Speaker 1: Absolutely. I still remember the first person I had to
Speaker 1: tell that they had cancer on a biopsy, and how
Speaker 1: completely bereft of any skills I felt I had, and
Speaker 1: how desperate I was to just model it based on
Speaker 1: something I had seen, like in a movie, or you know,
Speaker 1: is really grabbing straws.
Speaker 2: This is it's okay that you're not okay, and I'm
Speaker 2: your host, Megan Devine. This week on the show, Doctor
Speaker 2: Renna Otdish on compassion in medicine and what it really
Speaker 2: takes to listen to others and to your own self
Speaker 2: settle in everybody. An excellent conversation is coming up right
Speaker 2: after this first break before we get started. Two quick notes. One,
Speaker 2: this episode is an encore performance. I am on break
Speaker 2: working on a giant new project, so we're releasing a
Speaker 2: mix of our favorite episodes from the first three seasons
Speaker 2: of the show. Some of these conversations you might have
Speaker 2: missed in their original seasons, and some shows just truly
Speaker 2: deserve multiple listens so that you capture all of the goodness.
Speaker 2: Second note, while we cover a lot of emotional, relational
Speaker 2: territory and our time here together, this show is not
Speaker 2: a substitute for skilled support with a licensemantal health provider
Speaker 2: or for professional supervision related to your work. Take what
Speaker 2: you learn here, take your thoughts and your reflections out
Speaker 2: into your world, and talk about it. Hey, friends, So
Speaker 2: this week, this week, I would like to say that
Speaker 2: I uncharacteristically gush about my guest. But in saying that,
Speaker 2: I think it's possible that I might gush about a
Speaker 2: lot of guests. I don't know. It is true though,
Speaker 2: that I am a bit obsessed with this week's guest,
Speaker 2: doctor Renna Otdish. She's a critical care physician, founder of
Speaker 2: the Clear Program, which is a narrative based communications training
Speaker 2: that helps medical staff practice empathy in critical care, and
Speaker 2: she's the author of the book In Shock. I first
Speaker 2: found her through her essay The Shape of the Shore,
Speaker 2: where she writes what it was really like in those
Speaker 2: first early months of the pandemic for medical providers. It's
Speaker 2: haunting and gorgeous and really hard to read. Doctor Ottish
Speaker 2: is really really an amazing human being. I mean I
Speaker 2: feel like I say that a lot. This is one
Speaker 2: of the perks of doing the show is that I
Speaker 2: get to have conversations with really amazing people. But doctor
Speaker 2: Ottish Man who she is no stranger to loss. In
Speaker 2: her last year of medical residency, doctor Otdish became very
Speaker 2: ill a tumor burst in her abdomen, causing a massive
Speaker 2: loss of blood. She was seven months pregnant at the time.
Speaker 2: She lost the baby, as well as nearly losing her
Speaker 2: own life, and the things that she heard from her
Speaker 2: medical teams as she was waiting for surgery and as
Speaker 2: she made the long climb back to health, those things
Speaker 2: she overheard really opened her eyes or maybe her ears
Speaker 2: to the unfeeling, cruel and often unintentionally dismissive things that
Speaker 2: care providers say too and about their patients, especially when
Speaker 2: they think their patients can't hear them. That experience lit
Speaker 2: something up in her, a desire to help her fellow
Speaker 2: medical providers learn to communicate with compassion, to really listen
Speaker 2: to the patients and the families in the room. And
Speaker 2: as you'll hear her say in the show, she wanted
Speaker 2: more compassionate communication, not just for patients, but to help
Speaker 2: nurses and doctors and surgeons regain some of their own humanity,
Speaker 2: their own power that was maybe lost or ground out
Speaker 2: of them as part of the medical industrial machine that
Speaker 2: we all work in. And her approach to teaching is
Speaker 2: just so kind and so generous and so entirely shame free.
Speaker 2: Whether you work in the medical professions are not, I
Speaker 2: hope that you love her as much as I do. Now.
Speaker 2: If you do work in the medical field and you're
Speaker 2: still kind of reeling from everything these last few years
Speaker 2: have taken from you, please be sure to listen to
Speaker 2: this episode. It's a beautiful meditation on compassion in action
Speaker 2: for everyone. But if you're one of those people we
Speaker 2: called a hero over the last few years, you're really
Speaker 2: gonna dig what doctor Odish has to say. All right,
Speaker 2: on with the show with the excellent doctor Renna Otdish.
Speaker 2: Renna Otish, I am so glad you're here. Thank you
Speaker 2: so much for joining me. I know you're at the
Speaker 2: library at the hospital right now, so I'm just really
Speaker 2: thrilled that you're here.
Speaker 1: Thank you. I'm so happy to be joining you.
Speaker 2: So I got kind of lost in all of your
Speaker 2: writing over the weekend. I try not to work on weekends,
Speaker 2: but I started reading your book towards the end of
Speaker 2: the week and I couldn't stop reading it. So thank
Speaker 2: you for being such a beautiful and poetic writer. There's
Speaker 2: something really I'm going to go with the word luminous.
Speaker 2: There's something really lit from within in the way that
Speaker 2: you write and the way that you speak. So thank
Speaker 2: you for that.
Speaker 1: Thank you so much. I'm glad that you found it
Speaker 1: to be luminous. That's a love compliment.
Speaker 2: I love that word. That's a really good one. So
Speaker 2: I talked a little bit about your work and what
Speaker 2: you do in the introduction, but I would love to
Speaker 2: hear your story from you. So these days as a physician,
Speaker 2: you're focused on the patient experience and communication styles, but
Speaker 2: these aren't like those aren't typical things that a doctor
Speaker 2: focuses on. So what happened for you that made you
Speaker 2: feel like that kind of focus was important? Yeah.
Speaker 1: I had sort of two educations, you know. I went
Speaker 1: the traditional medical school residency fellowship route and learned so
Speaker 1: much beautiful science and just fell in love with the
Speaker 1: human body and all the different ways that it could fail,
Speaker 1: and really prided myself on helping in those acute situations.
Speaker 1: I went into pulmonary and critical care medicine. But because
Speaker 1: I think the universe understands irony, on the very last
Speaker 1: day of my training, I got critically ill myself and
Speaker 1: it began really a ten year odyssey into the patient
Speaker 1: side of medicine. And when I got sick, I really
Speaker 1: got sick. I had a tumor that was in my
Speaker 1: liver that ruptured and it was like an artery bursting.
