116 – Dr. Ni-Cheng Liang-Mindfulness for People on Both Sides of The Medical Field.mp3 - powered by Happy Scribe

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Hi, I'm Dr. Marcia Sirota, and I want to invite you to my next community event. It's going to be held on Thursday, July 25, at 12:30 Eastern Time, and we're going to be having a conversation on how to manage stress that's coming from the recent inflation and potential recession. This will not be financial tips. This will be a conversation about stress management and how to deal with these difficult times. This is going to be all about self-care, and it's going to be a conversation among the participants and myself. It's not a lecture. It's not me sitting there talking. It's really a conversation where everyone gets to participate and give input and share and see where everyone else is. And then, of course, there will be some helpful tips and good ideas that everyone will share about stress management in these difficult times. So please join me on Thursday, July 21, at 12:30 Eastern Time for our conversation on managing the stressful times with these economic downturns.

Welcome Ni-Cheng Liang to the Ruthless Compassion podcast.

Thank you so much for having me.

I'm very happy to have you on the show because you seem to have a lot of things going and a lot of interesting things that we can talk about today.

Yes, pick one and let's go.

Well, I think the best way to start is for you to kind of introduce yourself to the listener and share a little bit about your story.

Yeah. So I am an adult pulmonologist, a mom, a wife, also a cancer survivor that was diagnosed almost exactly to the day, actually eleven years ago with a very aggressive form of breast cancer in my second year of pulmonary critical care fellowship. And that really was a catalyst that I needed to finally put my own self-care at the forefront of my day-to-day living.

So how old were you when you were diagnosed?

I was diagnosed when I was 31. I'm 42 now.

Wow. So you were super young at the time, and I'm sure that was like a big shock. Completely unexpected.

Yes. And at that time, my now eldest but then only child was about a year and a half, so it really was a very challenging part of my time.

So just for those who aren't in the medical field, explain what a pulmonologist is.

Yeah, absolutely. Basically, I'm a lung doctor for adults.

And so here you are in a fellowship. And so this is after how many years of training? Up till that point from medical school onward?

We have four years of medical school, then three years of residency. I did a chief medicine residency, as well as basically three years of pulmonary critical care fellowship. But after cancer, which was diagnosed during my second year of fellowship, I actually drew a line in the cement for myself and did not complete my critical care fellowship and really focused on pulmonary fellowship and completion of that.

So you took a little step back. So you were saying that it made you really put yourself care first. Were you one of those super overachievers who kind of neglected their self-care up until then?

Yes, absolutely. I was a giver. I self sacrificed. I stayed until the work was done. I neglected my own basic bodily needs for a very, very long time to basically try to help as much as I could. But what I realized from the breast cancer journey was that you really can't help others unless you care for yourself first and foremost.

I want to ask you a personal question here. Feel free to answer as much or as little as you feel comfortable, but do you have any sense of why you were so neglectful towards your own self-care and so much of a giver up until that point?

Yeah, I think that that's a really long-winded potential answer. And it delves into my own culture as a Chinese Taiwanese American who is also female and where my family societal construct is. So, also the culture of medicine, we are in the midst of trying to change that. But even the culture of medicine, where there is a lot of giving towards others, that's expected as we train in medicine and even as supervising attending graduate physicians, that still somewhat is the expectation to this day. And there was actually reaffirmation so when you did self-sacrifice, when you did overwork, that was almost seen kind of like a badge of honor. And so there was this reaffirmation so it became a vicious cycle for me that I was almost addicted to that affirming quality of busyness and overwork and self-sacrifice to the detriment of my own health.

You know, you're absolutely right when you talk about this combination of our own cultures that we come from and then our environment that we're living and working in, and you have this kind of double whammy, it sounds like, right?

Yeah, I do like to consider it as a double whammy from cultural environment, just the institution of a health care profession.

So there you are, 31 years old, used to being a people pleaser, used to getting that hit of adrenaline or dopamine from being a giver, and then you get this very devastating diagnosis. Did you have to take time off for emotional or physical treatment reasons? Did you have to take a step back?

Yeah, I took a leave of absence from the fellowship so that I could focus on treatment and healing myself both externally, physically, but also internally from a mental health perspective. So there was five months of chemotherapy. I was also a clinical trial patient, happy to be one of the earlier women of color that was enrolled in the I Spy two clinical trials. So I'd like to say that I'm published in the New England Journal of Medicine, not as an author yet, but as a patient. And on the graph and on the chart I can actually point out exactly where I am because in the first cohort there were only three Asians in that study. So I'm one of those. And so five months of chemo and then three surgeries because I opted for reconstruction. And as the healing became more prevalent for my physical body, I realized that going back into the practice of medicine and to finish up training, I really needed help with healing my insides, so healing my mind and spirit. And I'm grateful to the psychotherapist that worked with me from the cancer center to be able to help me navigate the rough terrain of uncertainty.

