Yale Psychiatry Grand Rounds: "The Healer's Journey: Living the Oath with Integrity"

June 21, 2024

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June 21, 2024

Commencement Grand Rounds: "The Healer's Journey: Living the Oath with Integrity"

Lisa Harding, MD, Assistant Clinical

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00:00Katie, what an honor.
00:04All right, Is that it? That's it.
00:08Good morning, everybody.
00:09We all get those departmental emails
00:13from Doctor Crystal, you know,
00:14the very general ones that come out.
00:16And then I saw one that said,
00:18dear Lisa, and it was, am I getting
00:20called to the principal's office?
00:22Do I open this now or at the end of my day?
00:26Jokes aside, what an honor to be here,
00:29to give you stories and impart
00:32bits and pieces of my life in the
00:35hope that it inspires you and the
00:38exceptional honors because I am
00:40still learning and growing myself.
00:42To this graduating class, we have
00:45watched you grow and learn in medicine.
00:48This is the end of one kind of
00:51learning at the beginning of another.
00:54Throughout your residency,
00:55you've navigated the intricate landscapes
00:58of mental health care in America.
01:00Very diverse and often very patient.
01:04Very complex patient scenarios.
01:06Your dedication to understanding the
01:09nuances of psychiatric disorders,
01:12coupled with your tireless efforts
01:14to provide compassionate care,
01:16has undoubtedly shaped you.
01:19In these triumphs,
01:20you've also confronted challenges
01:22that are very unique to psychiatry,
01:25navigating stigma within the field itself,
01:29addressing systemic barriers
01:31to care for your patients,
01:33and above all,
01:34managing the toll of witnessing
01:37human suffering first hand.
01:39Your resilience in the face of
01:42these obstacles is a testament
01:44to your unwavering commitment to
01:46the well-being of your patients
01:48and your own professional growth.
01:51Today, we honor not only your achievements,
01:55but also your resilience in overcoming
01:58the distinct challenges of residency.
02:01Congratulations.
02:04Today,
02:04as we celebrate your achievements,
02:07I would like to ask you all to
02:10live the oath with integrity.
02:12I will share with you very deeply
02:15personal experiences and how
02:17this oath has been my guide with
02:21the hope that you're inspired.
02:23This is actually a picture of the
02:25hallway in my medical school in Cuba,
02:28El Juramento Hippocratico.
02:29To the right of this picture is
02:32the we have our anatomy labs.
02:34The Hippocratic Oath is attributed
02:36to Hippocrates of ancient Greece.
02:38It is actually dates back to
02:40between the 5th and 3rd century BC,
02:43and it is it is part of the Hippocratic
02:46Corpus and itself serves as the
02:49foundational text for medical ethics.
02:52I always like to note here the
02:54contrary to popular belief,
02:55it does not explicitly contain
02:57the the phrase first do no harm.
02:59That is,
03:00that is really attributed to it quite a lot.
03:05The modern version of the Hippocratic Oath
03:08is attributed to Luis Lasagna in 1964.
03:11Over time, the oath has undergone
03:13numerous revisions to align with the
03:16contemporary values of practice in medicine.
03:19Our oath as physicians encapsulates
03:22our commitment to ethical practice,
03:25compassionate care,
03:26and dedication to our patients.
03:30Living this oath means embracing
03:33our moral responsibilities,
03:35ensuring honesty, transparency,
03:38and respect in all interactions.
03:42As you begin your careers,
03:44let this theme guide you,
03:47reminding you that integrity is the
03:50foundation of our practice and the
03:53key to making a meaningful difference.
03:57I will respect the hard won scientific gains
04:00of those physicians in whose steps I walk.
04:03Many of who are here are here today
04:06and gladly share such knowledge as is
04:09mine with those who are to follow.
04:12These words of the Hippocratic Oath
04:15remind us that we are forever teachers.
04:18See one do one teach one.
04:22In everything that you do, you learn,
04:26you practice and you teach.
04:29We are so very proud of you.
04:32I hope that you're proud of yourselves.
04:34Continue to grow and educate
04:37in every space that you occupy.
04:40I did a search at ChatGPT of the
04:4210 most influential psychiatrist.