Speaker 1: I just lost all of my blood volume into my abdomen.
Speaker 1: I was seven months pregnant at the time, so we
Speaker 1: lost that baby. I went into multi system organ failure.
Speaker 1: I ended up on a ventilator. I required massive transfusions,
Speaker 1: replacing my blood volume probably three to five times over,
Speaker 1: and then woke up in my own icee you you know,
Speaker 1: on a ventilator with my priest praying on my body,
Speaker 1: and got to experience medicine from the other side of
Speaker 1: the bed. And when I say that, there were so
Speaker 1: many errors in miscommunication, there was nothing for me to
Speaker 1: do except to go into training physicians in compassionate communication
Speaker 1: after my illness.
Speaker 2: I love how you just phrased that like there was
Speaker 2: no other option, Like you can't experience that and then
Speaker 2: go back to business as usual.
Speaker 1: That's exactly right. And it took time because my first
Speaker 1: goal when I came back was I want to be different.
Speaker 1: I could see myself in every error I could see,
Speaker 1: you know, if my team said she's trying to die
Speaker 1: on us, I was horrified. But then I knew I
Speaker 1: had said that two weeks before, and so what was
Speaker 1: it about our culture that had us describing our relationships
Speaker 1: with our patients in these vectored ways that were very blaming?
Speaker 1: And so I went to improve my own communication skills.
Speaker 1: That really led me on a path of discovering how
Speaker 1: we could be better.
Speaker 2: Yeah, can you give me another example of the sort
Speaker 2: of errors that you experienced? I think that that can
Speaker 2: be sort of vague and esoteric for people. I bet
Speaker 2: that the people who have experienced what you just talked
Speaker 2: about are like, I know exactly what she means. But
Speaker 2: what kind of errors were you experiencing?
Speaker 1: There were really so many. So the first thing I
Speaker 1: remember was hearing in the operating room them saying she's
Speaker 1: circling the drain, and that one it got my attention
Speaker 1: because it indicated that they thought I was dying. But
Speaker 1: also that could have been the last thing I ever heard,
Speaker 1: and I also have said things like that, So again
Speaker 1: it was an awareness that we had acculturated to think
Speaker 1: that that was okay. Having the team say that I
Speaker 1: was trying to die on them, felt very blaming. I
Speaker 1: had a nurse who was very upset with me for
Speaker 1: not wanting to hold the dead baby. She really thought
Speaker 1: and told me that all babies deserve to be held
Speaker 1: by their mother at least once, and didn't at all
Speaker 1: take into account what was right for my healing in
Speaker 1: that moment. So lots of presumptions we know what's best,
Speaker 1: lots of not having a sense of awareness that the
Speaker 1: words we say around our patients impact their own belief
Speaker 1: about their ability to recover, their own sense of their
Speaker 1: resilience and strength and capacity and agency and just a
Speaker 1: real entitlement.
Speaker 2: Yeah, definitely that I know what's best thing right, and
Speaker 2: like for certain medical decisions, I'm sure you know a
Speaker 2: lot more than I do, knowing nothing but that sort
Speaker 2: of human connection, that relatedness is really where that gap.
Speaker 1: Is just massive, absolutely, And that idea that we we're
Speaker 1: the holders of medical information, maybe, but the patient is
Speaker 1: the holder of all of the information about their body
Speaker 1: and what they want from their life and what a
Speaker 1: good day looks like. And until we ask those things,
Speaker 1: I think it's impossible to make a recommendation about what
Speaker 1: a path a patient should choose. It's just it's not
Speaker 1: based in reality. It's just based in our own judgment.
Speaker 1: And bridging that gap, as you said, through conversations that
Speaker 1: are really generative, is critical.
Speaker 2: Yeah. I can hear you know, the healthcare providers listening
Speaker 2: to this thinking like that sounds lovely. I don't have
Speaker 2: time for that stuff, right, like the realities of managed
Speaker 2: care and short staffed hospitals and ice use and treatment centers.
Speaker 2: Like Okay, I'm going to use marketing terms here, like
Speaker 2: how do you sell this idea of compassionate connection to
Speaker 2: your patients to medical providers that are barely hanging on?
Speaker 1: Honestly, in so many ways, it sells itself because there's
Speaker 1: really good evidence that communicating compassionately doesn't actually take longer.
Speaker 1: We've all been in situations where we're talking to a
Speaker 1: patient and they're just telling us the same thing because
Speaker 1: they're not feeling heard. And often that's because there's an
Speaker 1: emotional cue that we're missing. There's something that we need
Speaker 1: to acknowledge to diffuse the situation, and we're reading the
Speaker 1: emotional cues as wanting a cognitive answer. So it is
Speaker 1: actually quite efficient, and that's true across the board, whether
Speaker 1: it's emergency medicine, family medicine, surgery. Not only do they
Speaker 1: can owners take less time, but the patients are more
Speaker 1: likely to adhere to the plan of care that you
Speaker 1: co create together. They're likelier to have better health outcomes.
Speaker 1: And frankly, that's the space where we have fulfillment. And
Speaker 1: so I think we have to redefine our idea of efficiency.
Speaker 1: I can get through a clinic visit in five minutes,
Speaker 1: my patient will have no idea what's wrong with them,
Speaker 1: and that's not authentic efficiency, really educating, really building a connection.
Speaker 1: You know, it saves time on the back end when
Speaker 1: you have to have hard conversations. You know who you're
Speaker 1: talking to and they know you, and that's priceless.
Speaker 2: I really love what you said in there. There's a
Speaker 2: book that maybe you're familiar with called Compassionomics. Nice. Yes,
Speaker 2: I love that book.
Speaker 1: My friends wrote it, they did.
Speaker 2: I have it on my shelf. I love it. And
Speaker 2: one of the things that I love about that book
Speaker 2: is they start right out by saying, look it actually
Speaker 2: it takes you, on average ninety seconds more in a
Speaker 2: patient visit to treat them like a human being and
Speaker 2: to hear what's actually in the room, because there is
Speaker 2: that reality of what it's like being a medical provider
Speaker 2: in the systems we're in, in the time that we're in,
Speaker 2: and what the healthcare profession as a whole has endured
Speaker 2: the last few years. I think you know, very often
Speaker 2: when we talk about burnout and resilience, it's about putting
Speaker 2: that burden of resilience and self care back on their
Speaker 2: providers who are already fried, and like, here's what you
Speaker 2: can do to make this better and version. So I
Speaker 2: want to take a step sort of sideways for a
Speaker 2: minute and talk about the experience of doctors and other
Speaker 2: medical providers for the last few years, and then we'll
Speaker 2: weave this back into how this relates to these compassionate conversations.
