself and your diagnosis, so that’s a little bit of narcissism. But the unhealthy narcissists, we all know the specialties that kind of attract them, those guys are usually more fragile on the inside.

[00:30:01] There’s the wounded healer, the people who get into medicine because of something that happened in their life, something they’re trying to fix, the orthopod who was the injured athlete kind of a thing. Yeah. And then Dr. Thomas Joiner was, is quoted in that book as there’s like the lethal trifecta and if you meet all three things, one, I felt like I was a burden to my family, that was exactly what I wrote in my suicide note. I’m sorry, I’ve drug you across the country multiple times for medical school, for residency, but after one last hurt, I won’t hurt you anymore.

[00:30:38] And then the feeling of not belonging, right? You feel like you don’t belong well, I’m getting kicked out of an ER group, even though I know I’m a good doctor. I’ve been told I’m a good doctor, I practice next to other academic clinical physicians and been told I’m a good doctor. But that’s not what’s happening here, I’m having my sense of tribe taken away.

[00:30:57] And then if the individual has the ability to carry it out, most physicians, we know it doesn’t take much to carry something like that out. So yeah, lots of warning signs. We’ve gotta figure out how to stop the suicide rate. I guess my message for that is start the conversation for yourself, for others. Nobody ever asked if I was suicidal, and I wasn’t at the time, but people did frequently ask– and this is what everybody did right around me– how are you doing? Checking in with me. I mean, I’m a normally chipper guy at work, like I am happy to see the next patient. I’m happy to help the nurses out, I’m happy, I don’t ever yell at the nurses, but I was just dragging my feet like I was wearing a pair of cement shoes. But you know, they did a survey, I think, I, I forget who did the survey, but it was published on one of the MedScape articles, they, they surveyed 1300 physicians– so this is prior to COVID– this is 2018 and out of 1300 physicians, 9% had actively, I think I forget the number for depression, but 9% actually said that they were depressed and had considered suicide, and 1% of 1300 people had attempted. That’s bad. And that’s prior to COVID.

[00:32:27] I’ve actually been approached, I’ve, I’ve lectured for residencies and and some national meetings and stuff, regional ER meetings and stuff, and every single time I’ve lectured, somebody has come up and talked about themselves and ” your story was me” thing. As my previous residents and previous like residency classmates and medical school classmates found out that it was me, to a T, every single one of them were stunned. I was not the depressed guy. I was the unstoppable, put another roadblock in front of me, I’m just gonna smash through it. But everybody has a breaking point. And if you don’t start the conversation, if you don’t talk about those feelings, they build up. You can, you can put ’em in a shoebox and file ’em away, but if you keep doing that, eventually they come out way stronger than what you had before.

[00:33:23] And if you start talking about it, if you recognize that people are down, if people aren’t acting right, if they have hopelessness, if they have withdrawal, if they’re talking about death or suicide, if they’re giving stuff away if, if you notice they’re looking for access to things like buying a gun or something like that, or they’re acting recklessly, increased alcohol and drug use, you need to be open. You need to be candid. You need to ask them, are you suicidal? Contrary to popular opinion, evidence shows you can’t make somebody suicidal by asking them about it. You can’t, that’s not the way it works. And then you try to be supportive and you don’t ask the question, like, “you’re not suicidal, are you?” You’re like, have you thought about harming yourself? Are you thinking about suicide. And then you need to be, even though it might slap you in the face, like you’re stunned, you need to be supportive. Well, how can I help? What can I do? Ask ’em if they have a plan in mind, this is what we do in the ER every day, do you have a plan? They’re at higher risk if they do. You can get them help, right? If you can’t stay with them, then you need to get ’em checked in. As much as they’re gonna hate you for it in the moment, you need to get ’em checked into the hospital. Get support from friends and family if you can’t stay with them. If they have, if they have a health, a mental health professional, get ahold of them, let them know what’s happening.

[00:34:46] There are so many things that you can do to prevent it. In the end, you can’t take responsibility for what they do, that’s not what I’m saying, but imagine if you didn’t say something. I had a two months out, still really in bad shape, chest compressions had dislodged cartilage and stuff, and yeah, I’d lost a whole bunch of weight, it was, I was still looking pretty bad, but we had just like an open house for some of the nurses that I’d worked with. And I didn’t realize the secondary harm to them ’cause they all felt bad because they felt like they hadn’t asked. You’re not alone. Start the conversation. You can be peer support for somebody and just venting frustrations and venting sadness and allowing some of those emotions out instead of locking ’em in, is gonna put you in a better place or your partner or somebody else in a better place. So I guess that’s the message, is you’re not alone.