04:44So you know, it's ChatGPT.
04:46So it's definitely true.
04:48You've had the opportunity to train with
04:51some key opinion leaders in our profession,
04:55Dr. Crystal, Dr.
04:56Sana Cora, Doctor Hilary Bloomberg,
04:59Doctor Rajita Sina,
05:00Doctor Block doctor,
05:03Doctor Chris Pittenger.
05:05These psychiatrists are not only recognized
05:08for their clinical expertise and research,
05:11but also for their innovative
05:13approaches and the significant
05:15impact that these approaches have
05:17had on the field of psychiatry.
05:20Guys, we walk in their steps.
05:22A little story about me.
05:26Guyana, where I was born,
05:28is mostly known for just
05:30the Jonestown Massacre.
05:32It is now on the world's radar because oils,
05:36oil reserves have been found
05:38off of the coast.
05:39I went to Queen's College in the capital.
05:42Ironically the name Queen's College.
05:44It only started admitting
05:46girls in 1975 and it wasn't.
05:49It was an all boys school until then.
05:52For as long as I can remember.
05:54I wanted to go to Yale when I was
05:5717 years old. I had three jobs.
05:59I made the equivalent of one U.S.
06:02dollar an hour.
06:03The undergraduate application fee
06:05for the for Yale was sixty U.S.
06:08dollars.
06:08I did my SAT's and I applied
06:11a few weeks later,
06:13excitedly got the letter addressed
06:15to me from Yale. I did not get it.
06:19It hurt.
06:21We all get to frame lessons
06:24from disappointment.
06:25I'm sure they're mathematicians in the room,
06:27so please start counting with me.
06:30This was rejection #1 while painful,
06:35I kept working,
06:37focused on my goal of being educated at
06:40a prestigious university here in the US.
06:43The picture on the bottom is
06:44the house that I grew up in,
06:46and my parents still live there today.
06:51A few years later I was awarded a full
06:54scholarship to attend A7 year combined
06:57undergraduate medical school program in Cuba,
06:59Ciencias Medicas facultad numero Uno.
07:03Completely intimidated, I was actually
07:05leaving home for the first time.
07:07I'd only left the country a couple of times,
07:10vacation and then come back living
07:13on the socialist island of Cuba,
07:15studying in a completely different language.
07:18I remember at one point I was actually
07:20the only English speaking person at my
07:23school in a different political climate,
07:25but wanting to serve my community
07:29by becoming a medical doctor like
07:32most of you did in medical school,
07:34I overcame lots of challenges.
07:37Still finishing at the top of my class.
07:40Internship in Cuba, where I still
07:42hold an inactive medical license,
07:45involves independent practice.
07:46You treat patients as a junior
07:49attending and you get a salary.
07:52I still remember collecting my
07:54first salary as a physician,
07:56the equivalent of 25 U.S.
07:58dollars.
08:01I left Cuba and moved back to the
08:04Caribbean where I completed my licensure
08:06and training and I was a senior house
08:08officer in the Emergency department
08:11of Victoria Hospital, pictured below.
08:13And that grainy picture at the top was
08:15the only one I could find of me in the ER.
08:17I didn't wear scrubs.
08:19I was always a fashionista.
08:21I operated autonomously in an 8 bed
08:24emergency room during my shifts.
08:27The work was hard and I was burning out.
08:30My husband, a native New Yorker
08:32and like any typical New Yorker,
08:34hates island life.
08:36I'm kidding.
08:37He hates the nonchalant pace of island life.
08:39And so we moved back to the US.
08:42As a foreign medical graduate,
08:43you guys know how difficult it is
08:45to match into any program in the US,
08:48let alone a prestigious program.
08:51I applied to the Yale psychiatry program,
08:54didn't even get an interview.
08:57Mathematicians rejection #2
09:06I matched at my number one
09:08choice which was the University
09:10of Kansas Rock Chalk Jayhawk.
09:13I decided to train under Sheldon Prescorn.
09:17He is one of the greatest educators alive.
09:21I get to call him Sheldon now.
09:22That's so weird.
09:23He taught me how to learn and
09:26he taught me how to teach.