Speaker 2: So you have an essay that you wrote called the
Speaker 2: Shape of the Shore, in which you describe what it
Speaker 2: was like working during those really terrifying early days of
Speaker 2: the pandemic inside the hospital. Can we talk about that
Speaker 2: essay for a minute? Yes, Okay, this was one of
Speaker 2: those ones where I was like, I just need to
Speaker 2: keep reading it and rereading it because it's so evocative
Speaker 2: and so beautiful. Can you give a little all summary of.
Speaker 1: What that essay is about it's honestly probably the hardest
Speaker 1: thing I've ever written. I was trying to capture, as
Speaker 1: you said, what it was like in those early days,
Speaker 1: our uncertainty about how the virus was transmitted, the sense
Speaker 1: of isolation and dependency that we all felt, the fear
Speaker 1: that we were taking it home to our families, the
Speaker 1: mass deaths that we witnessed, and then kind of how
Speaker 1: we found our way through those early days, which was
Speaker 1: really through peer support, really through sharing our experiences and
Speaker 1: identifying in each other the light and the beauty and
Speaker 1: the magic that we couldn't see in ourselves.
Speaker 2: Yeah, and there's something about the telling the truth part
Speaker 2: of that experience of peer support and really seeing each
Speaker 2: other that there's this great section where you're talking about
Speaker 2: I actually don't remember if it's in that essay or
Speaker 2: another one where you were writing about those early years
Speaker 2: where you're talking about, you know, they talked about us
Speaker 2: as heroes, and talking about us as heroes meant that
Speaker 2: they didn't have to see us, they didn't have to
Speaker 2: see what we were struggling with and the ways that
Speaker 2: we needed to violate our own morals, our own values,
Speaker 2: our own beliefs, because of the situation at hand.
Speaker 1: I've come to know that people call you a hero
Speaker 1: when they're going to force you to betray yourself, and
Speaker 1: that that is a signal that you are being sent
Speaker 1: into a situation that will not leave you whole.
Speaker 2: That's such a powerful way of describing it. I think
Speaker 2: everybody is so sick of it, right like, so tired
Speaker 2: of the pandemic, and there's just this like we're through
Speaker 2: the worst of it. Worst in air quotes here, but
Speaker 2: we're through the worst of it. So bounce back and
Speaker 2: look at the ways that you were resilient and let's
Speaker 2: pay attention to the task at hand. The sort of
Speaker 2: speed dating with trauma, right like, let's just get it
Speaker 2: over with quickly. But what you're talking about is we've
Speaker 2: really got to talk about what happened for us in there.
Speaker 1: And I think healing comes differently for everyone, and allowing
Speaker 1: enough intersection points where people can find their way in,
Speaker 1: whether that's through therapy, whether that's through their writing, whether
Speaker 1: it's through the creation of art, whether it's through running,
Speaker 1: which I will never do that for other people, right
Speaker 1: I hear it works. We just need to acknowledge that
Speaker 1: we've been through something and we can either a heel
Speaker 1: and talk about it or we can bury it. But
Speaker 1: it always floats, it will always resurface.
Speaker 2: Yeah, there's a section in that essay in the shape
Speaker 2: of the shore where you're describing like, Okay, so administrative
Speaker 2: staff realizes that this is really tough on our physicians,
Speaker 2: so let's put them in basically like an encounter group. Yeah,
Speaker 2: and the things that you describe in there. I was
Speaker 2: reading it and I was actually like yelling out loud,
Speaker 2: like how they've survived a bad breakup in the past
Speaker 2: is absolutely irrelevant to what they are witnessing on a
Speaker 2: daily basis. So I would love to discuss that just
Speaker 2: for a second, like that sort of well intentioned but
Speaker 2: wrong approach to trying to help people survive a violation
Speaker 2: of their values and their beliefs.
Speaker 1: You know, I have a really deep empathy for anyone
Speaker 1: trying to do wellness work or psychological first aid work
Speaker 1: in the time of a respiratory pandemic. There is nothing
Speaker 1: that is going to fix it. Everything is a band
Speaker 1: aid except structural change. Right, there are real structural changes
Speaker 1: that need to happen to keep people safe. But what
Speaker 1: we can do together in a room is just validate
Speaker 1: each other's experiences. And I think there was a real
Speaker 1: disconnect in those early days between the experience of the
Speaker 1: people providing the care and the people who wanted to
Speaker 1: help us, and in many ways that was even more isolating.
Speaker 2: Yeah, it's that the wrong tools for the situation, right,
Speaker 2: And I see this a lot with grieving people, especially
Speaker 2: for folks who have lost children or my sister was
Speaker 2: killed by a drunk driver, or these sorts of losses
Speaker 2: that we don't like to talk about, that we apply
Speaker 2: these tools that work sort of in normal everyday life,
Speaker 2: and they're really valuable tools, and they're really helpful. Absolutely
Speaker 2: the wrong medicine for the situation at hand, exactly. Hey,
Speaker 2: before we get back to this week's guest, I want
Speaker 2: to talk with you about exploring your losses through writing.
Speaker 2: There are lots of grief writing workshops out there with
Speaker 2: prompts like tell us about the funeral, that sort of thing.
Speaker 2: My thirty day writing your grief course is not like that.
Speaker 1: Them.
Speaker 2: Prompts are deeper, they're more nuanced. They're designed to get
Speaker 2: you into your heart and into your own actual story. Now,
Speaker 2: writing isn't going to cure anything, but it can help
Speaker 2: you hear your own voice, and that is incredibly powerful.
Speaker 2: You can read all about the Writing your Grief course
Speaker 2: at Refuge in Grief dot com backslash wyg. That is
Speaker 2: WYG for Writing your Grief. You can see a sample
Speaker 2: prompt from the course and get writing your own words
Speaker 2: in minutes. My thirty day Writing your Grief course is
Speaker 2: still one of the best things I've ever made for you.
Speaker 2: Come join more than ten thousand people who have taken
Speaker 2: the Writing your Grief Course refugegrief dot com backslash wyg,
Speaker 2: or you can find the link in the show notes.