[00:35:49] Dr. JB: That’s a powerful message because so many people, so many healthcare professionals do feel alone, isolated, like there’s something wrong with them for feeling the way that they do or responding the way that they respond to different situations. And then externally, they look at their colleague from across the way and they seem like they have it all together.

[00:36:19] Dr. Fish: And like I said, I have really close friends. I have a couple of really close friends, was talking to one of them, he was driving into a shift and he was a little bit distracted, at that point a little bit burnt out, similar situations with his job as I had had. And he was a phenomenal clinician, but had some patient complaint, some case review, whatever. And I got to the point and he goes, wait, what? I was like, yeah, dude, I took a bunch of pills. I almost, I don’t know why I’m here, like my labs, other than people who live chronically with some of those acidosis, I shouldn’t be here. You look at my labs, those are probably unsurvivable, in most cases. Out of hospital arrests are the odds, like super low. And he pulled over and he started crying and he said, Boyce, I, I had a gun in my mouth. I don’t know why I didn’t pull the trigger. And again, happy-go-lucky guy, not depressed, but the burdens that the job is placing on him.

[00:37:43] I mean, Jimmy over at the Physician Philosopher talks about medicine as a dumpster fire, and I don’t know that he coined the term, but it’s pretty accurate. I mean, we’re just staying around watching the whole thing burn down around us. And for-profit hospitals prioritizing profits over people, bad, bad choices, not trusting physicians to make good clinical decisions, putting clinical pathways in, I can’t tell you how many of those things I’ve seen come and go, time to pain medication for a long bone fracture, and then all different things that have come and gone. And you’re just like, why aren’t we just practicing medicine? why don’t you just trust us to do what we came here to do the vast majority of us aren’t here for money we’re here because we wanted to help people. That’s our job. We help people. And if they would just trust us, it would get better.

[00:38:39] Instead, there’s a coin that they’ve used, a term that they’ve coined in the military called moral injury, and it was PTSD cases that were refractory to the standard therapy. And they realized that all of these cases had something in common, they had either done something that they thought was morally wrong or witnessed something that was morally wrong or had not acted in a way that they thought they should have. And one of the British journals, the first time it started being relayed this way, said you have no right to co-op that term, medicine isn’t like that. I’m like clearly that dude’s never worked in an ER, which is essentially a battle zone, and especially over the past few years with people getting cursed at and sworn at and spit on and all the crazy things that are happening to doctors. But you think about it and moral injury really, I mean, having case reviews, even though I’d done things right. Having complaints, even though I’d done things right. That’s moral injury. And between that and having overworked myself prior to that, I had given myself a little bit of burnout. But if you, if you coin the term moral injury, people are more likely to be like, yeah, the system’s broken, not me.

[00:39:52] I talk about wellness as a four letter work. And only in this, clearly it’s not spelled with four letters, but you know, you think about physician wellness and that implies that we are all unwell. Are we, or is the system broken? Are we being forced to do things that aren’t correct? Well, you gotta give that patient pain medication, otherwise they’re gonna complain, and if they complain, then the hospital gets rated. And literally I have seen in a, in a hospital system, an administrator on call be called down by the patient because the ER doctor said, no, it’s an ankle sprain, I’m not giving you narcotics. You can have ibuprofen and a walking boot and crutches, and we can take care of this like everybody else. And that administrator talked to the physician and said, why aren’t you giving him pain medication? ‘Cause there’s nothing broken and this can be treated otherwise. And the family gets gift cards to a restaurant and another physician’s called in to give them pain medications. What the heck? I mean, the inmates are running the asylum.

[00:41:02] So, they talk about physician wellness and there’s been so many wellness programs, I think they’re getting better now, but ” practice mindfulness and deep breathing for two minutes during your shift and you’ll feel better.” Really? How about you just give me enough nurses? Or how about, since I know you’re a private equity group trying to make money, but how about we staff another physician since I’m seeing 30 patients in a shift? Or get me a mid-level that can take some of that pressure off? And so physician wellness, I mean, during COVID story of they’re down a physician, a mid-level, and multiple nurses because of COVID, and what does the administration do? The wellness committee brings ’em pizza. Really? That’s not gonna make ’em well, maybe just greasy and fat. So, yeah, we are the most resilient people. Made it through medical school, made it through residency, we’ve just gotta find our way back.