09:28He prepared me to reapply here
09:31at Yale and then told me you
09:34would be lucky to have me.
09:37When the third opportunity to
09:40fulfill my dreams came through,
09:42I applied to be chief resident
09:45of Intervention psychiatry.
09:46It was only one position that
09:48I applied to and I expect and
09:51I unexpectedly, Jen is here,
09:53got invited to open to apply for all
09:56the four open positions here at Yale,
10:00all chief resident spots.
10:01It was a really nerve wracking
10:03experience for me and really frustrating
10:05for Doctor Ostroff because he knew
10:08that my only intention was to apply
10:10for the position in intervention
10:13and after after interviewing
10:15all day from 8:00 AM to 4:00 PM.
10:17He was actually my last interview
10:19and all of the other positions were
10:22inviting me to do way less work
10:25for a Chief resident position.
10:27Doctor Diaz called me because
10:29Doctor Robal was out at the time,
10:31offered me a spot.
10:33All four positions were mine to choose from.
10:37I chose the one with the most
10:39work but with the most opportunity
10:42and the rest is history.
10:45Doctor Ostroff, for all of you that know him,
10:47shows his love by pranking you.
10:50Halloween 2019. I won.
10:52You guys don't even know.
10:55You have no idea how many sacrifices
10:57I had to make to the Halloween gods
10:59that he would show up for working
11:01that pinstripe shirt that day.
11:06Guys, there's so much to be
11:09learned from chasing your dreams
11:11because you sometimes catch them.
11:14I graduated from Yale four years ago as
11:17the chief of Intervention psychiatry.
11:20Mathematicians. You still with me?
11:22Yale two, me one.
11:25You see the lessons we learn sometimes
11:29for rejection, they go and come.
11:31I don't know, had I got into Yale
11:34the the two times before that,
11:35I would I would have even been ready.
11:39Like most psychiatrists,
11:41I have interests in other areas
11:44outside of my primary focus.
11:46I was an American Psychiatric
11:48Association Diversity Leadership Fellow,
11:50and during that time I was detailed
11:52to the Council of Psychiatry and Law.
11:55I had the opportunity to explore
11:57my passion for law and ethics in
12:00the area of forensic psychiatry.
12:02I read The New Jim Crow very early in
12:05my residency and wondered how much
12:07my working intervention, psychiatry,
12:09could intersect with forensics.
12:12I was able to have to interface and
12:16work with many national leaders,
12:19Doctor Paul Applebaum,
12:20Doctor Howard Zonana, Michael Champion,
12:23our very own Tobias Wasser,
12:26Deb Pinals, Ken Hope,
12:28Charles DK, Mike Norco,
12:30and so many others on high level position
12:33statements and resource documents.
12:36I was awarded a prestigious
12:39Rappaport Fellowship.
12:40The fellowship offers the opportunity
12:43for outstanding residents in
12:45forensic psychiatry to develop their
12:48knowledge and skills in the area.
12:51I pursued a fellowship in
12:53forensic psychiatry.
12:54In fact,
12:55after interviewing at a prestigious
12:57school in New York City and immediately
13:00being offered one of two of their spots,
13:03I declined with the intention to
13:06stay here at Yale and pursue a
13:09fellowship in in forensic psychiatry.
13:11Unfortunately,
13:12Yale did not share that intention,
13:15did not extend an offer for fellowship,
13:18citing concerns about my writing skills.
13:21Mathematicians still with me?
13:24Objection #3 In the spirit of threes,
13:27I am now serving my third year as an
13:31Associate Editor of the Journal of
13:34the Academy of Psychiatry and the Law,
13:36and editorial written by me on the
13:41regulation of ketamine has garnered
13:44recognition from both national
13:47and international regulatory
13:49and academic institutions.
13:52This is part of my reports card
13:54for when I was three years old.
13:56Yes,
13:56we give narrative feedbacks to three
13:59years to three-year olds in the Caribbean.
14:02There's a meme that my daughter once sent me.
14:04She said you can't hurt my feelings.
14:06My parents are from the Caribbean.
14:08They call these the general remarks.
14:12The first says this is the most
14:14beautiful thing about Lisa's a pupil
14:16well primed and ready to receive.
