Author Chat with Carolyn Roy-Bornstein

In this Author Chat, Josie van Londen and Brad Buchanan speak with pediatrician and writer Carolyn Roy-Bornstein about her new book, A Prescription for Burnout: Restorative Writing for Healthcare Professionals. Carolyn explores burnout not as a personal failure, but as a signal of disconnection from meaning, purpose, and the soul of medicine. Together they discuss how writing can help clinicians process grief, anger, moral injury, compassion fatigue, uncertainty, and the emotional weight of bearing witness to suffering. The conversation also explores reflective writing as a tool for self-awareness, restoration, openness, and reconnection with the sacred moments that still exist in healthcare.

Links relevant to this episode:

• https://www.press.jhu.edu/books/title/54082/prescription-burnout 
• https://www.carolynroybornstein.com/
• https://www.mindgarden.com/117-maslach-burnout-inventory-mbi 
• https://www.simonandschuster.com/books/How-Do-You-Feel/Jessi-Gold/9781982199784 
• https://www.buzzsprout.com/2308830/episodes/15489603 
• https://manuptocancer.org 
• https://www.cityofhope.org/about-city-of-hope/who-we-are/our-history 
• https://www.cityofhope.org/orange-county/blog/unveiling-a-new-symbol-of-hope
• Sacred Moment Experiences Among Internal Medicine Physicians https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834653#google_vignette
• https://suzannekoven.com/book/ 
• https://pemachodronfoundation.org
• https://www.mhe.cuimc.columbia.edu/division-narrative-medicine 

General Links:

• Disclaimers: https://cancersurvivormd.org/disclaimers/
• Brad Buchanan: https://linktr.ee/bradthechimera
• G [Josie] van Londen: https://linktr.ee/cancersurvivormd
• CancerBridges: https://cancerbridges.org/

Transcript

Author Chat with Carolyn Roy-Bornstein

[00:00:00] Welcome and Introductions

[00:00:00] Welcome and Introductions

[00:00:00] G van Londen: Hello everybody. Welcome to the next episode of CancerSurvivorMD. Today we are very fortunate to have a, an author talk with us on her publication day, and I'm going to give it to Brad to introduce our guest. 

[00:00:18] Brad Buchanan: Thank you Josie. Um, so yeah. Today we're talking with Carolyn Roy Bornstein, who is a pediatrician and writer whose work focuses on the emotional and narrative lives of clinicians.

[00:00:30] Brad Buchanan: Through her clinical experience and engagement with narrative medicine, she explores how reflection, especially writing can help your professionals process complexity, grief and meaning embedded in their work. She Is the author ofa Prescription for Burnout, restorative Writing for Healthcare Professionals, which is the book we're gonna be talking with her about today.

[00:00:55] Brad Buchanan: Uh, as well as a couple of other books I should mention also through Thick [00:01:00] and Thin, One, foster Family's Eating Disorder Journey, and Mother, A Son, and The Journey from Grief to Gratitude. Um, so a prescription for burnout is in my mind, a very timely book that reframes burnout, not as a personal failure or something to quickly fix, but as a signal of deeper disconnection from purpose, identity, and meaning in medicine.

[00:01:29] Brad Buchanan: So, welcome, Carolyn, to our podcast. 

[00:01:32] Carolyn Roy-Bornstein: Thank you so much for having me, Brad. Thank you for reaching out. 

[00:01:36] Brad Buchanan: Yeah, it, it's my pleasure. It's, it's delightful to be able to interview someone whose book I've just read and whose writing is, is inspiring me. 

[00:01:46] Why Writing Heals

[00:01:46] Brad Buchanan: so I guess I'd like to start with maybe a more personal question and, and you can take this in any direction you would like, but, you know, you have, obviously you have a medical career that you bring, to this [00:02:00] book, life experience, but also, you have a family as well.

[00:02:05] Carolyn Roy-Bornstein: And, I'd like to know how either your career or your family motivated you, to write this particular book. Yeah, so thank you for that question. Uh, I'm a pediatrician. I have been for over 30 years.

[00:02:20] Carolyn Roy-Bornstein: I was a registered nurse before that. I worked for 10 years and kind of my nursing and medical career overlapped, for a couple of years in medical school. and the beginnings of this book started with, well, I mean there were a lot of books on burnout out there, and I think a lot of them come from a research perspective.

[00:02:43] Carolyn Roy-Bornstein: studying the phenomenon and coming up with solutions that they're offering, or from the perspective of a burnt out physician who is offering their own solutions, what worked for them? My take on it is [00:03:00] coming through the lens of writing itself, having helped me at one particularly low point in my life, which was, we have to go back 20 years now when my youngest son was hit by a drunk driver and his girlfriend was killed, and he was left with a serious traumatic brain injury.

[00:03:22] Carolyn Roy-Bornstein: And as you can imagine, my family was thrown for a loop, kind of devastated. I turned to journaling. I turned to the page to process what was going on with Neil. what he had lost, how his whole world was changed as a senior in high school. What should have been the time of his life was not. my anger at the drunk driver for having caused all this.

