Beyond Busy: An Emergency Physician’s Awakening

Introduction and guest background 0:00

Without further ado, I'm going to jump into an interview with my dear friend and colleague, Tori McGowan. As a word of warning, we did record this podcast from a hotel room when we were at a conference in Orlando this spring. So every now and again, you do hear some heights pitch screaming of children in the background going down a waterslide. So I apologize for that, but I think the interview is so wonderful that you'll forgive us for that. So enjoy the interview. Welcome to Heartline, conversations with healthcare changemakers following their heartline.

I'm your host, Dr. Andrea Austin. I'm an emergency medicine physician, coach, and educator. I believe that healthcare needs to improve the quality care that patients receive and that supporting the workers is at the heart of this transformation. Tori and I have been friends for years. We met through the government services chapter of the American College of Emergency Physicians. She has had such an interesting life and career. I'm not going to even try to give it justice. I'm just going to welcome her here and turn it over to Tori to tell us a little bit about who you are, where you live, what you do.

Well, I'm excited to have the chance to sit down and visit with you because it's been too long. My name is Tori McGowan. I am an Air Force veteran, Air Force emergency medicine trained physician, spent 12 years on active duty, and then I separated from active duty in 2017. I then joined the Oregon Air Guard and spent two years just as an ER doc there while I was working on the civilian side as an emergency medicine physician as well. And then I spent two and a half years commanding our Sea Bernie Enhanced Response Force Package or SURF-P unit.

I just turned over command of that three months ago, and now I am looking at a flight doc job with the Oregon Air Guard. And then on my civilian side, I work as an emergency physician in two critical access hospitals and one community hospital that's staffed by our group. When I'm not doing emergency medicine, I have two boys, a nine-year-old and a 12-year-old that we are homeschooling for the second year, which has been its own adventure. My husband has a farm and anytime you can't find me, it's usually because I'm on a horse and I've turned off my cell phone because that's where I don't like to be bothered.

Wow, that is a lot. So just to recap, you are a civilian emergency medicine physician by day or night, and you're still in the National Guard. Yes, ma'am. How many deployments have you done? I've done two combat deployments. So I went to Bagram, Afghanistan in 2013 and Balat, Iraq in 2009. And then with my guard unit, I actually activated in January through March of 2021 as

Homeschooling, workload, and learning to say no 2:51

the officer in charge of the largest vaccine site in Oregon. And we had 90 Air Force Army personnel there administering vaccines for this day morning. Thank you so much for your service. I mean, I'm a veteran as well, but I am just blown away by everything that you've done overseas. And then back home, back home during a really challenging time. It's been a weird couple of years. Yeah, so on that note, you're an emergency medicine physician, your mom, your wife, you live in rural Oregon, you're in the National Guard.

How are you doing? It's been a really strange process over the last couple of years. When COVID hit, my kids obviously transitioned to virtual school and really did not do particularly well in that environment for a couple of different reasons. My husband is a farmer and so that gives him a lot of flexibility, especially during the winter time. And so we actually decided to pull our boys out and do homeschool with them. And we've done that for two years. That has completely destroyed my life because the time commitment is just incredible.

The first year of that, I had a lot of responsibilities that I couldn't put down. I was still commander of my unit. I have a lot of admin things that I was doing for my civilian job. I was still on the board of GSA set. All of those were still active commitments. And so when we figured out that we were going to homeschool the kids again this year, I really took a hard look at my life and remembering how incredibly difficult that had been being deployed. So when I was activated with my unit, I was three hours from home.

So trying to command a unit and a mass vaccine site and then run home on the weekends and do laundry and do all the school things and try to have some sort of a life, it just wasn't sustainable. So this fall, when I realized we were homeschooling the kids again, I took a really hard look at my life about what do I need to put down with this and take a step back from so that I could maintain sanity. And it's been a weird journey, but nobody's on meds in my house. We still speak to each other and they have not found school yet.

