Okay, hi, Dr. Foddy, sorry about that. I'm not quite sure why you didn't get the response or the invite. Can you hear me? Can you hear me? Yes. Okay. Yep. Let me Sorry. Okay, I should be able to hear you now. Hello. Hi. Figured out another way. Okay. I'm not quite sure what's all going on here. Yeah. So, does it allow you to share your screen. Yeah, I have that option. So, do you want me to share my screen. Go ahead and if you want to share your screen, and then you'll be able to move the slides if that's an easier way for you to do your presentation rather than have me move them it's up to you. Whatever works best. Yeah, definitely. And do you want like me and the slides next to each other or just the slides, how do you want it because it gives me. That's entirely up to you, whichever way you want to do it. So, I'm open. Oh wow I never even had these options before. Okay. Like a green screen right now I don't want to just do this. We'll just, we'll do it that way. Do you see my slides now. I do and I'm actually gonna set this up so that I am not there. Hopefully. You know my slides don't have anything that they have to read or anything so I'd rather that they could see me talking because that's kind of more. Yeah. Yeah. I'm glad we figured this out I'm sorry I didn't get it. What happened is that the zoom somehow isn't meshing with the AOS online platform. So we're having all sorts of issues with the latest update on it so. So, I'm so currently doesn't look like anybody has signed in yet. But I think we'll get started. And hopefully they will join in and I will tell you don't get discouraged if they don't, because even though the survey say they want live presentations. I have found that they sometimes prefer it on demand. And then also, who knew that there would be a presidential debate on tonight. Right. So, but I will say it's not on for another hour so they don't get that excuse. Personally, you know, I think that you're going to be much more informative. And I appreciate it. No, I listen I'm a physician I get it you know on demand as much easier they'll probably listen, listen to it in their car if anything I mean I get that. So totally understand. Do you want to give it another minute and then we'll get started. Sure, sure. If you. Yeah. And then what I would do is I will start the recording again. And then basically I mean you saw what I added. It's not really anything too exciting but stuff that I thought would be good to have. And you're okay with the presenting those initial slides you put in there. Absolutely. Absolutely, that's fine. Perfect. No. And then once I stopped the recording. That's it and it will be saved and put on with the on demand and then we'll start really hammering the advertising for it so awesome. Okay. Okay, well I can get started, that's fine. All right, let me get the person on my mouse is doing funny things, hit the recording. Yeah. Maybe it was recording this whole time. I think so. Oh, there you go. I see a little dot there, flashing, so maybe. Okay, maybe it is. All right. Do your thing. Sounds great. All right. Hello everyone and welcome. My name is Dr. Michael Foti. I am a clinical assistant professor of internal medicine and internal medicine physician, author and speaker. And today's webinar, hosted by the American Osteopathic Association, and the American Osteopathic Information Association is the stigma of mental health. And this is part of the regain your joy of practice educational series. Just some housekeeping. All participants will be muted. If you haven't taken the pre test you must take it now to obtain CME for today's webinar. To ask me a question you just enter that in the question section on zoom, which, and questions can also be sent to physician services at osteopathic.org with subject webinar question. The slides are available in the course at AOAonlinelearning.osteopathic.org. And to obtain CME credit you must have taken the pre test and complete post test and evaluation, following the webinar by visiting the course at AOAonlinelearning.osteopathic.org. My specific talk is called my battle with anxiety, a story of hardship, loss, and resilience. I have no disclosures or conflicts of interest. So, this is really also a story of my personal experiences with mental illness, which really all began at the height of the first wave of COVID. Back in the spring of 2020 if you remember, this is a picture of me as an intern in my internal medicine residency at Greenwich Hospital Yale New Haven health. During the spring of 2020. And for those of you who possibly weren't practicing at the time or maybe weren't in the inpatient setting, the environment was very much akin to a war zone. These were 12 to 16 hour days, not removing my N95. And what really made it so devastating was the amount of patients we lost, and not only the frequency of patients suffering and death but also their age. You know, these were patients who were 30s, they're in their 30s and 40s, you know close to my age, it was truly devastating to witness and what made it so much more difficult there was a disease we didn't know we didn't know how to treat we're trying our best as well, and. You know, family members weren't allowed in the hospital, it was it was very difficult time. And there's three patient stories that really shaped my time during that first wave of the COVID-19 pandemic, and really stay with me to this day. And really were a part of the emotional and mental toll that this pandemic took on me, and eventually led to my mental illness. So, the