How Stories Can Help You Beat Burnout

[00:00:00] Rachel: If you’ve listened to this podcast for any length of time, you’ll know that I’m a massive fan of self-help books. In fact, I’ve talked before about how I noticed that my stack of BMJs was growing and growing because I chose to spend my evenings instead of with Brenae Brown and Daniel Pink.

[00:00:15] Rachel: But while these pigs have a lot to say about what it’s like to be human, the stories we find in novels and poems, or even in films can teach us even more about how other people think and feel. And they give us the way to sort of practice tackling difficult emotions.

[00:00:31] Rachel: This week, I’m speaking with Dr. Tara George hosted the podcast Bedside Reading, and she runs the medical book club and a Facebook group focused on how fiction and other creative work can influence the care we give our patients and the way we interact with our colleagues.

[00:00:45] Rachel: Now, every week, as you know, we create a free downloadable CPD workbook to help with your appraisal. And this week’s pod sheet is packed with the book recommendations that we talk about in the podcast episode. So if you’re looking for a great read, then sign up using the link below to get your free workbook.

[00:01:02] Rachel: If you’re in a high stress, high stakes, still blank medicine, and you’re feeling stressed or overwhelmed, burning out or getting out are not your only options. I’m Dr. Rachel Morris, and welcome to You Are Not a Frog

[00:01:22] Tara: I’m Tara George. I am a GP, a trainer and a training program director in Derbyshire in the Peak District. And my big love is medical humanities. So I host a podcast of my own, bedside Reading where we Talk about books, predominantly novels, and also sometimes memoirs and sometimes some self-help and really think about how they can make us better clinicians. And really I would rather be reading than doing almost anything else, but talking about books and talking about the power of literature is definitely a favorite topic as well.

[00:01:54] Rachel: It is wonderful to have you with this. Tara. Thank you so much for being here. Uh, I like you am happiest of lying on a, well, preferably on a sun lounge in a very hot country, reading a book next to a pool, um, closely followed by a lovely glass of rosé and some nice, uh, food.

[00:02:10] Rachel: But yeah, I just, I just love delving into books. But you’ve taken that a, a step further with your podcast, your Bedtime Reading podcast. Um, how did you sort of get into thinking about the power of reading and humanities as a way of improving ourselves, of, of, of promoting resilience? I hate to use y word, but it, but, but your take on this is actually, it, it’s vital for, for working sustainably, for, for coping in today’s world.

[00:02:38] Tara: Yeah, so I think it actually goes back really long way. So I did English Literature A level, um, which was by far my favorite A level to do. And I was really torn about what I really wanted to do when I grew up. And, and to be fair, if it’s not a spoiler to say, I still, I’m 46, I’m not sure I have grown up and I’m not sure I really still want to know what I do when I grow up, which is, and perhaps why I do lots of different things. And, um, I suppose I am what could be described as a portfolio GP.

[00:03:04] Tara: Um, and I think I’ve, I’ve always read a lot, um, I come from a family of readers. When I was at medical school, I did my final year project on doctors in literature and started, did a project really thinking about the themes of doctoring that shone through in a variety of novels. Um, and thought about what are those almost idealized characteristics of doctors which appear in literature and whether maybe there was something about how patients view doctors, perhaps through an idealized lens, this sort of concept, which began almost for me with that idea of something like. Dr. Jekyll and Mr. Hyde.

[00:03:43] Tara: Um, and then that has sort of developed, so through teaching, through training, through being a trainer, and being a TPD and just really starting to play around and having that joy of a bit of a freedom in a curriculum,

[00:03:56] Rachel: And so how do you tend to use it then when, when you’re in a training? When you’re training session? Just like get out a per and go, let’s have a look at this guys? Or is it like a book group or is there like a variety of ways?

[00:04:08] Tara: I’ve used it in a variety of ways. So one of the things I really love, and I often encourage people if they are thinking about dipping their toe in the water in an educational con context, is thinking about session openers. So something that might be a bit illustrative of something. So a really short poem or a really short extract, um, to get us thinking.

[00:04:28] Tara: Um, and I suppose an example of that would be there’s a poem by Wendy Cope called Names, um, which is all about an elderly lady, um, and the fact that she’s given what I suppose we might colloquially call a Sunday name that she was never meant to be called, and then how that was contracted into a variety of other things that people caused her, called her. And then through her life, um, how she sort of eventually, um, becomes nan to everybody. And then at the end, she’s in a care home and they call her the name that’s on the paperwork. And actually her dementia is such that she doesn’t even recognize that anymore.

[00:05:01] Tara: And it’s an incredibly powerful poem, but it’s quite short. And I might use that as an intro into a session where we might be talking about communication or we might be talking about dementia, or we might be talking about identity. Um, so that’s certainly a way in that I might use it..

[00:05:15] Rachel: I love that idea of, of using sort of poems or extracts from books as, as illustrations of stuff to get people’s emotions going. Because medicine, but it can be such a dry subject, can’t it? But we’re dealing with people and it’s when you get, when you get the people there and, and humanities and writing and poems, what they do, I guess is they, they show us stuff rather than telling us stuff.

[00:05:38] Rachel: There’s, you know, you, you could have stood up and gone, right, okay, well there’s this woman in a nursing home and she didn’t recognize her name because, you know, she’d been called something else. But actually reading the poem just gets people’s emotions involved. Then they can start to look at it from, from different perspectives.

