How this physician discovered the power of mindfulness [PODCAST]

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“Could COVID-19 be an opportunity that brings the plight of health care professionals finally to the forefront? Protect us so we can protect you.  Do your part and stay home.  Flatten the curve to give health care professionals a chance.  Donate PPE. Donate food.  And yet through this war, we, health care professionals, along with the entirety of humanity, are united against a common, invisible enemy.  We are all human; we all seek to be healthy and happy, all deserving of love and connection. Are we able to remind ourselves that health care professionals have never been so united before? That humanity has never been so united? Can all the health care professionals, no, all of humanity bear the weight of the world together? We can; we must.  For our sake.  For humanity’s sake.”

Ni-Cheng Liang is a pulmonary physician and founder, the Mindful Healthcare Collective.

She shares her story and discusses her KevinMD article, “Undergoing an appendectomy in a pandemic.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Dr. Ni-Cheng Liang. She is a pulmonologist in San Diego. She wrote the KevinMD article “Undergoing an appendectomy in a pandemic,” and she’s also the founder of the Mindful Healthcare Collective. Ni-Cheng, welcome to the show.

Ni-Cheng Liang: Thank you so much, Kevin, for having me.

Kevin Pho: So before we get to all that, can you please share your story and your journey to where you are today?

Ni-Cheng Liang: Yeah, absolutely. I’m a pulmonologist in San Diego here, with two daughters, and I’m also a breast cancer survivor. Back in 2011, I was a second-year pulmonary fellow, and I actually was diagnosed with breast cancer. I had been going 200 miles an hour, working over the duty-hour restrictions and burning myself out, and my body was telling me that I couldn’t go at that speed any longer. I was physically forced to stop, to pause for a year, to take a year off for chemotherapy and surgeries.

Coming back into medicine, being a patient of integrative medicine, especially mindfulness-based practices, really enabled me to maximize my quality of life. And it was that mindset of self-care being a priority that I am back in medicine now, nine years plus as a cancer survivor, also teaching mindfulness and practicing as an adult pulmonologist, with my two daughters that I really enjoy spending time with.

Kevin Pho: And how has the pandemic affected you and your practice?

Ni-Cheng Liang: The pandemic has definitely revealed kind of the underbelly of the health disparities and the racism that’s intrinsic within chronic diseases and acute diseases. I consider myself lucky in that I’m in North County San Diego. But in the health care system, we get an update every single day of the number of cases at each different hospital within the health care system, and the further south you go, the more cases there are. And so in my practice, we have the least amount of active COVID cases in the hospital, but then as you go further south, we’re easily in the high 30s for COVID cases, the closer you get to the Mexican border.

In my practice, we do see coronavirus cases, but mostly on telemedicine for me, and I am seeing a lot of survivors from even the ICU, even the 80- and 90-year-olds. So it’s been hopeful, but I am very wary of the current uptick in cases right now.

Kevin Pho: I want to move on to your KevinMD article that you wrote earlier this year, and it was titled “Undergoing an appendectomy in a pandemic.” And I want to read a short excerpt from the article. You write, “Already in a fragile state from burnout, the pandemic weighs heavily on our souls as health care professionals. Pre-traumatic experiences, post-traumatic experiences, the moral injury, the death and human suffering that has and will come from all of this. Could COVID-19 be an opportunity that brings the plight of health care professionals finally to the forefront?” Please share with my audience the story of that article and why you decided to write it.

Ni-Cheng Liang: Whenever I write, there’s usually a compelling urge to write creatively, and usually I write nonfiction. And so after the appendectomy, probably actually the day after the appendectomy, I really, really felt compelled to share my experience, because it was so different than what I had ever gone through before, having gone through three different surgeries from my cancer experience.

And so I wanted to take my experience as a physician, but also as a patient, and not necessarily a cancer patient, but a cancer patient that has been undergoing an appendectomy during a pandemic, into the spotlight to bring a unique perspective. But then also reminiscing about the status of physician wellness and the situation that many physicians were in even before the pandemic, and then bringing that into the current status of wellness with the pandemic, I thought was an appropriate tie-in.

So yeah, I just felt compelled to share my story with your readers and your audience, because I thought it was a unique perspective, and it was an opportunity to highlight that health care conditions not COVID-related still happen, and burnout is still happening, probably more so now than before the pandemic.

Kevin Pho: Now, what are some of the lessons that you learned from that story that you could share with my audience?