[00:42:01] And I’m so happy that you’re out there podcasting and I’m, I’m happy that you have medical students and residents that are listening so that they have an idea of what’s coming.

[00:42:09] Dr. JB: I say, entering healthcare with eyes wide open. It’s something I didn’t have when I, I was watching Grey’s anatomy.

[00:42:21] Dr. Fish: So was my wife. She thought for sure I was gonna hook up with a nurse in elevator, like we don’t have time for that, I don’t think you understand. I, I trained in the day where we didn’t have patient caps. The one patient cap I had was at a internal medicine, I got pushed into it ’cause they wanted to keep the rotation open, but I already hated ’cause you just got worked. And as a medical student, you were capped during your 24-hour call at 10 admits. And that was the only cap I ever saw. Everything else was see as many as you can, do as much as you can. I remember back in the day when we were doing paper charts, you would literally sign as a medical student, an order for whatever and the only thing that was required is the resident that was supposed to supervise you would come around a countersign it later. Like we were practicing medicine back then and it was not Grey’s anatomy. And there’s not a bunch of beautiful people running around. There’s a bunch of bedraggled, beat up, drug out, but that’s where I think things can change, like for, as an individual, you have to take time for yourself.

[00:43:29] And that’s one of the things that I talk about in my life coaching is like, managing circumstances. Well, there are circumstances, right? You’re a resident, maybe you’re Q3 call or do they even do that anymore? I mean, that was, that was our trauma call, it was Q3 call, right? Every third day, you’re there for 30 something hours. And that might be a circumstance, but then how you think about that call changes how you feel. And so during my life coaching, it’s like, yeah, you’re miserable. Do you like that? No. Well, why don’t we redefine what the circumstance actually is like fact from fiction, what is the actual story? You’re a resident, you’re on Q3 call. How do you wanna think about that? You wanna think that you’ve only got four weeks of your six week or one week left. How does that make you feel? Well, like I have hope. Well, why don’t we focus on that? And changing people’s perspective from the inside out just by changing their thoughts, completely changes how they feel and then how they act. And I feel like this is a place that coaching is starting to make end roads for physicians, for medical students, for residents, it has a lot of power to bring back your resiliency. Resiliency that got beat out of you one way or another.

[00:44:47] Dr. JB: Yeah, I think along those lines, what you just said perfectly aligns with the mission of Hope4Med and especially with the potential or coaching and the importance of mindset. It’s extremely, extremely important because once you change your mindset, you regain your locus of control. You regain your power. So many of us feel hopeless, helpless, and the truth is you’re not.

[00:45:18] Dr. Fish: Not at all. And it’s just finding that medium. I mean, it’s not Pollyanna tip toeing through the tulips. Real stuff happens, but I really feel like if I had had a coach during those times to walk me through the processes. Well, how do you, does that? I mean, you’re making it mean that you’re a bad doctor, or you’re making it mean that they don’t like you, or you’re making it mean, is that, is that actually true or is that something that you’re thinking? And once you define fact from fiction there, you change how you think about it. And if I’d offloaded some of those pressures, then truly, I, I don’t know that I would’ve snapped on that case. And that’s again, you’re, you’re not alone in this. You gotta talk.

[00:46:12] Dr. JB: And so, with the offerings of Hope4Med is it’s a place where you come to release. I, I talk about the three R’s right? Engage in three R’s. And what are those three R’s? Well, one is release. In the very beginning, I used to refer to Hope4Med as a pop off valve, right? Just someplace to just, you know, the pressure’s building up, building up, building up, oh and I pop off, okay, like I can go back, I can go back into this battle and keep, keep at it, keep at it, right?