[00:05:53] Rachel: I think we are really bad at getting our emotions involved, aren’t we in, in medicine and some of the other high stress professions. Is it always a good thing, do you think? Or do you think it’s actually much better to be able to remain completely dispassionate?

[00:06:08] Tara: I think that’s a really important thing to talk about and a really important reason why I use the humanities, because actually I think sometimes if there is a remove from a patient situation, you can engage with those emotions in a really safe space. So I think it’s, it’s using, using these tools in a really safe educational context or when you are reading on your own to process some of those feelings that you might be happening.

[00:06:31] Tara: And I think there’s that really important thing isn’t there, that actually if we cry with every single one of our patients. We are no good to anybody. So I think there is that really important thing about having some kind of professional persona and professional disconnect, but it’s recognizing that we also need to contact those emotions at some point. Because actually, if you wall them off entirely through everything that you do, eventually you know that pot bottle is gonna get shaken and shaken and it’s going to explode.

[00:07:02] Tara: So recognizing the importance of having that professionalism, though, I would argue that, you know, emotions do have a place in a consulting room, but a controlled place in a consulting room. And then recognizing that actually, you know, in our personal lives. They can bubble out.

[00:07:17] Tara: I mean, I’m a terrible crier. My children almost refuse to watch films with me ’cause they say I cry all the time. And I’m, I’m a really big crier, but I think, you know, how often do I cry with patients? I have cried with patients a few times, but I could probably count ’em on the fingers of one hand, because actually, you know, the professional me knows that this is someone else’s space. But it doesn’t mean that I wasn’t having those feelings. It doesn’t mean that I don’t need to process those feelings in some way.

[00:07:43] Tara: Um, and I think that’s what’s really, really important is to say, yeah, you know, if all healthcare professionals are sort of, you know, sobbing in the corner with their patients, we’re not gonna be any used to anybody and it’s gonna be absolutely exhausting. But we also need to make contact with those feelings and make sense of them and know that they’re there.

[00:07:57] Rachel: Yeah, I guess reading books, watching films, that, that’s like a really safe emotional release, isn’t it? Because mostly they’re fictional, or if they’re not, if they’re not fictional, if it’s based on a true story, that story has already happened. You know that, that you don’t have any responsibility towards the person in the story because you know it’s on a film or something. So I can, I can see why. I can see why that’s just such a safe way to do it.

[00:08:18] Rachel: Are there other reasons why actually reading these things, reading works of fiction, watching amazing films, whether it be fiction or documentary or whatever, is really good for us? Because I sometimes feel really guilty when I am just like held up with a good book and that’s all I’ve done rather than a, a self-improving book. I guess that’s because it’s sort of, it’s sort of my job to read these sort of self-improving books and then share some, share some bits and pieces with people. So it feels like, oh, just a bit massive escapism, but I can’t spend all my time reading fiction or, or can I?

[00:08:52] Tara: Well, I think actually there is some really good evidence. I was really excited that there was, um, a meta analysis published recently looking at empathy scores, um, in people who used a variety of humanities modalities. And, and actually reading fiction was found to be the thing that was most likely to promote empathy, which I found. Very reassuring.

[00:09:13] Tara: And I think one of the things that’s, that’s important, I mean, there’s a lovely quote, um, from Kate Gross. So Kate Gross wrote this phenomenal memoir, um, which was sort of written as a love letter to her children when she was dying. She was a young woman, um, who died of bowel cancer. Um, and she wrote this beautiful book called Late Fragment.

[00:09:29] Tara: But there’s a quote in the beginning which says, if you can imagine, you can empathize. And I think that’s really important, thinking about imagination and the power of imagination. ‘Cause often actually within a lot of particularly medical Training, we think of ourselves as scientists. And then those of us who aren’t really scientists, feel an overwhelming guilt. And, you know, I’d like to, you know, reassure anybody that I think That my knowledge of science is more than good enough. But am I a scientist? No, I don’t think I am. Um, and I’m much, much more interested in humanities and social science.

[00:10:02] Tara: So actually to go, well actually there’s an evidence base that we can promote this empathy thing. And empathy is something that I also feel very strongly about. Um, and how we teach empathy. I’m an enormous fan of Brene Brown.

[00:10:15] Tara: Now, one of the things that Branda Brown talks about, um, is this idea of empathy, not being walking in somebody else’s shoes is that idea of listening to their story and believing them and believing them, even when it doesn’t match our own experiences. And of course, I think that’s something that’s really, really important to recognize, that no matter how wide and varied your own life experience is, it’s one life, it’s one person. And actually that’s quite limited. And our experiences, of course, they shape us.

[00:10:47] Tara: But so, so many of us have had a fairly privileged upbringing. So many of us have gone straight through a school system which worked for us into a university setting, which worked for us, have chosen whatever specialty we want to go into, um, and then are merrily doing that specialty. That’s actually a really narrow band of experience. It may be a wider band of experience than some other people that we know, but actually I think there’s something about reading, which enables us over the course of, you know, four or six or eight hours for a novel to go somewhere completely different. And I think that’s something that’s really important.

[00:11:27] Tara: So it’s then to start to recognize all of these other life experiences, and I think also to react to the characters. Now, you used a phrase earlier talking about a safe space, and I think that’s one of the things that’s really important. It’s one of those taboos, isn’t it? To say that you don’t like a patient, or that you don’t like something, actually, it’s okay when you read a novel to say, I found the protagonist of this absolutely unbearable because.