14:18However,
14:19she has a definite self recognized limit
14:22to how much work she will do at any time.
14:26Having reached this limit,
14:28she simply sits down and does nothing.
14:32I will leave those who know me
14:34to see if I have changed any.
14:38There is so much effort that we
14:41put into feedback this sandwich.
14:44The truth is I don't eat carbs,
14:47so the bread has never
14:49been of interest to me.
14:51Your lives will change when you
14:54figure out what to do with feedback.
14:58If all I could share with you was one thing
15:01today it would be if like 3 year old Lisa,
15:05you are always a student of life.
15:08Feedback is always easy to receive. Guys,
15:12if you think feedback in residency was hard,
15:16wait until you meet real life.
15:19No performance bonus,
15:23one star reviews on Google,
15:26no patients coming to see you,
15:27an empty waiting room.
15:30Understand that the feedback is
15:33never the rejection that you feel.
15:35Remove your own feelings from the feedback.
15:39The feedback to the source is
15:42the excellence that follows.
15:44I know I have so much more rejection
15:47and disappointment coming my
15:48way even from here within Yale.
15:51To the mathematicians,
15:53I don't care because I don't ever give up.
15:58If, in what you guys view
16:01as the harshest feedback,
16:02you can find one thing to improve upon,
16:06you win. You will find where you belong.
16:11I will remain a member of
16:14society with special obligation
16:15to all my fellow human beings,
16:18those of sound mind and body,
16:20as well as the infirm.
16:23The story that I'm about to share
16:25with you next I have never spoken
16:28about publicly until today.
16:30So you will hold my hand if I get emotional.
16:33I may need some grace through this.
16:36I grew up in the Caribbean,
16:38where at the time the auction
16:40to succeed was either becoming
16:42a lawyer or becoming a doctor.
16:45I did get into law school.
16:46That's another story.
16:47My father said no,
16:48go be a doctor when I was 20 years old.
16:52As I mentioned before,
16:53I got a full scholarship to
16:55study medicine in Cuba from the
16:57government of Guyana.
16:58That's where I was born.
17:00The terms of the scholarship
17:02were pretty simple,
17:03get good grades and obey
17:05the laws of the country.
17:07I was in my second year of Med
17:09school when I got pregnant.
17:11I decided that I could have
17:13a baby and finish Med school.
17:16As a foreigner in Cuba,
17:17you are required to complete the
17:19semester in Med school and then return
17:21to your home country to have the baby.
17:24After that, I could come,
17:25I could return,
17:26go back to my school and finish.
17:29Luckily for me,
17:30that meant I had to finish all my
17:32classes with hyperemesis gravidarum.
17:34In Cuba,
17:35Physical Education PE is a
17:37class that you have to take up
17:39until third year of Med school.
17:41So I had to run a mile while pregnant,
17:44steal my only C in Med school to date.
17:47I finished the year and move
17:50back to the Caribbean.
17:51I live between Saint Lucia
17:53and Saint Vincent and Kaya.
17:55Sitting here today with an
17:57interest in psychiatry.
17:59Don't know why was born in Saint Lucia.
18:03Shortly after Kaya was born,
18:06I received a letter that was sent
18:11to my parents house in Guyana saying
18:14that my scholarship was terminated.
18:16The end. Can't go back to Med school,
18:19can't become a doctor.
18:21That was the end.
18:23I appealed to the government,
18:25even to the president.
18:27Nope, that's it, you're pregnant,
18:29you can't go back.
18:34I then appealed to the Cuban
18:36government themselves,
18:37the government of Saint
18:39Vincent and the Grenadines.
18:41Their humanity, compassion,
18:42understanding allowed me to finish
18:45and go back to medical school in Cuba
18:48and graduate as a medical doctor.
18:54This is the world that I grew up in.
19:01A few years later they did the same
19:04thing to another female medical student.
19:07They terminated her scholarship,
19:09she sued them one,
19:12got her scholarship reinstated and
19:16went back to Cuba and finished.
19:21I am not alone.
19:23Sabrina Jacobs published
19:25findings from Data for Progress.
19:27Because this is an election year,
19:29I didn't break down this
19:31data across party lines.