Which basically is now lifelong for me as a cancer survivor. Even though it's now eleven years ago. But still grateful for that kind of foundational piece of how important it is to also prioritize mental health. Especially after something as traumatic as a cancer diagnosis.

At 31 with a new baby, it's pretty shocking. What kind of tools have you learned in terms of self-care? And this, I guess, can be something for any busy professional woman juggling marriage and family and a career. What kind of tools have you learned that would help not just yourself, but other women who are listening to this.

Podcast, I'll tell you a story about my discovery of self-care tools that have helped me. Shortly after my acute treatment for cancer, I went to a cancer survivor day and I sat in the audience of a talk being given by the founding executive director for the UCSC Center for Mindfulness at that time. And I am born and raised Buddhist, but it wasn't until that moment that practicing mindfulness and wanting to practice and wanting to teach it and bringing it more into the forefront of how I practice medicine and trying to share my story and also teach mindfulness to other healthcare professionals really became solidified. And it was that wanting to realize that my path was most likely not going to be a traditional one and giving myself permission that I was going to need to pivot when I came back to my practice of medicine, that really helped. And so I've been a mindfulness practitioner for over ten years. I've taught mindfulness to all levels of healthcare trainees as well as healthcare administration, to my patients, to the general public. For the better part of ten years been involved with curriculum development. Especially after the ACGME.

The Graduate Medical Education Council. Basically of America mandated that all training programs needed to have some component of well being for its trainees. That I became much more involved with that and wanting to help the next generation and also my colleagues basically navigate the terrains of stress because stress is an inevitable part of life and we know the system is broken. There are so many systems that are broken, especially after the last two and a half years of the Covid-19 pandemic and burnout being rampant amongst healthcare professionals. However, for me, because I was reinserting myself back into this kind of broken system to finish up training, I needed to find tools that would resonate with me to be able to care for myself better. And so mindfulness was definitely one of the forefront ways in which I took care of myself and then other aspects was really to identify the basic bodily needs that I had neglected previously. Simply going to the bathroom, giving myself permission to go to the bathroom, even if it meant I was going to show up a couple of minutes late for my next clinic patient when I was in training.

And maybe you had heard this as well in your own training. One of my senior residents told me, eat when you can, pee when you can, sleep when you can.

Yeah, I know that one.

And coming back from cancer, it was more like, no, I'm going to pee, eat and sleep when I need to, as opposed to when I can. So there was a lot of permission giving as part of my healing process as well. So I would say like mindfulness and giving myself permission to do more of what it is that I wanted to do, including self-care and honoring my needs as a human being, as some of the keystones of my own self-care journey.

It's so ironic to think that the people responsible for caring for the welfare of others have to almost demand permission to care for themselves.

Yeah, isn't it ironic? It's ironic that being in healthcare can be construed as a thing that can harm.

Yeah. I was talking to my assistant today about my own journey. I've been in practice for decades now and just about how it's been an ongoing effort on my part to make sure that I take care of myself. And I was very lucky because I was conscious of self-care from the start. But I have to say, it's been really a fight. I've been really fighting tooth and nail against all odds, against all the opposition so that I could continue to take care of myself. And sometimes I lost the fight, not because I wasn't trying, but I keep trying because I know that it's so important. But boy, there are so many things that are pulling us away from self-care, aren't there?

Yes, absolutely. And also another piece of perhaps inspiration or wisdom is not forgetting about just basically the five pillars of health that many of us teach our patients about and teach our family and loved ones about that we can also walk the talk as well with prioritizing not just sleep, but our own nutrition stress reduction. Which doesn't have to be mindfulness, but anything that resonates with you for stress reduction exercise. Doing what it is that you like to do. To move your body and not viewing it as something that you have to do. And then social connection. I think the last two and a half years have really shed light on the importance of social connection in safe settings and how that impacts our well being as well.

Yeah, and I think it's so important for us to keep sight of that. And I was reading a survey a while ago that said that especially mental health practitioners like psychiatrists, especially psychiatrists, tend to become more socially isolated over the years. And I was thinking about how the stress of dealing with very disturbed individuals year in, year out can make a person kind of sour on humanity and then withdraw from others, which is exactly the opposite of what we need. And so we have to really make sure that we resist that urge to withdraw and continue to engage with our loved ones so that we are healthy.