[00:11:52] Tara: So again, I think there’s something that’s really important about looking at other people and evaluating our own responses to things. Do we like somebody? Do we connect with somebody? Do we feel emotions towards somebody or feel for somebody, even though we recognize that they’re flawed? And I think that then helps us to come back into real life where even so, you know, it still may not be acceptable to say I really hate. Mrs. Smith, but actually to recognize what is it about Mrs. Smith that we are finding really difficult and really challenging? Maybe recognizing elements of her in a character that we’ve had some kind of response to. Um, and then helping us to kind of craft our own emotional response to that person in real life, having perhaps a little bit more of an awareness of what they might be going through or what their life might be like.

[00:12:44] Rachel: Yeah, as you were saying that, I just was sort of thinking about all the different characters in books that, that I have loved. And often the ones that I love are the ones that are slightly disaffected and they’re just like a bit pissed off with society and they’re like, in a rebellious teenager that, but I was never able to be actually.

[00:13:02] Rachel: Um, but what you get in fiction is that you get their thought patterns, don’t you? And you don’t get that in a film. You don’t get that apart from like, I know, or TV, Fleabag. You got a, you know, or Miranda, they occasionally talk to the camera. But, you know, fiction, you, you genuinely get their, their thoughts or obviously the thoughts of the author.

[00:13:19] Rachel: And for me, it’s not just empathizing with other people, it’s then hearing their thoughts and going, oh my goodness. Other people think that too. It’s okay to think that. It’s so, it, it’s okay. I’m just not, I’m not the only bo, I’m not the only person. And it does, it helps me feel seen when there is a character that I can identify with. I’m like, oh my goodness, that character feels exactly the same, exactly the same way. And then there’s characters that you find really shocking. You think, okay, why is it, why is it? And it’s, it’s like safe, safe, psycho-analysis, right?

[00:13:52] Tara: Absolutely. Absolutely. And I think that’s what’s really important that then if you then start talking about it, you know, you can, can end up, I mean I, I read a book from my book group, um, I have a sort of pseudo medical book group and we read a book the last month of our book group, which I disliked so profoundly. I had a really visceral response to this book, and I could not bear the characters.

[00:14:19] Tara: But actually when it came to discussing them and discussing it, I realized that actually it was probably quite important that I had read it, um, and to identify why had I had such a visceral response against the parents in this particular book.

[00:14:34] Tara: But it’s interesting, isn’t it? Because I think it’s that principle of that that unacceptable emotions or whatever it is that, that we push down. And I think that is one of the really big problems in healthcare. Um, we are presented this very idealized view of what health professionals are, and what they can be. And yet we are presented with, on a daily basis the very messy reality of people’s lives..

[00:14:58] Rachel: How does empathy in this whole story thing actually help us keep going and stay resilient and, and avoid burnout?

[00:15:07] Tara: I think there’s something really important about recognizing who does this story belong to? And also I think perhaps recognizing, um, something around the types of stories that we are hearing and the types of stories that, that we are reading. And so I agree because I think there is that accusation that’s often sort of leveled at people as, oh, well, you know, if you are really, really empathetic, um, all the time, you know, you are going to have nothing left and burn out. And I think there’s that really, really important balance.

[00:15:37] Tara: But I think there’s something there about recognizing, you know, when Branda Brown talks about listening to somebody else’s story, even when it doesn’t match our own experiences, it is understanding whose story is this, because it’s not our story, it’s somebody else’s story.

[00:15:53] Tara: And actually, if we are bearing witness to people and we are helping them to write a new ending to their own narrative, that doesn’t mean that we are taking on board all of their feelings. It doesn’t mean that we are taking their story.

[00:16:10] Tara: And something that really changed things for me, uh, relatively recently, probably in the last couple of years, um, was learning about Arthur Franks and Arthur Franks’s narrative arcs. Arthur Franks wrote a lot about them and I think they are beautifully, beautifully, um, explored in a wonderful book called Tornado of Life by Jay Baruch.

[00:16:29] Tara: Now Jay is, um, an emergency department physician in the US, um, who had the privilege of meeting a couple of years ago. Um, and Jay is an incredible storyteller. Um, and I will probably absolutely butcher the way he explains this. Um, so, you know, if you want to, to, to have the real, the real way of talking about this, um, yeah, Jay’s book is, is certainly, um, it’s, it’s full of brilliant, brilliant stories.

[00:16:50] Tara: But Arthur Franks has this idea that stories come in three forms. So we start off, um, with what is called the restitution narrative. Now the restitution narrative is very simple, it’s very simplistic, and I suppose it is what perhaps our 17, 18-year-old self in a medical school interview is thinking when they say, I want to help people. I want to fix people.

[00:17:14] Tara: Perhaps somebody has been climbing up a ladder and they slip and they fall and they fracture their wrist and it’s displaced, um, and they go to the emergency department and somebody pulls that fracture, puts it back in line, puts a pot on it, and then a few weeks later they live happily ever after.

[00:17:30] Tara: And, and that’s the very, very simplistic, um, very transactional sort of healthcare, which I think some people who are very unfamiliar with healthcare, believe is the majority of what we do. So that’s restitution.