19:32It is available if you
19:34want to go to the source.
19:36The overwhelming majority of
19:39voters are concerned that pregnant
19:42workers should have accommodations.
19:45However, 40% of them are not concerned
19:48about the fair treatment of pregnant mothers.
19:51Meaning that they think that it is wrong,
19:54but they don't recognize that
19:56it's actually a problem.
19:57Reminds us of racism.
19:58No, I think everybody across the
20:01globe says that racism is wrong.
20:03But I wonder what percentage of them
20:07actually think that this is a problem.
20:10the US Equal Opportunity Employment
20:12Commission published date in 2022,
20:15and these are claims that
20:17have been filed with them.
20:19The allegations of pregnancy
20:20discrimination are part of a subset
20:23of discrimination within Title Seven
20:24of the Civil Rights Act of 1960.
20:27Four,
20:2970% of women reported discrimination
20:34the grocer part,
20:3648% of them reported sexual comments
20:39towards them during their pregnancy,
20:42and 30% of them reported harassment
20:44so severe that some of them quit.
20:47With
20:50that, this is 2022.
20:52I lost my scholarship 20 years ago.
20:57Despite facing that discrimination and
20:59losing my scholarship due to pregnancy,
21:03I remain committed to be
21:05to becoming a doctor.
21:07Reflecting on my oath,
21:09it's a reminder that we are members
21:12of society with obligations to all.
21:15I persevered.
21:16I'm here treating patients,
21:18answering my call.
21:19This is Kaya in this pursuit
21:21to become a psychiatrist,
21:23taking some time off of high
21:25school and is our TMS tech.
21:33I will remember that I do not treat
21:35a fever chart a cancerous growth,
21:38but a sick human being whose
21:40illness may affect that person's
21:42family and economic stability.
21:45My responsibility includes
21:47all of these related problems.
21:51You see, for those of us who think
21:53advocacy is not a part of medicine,
21:55the Hippocratic Oath requires
21:58us to be advocates.
22:00One of the most important lessons I
22:02think I learned through that pregnancy
22:05discrimination was what it meant to
22:07me to become a discerning advocate.
22:10Like every single person of color,
22:12there comes a point in your career
22:15where you have to talk about how it
22:18feels to be ex minority in a space.
22:20So many different approaches
22:22to answer this question.
22:24My favorite was Neil deGrasse Tyson.
22:27When I heard him answer this question,
22:30he said I just want to be recognized
22:32as a phenomenal scientist.
22:35Funny enough, for me,
22:36it was the first time I felt
22:38like I could navigate my work
22:40and advocacy in my own way.
22:44The number of patients receiving
22:47intervention treatments in
22:49psychiatry remains really low.
22:51The number of minorities receiving
22:54care and intervention is even worse.
22:57This is a Day to note published by KFF.
23:00They're an independent health source
23:02for health Policy Research and polling.
23:04And this is data gathered pre
23:06pandemic from the National Health.
23:07In the National Health Interview Survey,
23:11more than 30% of patients adults
23:14with Medicare and Medicare reporting
23:17depression and anxiety did not
23:20receive any care and more than 50%
23:23of blacks reporting anxiety and or
23:26depression did not receive care.
23:29In our own health systems here at Yale,
23:31this is.
23:32Data published from 2016 to 2021
23:35for patients receiving ketamine
23:38and esketamine show that patients
23:40were that the patients receiving
23:42the treatment were predominantly
23:44white and privately insured.
23:47Sam did a publish.
23:49Sam published some work from 2014 to
23:522017 and they were two minority patients
23:55and I actually know one of those patients.
23:59My advocacy in medicine is
24:02excellence in clinical care.
24:05I first have to be able to deliver
24:08excellent care to understand and know
24:11what it looks like to then advocate for it.
24:16You see, for a long time I thought
24:19that in my pregnancy discrimination,
24:22I took the easy way out,
24:24that I didn't fight like that other student
24:27and taking the government to court.
24:30The truth is, as I grow,
24:33I realize we each get to decide how
24:36we deploy our efforts in advocacy.
24:39And to each of you in the room here,
24:43white, black, minority, majority,
24:45your method is not less than because
24:49it doesn't look like somebody else's.