first patient was a gentleman in his 40s. He was just trying to get back to his wife and children. I'll be all right I hear those monitors overhead I know you're busy you don't get out there do what you got to do and it was very humble to hear that, and, you know, he was very close to be discharged you know he had one foot out the door. But there was a moment where we had an RT called and it was to his room. And, which was very surprising for all of us again, he was very close to being discharged and, you know, we went there and suffice to say, the writing was on the walls. You know he was already in the prone position laying on his belly. He was pale he was diaphoretic oxygen dropping and I could see that, you know, he had went into full blown acute respiratory distress syndrome from his COVID and we were going to need to upgrade into the ICU and likely he was going to be intubated and put on a ventilator. And so I called my ICU attending to the patient's room, she evaluated him and concurred that, you know, he needed to go to the ICU and be intubated and you could see how much this really shattered his insides you know he was so close almost that he could taste it that he was going to be back to his family. And also just being your early 40s not knowing what kind of disease you have and then being told you have to be put on a ventilator you don't not knowing when you're going to potentially wake up if you're going to wake up, I mean it's devastating to hear that. And so, I could, I could tell that how much it was devastating to him and obviously my attending did, because, you know, to my much to my surprise and again it makes me speechless even to this day I didn't expect it, you know, she looked at him and she said, Are you a man of faith. And he said yes. And she said, Well, do you mind if we pray together. He agreed and he grabbed his hand and grabbed my hand and, you know, I'll never forget the words that she said. The Lord bless the hands, the minds and the tools of all those who will treat this man. And she went to go towards the ICU. I was going to follow her, and he grabbed my arm. And I turned around and he looked me dead in the face and he said, Doc, please call my wife, tell her I love her. And that just killed me, to say the least. And, but with all the adrenaline pumping I ran to the nearest nurses station and called his wife I updated her on the situation and let her know what he said and almost with this calm resolve. She knew he was going to be okay. In the way that she responded to me. And he was after a few months and in the hospital he was eventually discharged. The second patient story was a gentleman in his 50s, who, and this was pretty commonplace at the time where families were being admitted at the same time. And he had just been discharged maybe the week prior, and he was a man in his 50s and he just wanted to be discharged and get back to his wife and at the same time, you know he was the guy you could tell he was always outdoors so to be stuck in a hospital room and specifically to a hospital bed was not easy for him. And you know, with his level of ARDS, any movement really bottomed out his oxygen levels. And so, he was always trying to move though. And he, he frequently tried to get out of bed and we were frequently going in his room to remind him you know you need to. I know it's tough but you need to stay in bed and, you know, he would joke with us and say you know. All right, Doc, you know, just put my show on, he would say or something like that I think he loved game shows if I can remember and. So I was at the nurse's station running the list of patients with my attending, and at the corner of my eye I noticed a bed being wheeled towards the ICU. And it was him. And he was sitting up now having an oxygen mask a new oxygen mask on his face and laughing and he saw me and he said Doc I can't even go to the bathroom in this place. And I thought, you know, he moved too much they couldn't get his oxygen backup they'll get into the ICU stabilize and bring them back out. But day after day went by and I still didn't see him on my list. After about a week. You know my, my attending came to join me in the nurse's station to run the list again. And I could see the expression on his face was a bit different that morning. And he told me that that patient wasn't going to make it at the ICU, and it passed away. I was very difficult to hear, knowing that he wasn't going to get back to his wife. Fast forward a few weeks and I was transferred over to work in the ICU and at the time, I'm sure many hospitals had this, we had what were called crisis staff and crisis physicians, basically health care workers who were given emergency privileges to, you know, work in hospitals because we were so short staffed, you know, everyone was getting sick with COVID at the time and our ICU attending was a one of those crisis staff and he was very much a seasoned veteran of critical care medicine and I've been doing it for many years. He actually mentored one of my attendings and something that really struck us was anytime a patient was changed to DNR and CMO, meaning do not resuscitate and cover measures only, he made it his mission to, without saying a word to anyone, go into the patient's room and be by their bedside as they passed away, as if to say that that person was not going to be alone when they passed away because obviously their loved ones couldn't come into the hospital and really, again, struck all of us and I had been taking care of a patient, one of my patients