So I'm thinking it's a victory at this point. I would say it's a huge victory and I'm just so thankful that you're willing to share this very vulnerable time. And I think there's a lot of people out there that need to pull some things off their plate, but they don't even know where to start and they can't even get into that emotional space to do that. So how would you even suggest starting? That's a really tough question because it's been a process for me. And some of that is just learning and understanding about myself.

And I think especially as emergency medicine, we are really good at just putting our heads down and keep going and keep making it work. Just work harder and it's okay. And we get used to that pace and that frenetic energy that happens. And so as I started this process, First of all, I was afraid that I was going to disappear. That if I wasn't the person that was in charge of everything, what was I? And that's actually a really weird experience here at GSS this year. So we are recording this at a conference.

This is the first conference I've gone to probably in at least seven years, probably longer than that, that I haven't spoken at or been in charge of planning. And this morning I had this crisis about, do I need to bring my laptop? And I couldn't leave it behind. It's sitting over there because I was telling myself, well, you don't need it. You're not in charge of anything. You could show up with like a number two pencil and do everything you need at this conference. I couldn't leave it behind because I'm still not to the point where I've completely been able to drop that.

But the process started with my counselor. So I have an absolutely wonderful, she's called a reintegration counselor with the DA, with the Vet Centers, technically not the DA, the Vet Center. And she's a combat veteran. She commanded a transportation company in the army. I've been seeing her probably since about 2018. And she just helps me deal with all of the things of life. and some of the things I brought home with me for my deployments, as well as the things that we experience every day in the emergency room.

And she really helped me understand that in some ways I was addicted to that being needed to be the go-to person and having that define me, as well as that always being busy, never having a chance to just sit and be calm and quiet. And so she makes me do all of these uncomfortable things and I cuss her for it. And then the next month I say, okay, this is actually better, but it's a process and it doesn't feel good when it's happening. One of the things that she started me doing is meditation and mindfulness.

And I am totally not one of those. new age meditation sort of a people. So it's been uncomfortable. But one of the things that she really helped me learn how to do is tuning into what I feel when somebody asks me to do something. Because sometimes in my body, that answer is that, yeah, that sounds really interesting. And sometimes it's like, I actually don't want to go to that Zen meeting. For me has been the first step in saying, Just getting to be able to feel that that reaction has been really important to me so that I can start to identify whether or not I even want to do it before my brain gets involved.

my gut reaction will tell me whether or not that's something that's going to bring more to my life or take it away. And so I'm getting very deliberate about those. I really like that peeing into your body. And I have this theory that during residency, we're taught to ignore many body cues, simple things like, do you have to pee? Are you hungry? Are you tired? And what that did, I think to me and to a lot of people is you start to learn to shut off your body. You just don't respect it anymore. And then I would find that I, I didn't know and I would.

eventually be like oh my gosh i have to pee so bad right now or i'm so pissed right now and it took a long time to start to reconnect with oh i'm getting like a tightness in my throat around this person or i just this is making me feel uncomfortable because i was so used to shutting that off immediately. Yeah, I think you're right. Because we are taught so much to subjugate our own needs, and it's all about the patient. And I always smile when I run into the break room for my five minutes of lunch that I'm, you know, wolfing down as I'm trying to turn off.

My consultants have the most amazing ability to call me anytime I'm eating or peeing.

Meditation, sleep, and processing stress 10:42

And we don't have that opportunity to stop and relax. And you're right, you very quickly learn to just ignore it because that's what you need to get through. Yeah, I'm so, well, I'm not glad to hear, but it is nice to hear that your phone seems to go off at the most inopportune moments. And I was trying to have this conversation with a patient the other day and it was a complicated situation. You know, there was no right answer on how to manage this issue. and it really required shared decision making, and my phone just would not stop going off.