24:52We each get to X.
24:53We each get to decide how we advocate our X,
24:57our advocacy.
24:59My own sense of belonging in
25:02places still wavers at times.
25:05None of my mentors in intervention
25:07psychiatry are women, women of color,
25:10even men of color.
25:12You will find yourselves in
25:14rooms and spaces sometimes where
25:17there's no reflection of you.
25:19I am here to be the reflection
25:22for somebody else.
25:23I get to frame what my
25:25own advocacy looks like.
25:31Using your voice with integrity
25:34means speaking honestly,
25:36authentically, and responsibly.
25:39Our words are a reflection of our
25:43character and we must understand
25:45the impact they can have on others.
25:49Understanding that your delivery
25:51can obscure your message.
25:53My husband can attest that
25:55I'm still working on this.
25:58Before advocating for others,
26:00please take the time to gather as much
26:05information and inform your approach.
26:08Guard your integrity.
26:11During my residency,
26:13I had a report made against me
26:16from a from a fellow resident that
26:19I denied a patient a procedure
26:22in intervention psychiatry.
26:24She said that she was advocating
26:26for her patient.
26:27She did not clearly understand
26:30the indications for each procedure
26:33in intervention psychiatry.
26:35Guard your integrity.
26:37Gather the information before
26:40you make your case.
26:43I will not be ashamed to say I know not,
26:46nor will I fail to call in my
26:48colleagues on the skill of
26:50another is required or needed
26:51for a patient's recovery.
26:53In the Caribbean,
26:54we have a phrase that don't run your mouth.
26:57This is basically what the
26:59Hippocratic O translates to.
27:04Oops, the perimeter of ignorance.
27:08Again, you guys can tell I
27:10like Neil deGrasse Tyson.
27:11In 2005, he eloquently he wrote this eloquent
27:14paper called the Perimeter of Ignorance.
27:17If you ever have a chance to read it,
27:18please do. He eloquently explores in
27:21it the boundaries between scientific
27:24knowledge and the unknown.
27:26He argues the the greatest discoveries
27:30often happen in this perimeter where
27:33our understanding meets this vast
27:35expanse of what we yet do not know.
27:38He emphasizes that the pursuit of
27:41knowledge is a continuous journey
27:43driven by curiosity and desire to
27:46push beyond current limits.
27:48I will make Katie proud and
27:51says this is my Yale.
27:52He emphasizes here,
27:54and the amazing lesson is
27:57that as our knowledge grows,
28:00so does that perimeter of
28:03ignorance surrounding it.
28:04He advocates for embracing the
28:06unknown with a sense of wonder
28:09and a commitment to rigorous
28:12scientific investigation.
28:13This is the practice of medicine.
28:16Embracing the unknown and
28:19being honest about it,
28:23knowing what we do not know,
28:25is the most powerful thing.
28:29The care of my patients is my North Star.
28:32I have both professionals and trainees
28:35ask me all the time how to be an expert.
28:38My son Storm is not here today
28:40because he elected to finish.
28:42He is in the final of a basketball tournament
28:45and he says, Mom, my team needs me.
28:48He's apparently really also good at something
28:51called Fortnite along with basketball.
28:53And if you asked him how to move from
28:56a novice to an expert, his response
28:59is always you got to keep playing.
29:03Hours of work, lots of failure,
29:06sacrifice, looking at that failure,
29:10examining it and trying again.
29:14There is no shortcut.
29:16Stop looking for one.
29:19There is no work life balance.
29:21Not to the beginning anyway for
29:24anyone that is ultra successful.
29:28If you want to work life balance that is OK,
29:32but don't expect greatness.
29:34You will walk a very frustrated path if you
29:37think that reward does not require work.
29:45I understood very well my perimeter
29:48of ignorance and for those that
29:51have seen my lecturer knows,
29:52know that this is one of my
29:55favorite quotes from Rumi.
29:57When setting out on a journey,
29:58do not seek advice from those
30:00that have never left home.
30:02I wanted to understand the business
30:05of medicine and wanted to understand
30:07what I didn't know, so I went to folks
30:10who have journeyed away from home.