in the ICU was an elderly woman in her 80s who had been battling COVID for weeks and that shocked all of us, of course, her strength to fight on but eventually she lost the battle with COVID and same thing, you know, her code status was changed to do not resuscitate but this time on rounds, I told my attending I would go in and so I went in, sat by her bedside and just was there with her as her heart rate slowly dropped and something that was really interesting and really amazes me to this day is that the nurse then came in and sat next to me as if to say not only the patient not going to be alone but you're not going to be alone. We both just sat there and then even to my greater astonishment, the respiratory therapist came in and sat on the other side of me and again to say none of us would be alone and we all three of us sat there as the patient's heart rate climbed down to zero and again, a very dark and difficult time but at the same time, I know that patient wasn't alone and neither was I. Fast forward a little more after that, I'm now on night shift, it was about one in the morning and I get a call from my mom and she tells me that she's in the hospital. Immediately, my mind goes to COVID of course but it wasn't. She said, oh COVID was negative but what she hadn't told me, it was funny, my mom was funny that way, was that, you know, she had a son who she wanted to be a doctor her whole life and yes, she hated going to doctors and hated talking about health and all this stuff and she hadn't told me that she had been diagnosed with DVT about a week prior and was on a blood thinner. Well, now these blood clots had now traveled to her lungs. She was subsequently diagnosed with stage four lung cancer and then within about two weeks of her diagnosis, died from her complications. It's obviously a very, very, one of the darkest times of my life, it's not the darkest and days later, I was back in the hospital working because we were so short-staffed and this is a picture of me and my mom when I graduated medical school actually. Eventually, I graduated from residency and I was hoping for a new chapter. I was going to be a residency preceptor and was just hoping to start anew but unfortunately, was not the case. From day one, I developed the most intense panic disorder where every night I was waking up with just this intense sensation in my chest as if someone was trying to rip open my rib cage. I was trying to tear open my left arm, contractions on my whole body and eventually would remit after about an hour and then I'd wake up in the morning, intense fluttering in my chest and that would continue all day and all of this continued for months. I blamed it on the stress of the job. I was a new attending, I thought maybe it was just part of the stress and imposter syndrome and all of that and I kept pushing forward because that's the culture of medicine, right? Just push forward, we can't talk about these things and I did but eventually, I said, well, if it is the job, I'm going to have to switch jobs and so I did. I went into general primary care hoping for basically a solution to all of this but unfortunately, even changing jobs, the symptoms continued and that was truly my low point because I realized that, well, is it the job or is it that I can't do this and I'm not be a doctor and I felt like I failed myself. I felt like I failed my mom with these expectations. I was going to be a doctor, I failed my family, my wife, my kids and so it was very difficult, very, very difficult and I went into a depression. I started hiding away from my wife and my son and I just couldn't look them in the eye and it all boiled over one night where I had the most intense panic attack ever. The symptoms would not go away so much so that I thought maybe this is my heart so I had my wife bring me to the emergency room. They did all the testing on my heart and all of that was normal and I requested to see a psychiatrist and she sat with me for about an hour or two and just to talk and talked about everything that happened in my life and she looked at me, she said, Michael, this isn't stress of the job. Look at everything you've dealt with. You haven't grieved the loss of your patients. You haven't grieved the loss of your mother. This is anxiety and depression as a result of that, of all the unprocessed emotions, of all the unprocessed grief, of trying to just push this down instead of processing it and so I had to finally make a decision that I needed to start taking care of me. So took a medical leave, felt like a primary care doctor. I was started on an antidepressant medication, was referred to a psychologist and saw my psychologist every week and finally, finally started the road to recovery. That was the best thing I could have ever done and I realized a few things. I realized that it was the state of mental health where we feel, especially as physicians and anyone in the workforce, but really anyone dealing with mental health, that you can't speak about it as if mental illness is like a different type of illness that we can't speak about and that we're just supposed to push forward. The doctors are not supposed to develop anxiety and depression. We just have to push through this, but that's detrimental to our own well-being, right? Because I suffered in silence for so long because of this very stigma that we need to erase and I also realized that I had very much paired my identity, who I was, with just being a doctor, but there's so much more to me than being a doctor. I'm a husband, I'm