And they were minor things. So I finally was like, I walked out of the room, we have great nurses where I work, and I looked at one of the nurses and I said, I really need to talk with this patient and not be interrupted unless someone truly is dying for the next five to seven minutes. And so she held my phone. That sounds really simple. And if there's a non-physician listening, they're probably like, Yeah, but that's not when we're in residency and wrong call. you don't hang your phone off, you answer the phone.

And it's, you're right, it's hard to do that, but I, I hate, we have basically they're like iPhones that are our communication devices and the lab can text you about the blood hemolysis or this critical lab or, and it's such an interruption to your workflow and to the important things that we really do, which is more important, having that conversation about you have cancer and let's talk about what that means and where we go from here. or I need to redraw on bug 5. I leave my whistle phone at my computer all the time and they yell at me and I'm like, yeah, but you found me.

When it's really important, you will find me. And if not, if it's something that can wait a few minutes, then let's let it wait a few minutes. And that is a huge sin at Mesape. So I want to circle back to the meditation. And I had the privilege of interviewing Dr. Kat Landit earlier and she mentioned it too. And I'm on, I think I'm up to nearly 600 minutes of meditating. I have an app, I use 10% happier. And you know, F, if it doesn't effing work, and I have resisted meditation for years. I just recently was listening to a Brene Brown and the guest on said it's the magic numbers 12 to 13 minutes a day.

And sure enough, that is what 10% happier works you up to. So I now will choose meditation over working out. For me, a lot of cardio is about you're activating a sympathetic surge and meditation is about activating your parasympathetic and vagal response. which emergency medicine physicians are greatly in need of. So I'm curious about what's your meditation practice? Are you using any app? What does it look like for you? So typically I, when I meditate, it's usually when I'm going to bed and I use Insight Timer, which is another meditation app.

They have some great ones that are for falling asleep. For me, one of the times that I realized When I am getting more stressed and having more problems is when I stopped sleeping. So I am one of the laziest preachers you'll ever be around in my, in your life. I've actually learned a lot about this and about sleep and fatigue for speaking. And I am somebody who needs about night and nine and a half hours a night asleep. And I sleep between usually about midnight and 9 a.m. if you just lead me to my own devices.

It's been really great with the kids in home school because we can just, everybody sleeps on their own schedule and wakes up on their own schedule. So my preteen boy has undergone that normal shift towards night owl. And so he goes to bed about 11 and he wakes up, actually he'll sleep about 13 to 14 hours a day if I let him. But it's been nice to allow us all to get that rest. When I am stressed. sleep is what suffers for me. And that was actually one of the things that I noticed when I came back from Afghanistan that I think was a manifestation of the stress that I was dealing with from that deployment.

I had a hard time falling asleep and I had a hard time staying asleep. And some of that I think is because we got shelled a lot. And so you were pretty hair triggered to be waking up because you had to go to the bumpers and be ready to respond. And we had a couple of bad IDF indirect fire incidents there on base where we had mass casualties that came to the ER within two to three minutes of the strike and lots and lots of people. That was really hard for me to to bring back down from. And so now I'm much more sensitive to that when I stop sleeping is when all of the other things in my life start coming apart.

And so I am certainly not very good at making sure that I'm doing it every day. But as I'm laying there in bed thinking, why am I not falling asleep? Then it's time to turn on some of the guided meditations. And that helps me, again, tune back into those feelings about, okay, what is it that is so hard right now that you're dealing with that this is how it's coming up because I don't know about you, but I am really good about boxing things up and we will deal with this one later. And what I've learned during the pandemic is at some point later has to come.

And yeah, that was kind of about six months ago when I finally turned around and there's this giant room full of boxes, like a horror show of all of the things that I've labeled. I will deal with this later. I will deal with this later. I will deal with this later. I finally had to start unpacking some of that and the not sleeping is my cue to that's when you need to start behaving yourself and start dealing with some of that garbage that you're continuing to pile up and stop ignoring it. Yeah, that is so interesting.