[00:17:44] Tara: We then got the quest narrative, and I suppose the vast majority of films and novels are based on a form of quest. And actually, as clinicians, we quite like quests in healthcare as well. So in a, in a quest narrative, our protagonist goes on, something happens, and perhaps they are in mortal danger. And through this situation, when, you know, I suppose in the story of Rapunzel, when she is locked in the tower, um, you know, there is some, some sort of, some terrible thing that might happen and then everything is better and they are a better person.

[00:18:19] Tara: So again, we quite smugly like these stories, I think. Um, perhaps we’ve got somebody who is, I don’t know, the quite difficult type a personality, um, investment banker, um, who has no time for their wife and their children and has lots of affairs and takes too much cocaine and is generally pretty unpleasant, um, who then has a health scare or perhaps even has a heart attack, has some time away and actually decide to start baking sourdough bread and sets up an artisan bakery and works from home and is a wonderful hands-on father, and they all lived happily ever after. Because goodness me, Rachel, we love a happily ever after ending. We all want that, that that’s what we’re all seeking. We, you know, we’re brought up on a diet of it, and that all often makes us feel safe. So we love a quest narrative.

[00:19:05] Tara: And, and I think it’s really Important and really have to be really careful not to say to people, oh, well, you know, this will teach you something about yourself, or you will be a better person as a result of this, because actually this is their story. They need to find that at the end, when that happens. But that is assuming that there’s an end point. That’s assuming that something happens, there is some peril, something changes and then something else happens. Um, and you know, that is, that is a quest.

[00:19:32] Tara: The third sort of narrative that Franks talks about is the chaos narrative. So in a chaos narrative, there are many, many things going on at once, and I think we’ve all seen patients like this. Um, this is, as I was mentioning this, this Jay Baruch book. He illustrates this very beautifully with a, a character called Cheryl, who is in his emergency department. And she’s a drug user and she’s homeless and she can’t find her veins and she’s withdrawing from heroin, and there’s all these different things going on, but she isn’t here because she’s got cellulitis in her leg and she isn’t here because she’s withdrawing from heroin, and she isn’t here because her relationship has broken down. Um, and in the end she comes up with the title of his book because she says, I feel I’m caught in a tornado of life.

[00:20:19] Tara: And I think, you know, perhaps if you are in healthcare, you know, in a specialty where everybody has been referred to you, it’s a little bit more clear what the problem is. I think, you know, those of us who work in, in something like primary care or emergency medicine where people are just there completely unfiltered, actually there is so much that’s going on. And it may be that they start talking about that back pain and then they’re talking about their daughter and then they’re talking about their housing situation and then they’re talking about how they feel sick. And there’s all of these different things going on.

[00:20:49] Tara: And we have to recognize that. And I suppose this is a bit of science ’cause this is physics, isn’t it? Chaos and chaos theory that if you do something, you will change everything. And the importance of the care with which you need to approach these scenarios. Because actually, if there is something which appears to be completely chaotic, if we can’t see a clear thread or a clear passage through, we risk making it worse.

[00:21:16] Tara: And nobody really teaches us that, that actually sometimes the status quo is better than what we’re gonna do to somebody. But also it’s really, really easy. And I think I have been guilty of this. I think I’m less guilty of it now as I’m older and wiser and more likely to do nothing. But I think it’s very easy to see somebody who is in the middle of this chaos narrative and pull at something.

[00:21:39] Tara: So, well I will give you some betnovate for this rash on your arm. And it’s not necessarily the wrong thing to do, but actually they might not even be bothered about the rash on their arm, but it’s trying to find something. It’s trying to turn this massive of chaos into a restitution narrative that we can go, ah, you have eczema on your arm, I will give you some betnovate, I will tell you to use an emollient, and in 10 days time it’ll be better, without having considered the fact that perhaps the patient hasn’t got the money to pay for a prescription charge or has been banned from the local pharmacy, or, hasn’t got anywhere clean to keep their betnovate, um, or, you know, has got sourced all over their fingers, that means that actually if they squirt some betnovate onto their fingers, they make their fingers worse and they won’t be able to rub it into their, into their eczema.

[00:22:21] Tara: So it, it, it’s sort of really recognizing this is and recognizing those narratives, what they are is really, really important, in terms of not therapeutic nihilism. I’m not saying that we can do nothing, but actually to, to recognize our own limits in what we can do and think, actually I can’t solve all of the problems all of the time, and actually it’s not my job to do that.

[00:22:39] Rachel: Wow. Tara, I’m just in awe of you because you have so brilliantly described the drama triangle there and how something we teach about all the time is how, particularly as doctors, as healthcare professionals, as professionals working in instead of high stakes jobs, our job, we, we feel that our job is to fix it for people. Uh, and that’s what we’ve been trained to do. And that’s, that’s where we get our strokes and our likes and our well done, you fixed it for me. But sometimes things are just in chaos, and often fixing it for people. It is not the right response and it’s, and it’s not helpful. And I love the way you just described that as well, a, we teach the fixing, it doesn’t, it doesn’t really help. You need to help people fix themselves, you know, you need to get out a re the rescuer, the rescuer role, the, the restitution and the rescuer. And I guess in some of the narrative arcs, you’ve got a guide or a, a helper that comes along and, and that the, the bad helpers just tell people what to and fix it, but the good ones don’t tell people what to like Yoda, they just like come along and they hint at something and so someone finds the answer for themselves. But we are so quick. To try and sort the chaos out, and particularly for our patients, which often doesn’t work.