a father, I love to laugh, I love to joke, I love to watch sports, I love to play sports. There's a lot of things about me and all this goes on and it's very important to nourish that unique part of our soul because if you only see yourself as a doctor and if that ever gets called into question, your very soul will be shattered and that's what happened to me and so since then, I've dedicated my life to being a fierce mental health advocate because I don't want even a single person more to suffer in silence the way that I did. We cannot see mental health as a weakness anymore. Mental illness is like any other illness that deserves the proper care, the proper attention, and the proper treatment and then once you get that treatment, you go back to doing what you love, just like I did. We need to erase the stigma surrounding mental health. We need to empower the health workforce. We need to empower physicians to get the help that they need. They need to feel that it is okay to not be okay and in order to do that, there's a lot of change that needs to come. Healthcare institutions from outpatient to inpatient to medical education, we need to be campaigning across the country and really across the world on mental health so that those that work there, that those that attend those medical education institutions, our medical students, our residents, our fellows, and our attendings feel safe and feel empowered to get the help that they need. It starts there. Obviously, there's more systemic issues in the healthcare system that need to be worked on as well and that's not the objective of this talk but obviously, that goes into it as well to try to prevent burnout but there's other ways to prevent burnout as well, right? Choosing the career that you want that best fits the desired work-life balance so that outside of work, you can still nourish that unique part of you, right? So whether that be direct primary care, whether that be private practice, whether that be academic medicine, doing locum's work and then also doing other type of work, medical science liaison, medical writer, author, journalist, anything, right? So there's a lot of ways that you can pivot with this degree and create the type of career that makes you happy. Not worth spending so many hours doing something if you're miserable and no one should decide what you do besides yourself. You shouldn't push through something just because of someone else's expectations. That is a great way to prevent burnout. Another way also is reading the contract before signing on the bottom line. Don't sign on to something just because of a paycheck because it may very well lead to burnout. Choose the desired career that you want no matter what because at the end of the day, then it won't be worth it. And above all else, we are public servants. We devote our life to taking care of others but we cannot be healers if we first do not heal ourselves. You have to have self-compassion and love yourself enough to take care of yourself so that you can be your best you for your patients, for your fellows, for your residents and for your students. And it was when I first started practicing self-compassion is when I started on my road to recovery. I can now say I'm in the happiest position I can be. I'm teaching wonderful medical students at the Toro College of Osteopathic Medicine in Middletown, New York. I'm so happy with what I'm doing. I found such a joyful career that not only brings me joy but fulfillment and is the most rewarding experience I could have ever imagined. And that could be in many other forms for many other people. It may not be academic medicine or it may very well be. Happy to talk to you about academic medicine if you'd like to. But for me, that's what that was. And again, I'm so happy. So I also outside of academic medicine, as I mentioned earlier, dedicated my life to being a fierce advocate for mental health. I've spoken on several podcasts. I've spoken alongside our U.S. Surgeon General, as you can see there on the right, at the Health Workforce Wellbeing Day in Washington, D.C. And I will continue to speak up if it means not a single soul more will suffer in silence. And I'll leave you with this quote that really guided me through this whole journey of mental health, which is that a journey of a thousand miles must begin with a single step. Never feel afraid to take that step. Get the help that you need. Be your best you for your patients, your students, and most of all, your loved ones. Thank you so much. Thank you. Such moving, you know, stories. And I truly do appreciate you sharing that in itself will give somebody else the strength to talk about it. So thank you again so much. Truly do appreciate you sharing with your colleagues, with fellows, you know, the students, the residents, and practicing physicians. So thank you again. Truly appreciate it. Thank you for joining us. And then just a resource that actually is a physician hotline, support line that actually was developed by a DO. And there are physicians that are addressing those calls. So take advantage of it if you need it. Those listening in, we don't want anybody suffering. So, and then these are some of the AOA, AOIA resources that you're more than welcome to reach out to us for to help you with your practices. So thank you again, Dr. Fadi. Again, I'm very touched by your stories. So thank you. Thank you, Cindy. And thank you to the AOA and the AOIA for having me. Really appreciate it.

mental health

COVID-19

anxiety

depression

healthcare

advocacy