[00:03:48] Carolyn Roy-Bornstein: and also there was one aspect of it that left me feeling particularly lonely and, isolated, which is termed in the [00:04:00] psychiatry sphere as ambiguous loss or disenfranchised grief, in that I was the mother's whose child did not die, right? So whenever I would talk about Neil's second surgery for his leg or his, academic meeting to talk about

[00:04:21] Carolyn Roy-Bornstein: learning accommodations, I would kind of be met with this, either spoken or unspoken, but he's alive, right? And shouldn't I just be grateful is, is the feeling I came away from that with. And so the page became really important to me, to, as a place, to, a safe space that I could process all of this.

[00:04:43] Carolyn Roy-Bornstein: And it was empowering for me. I couldn't change what had happened to our family, but I could, kind of navigate it on the page. I could own my own story, tell my own story on a page in a way I couldn't at the time with, my friends and [00:05:00] family. so it became a really powerful outlet and a powerful tool for me, which I revisited maybe 10 years ago, thinking about writing a book, using writing as, a tool for healing.

[00:05:14] Brad Buchanan: Thank you, uh, very much for that background. Um, you know, 

[00:05:18] How does writing help when anger is involved

[00:05:23] Brad Buchanan: I'm struck by what you just said regarding anger in particular. I think that's a particularly difficult emotion to , process in real time, but it's also one that can be very counterproductive in real time. So how did you find writing helped to address diffuse reframe anger?

[00:05:42] Brad Buchanan: Because I think that is maybe the top thing that I've found personally in my own life, that the anger is always still there against, you know, for, there are certain doctors that I am very grateful to of course, but there are others I'm very angry at [00:06:00] still. so how does writing help when anger is involved?

[00:06:03] Carolyn Roy-Bornstein: I think one thing it does is simply give it a vehicle, a vessel, a place to set it down. I think there are some powerful and important scientific studies that look at, for example, functional MRIs of people who are, expressing strong negative emotions. And I think in psychiatry they call it affect labeling, but just that externalizing of painful, negative emotions has been shown to, in our brains.

[00:06:38] Carolyn Roy-Bornstein: The, the brain regions that tend to activate with distress are deactivated when we are naming externalizing painful negative emotion. So I think there's actually some science behind it. I've used it in other times in my life too, where when I've been angry, like you said, To just [00:07:00] write a letter, write a letter that never gets seen, never gets mailed, but it helps with taking perspective, keeping a sense of what's important, a sense of the bigger picture and not get lost in, the smallness, I guess that anger can be.

[00:07:18] Carolyn Roy-Bornstein: I agree it is one of those emotions that it is probably the least helpful in terms of, tapping into to heal. But like you said, if it is there, we need a place to lay it, to externalize it and writing can be that place.

[00:07:34] Brad Buchanan: Yeah. Thank you. That, that makes a lot of sense. And I, I will say one of the things I really enjoyed about your book. Was the way you incorporated, some of the cutting edge research, that's been done on how and why writing, helps us and, which areas of the brain indeed are engaged when we do certain types of writing activities or when we're feeling certain emotions and [00:08:00] expressing them.

[00:08:01] Brad Buchanan: but yeah, that's another reason why I was excited to talk to you, because I think it's really difficult to write an accessible book, that also incorporates, some fairly heavy duty, scientific inquiry into all this. And I think you managed to do it with a light touch that is also very persuasive.

[00:08:21] Brad Buchanan: So that's another reason why I wanna recommend this book. now I'm, I'm also wondering, you know, 

[00:08:26] Who the Book Serves

[00:08:30] Brad Buchanan: what motivated you to write this book now? Were the people you talked to like, we need help too, you know? to find new ways of coping with burnout through writing, like, and so I'd like to you delve into the prehistory of the book on that side of things, you know, from, from your professional background .

[00:08:48] Carolyn Roy-Bornstein: Yeah, sure. So the book started out as a different iteration. It, it was always a book about using writing to heal. but I was a little [00:09:00] fuzzy for quite some time on the exact audience. I thought at one point of directing the books towards women of a certain age, like myself. career path changing. 

[00:09:13] Carolyn Roy-Bornstein: I thought it could really help sort out some, ambivalences. I thought about gearing it towards people who had suffered trauma and loss and grief, like my family had gone through. ultimately as I kept writing, I began to really focus on my ideal reader. And the exercise I used that helped to crystallize my audience for me was, an exercise in which I was asked to describe my ideal writer, not my audience, writ large, which is what most book proposals ask you to write about.

[00:09:49] Carolyn Roy-Bornstein: Describe your audience and how you're gonna reach them. This asked me to describe one ideal reader. and so I did that just, [00:10:00] and I found myself describing myself. I found myself describing a physician at the end, near end, mid to end of her career, really frustrated with insurance, telling her, you know, what medication she could use or imaging studies she could or could not order.

[00:10:22] Carolyn Roy-Bornstein: Um, how many patients she could see and, and so forth and really ready to hang it up. And yet feeling like there was still a lot to give. I described, you know, as I began to write about this person, I've wrote about another person and I wrote about, a, a resident or rather, an early career attending who had finished residency, finished fellowship, thought she had gotten through the hard part, it would get easier, and then there were teaching responsibilities, and then there was committee work.

[00:10:56] Carolyn Roy-Bornstein: And she too was toying with the idea of maybe I [00:11:00] picked the wrong field and I can't quit. I have so much debt. And I realized this was before the pandemic. but burnout was starting to become an issue in medicine. and I realized that was, that was my people, that was my audience. That was, a group that I knew well, physicians and nurses.