Speaker 2: One of the things that I really love about your
Speaker 2: work is that you tell me if I'm phrasing this incorrectly,
Speaker 2: but I feel like for you, the medicine at hand
Speaker 2: is validation and acknowledgment.
Speaker 1: Yeah, it's been evolving for me. You know. When I
Speaker 1: wrote my book, I really thought that if we could
Speaker 1: just be present for each other's suffering, that that would
Speaker 1: be a kind of win. That we hadn't done that well.
Speaker 1: And what the pandemic really taught me is that that's
Speaker 1: like the lowest level. Being a bystander to trauma is
Speaker 1: basically what that is. You are observing it, you are
Speaker 1: apart from it, and there's nothing that's truly healing about it.
Speaker 1: And what I hope we can come to is that
Speaker 1: we all have different experiences, but we can validate the
Speaker 1: experiences of others as our own by saying I might
Speaker 1: not have had the same material experience that you did,
Speaker 1: but I too have felt shame, moral distress, isolation. I
Speaker 1: know how you got to where you are because I've
Speaker 1: gotten there too, and then have that kind of resonance
Speaker 1: between us as humans without invalidating someone's experience, without being
Speaker 1: reductive and saying this is just like a breakup I had,
Speaker 1: but really just letting our souls kind of resonate with
Speaker 1: each other.
Speaker 2: I love this. It's actually one of the quotes that
Speaker 2: I pulled from your work where you say bearing witness
Speaker 2: is one wrung up from being a bystander to trauma
Speaker 2: of just being a spectator. It's not sufficient and it's
Speaker 2: not healing. There's more to the assignment here than just
Speaker 2: saying I see you. I feel like I feel like
Speaker 2: we've talked so much over these last several years about
Speaker 2: bearing witness and paying attention that it's become sort of
Speaker 2: one of those drive by supports right, Like, yep, I
Speaker 2: hear you as this way to like, and let me
Speaker 2: tell you why you're wrong or why this isn't you
Speaker 2: know what you think it is that there is more
Speaker 2: there in our ability to actually see the other and
Speaker 2: connect with them and serve from that place of connection
Speaker 2: and seeing the other as human. But that door goes
Speaker 2: both ways. And I think one of the things that
Speaker 2: I really took from looking at your work with communication
Speaker 2: skills and training that you're doing is I want to
Speaker 2: ask you about the work that you're doing to help
Speaker 2: doctors understand new community communication styles. But even before we
Speaker 2: get there, like, I want to talk a second about
Speaker 2: the skills that we need to be better communicators and
Speaker 2: better at empathy and better connection. Like as this thing
Speaker 2: that you have to do for the other, Right, you
Speaker 2: have to do this as part of being a provider.
Speaker 2: You have to be able to deliver this beautiful, compassionate
Speaker 2: care to your patients. But what you're doing in training
Speaker 2: physicians in better communication styles is you're actually helping them
Speaker 2: to feel human again after a pandemic that robbed a
Speaker 2: lot of people of their humanity.
Speaker 1: I'm so glad to hear you frame it in that way.
Speaker 1: That's certainly the hope that when we connect with compassion,
Speaker 1: that it unlocks some part of ourselves and there's reciprocity
Speaker 1: in it, and we see ourselves as human and the
Speaker 1: vulnerability that we so often try to pretend isn't there
Speaker 1: is allowed to be expressed. And those connections, they're the
Speaker 1: only thing that will give young physicians longevity or joy
Speaker 1: and work or a sense of purpose, and none of
Speaker 1: the other things that feel so pressing or urgent that
Speaker 1: are always calling for our attention, the emails and the
Speaker 1: pages and the phone calls and the mandatory modules for complaints,
Speaker 1: and none of that's going to fill our bucket the
Speaker 1: way that a connection with someone you're caring for, who
Speaker 1: you see as a fellow human will.
Speaker 2: I have a friend who went to med school in
Speaker 2: her late forties, and as she was going through the
Speaker 2: med school experience, like she lost her hair, she had
Speaker 2: a whole bunch of like stress related illnesses. And I
Speaker 2: remember talking with her about it and she said, I
Speaker 2: swear med school is designed to beat the humanity out
Speaker 2: of you. How do you see the work that you're
Speaker 2: doing now as counteracting is maybe the wrong word, but
Speaker 2: how do you see the work that you're doing now
Speaker 2: interact with that med school culture of check your humanity
Speaker 2: at the door, don't bring your human self into the room.
Speaker 1: We've definitely come a long way from when I graduated
Speaker 1: from medical school twenty years ago. I think that was
Speaker 1: the culture break people and force them to be inhuman
Speaker 1: Medical education has softened a bit in the interim, and honestly,
Speaker 1: they come out really whole. I'm always amazed how much
Speaker 1: smarter they are than I was at that age. They
Speaker 1: see the community, the role of health systems and community.
Speaker 1: They see the role that racism has played in so
Speaker 1: many health outcomes. They have a wider scope of understanding
Speaker 1: of public health. But what happens is then they enter
Speaker 1: the industrial health care system that is built for efficiency
Speaker 1: and built for profit. And that's why I choose to
Speaker 1: work with new residents, because that's the point that everything
Speaker 1: they've learned, all of the beautiful generative thinking they've done,
Speaker 1: is liable to go right out the window, because they're
Speaker 1: going to think, well, that was school and this is
Speaker 1: real life, and in real life, this is how we
Speaker 1: do things, and there's no more time for that. And
Speaker 1: that was just what they taught us because that was
Speaker 1: their agenda. But here in the hospital, to fit in,
Speaker 1: I have to do these other things, the hidden curriculum,
Speaker 1: and I find if you can get them right when
Speaker 1: they've started to have trouble with these conversations, when they've
Speaker 1: started to find them challenging, and they have a little
Speaker 1: humility about it, but they still have all their idealism,
Speaker 1: that's kind of the perfect moment.
Speaker 2: Yeah, we want to protect the idealism, Like you see
Speaker 2: this work as sort of this buffer, Like, let's not
Speaker 2: let these new idealistic still human folks get devoured by
Speaker 2: the machinery.
Speaker 1: Exactly.
Speaker 2: Yeah, I love that. I also feel really hopeful in
Speaker 2: what you just said because I've talked to so many
Speaker 2: physicians who weren't trained that way during their med school time,
Speaker 2: and that they still need to worry about being seen
Speaker 2: as professionals if they cry on the job, if they're
Speaker 2: seen as even being affected by the work, even if
Speaker 2: they hide their emotions in front of a patient or
Speaker 2: in front of a family. And I think, you know,
Speaker 2: one of the things that I think the pandemic experience
Speaker 2: has done for the healthcare industry is made the humans
Speaker 2: who do the work a lot less willing to hold
Speaker 2: up the old.