30:13A very good friend of mine,
30:14now Doctor Steve Levine,
30:16is a pioneer in outpatient ketamine
30:19during its early stages of psychiatric use.
30:22He actually started quite a few
30:24clinics here on the Northeast.
30:25He will hate me for this,
30:26but if you're interested in learning
30:28about the early days of ketamine,
30:29his original videos are still
30:31on the Internet.
30:32So that thing your mom always says,
30:34but don't put it on the Internet,
30:35it's there forever.
30:37It actually is.
30:38I reached out to him.
30:40I will let him tell you that story.
30:42The first conversation I had with him,
30:44I was actually standing in
30:46the lobby of the YPH hospital.
30:49Over the years.
30:50He did not give me the playbook.
30:53He gave me the gift of his lessons
30:56learned from feedback and his setbacks.
30:59His direction ultimately paved
31:00the way for me to be in many
31:03leadership spaces that I am today.
31:07Doctor Michael Vollmer, he's,
31:08he also has a very extensive background in
31:12emergency medicine, if you didn't know.
31:14I think the only thing that tells you is
31:16that we both have impatience in common.
31:19The phenomenal thing that he did
31:21was he introduced me to others in
31:23Connecticut in private practice,
31:25but with models that I didn't
31:27work with Hash P sliding scale.
31:30In recognizing his own limits,
31:33he was able to push me in the
31:35directions to get the information
31:36and the answers that I needed.
31:38I also did my homework.
31:41I looked at the folks with MBAs and
31:43then looked at the coffee shop in
31:45Stratford where I like Cafe Talia.
31:47Successful businesses.
31:48I joined the Small Businesses Administration,
31:52taking their feedback and guidance.
31:56One of my mentors through SCORE
31:58was actually a former CEO of Timex.
32:01Another mentor was a Provost of a university.
32:03Here they read my business plan
32:06and redlined it.
32:08My husband also gives me
32:09fantastic feedback all the time.
32:11At one point I wanted to open a
32:13coffee shop with a yoga studio.
32:15Still a dream of mine,
32:17but he redlined that business.
32:18Planned very hard as well.
32:21I know when to say I don't know
32:23and when to get help.
32:27As I set out to deliver
32:29care in the community,
32:30I was faced many daunting questions.
32:34The one that was most important to me
32:36is that I wanted to provide the same
32:38quality and standard of care that
32:40patients would have getting through
32:42the doors of Yale New Haven Hospital.
32:44I wanted to do that in the community.
32:47Was that even possible?
32:50I knew I wanted to make
32:52intervention treatments accessible.
32:53I had to take insurance.
32:55I had to figure it out.
32:57I built an environment that is so
33:00beautiful for people of all walks of life.
33:05Katie mentioned it earlier,
33:06but I want you to know that the thing
33:09that I am a most proud of is when
33:12colleagues ask me to treat their families.
33:15That to me is the testament of my excellence.
33:19Clinically, my outpatient life
33:21has not been without challenges.
33:23You guys know these buttons.
33:25Ask the audience,
33:25Phone a friend 5050 you think of these
33:27as your options in clinical care.
33:29This is exactly what we do.
33:32I had my first,
33:32I do my own Ivs in the office.
33:34I had the one, the first one in Extravis 8.
33:36I called my phone, a friend,
33:39an ER doctor in New Jersey,
33:42his name is Patrick.
33:43We affectionately call him.
33:44Rocky answered immediately.
33:45When I treated my first acute trauma patient,
33:49I called Jerry.
33:51Sana Cora answered immediately.
33:53When I had patients,
33:55two patients with the same rare adverse
33:57events to both ketamine and esketamine,
33:59I called Sheldon and I called Jerry.
34:02I think I promised them
34:04that I'd write case reports.
34:05I will get to it, I promise.
34:07But they answered immediately.
34:10As you step into this new phase of your life,
34:15carry this reverence for the
34:17unknown with you and ask for help.
34:21Building and relying on a supportive
34:22network has always been paramount
34:24to my journey,
34:25both professionally as well as personally.
34:29The reality is,
34:30and I think in fourth year,
34:32you realize it,
34:33that the limited time frame of of residency
34:35can't encompass and we can't teach
34:38you everything that you need to know.