[00:23:50] Rachel: And I’m thinking about not just patients, but in our own lives as well, we are really uncomfortable with chaos, aren’t we? We just, well, I, I, I really am. I can’t handle it. And if there’s, if I’m feeling lives a bit chaotic or there’s something wrong, I try and find something that I can fix. But you are right. Often, often fixing that thing will have unintended consequences in another way.

[00:24:14] Rachel: And, and how do we get better and think, a lot of the people I talk to on the podcast talk about it, it’s actually about getting okay with those feelings of chaos and being able to sit with the negative emotions that brings us right back to the negative and difficult emotions and go, yeah, it’s chaotic at the moment. And I don’t need to turn this. Narrative of mine into a restitution narrative where my life felt a bit chaotic, my job was awful, it was, it was difficult, so what I did, I changed this, and then it was all sorted out.

[00:24:43] Tara: I, I completely agree. And I think for me it’s been about recognizing what story is being told here. And I think, again, you know, I’m, I’m a huge, huge fan of the drama triangle. Um, and I think that is, it is so important. It’s recognizing, again, it’s one of those very powerful things in terms of moving from rescuer to coach in our role as a healthcare professional, to bear witness to listen to this story, but to trust that people often do have it within themselves to solve a problem.

[00:25:12] Tara: And again, I think people sometimes jump up at this point and say, well, you know, if they’ve got, um, you know, an ingrown toenail, um, then clearly they need some antibiotics and some pediatric surgery and otherwise, you know, they’re gonna get sepsis and die. I recognize that, you know, not everything is, is able to be self resolved. There are situations in which clearly we need to do things to people or with people.

[00:25:36] Tara: But actually there is a huge amount of evidence that letting people solve their own problems, giving people space to talk, to think about what’s going on for them actually makes a, a huge, huge difference.

[00:25:51] Tara: Now, I’m, I’m not a, an enormous expert in it, but one of the things I have discovered in my reading, um, and I’ve ended up, um, doing a little bit of work on being on course on is the time to think methodology from Nancy Kline. And I think the thing that is so powerful there is it’s really about trusting people that if you give them the space to talk, that quite frequently they do solve their own problem. And again, I think that’s a hugely important thing.

[00:26:17] Tara: I find so often and people come and knock on my door and say, Tara, can I have a word? I just need to talk to you about this, this thing. And they sort of say, I’ve got this patient and they’re this and this and this and this. Um, and it’s just starting to get a little bit interesting. They’ve probably been talking for about a minute and they go, I know what to do now, and then they leave. And actually it’s brilliant. It’s brilliant because actually we’ve given them some space to solve their problem.

[00:26:37] Tara: An analogy I, I sometimes use, particularly with my trainees is this idea of saying in a very metaphorical way, and I don’t quite know how we exactly say it to patients, um, but my explanation is to, for the patient, the invitation to come into my room and tip out their bag, their very, very messy untidy bag that’s probably got, you know, a few rotten apple cores and some dirty tissues, tip it out on the floor, and I will help you look at it. And I’m happy to help you to name everything that’s in that bag and see everything that’s in that bag.

[00:27:05] Tara: But then at the end, you need to pack it up. And I might challenge you about which order you pack it in. And it may be that there are things like the rotten apple, which you hold in your hand and you throw in a bin in the carpark. But the key thing is it came in with you and it goes out with you. And it may be packaged in a different way. It might be packaged better. I’m not very spatially astute, so actually my backpacking is pretty bad.

[00:27:27] Tara: Take that bag away. Take your stories away. You can come back as many times as you want. You can tip these out in my room as many times as you want, but when you go, you take it all away with you.

[00:27:38] Rachel: That’s the key, isn’t it? That really, that really is the key. And we did a podcast a while back called, um, it’s about naughty monkeys, about taking the naughty mon, you know, people come, come to see you with all these naughty monkeys. And this doesn’t just apply to, to doctors and nurses and healthcare professionals. A lot of the time, if you’re a leader or a manager, people come in with all their naughty monkeys. They wanna dump, they wanna give the naughty monkeys to you to take on.

[00:27:59] Rachel: And you are yet, you can take them, you can hold them, you can look at them and play with them, and then you give them back and they, they take them away. But I love that metaphor. That is brilliant. Yeah. You are coming here, you tip out your bag and we’ll just look at it and go and go. What’s going on? And just before you mentioned Nancy Kline, I’d literally just written down a quote in my notes from her that I love, which is the quality of my listening determines the quality of your thinking.

[00:28:20] Rachel: And her, I’ve, I’ve got a friend, she, she’s, she’s wonderful. She works a lot with teenagers and she often goes Cor, he needs a damn good listening to, doesn’t he? You know? Um, and it is so, it’s so powerful. And this is not just for our patients, is it? It’s for our colleagues and ourselves.

[00:28:36] Rachel: And you talk a lot, I know about people witnessing our suffering or witnessing our story, just people being there to listen to what is going on. And I’m always really struck, I get, um, lots of lovely, lovely emails from listeners about the podcast. Nine times out of 10, I mean, I do get people saying, well, what you said that that model where that you shared was really helpful and that’s helped. But mostly they say, when I listened to your podcast, I felt heard. I felt that someone had seen my life and what it was like for me. And that gave me permission to go off and do X, Y Z. And then they made the changes. So it was nothing that we said, it wasn’t advice that was given, it was just that they realized that other people felt like that too, through the guests, through what the guests were sharing, through me sharing some of their story.