Speaker 1: System, absolutely, because I think it became very apparent when
Speaker 1: you know, many places didn't have adequate personal protective equipment
Speaker 1: and we're still sending in their staff and putting them
Speaker 1: at risk, and people were dying that a bad system
Speaker 1: disadvantages everyone equally. And so the same way we saw
Speaker 1: it hurting our patients saw it hurting our providers. And
Speaker 1: if we figured out how much we have in common,
Speaker 1: I think that sort of combined lobby of professionals and
Speaker 1: patients could do anything.
Speaker 2: Yeah, there's a program that you do now in training
Speaker 2: these I just keep seeing this, Sorry, everybody, I keep
Speaker 2: seeing y'all, these like little fuzzy chicks that we want
Speaker 2: to protect and let grow into the full expression of
Speaker 2: the reasons that you got into this field in general.
Speaker 2: So that's where my mind is today, protecting the new chicks.
Speaker 2: But your training doctors in these new communication styles really
Speaker 2: rooted in empathy and connection and humanity. The program that
Speaker 2: you run is called clear So can you tell us
Speaker 2: about that program?
Speaker 1: Yeah, so it really was born out of Vital Talk,
Speaker 1: which is a national program, which is where I went
Speaker 1: to train after I first got sick. Shaped into a
Speaker 1: little bit of our Detroit Henry Ford culture to suit
Speaker 1: our trainee in their backgrounds. So what we do is
Speaker 1: we utilize improvisational actors and they're really really skilled. So
Speaker 1: depending on the skill level of the person who's in
Speaker 1: the chair or the learner, they can modulate the experience
Speaker 1: from one where it's really introductory level just delivering serious
Speaker 1: news to someone who's a little anxious all the way
Speaker 1: up to this father just got a call that his
Speaker 1: daughter drowned in the mini pool at daycare, and you
Speaker 1: have to tell him, and he is angry and screaming,
Speaker 1: and you have to facilitate this conversation. And you know
Speaker 1: when I say that, obviously that would be any physician's
Speaker 1: worst day to have to tell someone that their daughter died.
Speaker 1: But the thought that we used to do that without
Speaker 1: training is banana. So we think of it just like
Speaker 1: we think of you know, a lot of the procedures
Speaker 1: we do, none of them are the same, No conversation
Speaker 1: is the same. But there are signposts you can look
Speaker 1: for that you can mark. There's a toolkit that you
Speaker 1: can draw off of, and it really creates an environment
Speaker 1: that I think no one is hurt, right, It's an
Speaker 1: experiential learning, and they get to try out new skills
Speaker 1: in a safe place with their peers who give them
Speaker 1: feedback about what went well. You know, I saw that
Speaker 1: when you acknowledged her anxiety, that really the emotion in
Speaker 1: the room de escalated and she was able to hear
Speaker 1: you differently. And then they walk out with that awareness
Speaker 1: and it's like a bodily awareness because it happened. It's
Speaker 1: not something we taught them. They had the experience, and
Speaker 1: that's really where the magic comes in.
Speaker 2: Yeah, I love all of this. I love that it's theater.
Speaker 2: I love that we're employing actors. I also love the
Speaker 2: permission to experience experiment with that right because this is
Speaker 2: this is really really daunting. I talk about this a lot,
Speaker 2: and I teach about this a lot, like really paying
Speaker 2: attention and improving your communication skills and listening to what's
Speaker 2: being said and not being said right, address what's actually
Speaker 2: unfolding instead of managing what's unfolding. Right. I love that
Speaker 2: we're not expecting You're not expecting these providers to already
Speaker 2: know how to do this. I think there's just so
Speaker 2: much sort of pop psychology out there about like express
Speaker 2: your needs and have a better conversation. But they don't
Speaker 2: really talk about how terrifying that is and that there
Speaker 2: are real skills involved in this, and real skills that
Speaker 2: you can practice in really low stakes situations. Right, you
Speaker 2: don't want to have to learn this stuff on the
Speaker 2: fly and make things up and like feel confident in it.
Speaker 2: That's just I think that's way too many barriers.
Speaker 1: Absolutely. I still remember the first person I had to
Speaker 1: tell that they had cancer on a biopsy, and how
Speaker 1: completely bereft of any skills I felt I had, and
Speaker 1: how desperate I was to just model it based on
Speaker 1: something I had seen like in a movie, or you
Speaker 1: know it is really grabbing straws, or you have a
Speaker 1: mentor who did it well and you try to dissect
Speaker 1: what they do, but it seems like magic. You can't
Speaker 1: even see what the steps are and you don't know
Speaker 1: how to emulate it. And the idea that we wouldn't
Speaker 1: train in communication when it's so impactful is just bananas.
Speaker 2: It is bananas. I mean it really truly is that,
Speaker 2: like this is as somebody who has received medical care
Speaker 2: and who is not a medical profession other than being
Speaker 2: a therapist, but like you just want to be seen
Speaker 2: right and giving somebody who is in a stressful situation
Speaker 2: or they're anxious about somebody they care about, or they're
Speaker 2: anxius about themselves, like hitting them with a bunch of
Speaker 2: medical terminology is the opposite of helpful. But I feel
Speaker 2: like that's sort of my role as a provider. I
Speaker 2: will give medical information and this, but this is really
Speaker 2: what you're doing is really turning that upside down and
Speaker 2: again coming back to you like the medicine is in
Speaker 2: the connection.
Speaker 1: The medicine is in the connection, and the best medicine
Speaker 1: in the world doesn't work on the wrong story, So
Speaker 1: you better know your patient's story.
Speaker 2: Ooh, tell me more about that. That was beautifully said.
Speaker 2: The best medicine in the world doesn't work on the
Speaker 2: wrong story. What do you mean by that?
Speaker 1: That is something that is attributable to somebody. So I'm
Speaker 1: going to have to give you his name. It's j
Speaker 1: Beruche and he articulated those beautiful words at a narrative
Speaker 1: medicine conference. And narrative medicine is another one of the
Speaker 1: tools that we use to try to increase empathy and
Speaker 1: compacts and that kind of close reading that you're talking about,
Speaker 1: that there's what's being said, but also how it's being
Speaker 1: said and what's not being said, and what's between the
Speaker 1: lines and the words, And it's something that I find
Speaker 1: really exciting.