[00:46:41] Both of us work in the emergency room, when do you have time to debrief on anything, right? The waiting room was, is filling up, the patients are after you for a variety of things, doc, I need pain meds, this family’s calling, like you step out of the room, you get pulled in a million different directions, right? And then when your day is done, what do you wanna do? Do you wanna hang out in the ER and decompress? No, you wanna get out of there. You just wanna leave and you wanna forget about it and you don’t wanna even talk about it when you get home. And then you sleep. And if you’re working a stretch, you wake up and you do it again, right? And so I realized that there wasn’t this place where, you know, when I’m ready to debrief or process or whatever, according to my schedule, where can I go? Who can I talk to? And so that’s why Hope4Med was created, to be this, and then again, as an ER doc, ER doc, ER doc, one of the things that I hate is, oh, I can meet with you every Monday at three, right? And…

[00:47:56] Dr. Fish: But I work every third Monday, right?

[00:48:00] Dr. JB: Exactly, right. Or maybe I do want to meet up because I’m getting off at two, but a code comes in and I’m not able to leave when I’m supposed to leave, right? When I’m scheduled to leave, for whatever the reason may be. And so, you need that flexibility in there so that we don’t wanna add more pressure to the pressure that’s already there, right? So we needed to have something that’s available. That’s just available for you when you need it, when you want it, 24/7. And so that’s what Hope4Med, we’re gonna be launching soon, but that’s what it’s gonna offer. It’s through the lens of an ER doc that this was created.

[00:48:46] But going along with what you were saying, it’s so true. It’s, it’s so true that a lot of, a lot of the times the healthcare professional doesn’t have this diagnosis of major depression disorder or anything like that, right? And like you said, you weren’t diagnosed or feeling super depressed before, and you not on medications after. It was just this period where the pressure was building. You’re like in a pressure cooker, right? It kept building and building and building until you acted. And I’m so, so happy to know that you were found, you were surrounded by so many people who loved you and kept and kept trying to intervene. And even after you were arrested, they’re like, oh, the guns are out, they were like, no, no, no, no, no, keep an eye on him. Cause there were so many people who loved you and love you, and those same people were there before, but sometimes when we get into this dark place, you forget about all the support that’s, that’s there and all the love that you have, right? And sometimes you just don’t feel like people understand, can relate, can truly relate, right?

[00:50:10] So that’s why, with health Hope4Med, it’s for healthcare professionals. Cause I completely understand what you’re saying to me. I completely understand your story. I won’t say 100%, I will never say 100%, cause of course we never could say 100, but I follow you 95% of it, at least. Right? Because we got the same hoops.

[00:50:28] Dr. Fish: I, I would be shocked if you say you didn’t have some of those stressors and feelings in your life, I’d be stunned.

[00:50:34] Dr. JB: Oh my goodness, of course, right?

[00:50:35] Dr. Fish: I’d be like, where do you work? I wanna work there.

[00:50:38] Dr. JB: [Laughs] Right?

[00:50:40] Dr. Fish: That’s not how it goes. I don’t, I did have a perfect job, they closed that hospital, but I had, I worked inner city in Dayton, Ohio, and I loved it. Those were my people. They didn’t have doctors sometimes or they didn’t understand why they were on medications and I got to teach them and I got to help them. And I loved, I loved my people. And they would tell you that, they, they, my patients would tell you that. I mean, a few of ’em obviously, pain meds, whatever, but the vast majority would tell you that I, they knew that I cared. And I had a case where somebody had filed a complaint with NAACP that I was a racist and this and that, I think it was the COO of the hospital was also black, came in, did his research, and then he approached me. He is like, we’ve got this letter. I was like, yeah, I heard about it. I don’t know what to do, like I’m not gonna change the way I practice. I love working here. I love helping people. If somebody thinks I’m a racist, I don’t know what to do about that. And he goes, well, I’ve done my homework, he goes, if this letter from this lawyer representing the NAACP goes any further, we are putting our lawyers behind you. You don’t have to worry about it. Because it was obvious, like I loved my job, I loved my people. I loved working there and somebody’s throwing around the race card on me.

[00:52:17] That was the perfect job for me. I was working with my people, for people who appreciated care. I loved that. I was not quite as good as serving a medical mission. I’ve done a few of those down in Haiti and Croatia and I’ve done some, some mission work and that is truly rewarding, but you know, you can’t do that forever ’cause it’s free. In fact, you’re usually paying money to be there. But yeah.

[00:52:45] So yeah. I’m glad that things are, I’m glad that you’re out there for people. I’m glad that you have an audience of people that have access to hope, ’cause really that was the absence of hope was where I stopped.

[00:53:00] Dr. JB: So what made you decide to transition into life coaching?