[00:29:25] Rachel: And once you feel heard and seen that, for some reason is, is massively empowering when you, when you also feel that, oh, I’m, I’m not the only one. So that brings us right back to the, the, the fiction thinking, well, okay, if the author’s written that and they’ve been thinking that, then obviously that thought’s gone through their mind. So I’m not the psychopath I thought I was, you know, and sometimes thinking my family are driving me mad or, or whatever.

[00:29:50] Rachel: So, sorry, that was a bit of a, like a brain splurge for me. But I I, it’s just, it’s just occurring to me that this listening thing, it sounds so trite, doesn’t it? It sounds so trite. And I know we talk about that, it’s GP trainers, it’s like we were the golden minute and that listening thing, but we don’t do it enough. And maybe one of the biggest gifts you can give to a colleague today at work is, is giving them a, a damn good listening to and looking at that I love that image, their, their metaphorical handbag being dumped on the floor in front of you and just naming a few of those things that are in the handbag.

[00:30:19] Tara: I think it’s really important ’cause actually that listening also, it’s very, very powerful in terms, it’s actually very freeing as the listener. Because I think one of the problems when we invite a disclosure is thinking, I don’t know what to say. I don’t know what to do. And actually that’s making us all about us all over again. So it’s going back to, you know, whose story is this? Whose narrative is this? Do we trust that this person has got the tools to start to resolve this for themselves?

[00:30:47] Tara: And of course it may be that they, you know, need to book an appointment with, I dunno, an estate agent to sell their house. Or it may be that they need to book an appointment with a healthcare professional of their own. Or it may be that they need to put on their big girl pants and go and book an appointment with the dentist to have their tooth out or whatever it is that they’re, that they’re struggling with.

[00:31:03] Tara: But I think there is this worry, and I think it again, does come all back to that 18-year-old, I want to help people, I want to fix people, and that, that sort of rescuer mentality. And actually as a listener, all we have to do is give listening space to make it a safe place to disclose and recognize that actually we are creating that safe space for that narrative to come out. And, you know, we may be making, you know, an encouraging neutral face to, to help them to keep on talking.

[00:31:35] Tara: But actually fundamentally, it’s their story. We don’t need to be shocked by it. We don’t need to react to it. We don’t need to do anything with it. And again, you know, perhaps as you say that whole giving somebody some listening time, it’s really important to be really clear. So if they say, I really want your help, I just need to talk about something, say, well actually, yeah, I’m happy I can listen to you. That’s really important. And somebody says, I really want your opinion, that’s actually much more challenging, isn’t it? I want your opinion because you are being encouraged to put your own spin on what it is that you are hearing. But so often actually just giving somebody the space to talk about what’s bothering them, they will know what to do in the end.

[00:32:15] Tara: Because I think, again, it’s that crazy, isn’t it? You know, you talked about that sort of, you know, that mind splurge and again, I, I know you’ve talked about this before, this whole extrovert introvert thing, if you are an extrovert, actually often your thoughts don’t really make any sense until you’ve articulated them. I’m, you know, I’m very guilty of this. So actually it’s that whole thing about, I always think if I have put the crazy that is in my head into sentences, fit for consumption by somebody else, it’s probably ordered my thoughts in a way that once they are out in the space, I can do something with them. But they are fragments of something as they are sort of pinging around my brain. Until they have been turned into sentences. They make no sense at all.

[00:32:55] Rachel: and I guess that is also then the power of of of, of the humanities, of fiction poems and all, and all that, because the stuff that’s in your head that you sort of know that you can’t quite express. Often someone’s done it much better. I was reading a book last night and there was a, a quote from Rumi, which I just love. It just expresses what I’ve been thinking a lot, but I can’t express it as well. It was something like beyond right and wrong, there is a field. I’ll, I’ll meet you there, I’ll meet you there. But you know, I can’t, I’ve, I’ve obviously butchered that, but I’m like, that’s exactly what I’ve been thinking. We’re self-obsessed with right and wrong. But just that one line sums up everything I’ve been thinking in a really, really beautiful way, which is, which is I think why poems really just, just touch a, don’t they? ’cause they’re like, oh my goodness, that I couldn’t have put it better. It summarized exactly, exactly what I felt there in a way that, you know, is succinct and makes sense and, and,.

[00:33:50] Rachel: And so, and the more you read of, of just random that, that, and that was just a completely random book I was reading about a, a, a forest monk, which was fascinating. But you don’t get that unless you’re sort of, if you are only reading the things that you think you should read or that, you know, I’ve gotta read this book or that book or, and you are not reading widely, you often just miss that stuff that comes from left field, from from somewhere com completely different, which is, I think one of the wonderful paths of fiction is just to get a different perspective on stuff that is, that is going on. So I do need to break out a little bit of my own particular sort of sub help bubble, but I, I do find that fiction really helps.

[00:34:30] Rachel: I just wanna come back, Tara, to when you’re talking about listening to people, and when you say that patients are struggling and you, you worry that you need to have the answer. I think one of the big barriers for us offering support to our colleagues at work who are struggling, particularly if they’re stressed and near burnout, is our fear that if we listen to them, we need to do something about it.