Speaker 2: Yeah, narrative medicine is one of my favorite things ever.
Speaker 2: I remember back in my early days, when I was
Speaker 2: just a tiny wee baby duckling therapist, I had a
Speaker 2: book called Poetic Medicine, which talked about like the importance
Speaker 2: of story. I think in the psychotherapy world we often
Speaker 2: talk about the power of telling your own story as
Speaker 2: a way of healing what's wrong. Right, there's always sort
Speaker 2: of that transactional piece to it that, like, you do
Speaker 2: this in the service of getting better. I feel like
Speaker 2: you come at narrative medicine without that expectation of a
Speaker 2: happy ending. Is that accurate?
Speaker 1: Yes, I rarely have an expectation about happy ending. I
Speaker 1: think just going deeper is all I ever hoped for.
Speaker 2: So being allowed to read the story in the room
Speaker 2: lets you be more effective and therefore more efficient in
Speaker 2: the care that you're trying to deliver.
Speaker 1: And having a belief that I have the capacity to
Speaker 1: hold whatever suffering reveals itself. One of the things that
Speaker 1: I think we don't necessarily believe in in medicine is
Speaker 1: that there is a value in that that sitting and
Speaker 1: holding space for someone else's suffering is valuable, and we
Speaker 1: worry about the toll that it will take on us,
Speaker 1: and for me, recognizing that often for our patients and families,
Speaker 1: just having a safe container for it is the most
Speaker 1: meaningful thing that I do, because I can't alter the outcome,
Speaker 1: even if I had a magic wand I can't change
Speaker 1: someone's death from being deaf, but I can be present
Speaker 1: for it and attend to it and trust that that's
Speaker 1: enough in that moment.
Speaker 2: Yeah, allowing what is true to be what's true is
Speaker 2: a really powerful act in that moment. I think there's
Speaker 2: so much speed in so much of what we do, right, Like, yep,
Speaker 2: this accident happened, and this person is dead, and we
Speaker 2: need you to make a decision about organ donation, and
Speaker 2: like just kind of ticking those boxes and chop, chop, chop,
Speaker 2: because I've got sixteen patients all in a row waiting
Speaker 2: for you after this, and feeling like you don't have
Speaker 2: the time to take a breath, but also feeling like
Speaker 2: even if you had thirty seconds, you have no idea
Speaker 2: what to do. Yeah, with that, so you lean on
Speaker 2: what you know, which are the facts.
Speaker 1: Yeah, it's a cloak, right, a shield, It's something we
Speaker 1: hide behind. But I've never not done it. So when
Speaker 1: I have avoided these hard moments, I've always regretted it
Speaker 1: when I've made myself too busy to be present intentionally,
Speaker 1: when I have avoided, I've always felt like I robbed
Speaker 1: myself too. I didn't trust myself enough to have that moment,
Speaker 1: and I've always regretted it.
Speaker 2: Interesting, like it makes me think of, you know, coming
Speaker 2: into the medical profession as a commitment and you kind
Speaker 2: of have to take every opportunity for nourishment that you can, right,
Speaker 2: and you don't get those moments back. Yeah, right, you
Speaker 2: don't get those moments back to be fed in that way.
Speaker 2: And I think there's the two pieces of that as
Speaker 2: one is seeing that human connection as nourishment and two
Speaker 2: adapting your style so that you can be fed in
Speaker 2: that way, so that you can help co create the
Speaker 2: situations that allow you to make those connections. So you
Speaker 2: have regrets about who you are as a person showing
Speaker 2: up in this system that is sort of designed to
Speaker 2: drill out your humanity.
Speaker 1: Yeah, preserving your role as a healer. I think against
Speaker 1: a system that would have you just be a therapeutic
Speaker 1: robot of some sort. It's not easy, but it's for
Speaker 1: us as well as our patients.
Speaker 2: Yeah, I want to go back to what you were
Speaker 2: talking about in the beginning with your experience and the
Speaker 2: sorts of things that you heard people say, like she's
Speaker 2: circling the drain or she's trying to die on us.
Speaker 2: I feel like maybe there's two different parts of your
Speaker 2: communications work. One is like taking the people who are
Speaker 2: interested in learning how to connect and how to address
Speaker 2: what's actually in the room. And then there's sort of
Speaker 2: overhauling the internal communications culture. How do you approach that
Speaker 2: from a system's perspective and on an individual perspective to
Speaker 2: get people to realize that their words matter and that
Speaker 2: maybe the things that we say in the operating room,
Speaker 2: like you know your people can hear you. Yeah, how
Speaker 2: do you approach that?
Speaker 1: You're speaking to two really important things? One is accountability.
Speaker 1: How do we hold each other accountab bilt to the
Speaker 1: standards that we would want for our own care, for
Speaker 1: our family's care and vulnerability. And for me, the only
Speaker 1: way I was able to write about the bad things
Speaker 1: that happened were because I had been a part of
Speaker 1: those things myself, and I knew I wasn't intentionally trying
Speaker 1: to hurt anyone. It was just an accepted part of
Speaker 1: the culture. And so by pointing out things that had
Speaker 1: hurt me and being very vulnerable and going to the
Speaker 1: nick you nurse and saying you know, it sort of
Speaker 1: broke my heart when you said that, And to be
Speaker 1: able to have a conversation that says that ends really
Speaker 1: with her saying, you know, I just thought I was
Speaker 1: advocating for your healing. It didn't occur to me that
Speaker 1: there was another way to heal. I wasn't taking your
Speaker 1: perspective into account, and I'll do that in the future
Speaker 1: with other mothers. I just didn't know. When you realize
Speaker 1: that everyone who walks into the hospital comes here not
Speaker 1: wanting to hurt anyone and wanting to do their best,
Speaker 1: and sometimes they're at their limit and they don't have
Speaker 1: the capacity to do their best, but by and large
Speaker 1: they want to do what's right. I think it opens
Speaker 1: the possibility of having these discussions and pulling someone aside
Speaker 1: and saying, you know, it's a shame that you phrase
Speaker 1: things that way. In front of the patient, because I
Speaker 1: think it left them feeling like you didn't care, and
Speaker 1: I know you care, and I wonder if we could
Speaker 1: brainstorm differently, how we could say the same thing but
Speaker 1: with different words.