[00:53:05] Dr. Fish: It is a long story, but, I had, I had shared my story multiple times and I had seen the effect of it both with the initial blog that was on Kevin MD, pamela Wible wrote up my story with a little bit of, I guess she took a few liberties with it, but at, at the same time, it was a well written story that kind of touched people. And it was really obvious that it did. And then I was approached by people who knew that story was me and they said, we want you to talk to our residents and then more residents and then a whole state’s worth of residents. And then a national meeting for obstetricians and gynecologists. And every time I’ve done that, I’ve been overwhelmed of people who wanted to talk about their story, of their mentor who just committed suicide, of their friend who just did that, their family member, a nonstop and so much so that I told them at the conference, I was like, well, when is my presentation? What does the rest of the day look like? Because I’m gonna tell you it’s hard for me to get away from people. They want to talk. And that’s what I’m there for, is to talk.

[00:54:13] So my wife was in, after we’d done a few of these lectures, she was she’s like, you should be a life coach. And she’s sending me these podcasts, and I was like, yeah. Don’t get me wrong, I’m like this, this might sound, they were like kind of a girls club. Lot of female life coaches out there, there’s not a lot of guys. And I said, I don’t see any, well, and then she sent me one that was from a doctor’s panel, also all female at that point, and then she sent me one from a men’s panel, for men’s coaching. I was like, wait a minute, there aren’t enough male life coaches. And there aren’t enough male physician life coaches. Right? And from the life coach school where I certified, I think there’s over 280 physician coaches now that have gone through certification. And the vast majority of them in some way are reaching back out to physicians. Some of ’em focus on finance, some of them focus on various aspects and, and clearly burn out, moral injury is my focus. I want to help people. I, I feel like if my story is going to help people, then people will reach out.

[00:55:23] My people will find me and I have not done any advertising for my clients, it’s been word of mouth. And, and people have found me and wanted to be coached and needed to be coached. And I’ve seen phenomenal results. Right? And if you talk to some of those 280 something physicians that are also coaching, you will have story after story after story about lives just massively changing. Massively changing. And that’s, that’s the goal is I, I’m not here to talk people in or out of medicine, that is your choice. But if you’re gonna say goodbye to medicine, let’s make it a good bye. Make sure you’re doing it for the right reason, make sure that the facts are separated out from the thoughts and the feelings. And if you don’t want to get, if, if you cannot see a way back to what you envisioned as a physician, then let’s find something else for you to do, ’cause there’s plenty of things to do for physicians. And if you do find your happy place and realize, maybe this is just a malignant job, despite what some people might think, that was definitely my situation there. That might make some people mad, but it was very malignant.

[00:56:36] My brother-in-law before I came out here compared it to the firm and just how treacherous it was gonna be. And I was like, yeah, I can do that. I’ve done hard things before I went to medical school with kids, come on now. Before I was outta residency, I had a kid in college. I can do hard things. Yeah. Well sometimes. But yeah, that’s, that’s where life coaching went is I just, I felt like if that story was that powerful, then people needed to be coached. And there’s a lot of people that wanna talk to me because I’m “that guy.” And when I say “that guy,” let’s put air quotes around it, that guy is the guy that is the kryptonite to doctors invincibility. Right? I’m proof that doctors aren’t Superman. And since I’ve already done the worst thing and I haven’t run into any of my clients that have gone as far as I went, but I know some of them have thought about it, but since I’ve done that, they feel open to talk to me about what’s going on for them because I’ve already done, it’s, it’s easier to talk to a guy that has been around the block, so to speak.

[00:57:49] Dr. JB: You were given a second chance.

[00:57:52] Dr. Fish: A hundred percent.

[00:57:54] Dr. JB: Whatever the, whatever the reason was and, and right now, listening to your story, and I’m realizing that you are providing unlimited amount of, of good in this world. You were doing it already before this incident, and now you continue even afterwards, it’s just on a, on a different, deeper, more profound level.

[00:58:25] Dr. Fish: So here’s the thing, let’s say you are a burnout physician. If I change your perspective on life, say that we end up, you find your happy place again, and you’re working again, how many people does that affect? Every single nurse and tech that you work with, every single patient you see from now on, affecting one person has a watershed effect of, of what it changes. Not to mention if you can just avoid a few of these 300 to 400 prior to COVID numbers of people dying every year. That’s a medical school class and then some, every single year is dying. We don’t have unlimited numbers of physicians. And with number of physicians leaving medicine increasing at a breathtaking rate, just helping a few of them come back or leave happy, however, however they want to get to it, just helping those people, that’s been my goal.