I think during the pandemic, some of our normal activities that we used to cover up, to numb, to avoid dealing with all of this crap were taken away from us. And what I realized is, I think similar to you, is that there was, in my case, about 10 years of, I guess, what's in the psychological literature, residue is the term. And I actually really like residue because when you go into a patient room or, you know, a family member, your own family, there's a difficult interaction. you internalize that, you know, this is hard and I'm upset about this.

And then you're like, well, I'm just going to compartmentalize it. And man, if there's a better compartmentalizer than ER doc, I don't know who it is. Maybe some of our special forces snipers probably are pretty good at compartmentalizing too, but we're right up there. But the dirty secret that nobody taught us, nobody talked to me about it, like very, I guess, directly during residency is that you really do have to unpack that stuff. And you know, I recently just wrote a blog about that and I compare it to when you dump out the vacuum cleaner in your trash and that little poof cloud comes up.

So I had like 10 years of poof clouds that that little trace residue that you can't really see on your clothes turned into like layers of cake. And you have to go through that, which is not fun. But I want to ask you, as you've been doing all this work and taking some things off your plate, It is hard, but what have been the golden nuggets that have come out of this? I think that's the fun part because I'm finally getting to those areas because one of the things that again, Amanda, my counselor has helped me realize and that I'm coming to understand is that every time we say no to something that we didn't want or that we've let something go off our plate, it opens up opportunity for something that maybe isn't there.

The economists talk about it as an opportunity cost.

Reclaiming time, family, and new priorities 19:30

What is the opportunity cost of being so busy that you can't add anything else into your life? And it's really easy to just keep doing the same thing that you're doing because it feels safe and it feels this is what we know, even though maybe it doesn't serve us that way. The wonderful things that I found are, I kind of made the joke that homeschool has ruined my life. It certainly has made things more difficult professionally, but All winter long, I got to go skiing with my kids on a Wednesday.

We took Wednesdays as our PE days and we went up and skied every week. And my 12 year old is this super funny, sarcastic, smart kid that is really fun to hang out with. And he can't ski as well as I can, but he's getting there. And my parents never got to be that much in my life. I've never been that much in my own kid's life. and up until now, and you know this, I have a lot of... I think mom give this always a thing and we all deal with it when we go to work and you have to leave your kids. I left my kids twice when I was in the military.

So my oldest son was four months old when I deployed for six months. And then my youngest was seven months old when I deployed my second time for again, six months. And so my 12 year old, I missed a year of his life. It was really awkward to be at the pediatrician and to have them ask when was, what was your son's first word? and I look at my husband and I say, I don't know, I wasn't there. I've really enjoyed this opportunity to get to know my kids again, and so that's been really good. The other thing that is just starting to happen is I'm trying to figure out what I want to be when I grow up.

I thought I would be done by this point. Me too. I thought I'd know at this point. My counselor said the last assignment that she gave me that I've been chewing on since our last session, And she said, you know, you work so hard during the early part of your career and you say yes to all the things because you never know what's going to spark your passion. You don't ever know what's going to be the one thing that is the that amazing piece that you really enjoy that takes you forward. And she said, you've done all of that and you've done all of this amazing work.

Now is the time to reap that. And you don't have to keep going a hundred miles an hour with the throttle full forward to prove yourself. You've done it. Now's the time that you get to sit back and look around and say, what of this that you built is what you want to pick up and carry forward. And so now that's where I'm in the process of having a little bit more space in my life to be able to say, this is something that I'm interested in and passionate about. and have the credentials to carry me into that.

So that's been the new part of what I'm exploring right now is what is it that I wanna do that somebody's gonna pay me to do? That's also a nice, important thing to create the next piece of what my life looks like. I'm just irritated I'm still having to do that. Thought I'd be done now. Yeah, I totally get where you're coming from. And what I noticed is, I've noticed two things. Well, when I took a step back and took some time off, regulated my sleep, I began to notice that my creativity was returning and my excitement and optimism was coming back.