Speaker 2: I love how kind that is. I love how what
Speaker 2: a kind teacher you are.
Speaker 1: Thank you.
Speaker 2: Yeah, I think we just hear so much you did
Speaker 2: this wrong? Do better? And again, you know, like the
Speaker 2: medical profession has been through so much and even of
Speaker 2: course predating the pandemic like something the system was never
Speaker 2: built for humans, but like there's just so much pressure
Speaker 2: to like do better, get better on fewer resources and
Speaker 2: kindness inside teaching.
Speaker 1: We cannot add another layer of shame to medicine. It's
Speaker 1: all built on shame, and so being able to say
Speaker 1: I hold you an unconditional positive regard. I believe that
Speaker 1: you have the values that make you so wonderful, and
Speaker 1: in this moment you didn't express them and I noticed,
Speaker 1: and I care about you too much to let that
Speaker 1: moment pass. It's a way of still allowing people to
Speaker 1: learn without hurting them.
Speaker 2: Yeah, that is just beautiful and useful and I love
Speaker 2: it and I love what you just described. Going back
Speaker 2: to that nick you nurse because people really do think
Speaker 2: that they are being helpful and they're being advocates. And
Speaker 2: what you describe her saying is like, you have to
Speaker 2: be curious about what feels like healing to the person
Speaker 2: you're talking to. Yes, right, you have to be curious
Speaker 2: about who they are and what does healing mean to them,
Speaker 2: and then help advocate for them to get Like that's
Speaker 2: where your advocacy impulse comes in. Is how do you
Speaker 2: advocate for what feels like healing to the person in
Speaker 2: need of healing and not your agenda of what that is.
Speaker 2: And there's just so much around what we think people
Speaker 2: should do, and really curiosity sounds like the better medicine there.
Speaker 1: We have to start with curiosity. Otherwise we fill in
Speaker 1: the blanks with everything that we believe and it's not
Speaker 1: really healing at all.
Speaker 2: It's not and it just becomes one more thing to
Speaker 2: sort of steamroller over the people in the room, which
Speaker 2: is again not why so many people get into the
Speaker 2: practice of medicine. They get in because they want to
Speaker 2: be of service. And what I love about what you're
Speaker 2: doing is you are giving people the tools and the
Speaker 2: insight to be able to be of service in the
Speaker 2: ways they most want to and maybe haven't been allowed
Speaker 2: to explore in sort of a shame free and accepting environment.
Speaker 2: So thank you for that. One of the quotes that
Speaker 2: I pulled from your work was the work here is
Speaker 2: to grow a heart that can hold all of this
Speaker 2: even now, And I feel like that's what we've been
Speaker 2: talking about from all of these different angles, from being
Speaker 2: a patient, from being a family member, from being a
Speaker 2: provider who has been in the healthcare industry for a
Speaker 2: long time and has been sort of ground down to
Speaker 2: leave their humanity behind, to the new folks coming in
Speaker 2: to how do we create systems of growth and insight
Speaker 2: and learning that don't have shame and badgering at their root.
Speaker 2: Like all of these things come together in that line
Speaker 2: that you wrote, The work here is to grow a
Speaker 2: heart that can hold all of it. I mean, this
Speaker 2: is the work.
Speaker 1: It feels like that's what I'm called to do for myself,
Speaker 1: and whatever little bits of wisdom I pick up along
Speaker 1: the way, I share because I think we're all trying
Speaker 1: to learn how to do this.
Speaker 2: So you've lived through your own life threatening medical condition,
Speaker 2: you are on the very front lines of suffering and
Speaker 2: death during the pandemic you continue to teach communication and
Speaker 2: connection inside a medical industry that, as we've said, hasn't
Speaker 2: always cared about the humans on the floor. Now, the
Speaker 2: subtitle of your book is The Redemptive Power of Hope,
Speaker 2: So I'm really curious. I guess two questions. One is,
Speaker 2: how has your understanding of hope changed since you wrote
Speaker 2: the subtitle of that book, and what does hope look
Speaker 2: like for you now in this moment in time.
Speaker 1: As an intensive care physician, I had a really complicated
Speaker 1: relationship with hope. And when I wrote the book, I
Speaker 1: was still struggling with this notion that someone could be
Speaker 1: dying and the family might not see it the way
Speaker 1: that I did, and it felt like a denial of
Speaker 1: everything that I knew, and it felt like we were adversaries.
Speaker 1: And slowly, over time, I came to realize that hope
Speaker 1: isn't this unfettered optimism. Hope is gritty. Hope is when
Speaker 1: you've looked at it and you know there is nothing
Speaker 1: and you have one last thing you can keep, and
Speaker 1: that's hope. That was hard to come by, truly as
Speaker 1: an intensive care doctor, but I got there. And now
Speaker 1: it's interesting because I'm navigating life as someone who's newly
Speaker 1: diagnosed with cancer. And I found that when I was
Speaker 1: going through the testing that led to the diagnosis, there
Speaker 1: was so much hope around. I hope it's nothing. I
Speaker 1: hope that it's benign. And that hope wasn't helpful to
Speaker 1: me because it didn't allow me to experience just what
Speaker 1: was unfolding, what was true. And what I needed was
Speaker 1: a kind of hope that wasn't vectored, that wasn't dependent
Speaker 1: on any outcome, just hope as an orientation to the future,
Speaker 1: full stop. And that's where I am now. With hope.
Speaker 1: It's just an awareness that life is unfolding and there
Speaker 1: will be joys and things to look forward to, and
Speaker 1: none of it's mappable and none of it's controllable. It
Speaker 1: just is available, and that is what hope is to me. Now.
Speaker 2: It's interesting you said, you know, hope sort of lives
Speaker 2: in the future, or that there is a future. One
Speaker 2: of my other guests this year said that his issue
Speaker 2: with the word hope is that it is future related, yeah,
Speaker 2: and that his understanding of hope now is like I
Speaker 2: can find the stillness in this moment. So just I'm
Speaker 2: really fascinated by everybody's different ideas of what hope is
Speaker 2: and where it lives. And you know, going back to
Speaker 2: what we were talking about with meeting stories with curiosity, like,
Speaker 2: hope is an individual thing and we can be curious
Speaker 2: about what does hope look like for my friend, What
Speaker 2: does hope look like for this patient or this family,
Speaker 2: what does hope look like as a provider for what
Speaker 2: I'm living as a as a doctor or a nurse
Speaker 2: or a you know, reproductive midwife. You know, like what
Speaker 2: allowing there to be curiosity about hope, I guess is
Speaker 2: what I hear in what you're talking about that hope
Speaker 2: is a is a living thing that shifts and changes.