[00:11:21] Carolyn Roy-Bornstein: I had worked in a variety of fields as a doctor and a nurse, including the emergency room, including labor and delivery, ICU, primary care practice, solo practice. so I felt I had a good handle on that audience and that, like you said, they could really use a tool and it's a small tool, but it's sort of what I have to give and it's what I have that worked for me that I wanted to share.

[00:11:46] G van Londen: Caroline? Yeah. sorry, Brad, I have a, a question if you don't mind. Is that okay Brad? 

[00:11:51] Brad Buchanan: Oh, of course. Right ahead. 

[00:11:54] G van Londen: the way you're talking to me reflects that you see [00:12:00] writing. I'm sure you will talk more about how to write, later in the podcast, but you see writing as a way to validate yourself as a way to reframe your feelings and, many other items, I'm sure.

[00:12:24] G van Londen: But what I'm also hearing is a way to empower yourself to channel that energy, whether it's positive and or negative, in a way that allows you to act on it constructively to make your own life better, and maybe beyond that, healthcare better. The way you talk resonates a lot with me, and I looked it up so I am going to quote it here here.

[00:12:52] Burnout as Soul Erosion

[00:12:52] G van Londen: I don't know if you're aware of the City of Hope. That has a gate when you enter their facilities. That bears the [00:13:00] words of the early city of hope leader that says that I'm quoting here. There is no profit in the curing of the body if in the process we destroy the soul. And I think that resonates a lot with what you're trying to do.

[00:13:23] G van Londen: Well, I think that resonates both with the concept of burnout and with writing itself, where you, we talk about, damaging the soul and my book is structured around Christina Maslach's three dimensions of burnout 

[00:13:40] Carolyn Roy-Bornstein: I've heard her talk about, burnout as an erosion of the soul. And I think. That kind of gets at, the moral injury that we sometimes come up against, where the values and beliefs that we came into [00:14:00]medicine with are kind of, butting up against the constraints of the work environment.

[00:14:08] Carolyn Roy-Bornstein: for example, how much time we have to spend with patients. If that is, curtailed, that feels like we're not giving of ourselves the way we were taught, the way we believe in the way we want to. even something as simple as prior authorization in insurance where a medication or a formula is denied and we have to appeal, we have to write letters, we can, have a phone to phone, peer to peer, doctor to doctor conversation about, 

[00:14:38] Carolyn Roy-Bornstein: These medications or formulas, and they're still denied. So we have to kind of watch our patients suffer for that 30 day period after which the insurance company will say, okay, that now we'll consider that a failure. And in the meantime, you know, we both know that it's going to be a failure and, you know, find ourselves frustrated and angry that we're not allowed to [00:15:00] make the decision to start the patient on this medication or formula earlier.

[00:15:05] Carolyn Roy-Bornstein: so that feels very, that's like getting at the, the soul of medicine, the soul of us, our purpose, our meaning. But it's also something that writing is, one of the things it's particularly good at is getting down to that meaning to that purpose, reconnecting us with purpose, 

[00:15:25] Carolyn Roy-Bornstein: cultivating the openness that we need to, create that meaning or recognize meaning in a particular doctor, patient interaction or relationship or conversation. so, it, it can be, the erosion of the soul can be the issue that writing, is maybe most adept at, at, helping us with.

[00:15:47] Brad Buchanan: Thank you, Carolyn. That's a wonderful answer. Um, 

[00:15:50] Signs and Misconceptions

[00:15:56] Brad Buchanan: I'd like to maybe talk a little bit more though about like what are the symptoms of burnout, from your point of view, like what does that really look [00:16:00] like, for people in the medical profession or. Asking themselves, am I just really tired? Am I frustrated?

[00:16:08] Brad Buchanan: do I, am I actually depressed? You know? and what do people misunderstand maybe about burnout from your point of view? 

[00:16:16] Carolyn Roy-Bornstein: Yeah, so maybe I'll start with Maslach's three dimensions that she outlines, which are one you mentioned emotional exhaustion, and I think it's more than just fatigue, more than just

[00:16:31] Carolyn Roy-Bornstein: being exhausted at the end of a, a busy day. It's more depleted. It's more like you have nothing left to give. Right? and then there is, the, the depersonalization, the cynicism that kind of slowly creeps into our work. and then there's the feeling that it doesn't matter, a feeling of, a lack of personal accomplishment.

[00:16:58] Carolyn Roy-Bornstein: It's not that we [00:17:00] are not effective, but it's that we feel ineffective. We feel like we're doing the same things over and over again, and it's not getting us anywhere. and depressive symptoms can look like that. And that is important to distinguish burnout. Isn't in the DSM, it's not considered a mental illness, but, depressive symptoms can be intertwined with that.

[00:17:24] Carolyn Roy-Bornstein: burnout is specifically occupation related, work related. so that's really important and I think people will often, think they're not there yet because they don't experience all those symptoms. and just recognizing that even if you are experiencing one or even not every day or all day, but just, you know, from time to time you keep noticing that, geez, this is beyond the usual, you know, I'm kind of exhausted here.

[00:17:55] Carolyn Roy-Bornstein: and, looking into changing something, looking into, getting some help. [00:18:00]there's been, less stigmatization of getting help as a physician. it used to be that re-credentialing and, hospital applications would ask stigmatizing questions about mental illness and that is beginning to change.