[00:34:53] Rachel: Because we feel, well, I know, you know, if someone in my team tells me that they’re feeling, they’re feeling stressed or they’ve got a lot going on, I immediately feel, oh, what can I do to sort this out or to help them? And, and they don’t want that. They just want, they just want it to be acknowledged and, and witnessed.

[00:35:10] Rachel: So how, how do you think we can get more in that mindset of just that I’m just here to witness your story and, and how do we help ourselves or other people identify perhaps which of those narrative arcs they are in right now?

[00:35:26] Tara: I think that’s, I think that is really hard. I mean, I will always remember when my children were very small, when my eldest child is very small and literally never ever slept, and my mom saying something to me about, oh, you know, in three months time, you know, you’ll look back on this or whatever. And I, that point was like, and by then I might be dead. I might have died of sleep deprivation. I mean, because, you know, I am a little bit of drunk queen.

[00:35:48] Rachel: No, we’ve all, we have all been there with non sleeping children. It’s like, yes, I didn’t realize you could die of sleep deprivation, but it’s gonna happen to me next week.

[00:35:55] Tara: Um, and there is, and there is a bit, there is a, there’s a book that was, um, on the shortlist for the women’s prize this year, a book called Soldier Sailor. And there is this incredibly dark part in the beginning. It’s, it’s, it’s this woman, um, and her baby. And there’s a bit where she’s had enough. And she, she and this baby, they go for a walk and she just thinks, I won’t hack this anymore. And she walks into the forest and she leaves the baby in the forest and runs away. And then thinks, oh my goodness, what have I done? And it’s all right in the end and nobody finds out.

[00:36:23] Tara: And actually I think it’s one of those things. I remember reading that just thinking. I’m really glad I’ve read this now while my children are teenagers. I’m that far away from this. But actually I found it so compelling because I thought, actually I’ve never seen anybody write like this before, and actually I don’t think at any point that the mother in this is unwell because I think it’s then very easy to, to overlay a diagnosis and say, oh, you know, well she’s clearly got postnatal depression. I don’t think she has got postnatal depression. I think she’s just completely overwhelmed.

[00:36:52] Tara: And for a moment, and I think, you know, how often do we think I need to run away from my life? Um, and there are all sorts of things that stop us doing it. So I think seeing that, um, you know, is incredibly powerful and, and coming back to that sort of sense of actually, you know, recognizing, you know, what is going on for people? And sometimes people do just need space to, to be listened to.

[00:37:11] Tara: And I think perhaps if you’ve got a colleague, um, you know, when there’s all this, all this stuff that’s, that’s going on, actually, that’s, coming back to empathy, that empathetic, oh my goodness is reckon. And people say, I don’t know what to say. And I always find that a really interesting thing to say. I don’t know what to say. And I think that’s because again, they are in fix it, rescuer mentality, aren’t they? Don’t know what to say. Because actually frequently there are no words. And it’s okay to say God, I don’t even know where to start with this. Gosh, this is so big.

[00:37:40] Tara: And actually it was very powerful. I once, um, was in a situation where I, I had to contact somebody who was very, very senior. I was working in a fairly senior role in the deanery. Um, had to contact someone very, very senior about some really, really, really awful thing that had happened. And the people who’d reported it to me said, oh, you’ve probably dealt with this before. And I was thinking, oh man alive, I have literally no idea what to do. So I kind of rang my boss and my boss was on holiday, and, and his voicemail went to, oh, you ring this other person who was covering it was this person I barely knew, who only thought fully had it together, like would literally know everything that there was to know.

[00:38:10] Tara: And, and I told him, and there was this sort of pause on the phone where I thought perhaps we’d got cut off. And he went, I’ve absolutely no idea what to say. I am absolutely sure that telling me was the right thing to do. I’m going to hang up the phone now, Tara and I will ring you back in 20 minutes when I’ve worked out how to react to this, is that okay? And hung up.

[00:38:28] Tara: And actually that was probably in the moment, the most helpful thing anybody could have said or done. That acknowledgement of, I don’t know what to do, but I’m gonna try and work it out for you. And also you are not alone in, in this all feeling so big and so overwhelmingly overwhelming, because it is. Um, and I think perhaps we need to get better, perhaps at that kind of authentic vulnerability and saying, I dunno, but I’ll help not, well, I dunno. Is that, I don’t know. Leave it with me for a moment. Let me think about it.

[00:38:54] Rachel: Totally. Because it’s, it’s better than making something up or, and, and when you try and give the advice and try and fix it, it never works. It never works anyway.

[00:39:02] Rachel: Tara, we could keep talking about this forever, but we, we’ve gotta finish at some point, I am going to ask you for some book recommendations now. I’m gonna ask you for some book recommendations. Firstly, for people that are trying to maybe make sense of their jobs. So what have you, what would you recommend for healthcare professionals, um, in in particular that, that’s really helped? You’ve already mentioned that book by, and I’ve written it down. Jay. Jay Baruch.

[00:39:24] Tara: Jay Baruch. Yeah. Tornado of Life by Jay Baruch. Um, yeah, I would really, really recommend, which is just really thinking about stories. Um, and he’s an emergency department physician. Um, so they are sort of fairly ED based, but he, I mean, he’s a writer, and he’s a brilliant, brilliant storyteller. So I would really, really recommend that as just something really to start thinking about all the different sorts of human stories, um, that you might encounter.