Yeah, absolutely.

Wow. So you've really had quite the journey. And I was reading some of your literature and you were talking about living with uncertainty. And I was just thinking, in the light of the Covid pandemic, that topic is more relevant than ever. Can you say something about learning to live with uncertainty?

Yeah, absolutely. I think it's important to realize that the only certainty in life is that it's uncertain and to accept that. But our human brains don't want to accept that. We love and crave certainty because it's easy, it's efficient for our brains when something is quite certain, but it does us more harm to resist that. And so when we allow and accept that life, this pandemic, what's going to happen with the world is uncertain. It can somewhat free us. It can be a liberating, compassionate act to accept and allow the uncertainty. And if you do notice resistance, perhaps getting curious about where that resistance is coming from. Is it stemming from a need to control? I myself, definitely catch myself doing that. And it's not to shame myself like, oh, you shouldn't be trying to control the situation, but it's more about noticing when our habitual patterns of what we need to achieve certainty come up. And that's where we can really start delving into the reasons for why that's coming up and then choosing to respond to the uncertainty in a healthier way. And oftentimes that healthier way is allowing and accepting and then meeting the uncertainty with curiosity and compassion as opposed to fear and resistance.

Yeah, absolutely. You've also spoken and written about perfectionism. How does that all play into this discussion today?

Perfectionism. I'm a recovering perfectionist.

Hello, my name is Ni-Cheng Liang and I'm a

Recovering perfectionist. And that being said, that kind of mentality really did serve me well in academics, for sure, where perfectionism is quite literally rewarded with higher grades and higher scores. But then as we grow in our lives, in our careers, amongst our family, we learn that perfectionism actually holds us back and no longer serves. And I think it's important to recognize when it still shows up. Because for me, it's literally decades and decades of that habitual pattern of wanting something, an outcome or something that I do or say to be absolutely perfect, perhaps even touching upon the people pleasing tendencies that I used to have and that still show up for me to this day. But really realizing that perfectionism and being perfect is actually a fallacy and that all of us as human beings are perfectly imperfect, just as we are. And that's what makes the spectrum of our identities and the human experience all that much more rich, is because of the composite, the collective of imperfections. So I think that perfectionism used to serve, but now it does not serve. And we can again meet the perfectionistic tendencies with curiosity and compassion. And if we choose to respond in a different, healthier way, that isn't holding ourselves up to these perfectionistic standards that are impossible, frankly, to meet.

I agree. I think I've dealt with perfectionism with my patients so often, and I've used the same line we are perfectly imperfect and good enough as we are. And I can say it to them a few times or a few dozen times, and sometimes it's hard to penetrate because they believe that the only way that they're lovable or valuable is by trying to be perfect. And we have to all see that that's not true.

Yes, and perhaps going from perfectionistic tendencies to embracing imperfection is too big of a jump for many, especially after decades of conditioning. But what if we crack the door just a little bit and simply say to ourselves, a more believable thought in that I'm willing to learn to love and accept myself just as I am perfectly imperfect and perfectly imperfect in all aspects of my life?

Yeah, it's a good start. Well, kind of on this topic, I wanted to touch on workaholism because I think that's a big issue for not just for physicians, but for a lot of people these days. We get caught up in work and we just don't know when to stop. And especially now that people are working from home, I think it's like the workplace is now a 24 hour cycle. So, what can you say about workaholism?

It is pervasive, I think, in our society and our culture today. While technological advances have been amazing and really quite a miracle for the 21st century, I also think that one of the downsides of it has been to create this 24/7 type of culture of access and demand. And so I think that in the midst of technological advancement and the Internet being available and how connected we can all be electronically, that it's even more important for us to have fierce boundaries about that. So be it putting your phone or your computers in areas of the home that are not as easily accessible, having that boundary for yourself. I myself, it took a long time for me to do this, but I no longer chart at home. I finish all of my notes in clinic, actually, 99% of the time with the patient sitting in front of me, letting go of the perfect note that I used to be able to write but spent way too long trying to perfect that note when I was a trainee, for instance, and a junior attending. But in order to have those fierce boundaries, sometimes you have to actually, a lot of the time you have to let go of the perfectionism. And those fierce boundaries can help protect you from the very tempting aspects of workaholism.

Which leads to burnout. Yes, I agree. I think it's so important to carve out those boundaries and really have your work life and your home life separate and know when it's time to be a person again, rather than whatever your professional designation is.