[00:18:17] Carolyn Roy-Bornstein: People should feel, empowered to go ahead and reach out. And it's not always easy to recognize. So just getting help, just getting someone to bounce this off of is helpful. a colleague of mine, Jesse Gold, she is a psychiatrist. She wrote a book and she's a Chief Wellness Officer at the University of Tennessee, and she wrote a book called, how Do You Feel. It's, it's part memoir about her own experience with burnout and part, prescriptive nonfiction book.

[00:18:46] Carolyn Roy-Bornstein: she, it took her a while. It took her several chapters, or several months or years to figure out what was happening with her and kind of acknowledging and labeling it as burnout. so I think it's not, you're not alone. if you're [00:19:00] thinking, do I have it, do I not?

[00:19:02] Carolyn Roy-Bornstein: am I depressed? Am I just anxious or, or am I starting to burn out?

[00:19:07] Brad Buchanan: Thank you. my former wife, we're amicably divorced, but, she wrote a book, on caregiving and burnout. 

[00:19:14] Carolyn Roy-Bornstein: Oh yeah.

[00:19:15] Extract Meaning from Patient Stories but Leave the Suffering on the Page

[00:19:15] Brad Buchanan: In America. Her name's Kate Washington and the book is titled Already Toast, caregiving and Burnout in America. And, um, I 

[00:19:23] Carolyn Roy-Bornstein: reviewed her book actually. 

[00:19:25] Brad Buchanan: Did you really?

[00:19:26] Brad Buchanan: Yeah. Oh, it's a small world, isn't it? Yeah. Well, you know, I think one of the ways, I mean, she, she took an online test as at one point, to, to figure out, okay, how badly burned out am I? And there were a bunch of markers and I, I seem to remember that compassion fatigue was a metric for burnout, right?

[00:19:47] Brad Buchanan: Mm-hmm. And that would seem to be especially important in the medical profession, right? If you're unable to feel any compassion or less compassion for Your patients, is that an [00:20:00] especially concerning warning sign? 

[00:20:02] Carolyn Roy-Bornstein: Yeah. And I think that's where the, the second dimension of the depersonalization and cynicism come in and, and it's a real, occupational hazard in this field, which is a, a giving profession, a caring profession where we're asked to have empathy and compassion.

[00:20:24] Carolyn Roy-Bornstein: we bear witness to suffering every day and. Rita Sharon, who directs the narrative medicine program at Columbia, she talks about doctors having a porousness that we must develop a permeability so that we can absorb these stories of illness that our patients tell us, which I agree with.

[00:20:50] Carolyn Roy-Bornstein: It's really important to hear those stories, to, take in those stories of illness, to understand the patient where they're coming from, to get the [00:21:00] diagnosis right, to get the treatment right. But in that process, I think what happens is that we continue to carry those stories, right? We walk through the rest of our day with the story and the suffering of the first patient we saw, and I think writing can really help be that filter for which we

[00:21:26] Carolyn Roy-Bornstein: take in the story, but then release the suffering that belongs to the patient. That does not belong to us. And I, I think that's, that's the key because the filter can let go of the suffering, but also retain the meaning that we, as we're writing, as we're releasing the suffering, we can also look more deeply at the interaction, the conversation, and extract meaning as well while leaving the suffering on the page.

[00:21:59] Openness Beyond Writing

[00:21:59] Brad Buchanan: Thank [00:22:00] you. does that also connect to the concept of openness? I'll frame my question in terms of my own experience. I've recently gotten much more involved in the cancer support space with a group called Man Up to Cancer, where it's an emotional support group for men who don't join other emotional support groups.

[00:22:19] Brad Buchanan: Basically, uh, at the same rate that women do. And, um, I found that what that group has enabled me to do in essence, was to share my story, in a context where I'm hearing lots of other men sharing their cancer journeys. but being willing to open up and share my story again, I'm also willing to hear more of their stories and to be open to more of their experiences and to be able to show compassion and support for them.

[00:22:47] Brad Buchanan: Um, so it, you know, in some ways getting your own thoughts down on the page, I have found anyway, is a way to then refocus outward and say, okay, I'm ready for someone else to walk through the door [00:23:00] and tell me about their difficulties too. does that resonate with you in any way ?

[00:23:07] Carolyn Roy-Bornstein: I think, I think you can tell by the way I'm nodding enthusiastically as you're speaking, but yeah. Um, writing can, you know, openness is one of the big five personality traits that they talk about along with, you know, introversion, neuroticism, conscientiousness, and I'm missing another one. But, you know, you think, well, can you really cultivate a personality trait?

[00:23:33] Carolyn Roy-Bornstein: Aren't you like born with these personality traits? And yes, and to, to a certain extent they are inherent. but you can, and this has been scientifically shown, you can, cultivate openness. And in medicine that can be particularly helpful because we deal with a lot of uncertainty, as I'm sure both of you in your cancer journeys have had to deal with uncertainty.

[00:23:59] Carolyn Roy-Bornstein: In medicine, [00:24:00] if you don't tolerate ambiguity as they call, call it, talk about it. you know, you can find yourself jumping to conclusions, jumping to a quick diagnosis just to have a diagnosis and not have this uncertainty or this working diagnosis kind of hanging over. We wanna, we want answers.