Speaker 1: Absolutely and lives in the moment just as much as
Speaker 1: it lives in the future. Where can you find joy now?
Speaker 2: Yeah, I like the idea of the of hope in
Speaker 2: the future too. It's like it's not predictive, it's not
Speaker 2: predicated on any specific outcome, but that there is a
Speaker 2: moment to come, even if those moments are very very
Speaker 2: limited and and prognosis says there's not going to be
Speaker 2: you know, very many of these moments left, but that
Speaker 2: there is hope in what we can reach for in
Speaker 2: those moments that are to come. Yeah, that's really beautiful.
Speaker 2: I really am just such a such a fan. I'm
Speaker 2: going to wrap us up because I'll just do that
Speaker 2: in my in my you know, promotion of this episode,
Speaker 2: because I think everybody really needs to listen to you,
Speaker 2: both consumers of healthcare but also providers. It's really just
Speaker 2: been such a long road in such a broken system,
Speaker 2: and I just I feel like you bring really useful,
Speaker 2: actionable tools to help people stay rooted in their own
Speaker 2: humanity and deliver the kind of care that they got
Speaker 2: into this profession to deliver. It's just I just really
Speaker 2: dig you.
Speaker 1: Thank you, I dig you right back. Awesome, you so
Speaker 1: much for highlighting the power of hope and optimism and
Speaker 1: curiosity and learning and it's beautiful.
Speaker 2: Yeah, I really, I just I feel like we really
Speaker 2: can create the networks and the relationships that so many
Speaker 2: of us long for if we pay attention to our words.
Speaker 2: You know, I kind of I have to think that
Speaker 2: way because I'm a writer and because I'm a speaker,
Speaker 2: but I really just there is just such power in
Speaker 2: narrative medicine, in really hearing the story and being curious
Speaker 2: about the story. So thank you so much for being here.
Speaker 2: It has been such an honor. We're going to link
Speaker 2: to your book. We're going to link to the essays
Speaker 2: that I was obsessed with over the weekend. But where
Speaker 2: else can people find you? Especially if somebody wants to
Speaker 2: train in the things that you've been talking about, Like
Speaker 2: where where can people go? Bask? And you're awesome?
Speaker 1: I live on Twitter. I am very happy there and
Speaker 1: like many people, and my website are not addish. Empt
Speaker 1: has links to all the podcasts and articles and it's
Speaker 1: a nice place to be if Twitter is scary.
Speaker 2: If you are a Twitter averse to the Twitter universe,
Speaker 2: so you will find doctor Otdish on her website. We're
Speaker 2: going to link to all of that stuff over there. Friends,
Speaker 2: stay tuned. We will be right back with your questions
Speaker 2: to carry with you and more gushing from me about
Speaker 2: today's guest. We'll be right back each week. I leave
Speaker 2: you with some questions to carry with you until we
Speaker 2: meet again. You know what really struck me in today's
Speaker 2: conversation was doctor Otdish's generosity of spirit, you know what
Speaker 2: I mean? Like the way that she talks about leading
Speaker 2: with curiosity and kindness, teaching without relying on blame or shame.
Speaker 2: That's a really uncommon and amazing approach to communication work.
Speaker 2: I mean, communication training is very, very often and I'm totally,
Speaker 2: I totally do this sometimes like you're doing everything wrong,
Speaker 2: let me show you why, and Doctor Odish just doesn't
Speaker 2: roll like that. It makes me feel so hopeful for
Speaker 2: the medical world and so happy for anybody who has
Speaker 2: had the opportunity to work with doctor Otdish or be
Speaker 2: tended by a medical provider who doctor Otdish has taught.
Speaker 2: It really makes me feel hopeful for that world. What
Speaker 2: parts of the conversation stuck with you today? What parts
Speaker 2: made you think about the ways you communicate and what
Speaker 2: you really want from the world around you. Everyone's going
Speaker 2: to take something different from today's show, but I do
Speaker 2: hope you found something to hold on too. I'd love
Speaker 2: to hear what connected with you or for you today.
Speaker 2: Check out Refuge and Grief on Instagram or here after
Speaker 2: pod on TikTok to see video clips from the show
Speaker 2: and leave your thoughts in the comments on those posts.
Speaker 2: That's a great way to tell me how this show
Speaker 2: felt for you. Be sure to tag me in your
Speaker 2: conversation starting posts on your own on social accounts. If
Speaker 2: you want to open a conversation about how we communicate,
Speaker 2: use the hashtag here after pod on all of the platforms.
Speaker 2: We love to see where this show takes you. Remember
Speaker 2: to subscribe and leave a review. Those reviews help more
Speaker 2: than you know. If you want to tell us how
Speaker 2: today's show felt for you, or you have a request
Speaker 2: or a question for upcoming explorations of difficult things, give
Speaker 2: us a call at three two three six four three
Speaker 2: three seven six ' eight and leave a voicemail. If
Speaker 2: you missed it, you can find the number in the
Speaker 2: show notes or visit megandivine dot co. If you'd rather
Speaker 2: send an email, you can do that too, right on
Speaker 2: the website megandivine dot co. We want to hear from you.
Speaker 2: I want to hear from you. This show, this world
Speaker 2: needs your voice. Together, we can make things better even
Speaker 2: when they can't be made right. Want more Hereafter. Grief
Speaker 2: education doesn't just belong to end of life issues. As
Speaker 2: my dad says, daily life is full of everyday grief
Speaker 2: that we don't call grief. Learning how to talk about
Speaker 2: all that without cliches or platitudes, or just practice gratitude.
Speaker 2: All of that is an important skill for everyone, especially
Speaker 2: if you're in a helping profession. Find trainings, professional resources,
Speaker 2: and my best selling book, It's Okay that You're Not
Speaker 2: Okay at Megandivine dot Co. Hereafter with Megan Divine is
Speaker 2: written and produced by me Megan Divine. Executive producer is
Speaker 2: Amy Brown. Co produced by Elizabeth Fozzio. Logistical and social
Speaker 2: media support from Micah, Edited by Houston Tilley, music provided
Speaker 2: by Wave Crush and background noises provided by Luna yelling
Speaker 2: at anyone walking by