Yeah, absolutely. And then also to let others know part of your boundaries. Yes, you can set up your boundaries for yourself, but communicate that. Spread ripple effects of boundary setting to your team, to your colleagues. Don't expect email responses in evening hours and weekend hours, for instance, and make it known. So I think that setting up boundaries for ourselves, but then also communicating that and helping foster that for others can be really empowering and also combat that culture of workaholism.

Yeah, by telling people it reinforces for yourself and it helps them understand what they can expect of you. And if you don't communicate it, people just can keep pushing and pushing and asking for more because they don't realize what they're asking for, how much they're asking for. They're just asking they're just assuming you're available 24/7.

And tying boundary setting in with your title of your podcast, Ruthless Compassion. Yeah, this is a type of ruthless compassion. It is a fierce, self-compassionate act to say no to your boundaries and to say yes to your needs. Borrowing some of that from Kristin Neff's pioneering work.

Absolutely. For me, Ruthless Compassion is both something you do for yourself and something you do with others. So in the internal, it's like you were saying when you notice that you're doing something that doesn't work, instead of beating yourself up, just noticing it and going, that doesn't work, let's try something else. And that helps you be honest because you're not, you know, beating yourself up every time you have an insight. Your insights are no longer associated with self-criticism, so they're easier to come by. And then with other people, the Ruthless Compassion is saying, this is what I'm willing to accept, this is what I'm not willing to accept. This is what I'm willing to do. This is what I'm not willing to do. And that's just how it is. And you're not doing it aggressively or defensively, you're just doing it very straightforwardly. And if the other person has a problem, the ruthless part is it's like, that's your problem. And the compassion part is, I'm sorry, I'm still not going to change. Yeah.

And even like take out that, I'm sorry. There's nothing to be sorry form right. Like it's simply you showing up as your authentic self

For sure.

Doing things and making it known that your authentic self includes prioritizing yourself and your wellbeing.

I used the I'm sorry as a polite thing.

Absolutely.

No, I'm sorry. I'm being polite now. It's important to be polite when you're setting really fierce boundaries. So you are in California, right?

Yes.

What's the Covid situation right now where you are?

It is way better, but we have had kind of an increase over the last two weeks or so. We saw horrendous really scary wave with Delta back in January of 2021 where we were rounding intense and my consult list of patients used to be non Covid patients and then it was flipped to all Covid patients, not surprisingly. And then now I'm back out, mostly in the outpatient clinic setting and I still see Covid every day, but a lot more long Covid as well, which has been such an unfortunate debilitating situation, especially for young adults. Right now, I would say it's manageable, it's slightly on the uptick, but nothing near as bad as it used to be.

I was just reading about how when we have all this uncertainty around Covid, it just creates such an anxiety in the general population. What kind of thing can regular folks do dealing with the uncertainty of Covid and not knowing if when we're going to be able to go back to some semblance of normalcy?

The uncertainty of Covid is a really great reminder of basically the pervasiveness of uncertainty in life and how you kind of deal with Covid could be a reflection of how you deal with uncertainty in life. And so I encourage listeners to think about that. Like, is it, has it been a reflection of how you've dealt with uncertainty before in life? And I think realizing you are doing the best that you can and assuming positive intent of other human beings I know this is potentially hard sometimes, but assuming positive intent, that another human being that you don't necessarily agree with, that they're also doing the best that they can and that you doing the best that you can is more than enough. So in terms of getting vaccinations, continuing to mask washing hands, staying 6 feet apart, those things may or may not still work for you and your loved ones. And that's okay. There is such a heterogeneity of what normal looks like now. I think a lot of people are still trying to figure out what normal is in our society now. And this kind of tension between that very extreme but effective lockdown that happened in early 2020 compared to complete liberation of no masks and no vaccines.

So something in between will probably feel more comfortable for you and to honor that when you do find that kind of balance. And it's a dynamic process. So as the Covid situation changes, which none of us really have all that much control over, you are probably going to have differences in how you're feeling about the current circumstances, your emotions around it, and different levels of tolerance with regards to the uncertainty.

For sure. I want to tell you something a little funny. Okay. So as you were talking, I was thinking, yeah, I'm cool with people who want to wear their masks all the time, and I'm cool with people who don't want to wear their masks all the time, although I might not hang out with them. The thing that I'm not cool with is people who wear their masks over their mouth and under their nose. That drives me completely crazy.