[00:24:17] Carolyn Roy-Bornstein: We wanna close the case. we wanna cut a patient off. If you don't have an openness, you can, you know, studies have shown that we give a patient all of 11 seconds to speak before we're jumping in saying what we, we think we know already, before we even hear most of your story. and, and writing has been shown to be able to cultivate that openness.

[00:24:39] Carolyn Roy-Bornstein: So we can sit with that uncertainty and, like you mentioned, Brad, we can let in other stories.

[00:24:46] Two Empathy Components

[00:24:46] Carolyn Roy-Bornstein: And getting back to your previous question in yours, Josie, About compassion and empathy. There's, there's sort of two components to empathy, a cognitive empathy where you understand intellectually what someone is going [00:25:00] through.

[00:25:00] Carolyn Roy-Bornstein: And then there's the emotional empathy where you are actually asking me to feel what you feel, what you're going through, and that can drain us and contribute to burnout, whereas the cognitive empathy is actually protective, against burnout.

[00:25:17] G van Londen: Carolyn, you say so much, my head is going all over the place and I can't wait to read your book.

[00:25:25] G van Londen: And so we should talk probably a little bit more about what is really in the book. But, one thing you hit on and, I've received psychoanalytic training, because I think that field is fascinating and one of the biggest accomplishments in that field is to be able to tolerate the unknowns, the uncertainty, not having answers, being able to accept that, make peace with that.

[00:25:54] Systemic Failures, Personal Failures, and Resilience

[00:25:54] G van Londen: but when you started talking that way that I started to associate [00:26:00] to my own work when I used to work, one of the things that they did to prevent reduce burnout is to work on our ability to tolerate more,

[00:26:16] G van Londen: Making us providers feel like burnout is our problem, our failure, we're not coping well enough. But I think burnout is, a much, much bigger picture. It's not the fault of the providers, not the fault of the caregiver. Wherever burnout occurs, it just means that there is an imbalance between what we're being asked to do and what we're capable of doing.

[00:26:46] G van Londen: And everybody has limits at a capitalism, you know, it's a pendulum. We try to put more on somebody's plate, until they have reached their limits. And I [00:27:00] think in society as a whole, we are reaching our limits. 

[00:27:06] Carolyn Roy-Bornstein: Yeah. No, I do see what you're getting at in terms of just being overwhelmed by what, whatever it is that's being asked of us. whether it's in politics, everyday life, family life, or work. 

[00:27:20] Carolyn Roy-Bornstein: And I think that's the pushback people get when they are talking about resilience. And I think, you know, the entities, the administrations, the organizations, the hospitals are beginning to understand that they need that this system that needs to change, that they are recognizing and hiring wellness officers, instituting wellness curriculums. And I think when this first started, one of those curriculas was, resilience workshops. And I think if you're sitting in a resilience workshop and you have a million [00:28:00] patients and very little time to see them, it can feel like, why am I being asked to be resilient?

[00:28:06] Carolyn Roy-Bornstein: Why aren't you the one changing my schedule so I can rest and recharge and so forth? And I do have a chapter on resilience in my book, and my point about that is that even if we are in an ideal practice environment, we still are bearing witness to suffering. There will still be adversity in our clinical practice every day.

[00:28:35] Carolyn Roy-Bornstein: And so. Resilience. It to me is not how well I hold up to having one thing after another, after another piled upon me, but it is also about what are my inner strengths. it's about creativity and flexibility and optimism and all of these other, more [00:29:00] positive aspects that we can bring to the table, in finding solutions to these issues.

[00:29:06] G van Londen: It's a problem that needs to be solved on multiple levels. 

[00:29:10] Carolyn Roy-Bornstein: Yes.

[00:29:11] Brad Buchanan: Yeah, I, I'm glad that Josie addressed that kind of the systemic failures that are convincing us that it's our personal failures that we need to rectify. 

[00:29:22] Writing for Non Writers

[00:29:22] Brad Buchanan: but yeah, I mean, I sort of do want to get back to the writing. For, for, clinicians who say, well, I'm not really a writer. How do you invite them in or motivate them to find that writer in themselves? 

[00:29:35] Carolyn Roy-Bornstein: Sure. so that is one skepticism I run into a little bit. I'm not a writer and I try in my writing workshops to kind of level the playing field right off the bat and say, we are none of us Shakespeare.

[00:29:50] Carolyn Roy-Bornstein: And it truly doesn't matter. That is truly not, what this is about. It's not about pretty pros. In fact, the guidelines are, [00:30:00] not to spell check, not to grammar check, not to let your pen move off the page, just keep writing. And, you know, the reflective writing practice that I describe in the book is an inherently self-compassionate practice.

[00:30:16] Carolyn Roy-Bornstein: Because there is no right answer. There is no wrong answer. It is whatever the answer is for you today at this moment. And you know, whether you are an accomplished writer, a published author, or not, the beauty of writing is that it meets you where you are, right? it adapts to, whatever it is that you bring to the page.

[00:30:44] Carolyn Roy-Bornstein: So a lot of my workshops, I mean, some of them are just meant for physicians or healthcare professionals. Others have a very, very diverse audience. and it, it's sort of my job to, to [00:31:00] lay those ground rules and to level that playing field. And writing inherently does that.

[00:31:07] Brad Buchanan: Uh, thank you. And this is a very self-serving question, so I, I apologize. But, um, I have something that I think of as my magic pumped. So when I come to a group for the first time, I ask them to write about a transformative experience, but in the, present tense and in the third person. So not, you know, when I had my stem cell transplant, but when his stem cells go in, he starts to feel sleepy or whatever.