[00:59:33] Dr. JB: And how long does it take to make a physician?

[00:59:38] Dr. Fish: How… Well, how long? Well, when you’re about 30, you’re a doctor, right? Like it, if you’re trying to get people to train in a profession, I have no idea what the admission number’s gonna look like after COVID, but nobody wants to be a doctor after COVID, right? After seeing what the doctors went through. But you know, four years of medical school, four years of residency, and that’s be that’s before you already did four years of, you know, of undergrad. If you took the shortest route.

[01:00:09] Dr. JB: How long does it take to lose one?

[01:00:16] Dr. Fish: There’s people quitting after a year. I mean, it, it, in, in the case of suicide, it can be a matter of months. It takes months.

[01:00:29] Dr. JB: In the case of suicide, it’s seconds, right?

[01:00:32] Dr. Fish: Yeah.

[01:00:32] Dr. JB: But, so it takes 30 years to make one and seconds for them to die. So, the significance of this conversation and conversations like this cannot be underestimated. When I came up with the, the whole concept of Hope4Med, I thought if this podcast makes it to the ear of even one healthcare professional who was contemplating suicide and it contributes to them changing their mind when they realize that, oh, I don’t have something inherently wrong with me. Like I’m not alone. If this podcast can do that for one person, one person is enough.

[01:01:35] Dr. Fish: That’s what I say every time I lecture. And I’m always nervous and I’m always ashamed, and I shouldn’t be, right? But it doesn’t change the fact, I’ve done a lot of thought work and a lot of coaching on this. Self coaching and talking to my coach about this, like, but every single time I’ve spoken, it’s not one person. It’s not one person that hears the story and it affects them. It’s dozens. It’s everybody in the room. That last one in Texas a couple weeks ago, people were dabbing their eyes. It was, I had everything, I looked like I had everything, and I threw it all away. And then the story about my family and the secondary harm and all of the things, it’s gut wrenching and gives you perspective. And I think in some small way gives people hope, but in the biggest way, it starts the conversation. You’re not alone, might feel like it, but you’re not alone.

[01:02:55] Dr. JB: If my listener wanted to find out more about you, how can they do so?

[01:03:01] Dr. Fish: You can find me at my website. There’s, there’s two ways to do it. The website is www.thelifecoachphysician.com, but it’s probably easier, I’ve got another domain, drboycefish.com, D R B O Y C E F I S H.com that points right to it. They can reach out there and do a contact me thing, from there they can schedule a consultation call, which is a hundred percent free. I actually offer a money back guarantee on all my coaching packages. It’s, they can find my story there. We are in the process of, I’ve got fancy microphones here getting ready to start my own podcast. We’re creating evergreen content that will eventually be sold as coursework, that will be a cheaper way to access coaching. Still trying to work out the details of how to deal with medical students and residents, because it’s a need, but at the same time, if I’m taking time away from other clients, then I do need to be reimbursed somehow, and I think the model’s gonna probably be group coaching, is offer people, access to group coaching as medical students and residents at, at a much cheaper rate. So yeah, reach out if you want to talk. If you just wanna chat with me for a free consult call, I’m always available. I have set times you, you use Calendy, it’s I do the same thing. They log in, they schedule a call, and we work things out.

[01:04:33] Dr. JB: I wish this podcast was being sponsored by Calendy. It’s great.

[01:04:39] Dr. Fish: It works really good. There’s a couple of ’em out there, but…

[01:04:43] Dr. JB: So, in closing, do you have any pearls of wisdom you’d like to leave my listener?

[01:04:49] Dr. Fish: Yeah. No matter where you are on the road to medicine, you do need to focus on what brought you there and what the goal was and what your dream was. How did you want to practice medicine? And it’s probably still available to you. And you’re not alone. Like, everybody’s struggling. The struggle bus has unloaded everybody, but at the same time, reach out, talk to somebody, it doesn’t have to be me. There’s other coaches out there if, if my story does not resonate with you, there are dozens of coaches out there, and I can point you to other people if you need me to, but find somebody to talk to because you do not want to be me.

[01:05:37] 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 pre-recorded come learn some, each one teach one. I’m done.