Ni-Cheng Liang: From the appendectomy experience, I think that in the time of coronavirus, there’s the adage of “There is no emergency during a pandemic.” And it’s an opportunity for all of us to slow down. When we put on our PPE, when we telemedicine our patients, when we see perhaps fewer patients in person, all of this is an opportunity to slow down, and perhaps it is a unique opportunity to incorporate mindfulness, which is paying attention on purpose to the present moment, more intentionally into our practice of medicine.

Kevin Pho: Now, you’re also the founder of the Mindful Healthcare Collective, which is a resource for health care professionals, with free mindfulness sessions. A lot of us in health care are going through a tremendous amount of stress during a pandemic. Now, what are some tips that you can share with these clinicians to help them with their stress?

Ni-Cheng Liang: Anytime that we’re doing anything, we can bring a mindful intention to it, from the donning of PPE. In fact, it is to our benefit if we are extra mindful for ourselves donning PPE, and also being kind of the buddy or the witness to a colleague donning PPE. So I think that taking every opportunity, particularly the ones where you’re self-caring in order to care for others, is uniquely a great chance to practice mindfulness.

Also, the human connection is really special right now during the coronavirus pandemic, because loved ones are not allowed in the hospitals right now. So you become the familiar eyes, the familiar voice to these patients. So I would recommend approaching mindfulness as moments of mindfulness during clinical practice. You might be able to gain a new perspective that reminds you of, and perhaps brings new meaning to, why you’re practicing medicine.

Kevin Pho: Now, we are six months plus into the pandemic. Is there something that you know now, when it comes to physician self-care, that you wish you knew back before the pandemic started?

Ni-Cheng Liang: I think that now, being in the pandemic and going back and forth between lockdowns of different prohibitive activities, I would have taken more opportunity to travel and to engage in different unique activities, likely outdoors, had I known about the pandemic. But that being said, I also think that the pandemic affords new opportunities to discover and explore our hometowns and the nature around and in our hometowns in unique ways, from hiking to, I’m an avid paddleboarder, discovering new waterways on my paddleboard, and now to kayaking, because I’m also part of a dragon boat cancer survivor team, and we can’t get in a dragon boat right now. Now we kayak for practice.

So I think that, yes, I really wish I would have taken more opportunity to travel before the pandemic, but now I see this current situation as an opportunity to explore and discover and notice.

Kevin Pho: Now, let’s take a step back. I was wondering if you could share something that you’ve been curious about or something that you’ve been passionate about over the past few months.

Ni-Cheng Liang: I’ve been a really avid reader for quite some time, but with George Floyd’s death, I think it really struck a chord with me as a pulmonologist because of the way that he died. So there’s this concept of breath, and breath being a constant recommended anchor in mindfulness, and how that can actually be taken away forcefully, whether it be because of COVID or because of a racist attack.

So I’ve been really interested in the intersection of breath, coronavirus, and racism, and reading more about how racism has been interwoven into our society, and learning to be an intentional anti-racist through the lens of mindfulness. So that’s kind of what I’m working on, and maybe I will be submitting an article about the intersections of that to you soon.

Kevin Pho: Fantastic. I would welcome that. We are talking to Dr. Ni-Cheng Liang. She’s a pulmonologist in San Diego. She wrote the KevinMD article “Undergoing an appendectomy in a pandemic.” Ni-Cheng, what’s your take-home message for the KevinMD audience?

Ni-Cheng Liang: My take-home message is, throughout all of this, the pandemic, your life, remembering that you get to choose. You get to choose your responses to all life stressors, all different circumstances. And you can cultivate the ability to simply notice, breathe, attend to yourself, not forgetting your needs, and that might be enough time for you to choose an intentional response that might be a healthier choice, as opposed to a stress-reactive response.

So I’m going to leave your listeners and viewers with the BAT mnemonic. So, breathe, for taking a mindful breath. A is to attend, to attend like we attend to our patients, but really attending to ourselves and asking ourselves what we need in that stressful moment or difficult moment. And then T is for transition to greater skillful action.

Kevin Pho: Well, thank you so much for sharing your insight and your time. How can people reach you?

Ni-Cheng Liang: You can find me on my personal website at [website removed by the editor], but MindfulHealthcareCollective.com is also another way, where there are resources for health care professionals. And then for the general public, MindfulHealingCollective.com is also available, with free resources there as well.

Kevin Pho: Fantastic. Thank you so much for being on the show.

Ni-Cheng Liang: Thanks for having me, Kevin.

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