[00:31:37] Brad Buchanan: reframing that experience, you know, as happening right now, but to someone else, is a sort of, I found it to be, in my own writing practice to be a wonderful way of getting at experiences that I had that I didn't know how to write about. Because I didn't have clear memories, for example, of the day that I got my brother's stem cells, I was [00:32:00] drowsy. but reimagining that as when his brother's stem cells go in, I managed to write a poem. But do you have that magic prompt? or is there a particular exercise that you found that it helps, people open up quickly in a way that you, you hope that they would?

[00:32:18] Brad Buchanan: I'd love to get, A magic recipe from you, Carolyn? 

[00:32:22] Prompts Perspective and Insight

[00:32:22] Carolyn Roy-Bornstein: Yeah, I, I think before I get to any magic recipe, if I even have one, I, I think it's interesting that you use the third person in that way. I hadn't really thought of using it in that way. The way I use it is to use third person to describe an event, a conversation from your own perspective, and then describe it from the person on the other end of the conversation.

[00:32:47] Carolyn Roy-Bornstein: to just kind of get their, perspective, taking a different perspective taking, but to kind of, use it as a way to put yourself in more of an observer position. And you can [00:33:00] describe what may have been going on with yourself, like if you didn't remember, as you say, I think that's a really interesting way to use third person.

[00:33:08] Carolyn Roy-Bornstein: we do something similar in narrative medicine when we're doing not straight reflective writing, where we go right to the prompt, but we back up a little and use a piece of literature or art first, and we discuss the poem that maybe accomplishes the same thing because we're sort of discussing it objectively.

[00:33:30] Carolyn Roy-Bornstein: What did you think about the poem? Who's, you know, what point of view is the poem? And you know, what does this metaphor mean? And you know, why is this person stopping here? What does this white space mean? So it gets us kind of talking as colleagues, as a group. It gets us to know each other so that when we get to the prompt, we're not just diving right in, okay, here, write about this.

[00:33:50] Carolyn Roy-Bornstein: We, we've had a chance to kind of, um, connect a personal or clinical experience of our own with a, a [00:34:00] story that's happening on the page with an objective story. So, so I, I agree with that piece of it. I kind of tried to do the same thing in a little bit different way. but the, so in my book, I have roughly three prompts for every chapter. So that's almost a hundred prompts. And they generally form the same kind of pattern where I'll ask you first to simply describe a conversation or, or situation or something that you want to, examine. And it, we have usually chosen a theme or I have chosen a theme based on whatever. In July, I might talk about transitions because new medical students are becoming interns and

[00:34:43] Carolyn Roy-Bornstein: medical students are becoming residents and so forth, or the residents experience the death of a beloved patient. So we had a theme of grief. So I might construct a prompt based on that theme and ask us to relate it to the [00:35:00] poem or artwork that we've just been discussing. And then I ask them just to describe it, and then we talk about our thoughts and feelings about it.

[00:35:10] Carolyn Roy-Bornstein: And then the last thing is to look at what can I learn from this? What lesson can I take? What practical wisdom can I glean from what happened? And that is the kind of third and final, part of that. So that is where sometimes the magic happens when you're thinking, oh wow, I didn't, I didn't realize I had that, anxiety or that, that feeling of guilt there.

[00:35:41] Carolyn Roy-Bornstein: There's a lot of that, self-awareness that pops up in writing. 

[00:35:46] G van Londen: So it brings something to the level of consciousness 

[00:35:54] Brad Buchanan: that was there all along. yeah. Um, I think to recall that, you used [00:36:00] that reframing of point of view, to get, writers to reconsider moments when they themselves have, closed down. In the past. Right. And by close down, I'm assuming you mean where they stopped kind of listening to what someone was saying. Just, and they had spent that 11 seconds, you know, that you were talking about, you know, of doctors listen to their patients for only so long before they say the thing that they were gonna say all along.

[00:36:30] Brad Buchanan: the exercise that you kind of invite your readers to, to do is to go back to that moment of having closed down and then reframe and, and, and write from the other person's point of view. I, I seem to recall, that, that that seemed a very useful way of trying to open people back up to those, to those moments, where they thought they had.

[00:36:54] Brad Buchanan:

[00:36:54] Carolyn Roy-Bornstein: Yeah, that prompt came from the Buddhist nun Pema Chödrön, [00:37:00] who said in an interview, and I'm paraphrasing something like, we will only begin to open when we recognize that we're closed. So that was trying to get someone to realize, like when did you tune out?

[00:37:15] Carolyn Roy-Bornstein: When did you kind of stop listening and what might you have gained if you had remained open? 

[00:37:22] Brad Buchanan: Yeah. I mean, I think, honestly, just speaking candidly, I think that's the hardest thing for me to do is to try to, find my own blind spots. That is the, the ultimate challenge, I don't mind reflecting on my own life, but finding my own blind spot is virtually impossible.

[00:37:41] Brad Buchanan: I need other people to point that out to me as a rule, 

[00:37:45] Carolyn Roy-Bornstein: And I talk about that in the self-awareness chapter that we, you know, self-awareness is kind of built over time from when we're very small. And, you know, some of that is just everyday lessons learned. Like my dad would call it the school of hard [00:38:00] knocks.

