#113 Reading the Ladies of Medicine
Redefining Real Selfcare: a review
Image from Black Rose Writing
National Women’s Physician Day occurs on February 3rd every year to celebrate the birthday of pioneering lady doctor Elizabeth Blackwell. Women physicians have made great strides in practice, academia, administration, and in authoring books. Like their male counterparts, many female physicians have chosen to share their creative talents in memoirs, medical references, and other genres of storytelling. I have reviewed several here in The DO Book Club column.
The stereotypical portrayal of a male physician struggling through sleepless nights or falling in love with a pretty young nurse, have been nudged aside by a cadre of women physician authors. As a premed, I was inspired by Dr. Elizabeth Morgan’s classic The Making of a Woman Surgeon. In Not an Entirely Benign Procedure, Dr. Perri Klass featured the engaging stories and lessons she learned as a pediatrician.
Dr. Danielle Ofri has contributed several medical memoirs and narratives from her rich experience as a general internist at Bellevue Medical Center in New York City. Her book, When we Do Harm is reviewed here. In 2020, Dr. Michele Harper added the voice of a black woman who trained in and practices emergency medicine in The Beauty in Breaking.
Drs. Madha Singha, Shirlene Obuobi, and JL Lycette are practicing women physicians who have chosen to write novels with diverse characters, who work as physicians while they fall in love, get their hearts broken, and solve a few mysteries. Dr. Rebecca Levy-Gantt, who practices as a gynecologist in Napa, CA, loved to write the narratives of interesting cases and dramatic deliveries she saw during her training and years of practice. She published two volumes and is now turning her attention to educate the public in her newly published book Perimenopause for Dummies.
Dr. Rana Awdish shares her harrowing story of the doctor as patient in her memoir: In Shock. After observing some of the dismissive and hurtful communications she experienced as a patient in the Detroit intensive care unit where she worked as an intensivist, Awdish wanted to help make a change. She spent more than a decade writing her book and creating a program to improve communications between physicians and their patients.
In my own case, after a career practicing emergency medicine, I wanted to send a message to physicians, nurses, and other clinicians who are suffering with challenging patient interactions. I wrote Changing How We Think About Difficult Patients as a gift to all the healthcare professionals. If clinicians can accept their patients and their difficult behaviors, perhaps more will stay at the bedside taking care of the aging population of baby boomers like me.
Redefining Self-Care
photo by Joan Naidorf
Dr. Pooja Lakshmin is another physician who recognized the need to share her expertise and advocacy work with a wider audience in the form of a book. She noticed the high achieving perfectionist ladies in her psychiatry practice were struggling as part of a wider, systemic problem. In response, she published Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included)
Lackshmin notes that the game is rigged against women in American society. Women are expected to work full time jobs, care for the kids, the pets, and the home; all with inadequate childcare, lower pay, and scant parental leave. Throw in the stressors of on-line learning during a pandemic, appearing at kids sporting events, being a wife, and caring for elderly or ailing parents. Lackshmin was not only feeling the overwhelm and burnout herself during the days of her psychiatric residency, she was also noting the distress daily in the postpartum women who were coming to her for mental health treatment.
In response to the feelings of drowning, ladies are sold what the author calls “faux self-care” as the solution. Here is where the meditation apps, crystals, cleanses, and bubble baths come in. Lakshmin notes that a mani-pedi, although lovely, will not solve the systemic issues of inadequate childcare and long work weeks. The author writes that,
“Real self-care, as you’ll see, is not a one-stop shop like a fancy spa retreat or a journalling app; it’s an internal process that involves making difficult decisions that will pay off tenfold in the long run as a life built around the relationships and activities that matter the most to you. “(page xiv)
The author goes about explaining some of the systemic issues by sharing her own life story as well as the typical experiences of several of her patients. Once people understand that many societal pressures have placed them in an impossible position, they can stop feeling blame or shame and make their own decisions. Women can take ownership of their choices and their time so they can feel more empowered in their work and personal lives.
The Four Principles
To accomplish this rather tall order, Lakshmin introduces four principles of real self-care with useful self-assessment exercises for readers to become more aware of where they fall on the scale, she devised to identify people in the green, yellow, and red zones. People in the red zone are what I affectionately call a “hot mess.” We have all been there at one time or another. She recommends coming back to the self-assessment tools to guide useful actions and to judge your progress over time.
The first principle is setting boundaries and dealing with guilt and reaction of others. Boundaries are defined as the pause one makes before deciding. One can decide yes, that something or request aligns with what they want and their values, or no, they do not. The second principle Lakshmin describes is self-compassion. She teaches how to adopt less critical self-judgement and more kind self-talk.
The third principle is getting clear on your values and this is hard for many women who are raised to put their spouse’s and families’ needs first. Lakshmin helps with more assessments and exercises. She writes,
“It looks different for everyone, but it means that you feel connected with your values and are engaged in activities that align with them. Identifying our values in an explicit way emboldens us to make clear choices. And those choices lead to purpose and a sense of fulfillment.” (p. 164)
The fourth principle is recognizing your power. Although there is so much that is out of one’s control, there are dozens of daily decisions where one can exert her own power. Lakshmin advocates becoming more hopeful.
“People who are hopeful don’t pretend bad things aren’t happening- rather, they understand that to move forward, we must integrate the good with the bad.” (page 203)
This is a short and useful self-help book that people can revisit as needed. Dr. Lakshmin reminds us that, “Real self-care is not a thing to do – It’s a way to be.” (p. 197)