[00:39:48] Rachel: Any others that you would recommend from the sort of healthcare world?

[00:39:51] Tara: Um, from the healthcare world. Um, Suzanne Koven, um, who again, is another US physician, has written an amazingly good book, um, which, um, is called Letter to a Young Female Physician, and it’s sort of the letter that she wishes that somebody had written her when she was starting out in her career. So, um, somebody looking back at a lifetime of narrative medicine, the things that she’s learned, um, and the things that she wants.

[00:40:15] Tara: And then we were talking about listening. So we’ve mentioned Nancy Kline, and I think there’s, there’s three Nancy Kline books. And actually, I think the most recent one, the Promise, um, sort of stands alone, um, and is, is probably the most accessible as a starting point. But I’d really, really recommend the book Listen by Kathryn Mannix, which I’ve recommended to so many people, um, and often buy for my trainees.

[00:40:37] Rachel: Brilliant. And I now want three rollicking Good reads that you’ve read in the last, you know, year or in the last five years, that you just think everyone should read these books ’cause they’re just blooming brilliant.

[00:40:47] Tara: Okay. So quite a serious one, but I think my absolute top read of 2024 so far, um, is a book called Brotherless Night, um, and it won the Women’s prize for fiction. Don’t be put off that if you don’t like prize winning books. Um, it is the story of Sashi, um, who is a, starts off as a teenager, she wants to go to medical school. She’s in Sri Lanka. And it set, um, in the Sri Lankan Civil War. Really thinking about what the Civil War did to Sri Lanka. And that idea, it begins with the lines that she’s something like today I went to meet a terrorist. What do you say when you see a terrorist? You say, how are you? And it’s that idea about our perceptions, um, and, and what do we, what do we see a terrorist as being? So that is brilliant, escapist, fiction, which was something that, that will really make you think and learn and, and made me think an awful lot about actually some interdepartmental conflict that I experienced as a junior doctor many years ago, um, between two very senior Sri Lankan colleagues, one Tamil, one Sinhalese. And it suddenly made me go, oh God, that’s what that was all about.

[00:41:45] Tara: I think Shuggie Bain, um, by Douglas Stuart is one of the best things I’ve ever read. I mean, it, it, it will make you cry, but it’s very, very beautiful. Um, and I think an incredible reflection of love. It’s a love story. Um, and really thinking about the different forms of love. And yeah, there is poverty, um, there are gangs, there are bad decisions, there’s alcoholism, but fundamentally it’s an incredibly, incredibly uplifting love story. And yeah, who doesn’t love a love story?

[00:42:15] Tara: Um, so that would be my second. And then you said a third and I am going to say Love After Love by Ingrid Persaud, which I think is one of. My favorite things that I’ve ever, ever read. It is set in, um, Trinidad. And again, it’s a love story. Love after love. Um, at the beginning you’ve got the de the beautiful Derek Walcott poem. So if people don’t know the Derek Walco poem, it is Love After Love. It is an absolutely, absolutely beautiful poem. And at the end it talks about meeting yourself and that idea of that actually, yeah, if you can’t show love and compassion for yourself, you really can’t be any good to anybody.

[00:42:48] Tara: Um, and love After Love is this fantastic family saga. Um, really thinking about what is a family set in Trinidad. Um, you know, we’ve got young people, we’ve got older people. We’ve got this very unlikely, um, relationship between the elderly gay man who has moved in with the scandalized single mother to bring up the child in this house, um, in Trinidad. Um, and what’s gonna happen and what happens when you go off to find your fortune and think that your own world is too small, and needs to come away from your own world and go and seek, seek your fortune in the big, bad world. Um, it’s absolutely compelling. Really, really gripping and an incredibly, incredibly good read.

[00:43:23] Rachel: Tara, thank you so much. Thank you so much for being with us. Thank you for the, the book recommendations. If, if anyone wants to find out more about you, obviously they can listen to your podcast, Bedside Reading. And do you run any of these, these, can people join your book clubs or do you have anything online that people can go to, or?

[00:43:39] Tara: So I run a Facebook group, which is called Humanities in Medical Education. So if anybody is even tangentially interested in using the humanities in medical education, um, I have got a group there. Um, I am on X, formally Twitter, both as the podcast and as myself. And, um, yeah, very happy. To talk about books, post quite a lot about, um, about books and literature, um, in that space, and happily kind of talk to people, um, come out and, and give recommendations, um, run book groups, um, or come and come and run things for people, um, if they want to get in touch.

[00:44:12] Rachel: Wonderful. Thank you so much for, for being on. We’ll, we’ll get you back at some point to talk more about this, this sort of stuff. Uh, we’ll put all those links in the show notes. So thank you for being with us and have a good day.

[00:44:21] Tara: Yeah. Brilliant. Thanks for having me.

[00:44:24] Rachel: Thanks for listening. Don’t forget, we provide a self-coaching CPD workbook for every episode. You can sign up for it via the link in the show notes, and if this episode was helpful, then please share it with a friend. Get in touch with any comments or suggestions at hello@unnotterfrog.com. I love to hear from you. And finally, if you are enjoying the podcast, please rate it and leave a review wherever you are listening. It really helps. Bye for now.