Me too. And in my clinic. In a pulmonary clinic. Regardless of the recommendations, right now at this instant in time, we are requesting and basically demanding there's really very little room for deviation from this. But that everyone in our clinic wears a mask still just because our patient population is so fragile and at risk for levels of complications of Covid that are quite different and more severe than the general population. So even in the settings that you find yourselves in, there are going to be different approaches to the tolerance of uncertainty.

I just want to ask you a little technical question just for the sake of the listeners, because the other day I had a patient who was saying that they couldn't breathe in their mask. And as a psychiatrist, I said, it sounds like you have claustrophobia. It's probably not an oxygenation issue, it's probably a claustrophobia issue, and that's why you're getting short of breath behind your mask. So I just wanted to ask you, as the pulmonologist, what is the difference in terms of how much oxygen you're actually getting when you're wearing a mask versus when you're not wearing a mask?

That's a great question. And so they actually have been studies about this because people are worried that the mask wearing is going to contribute to basically training our exhaled carbon dioxide. So there's a certain amount of that, but at the same time, it doesn't affect our oxygenation at all. I know even on social media, there have been doctors who have been exercising on their peloton bikes wearing a N 95 mask, very tightly fitting, watching their pulse oxymetry, and it doesn't dip at all, or it doesn't dip below clinically significant levels. And so I think that the sensation of breathlessness when one is wearing a mask is one that is of course valid because to each their own in terms of what your experience of wearing a mask is, like. But from a physiologic standpoint, there really is no downside to wearing a mask. And in fact, even after the lifting of mask restrictions, hopefully someday that will come during the cold and flu season. I very well might just adopt that when I travel on planes and when I see clinic patients, because it is so effective with regards to infection control, not just of Covid but of flu and other really common respiratory viruses. So hopefully that helps.

Yeah. So if people recognize that if they're having shortness of breath in their mask, it's probably more of a psychological issue than a physiological issue, then they can work on trying to do some mindfulness techniques so that they can be more comfortable in the mask.

Yes. So in our early beginning parts of the pandemic, I actually did lead mindfulness meditations for mask wearing. So you can be very mindful about putting on your mask, noticing the texture, the sensation of the fabric or the cloth or whatever it's made of, and then taking a couple of deep breaths through the mask and acknowledging the potential physical discomfort that you have, but also just closing that with the level of protection that you are giving yourself and also to others. So hopefully that can also help in that simply noticing and slowing down this process can help with increasing the tolerance of mask wearing.

That's so cool. I love that. And over the nose, right?

Yes, please. Over the nose, not under the chin.

Cool. Well, listen, I think it's time to wrap up. So I'm going to ask you our last little group of questions. The first question is, if people are interested in finding out more about you and all the interesting things that you do, where can they find you?

Thank you so much for having me on. I really enjoyed our time together. If you are interested in learning more about me, you can find me over at my website at AwakenBreath.org and I'm also on Twitter at DrNiChengLiang And Instagram @nclangmd.

Cool. And you were saying before we started that you have an interesting upcoming event. Maybe you'd like to talk about that.

Yes, thank you. For any health care professionals out there, we would love to have you join us in Magical Mirror Beach and Mere Woods in the San Francisco Bay Area at Green Gulf Zen Center for the first ever Mindful Healers Connect in Nature Retreat. There are continuing medical education credits for physician attendees. And this is going to be co-lead by my podcast cohost of the Mindful Healers podcast, Dr. Jesse Mahoney. And yeah, we hope to really immerse in experiential practices with you as building upon tools to help optimize your health and well being as healers.

And that's in July.

That is July of this year, 2022.

Cool. So, yeah, I'll put that also in the show notes for people who are interested in looking at that. And my last question before we go is. Do you have a call to action for the listener today?

Yeah, if you're especially in healthcare, to please consider joining me and some of my other colleagues over at the Mindful Healthcare Collective. So I started a Facebook group and also a community to simply alleviate suffering because we knew going into the pandemic, health care professionals were 50% or more burnt out has gotten worse over the pandemic, not surprisingly. And we offer free online wellness sessions and we've offered more than 200 over the last two years or so. So Mindful Healthcare Collective.com or join us on the Facebook group of the same name.

That's wonderful. Well, listen, nicheng ling, I really appreciate you coming on the show today and sharing all your wisdom and I wish good health for you and good boundaries in the future and all the best.

Thank you so much for having me.

This is Dr. Marcia, sirota. Thank you for listening. Please leave a review and your comments wherever you listen to podcasts. And don't forget to sign up for my free newsletter at Marcia Sirota.com, where you'll learn about upcoming online and events as well. Also, we love getting referrals from our listeners about future podcast guests, so please email us at info@marciasrodamd.com.