So that was really key for me. And then the other thing, it's funny about how we've had different, same different experiences at this conference. This was the first conference that I did bring my laptop into the meeting room. And I usually just have so many different things I have to do that during any downtime or frankly, if I would get bored, I would open up an email, work on a project real quick. And this conference, I didn't do it. And I just enjoyed listening to my colleagues, even if it was a subject that, you know, I'm not in the military anymore.

So some of the topics are less relevant to me, but I just sat and listened in awe of what they're doing and being thankful that they are sharing their experiences from down range. So I think, you know, for the skeptic out there that's like, well, F that meditation. my attention and presence has returned and everything you read about happiness is tied to those two things. And one of the things that really helped change my mind and helped me a little bit more embrace the meditation part of it, because for me, rather than meditate, I rather go ride my horse.

My husband jokes because when I'm having a bad day, he kicks me out of the house and he says, go be with your horses. That's my happy place. And that's actually been really hard in the pandemic because everything came home. I don't ever get to send my kids away. I haven't been alone in my house in probably three years because everybody's home all the time. Wow. That's hard and I'm an introvert. I have to run away and I run away to the barn. My husband will laugh and he'll say, okay, did you solve all the world's problems while you were out there?

Usually the answer is yes and now I know what I'm needing to do. But we took a vacation in January and went to Hawaii and I told myself, hey, you're going to sit on the beach and you're going to read some books. One of the books that I read was called The Shallows. And it talks about how the internet has changed our brain. And I think that in itself is an interesting topic, but to me, it spoke a lot to Our brains are incredible and they're very malleable and we can change them. But physically, our neurons will change when we do the same process over and over again.

And that's when we build muscle memory and we, you know, when we study and do all of those things, we're building, we're building those neural pathways. And for the longest time, I built a neural pathway of You don't ever get downtime. You have to be doing something important. You need to be checking email. You need to be responding to something. You've got something in your email box to sign. There's a form that needs to be signed. You need to write a lecture. You need to do Air War College. You need to be, you know, managing the kids or doing something.

And I had built that neural pattern of always be busy, always have something to do. If you're sitting around doing nothing, you're not doing the right thing. And so learning how to be comfortable with not being busy has been one of the most, like it makes the back of my neck itch when I feel like I need to be doing something and I'm not. And that's taken some real work. And that's a little bit of where I do use some of the meditation of realizing that that feels bad in my body and how do I work through that and not letting that make me say yes to things I don't want to do.

but learning to be comfortable with that feeling and realizing that that's part of an addiction that my brain had to being busy and that busy does not equal success. Uncoupling those two have been a big piece of this journey in getting comfortable with. I sat on a beach and I read nothing but trashy novels for meat and The first couple of days, it was really hard and I'd pick up my phone and I'd like start to,

Acceptance, resilience, and looking ahead 27:27

and then I put it down, stop it. You don't need to look, nothing. The world is not going to end if you don't respond to that email and pick up the book and read. By the end of the week, I was doing great and I didn't touch my phone at all. And now I'm actually much better with that in. I am getting more comfortable with, yeah, I've had an email in my box for two or three days and I don't have to respond to it. I'll get to it when I'm ready. And that has been a powerful part of claiming that space back.

And again, that mantra, don't just do the work that matters. Boy, that will be the tagline of the episode. Yeah, I think busyness is definitely a badge a lot of us wear. It feels good. Like you said, it has that kind of addictive property to it. But I guess what I would ask the listener is what is the busyness covering up and what is it keeping you from really doing? That's what I've started to find and I'm kind of excited. Well, this has been so fun. But to our listeners, we actually want to go grab a cocktail at this conference and catch up with our friends.