[00:38:00] Carolyn Roy-Bornstein: Like what, what you learned about yourself just going through life. But some of it is what feedback you get and, you know, that can be feedback from a job interview, but it can be feedback from, you know, a, a family member. I remember I'm, I'm the one who does Thanksgiving, um, the last, I don't know, 10 years.

[00:38:21] Carolyn Roy-Bornstein: And I remember, cooking and preparing and making an offhand comment to my sister-in-law that, gee, you know, maybe I'm not the go with the flow kind of person. I, I like, I like to think I am. And she said, you think, and I was really taken aback because I kind of did think of myself as a easygoing, go with the flow kind of person, but clearly everyone else knew that I was not.

[00:38:49] Carolyn Roy-Bornstein: So I think you're right, Brad. You do kind of, you do have your blind spots that you need pointed out to you. 

[00:38:57] Brad Buchanan: Yeah. I, I, I [00:39:00] certainly agree with you and that's a very funny, uh, anecdote. And, and thank you for, for sharing that. Um, 

[00:39:06] Letters of Wisdom and Self Compassion

[00:39:07] Brad Buchanan: I, I guess I also wanted to, ask a little bit about the reframing in the terms of practical wisdom, like lessons learned.

[00:39:15] Brad Buchanan: You know, one, one of the writing workshops that I facilitate, we always ask people after they've written expressively about their feelings to then turn and write a, a piece of advice to someone who's in a similar situation, right? And that is a way of sort of reframing the experience in terms of, here's what I learned and here's what I can offer you by way of wisdom.

[00:39:38] Brad Buchanan: That seems to be particularly, it seems like it ought to be particularly beneficial in a medical profession where I would hope and assume that there's still a lot of mentoring that goes on between junior physicians and older, more experienced, um, positions. But I, I'm wondering if you see writing as having any role in that [00:40:00]ongoing sort of sharing of advice and, and practical wisdom where it comes to burnout questions.

[00:40:08] Carolyn Roy-Bornstein: Yeah. And I think that reframing, is, is really important. We, you know, we use, in psychology and psychiatry, they use writing. they talk about trauma narratives that they have, you know, people who have experienced trauma, who maybe having PTSD symptoms, they advise the client to start writing it, writing it out, and then reading it aloud.

[00:40:33] Carolyn Roy-Bornstein: And I think one way that helps is just, it, it loses its power to, to hurt you, to harm you. That, you know, the more you kind of sit with it, write it, read it. and the, the another way that trauma narratives can be helpful is like, like you said, Josie reframing, or you said Brad, like finding advice or finding the positive in

[00:40:59] Carolyn Roy-Bornstein: the [00:41:00] adversity. And I think that's a great exercise and a great way to get at that. Like if you can't see it for yourself, to ask you to, advise someone else or write a letter to someone else, and give them advice. Because I think one thing, it, it's true in medicine, and it may be true in general, is that we seem to have an easier time having compassion for other people than we do having self-compassion.

[00:41:30] Carolyn Roy-Bornstein: So I think framing it in that way, what would you tell someone else? I'll often have someone write a letter to their younger selves. and just turning it, making it, almost a pretend point of view, third person point of view exercise. just makes it a little easier, you know. That difficulty, giving ourselves compassion, um. Can be overcome with that third person.

[00:41:54] G van Londen: Yeah. The current generation of medical [00:42:00] students, for them learning to write and take a breath and sit with a cup of coffee or tea and write this letter to your future self during medical school to get into the habit early on so that they hopefully will take it with them as they grow in their career.

[00:42:23] G van Londen: Yeah, that's interesting that you say that. Josie, my friend Suzanne Koven, she is the writer in residence at Mass General and she published a, I guess you would call it a memoir in essays called Letter to a Young Female Physician. And that, um, I can see you've read it the way you're nodding enthusiastically, um, that, that

[00:42:47] Carolyn Roy-Bornstein: book started when she was in her role as the writer in residence. She was addressing a room full of interns and she assigned them this very assignment that you [00:43:00] just mentioned. Write a letter to your future self. And as she was looking over this room full of young doctors, most of whom I think were women at this point, which is very different from her early career, she was very moved watching them all, you know, scribbling attentively.

[00:43:18] Carolyn Roy-Bornstein: And she decided to, while they were writing to their future selves, she decided to write a letter to her younger self. And that, you know, she had only given them five or 10 minutes. And that essay, she kept working on it and published it in the New England Journal of Medicine and it kind of went viral. and that's when she decided to

[00:43:39] Carolyn Roy-Bornstein: write a book. So you're right when you're saying this can be a powerful tool that's writing a letter to our future selves. To our, our past selves.

[00:43:49] What Tends to be Uncovered in Writing

[00:43:49] Brad Buchanan: Yeah. Thank you. Um, sort of on that same theme, what are some other, you know, episodes that, that you've encountered of people writing, [00:44:00] in either one of your workshops or in a similar workshop like, you know, medical staff writing? What, what tends to surface in those folks? Like what emotions do they uncover that they might not have otherwise found?

[00:44:14] Brad Buchanan: Um, and I'll share that, you know, in the support group that I am part of, man Up To Cancer, there's a lot of survivor guilt. Uh, of, you know, people who are like, well, why did I survive? And my buddy didn't make it? And, you know, I'm sure doctors have seen a lot of death too. Uh, anyway, but I will not, uh, I'll, I'll try not to preempt the answer any further, but, but yeah.