34:40But what I am confident in is that
34:43we have equipped you with a framework
34:45and a mindset to embrace lifelong
34:48learning and always strive for excellence.
34:51During the pandemic,
34:52I think we all took a collective pause,
34:55lots of introspection.
34:56Medscape helped us out and did
34:59a a survey of of about 13,000
35:03physicians across 29 specialties.
35:05As you guys can see up there,
35:06it's clearly too late to
35:08become a dermatologist.
35:09And curiously you see that oncologists
35:11are less burnt out than we are.
35:14I would have never guessed that as a
35:16multiple choice answer to that question.
35:19But we are the gurus of self-care.
35:21Spending time with family and
35:23friends is how we stay happy.
35:30The renowned Harvard study
35:32spanning 80 decades, 8 decades,
35:3580 years, serves as a poignant
35:37reminder that ultimately,
35:39the source of happiness lies in
35:43the quality of our relationships.
35:45In fact, for those psychotherapists
35:47in the room you tell,
35:48we have all been taught that a
35:50person's response to psychotherapy,
35:52the measure is what is the quality of their
35:55personal relationships that they have.
35:58As we navigate our careers,
36:00nurturing authentic
36:01connections with colleagues,
36:02patience and our widest and our
36:06wider community becomes indispensable
36:08for measuring our fulfillment.
36:11My philosophy encapsulates fairness,
36:14kindness and paying it forward.
36:17These guide my approach in both
36:20business and professional interactions.
36:22I will not help someone that is selfish.
36:26In my role as a business owner and a
36:28medical director, I appreciate my team.
36:31I placed unwavering trust in my team,
36:35allowing them the freedom to grow and excel.
36:39I will share with you that I have
36:41treated 21 patients with ketamine and
36:44esketamine and still left work by
36:473:00 PM to catch my 4:00 yoga class.
36:50I firmly believe the strength of my
36:53team is a reflection to our collective
36:57dedication and mutual support.
36:59Casey, Patrick, Nora, Jesus,
37:02Terrell have been instrumental
37:04in my success story.
37:06While building any team is an
37:10iterative process, each member,
37:12regardless of whether they remained or left,
37:16imparted valuable lessons
37:18that have shaped my journey.
37:20As we embark on a second location,
37:23I am reminded that investing in this team,
37:27I'm included in this team.
37:28So investing in myself is not
37:31just about the business goals,
37:33but about creating a positive
37:36impact on them and our community.
37:39Southport, Connecticut, here we come.
37:41Mathematicians, I know you're still there.
37:45Our department's mission
37:47statement was revised last year.
37:50I share this portion that resonates
37:53with my message to you today.
37:56Yale's mission is to improve the
37:58world for generations to come through
38:00outstanding research and scholarship,
38:02education, preservation,
38:03and practice.
38:05This mission lives through us,
38:08through you as you graduate
38:10and continue to and continue
38:12on this professional journey.
38:16Recently, I went to Kansas.
38:19Mariela, who was like a daughter to me.
38:21She graduated medical school a
38:24few weeks ago and I had the honor
38:27of performing her hooding as we
38:30have all done here in the room.
38:32The graduating class recited the SIP,
38:35the Hippocratic Oath.
38:37It was such a reminder.
38:39I would like to invite you all with
38:41me in the room today to stand.
38:47I would like you to say this with me
38:52if I do not violate this oath.
38:55May I enjoy life and art,
38:58respected while I live,
39:01and remembered with affection thereafter.
39:04May I act, may I always act
39:07so as to preserve the finest
39:10traditions of my calling.
39:12May I long experience the joy.
39:18Thank you, you can say it.
39:20Thank you experiencing that joy of
39:24healing those who seek our help.
39:27Thank you so much for
39:29allowing me to share my part,
39:31the parts of my life with you.
39:33I hope my stories have illustrated
39:36how the power of resilience,
39:39continuous learning,
39:40and incorporating feedback
39:42have been vital to my journey.
39:46I hope you share my dedication to
39:50lifelong learning and to my Yale
39:52and the importance of being open and
39:55honest of what we yet do not know.
39:59Thank you.