So I'm going to move into our wrap up questions. So what I think I already kind of know, but I'd like you to elaborate on what would be your ideal self care day. I sleep late because that's how I do it. I would have a a cup of tea on my back porch and watch not the sun come up because that should have happened long before I got out of bed. Just watch the morning move across my back pasture. So I look out over Mount Jefferson in Oregon on my back. And considering throwing some kayaking in there, because I did some kayaking in Hawaii that I really liked, but I'm not sure if I'm good enough yet to not kill myself.

So that's still a maybe. And then my husband has a fabulous cookie would make me a fabulous dinner and I'm going to bed totally full of something delicious. That sounds really fun. The last question I have is. We're still in a pandemic and things are hard. We're both emergency docs and there's a lot of uncertainty all the time in our lives, but this has been a particularly challenging time and I'd like to say that I think it's gonna get easier, but I'm not so sure. I think we're moving through a very tumultuous time in the world.

So what is your advice for people moving forward during a time that's going to probably include more change and tumult? I think one of the most important things that has been powerful for me is to accept exactly what you just said. For the first couple of months of the pandemic, I had this attitude of, if I just get through this, and this is a lie that I finally recognized was a lie and stopped telling myself, because what I would say is, if I can just get through ASAP and get through those lectures, I'll be less busy.

If I can just get through the Kingston Vienna School and it's summertime, I'll be less busy and it will get better. What I realized is that's actually a lie. It never gets better unless I change something of what I'm doing. The only way that I made it get better wasn't this very deliberate, I don't know if I'm going to use you quite as dramatically as I have, but just drop all of the things that are, but the very essentials of my life. And then learn how to pick those back up of what was important to me and accepting that I don't get to control what the rest of the world is doing.

that changes the new constant. And the only part of that that I own is a very small piece of that and becoming very deliberate about how I approached those pieces that I could control. The other part of that is I stopped saying, I will, it will be fine if we just get through Delta Way. Right. You can just make it past Omicron. I had no desire to learn the entire Greek alphabet, but we're all gonna. And some of this harkens back to deployment. I never counted down the days of my deployment. I counted up because this idea of you're there until you're gone, we're in this for the foreseeable future.

And if you keep saying, if I can just make it through this next wave, or if I can just get through June or whatever, And it doesn't happen, it's demoralizing. When it doesn't change, when it's June and you're still in the middle of it and the next wave is coming and the kids are still busy and you still have no time. Instead of that, I've changed my perspective to. I'm here until it's done, whenever that is. And while I am here, I will be the master of this knotted sleigh. That is such a great, great point.

And I noticed that unfortunately too late into this. shit show that the major issue was a refusal to accept that it is the way the world is right now. And I will continue to have people come into my emergency department that do not believe they have COVID and are hostile to me suggesting a COVID test, which defies my, well, I'd say it defies my understanding, but I do understand it. I understand that they have fallen victim to misinformation. And I can be upset with it, but it is a reality. And that constant lack of acceptance, I didn't recognize that because I think the other thing for emergency medicine and veterans is we identify with being fighters and it felt good to be angry and to say that is unacceptable.

Well, I don't like it and I don't think it's right, but it is reality. So, all right, let's end on a happier note. What are you most excited to do in 2022? Well, honestly, one of the most exciting things is we just finished putting up my horse arena, so I'm going to be spending a whole lot more time on my horses. And if I can, August of 2022, drop my kids off at school and they will be educated by somebody else and somebody else can teach my son long division, that's when I win. That's when that will be the pinnacle of feeling safe enough that my family can kind of resume life again and I can spend some more time with my horses.

I love it. Well, thank you so much, Tori. This has been such a treat. And I'm so thankful to have you as my friend and my colleague. We should have wine for this one. Oh, we're going to have it soon. Don't worry. It was just a chance to chat with you, which is really fun. Thanks for listening to Heartline, conversations with healthcare changemakers following their heartlines. I'd so appreciate it if you could take a quick moment and hit the like button and also the subscribe button that you'll find within your podcast app or platform that you're listening on.

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