[00:44:40] Brad Buchanan: Like what types of feelings tend to surface in your experience when medical people start writing along these lines? 

[00:44:47] Carolyn Roy-Bornstein: Yeah. One thing I have seen, I mean, there is what I mentioned before, the wow, I never knew I felt that way before. I did a workshop for brain injury survivors, and [00:45:00] there was one who said her wow was, wow.

[00:45:05] Carolyn Roy-Bornstein: I guess I'm actually thankful, grateful for my brain injury. I, I, I've never thought about it that way, but, but I think I really see that now. So that was one thing. There's also, you know, frustrations come out, senses of helplessness come out, as you know, and I felt this way caring for my son after his brain injury.

[00:45:30] Carolyn Roy-Bornstein: As a doctor, we're, we're programmed to heal. We heal, we cure, we take away pain. And you know, when you can't do any of that, you feel less than, you know. So a lot of that comes out. But interestingly, what can also come out of those pieces of writing, if the workshop includes sharing, is, a reframing from another person's point of view, and realizing that there [00:46:00] are other roles for physicians there

[00:46:02] Carolyn Roy-Bornstein: can be an advocacy role that maybe you didn't realize was an option for you, was there for you. or there's a simple bearing witness role, like maybe you don't have the answer or the cure for the patient. Maybe no one does, but your presence is still valuable and that has come up in various situations as well.

[00:46:26] Brad Buchanan: Thank you. Um, 

[00:46:29] Restoration Sacred Moments Flourishing

[00:46:29] Brad Buchanan: Carolyn, maybe a final question here, going back to your book and the title, the subtitle is a Restorative Writing for Healthcare Professionals. What does restoration look like in that title? not just relief maybe, but sort of reconnection in some way.

[00:46:49] Brad Buchanan: What is your definition of restoration and what, by extension then, would be the thing that you would want the reader of this book to take from your book along [00:47:00] those lines? 

[00:47:00] Carolyn Roy-Bornstein: Yeah, I think it, I think it is that, connection, that engagement, that being open. You know, um, I don't know if you're familiar, this just came out a, a few months ago, or maybe it was a year ago, but it's maybe a few months ago.

[00:47:18] Carolyn Roy-Bornstein: Um, a study out of the University of Michigan on sacred moments, Sanjay Saint in his group asked over 600 internists internal medicine physicians, whether and how often they had experienced sacred moments with their patients. And by that they described the sacred moment as brief period of meaningful connection with a patient and over two thirds of internists said, yes, I know what you're talking about.

[00:47:53] Carolyn Roy-Bornstein: I have had that moment. And the follow-up question, which interested me even more was, [00:48:00] have you shared that with your colleague? And the overwhelming answer there was no. And I think, right. And I, I think that's another place where writing can be helpful is to name and normalize these sacred moments and to open us to them, to make room for them to have us.

[00:48:27] Carolyn Roy-Bornstein: Be open to the possibility of them, to the recognition of them, to the creation of them. So I think that engagement and that openness is what I would hope for for my readers. And I think also, you know, we say health is more than just the absence of disease. And I think in medicine, wellness in physicians is more than just the absence of burnout.

[00:48:54] Carolyn Roy-Bornstein: And what I strive for in this book is for readers of it [00:49:00] to actually flourish. the book begins with, stress and what is it doing to our bodies and bearing witness and vicarious trauma and secondary suffering. But it moves us to the end of the book. We're talking about wonder and awe and joy and optimism and creativity and flourishing.

[00:49:21] Carolyn Roy-Bornstein: So that is my. Hope for the readers of the book. And that is the transformational journey I'm trying to bring writers on through this book. 

[00:49:33] Brad Buchanan: Well, 

[00:49:34] Recommendations and Closing

[00:49:34] Brad Buchanan: I think, you know, from my perspective, you are well on your way to accomplishing that. In fact, I've already recommended your book to staff of the Roswell Park, cancer Center for whom I do writing workshops on a monthly basis.

[00:49:49] Brad Buchanan: one of the things that I've tried to do is I've tried to reach out to cancer centers to see if I can do writing workshops for their patients, but it's difficult actually to get access to the [00:50:00] patient. So I'm doing it for the staff instead because they need it too. Mm-hmm. And I certainly think they can benefit from your book as well, Carolyn. So, uh, but yeah, hopefully, you know, maybe they'll reach out to you and, do, you know, do an in-person workshop one of these days. Who knows? But, yeah, I, I strongly recommend a prescription for burnout, which, which is, you know, it's not a prescription that will get people burned out.

[00:50:26] Brad Buchanan: It's, you know, a way to address burnout. Of course. 

[00:50:30] Carolyn Roy-Bornstein: Thank you so much. 

[00:50:33] G van Londen: Thank you both, Carolyn and Brad. And remember the relevant links, will be in the show notes for topics, and references we spoke about. I thought this was very enlightening. It was very touching to me. Carolyn, I thank you for taking the time with your publication day to sit down with us and please keep writing.

[00:50:57] Carolyn Roy-Bornstein: Oh, thank you. It was my pleasure. Thank [00:51:00] you, Josie. Thank you, Brad. 

[00:51:02] Brad Buchanan: Yeah. Thank you so much Carolyn. It was wonderful to to chat with you.