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In this episode, we welcome Maria Xiang, a pediatric neurologist, join us to share her personal journey and insights on how to remain emotionally present in the midst of life’s challenges.
Maria opens up about how she believed that virtue and self-sacrifice were her protection, leading her to overwork and overprepare without considering her own worthiness and fulfillment. She shares how this mindset affected her during her medical training, especially when dealing with her mother’s end-stage cancer.
She also shares practical tips and strategies she’s learned over the years to help her remain emotionally present and connected with her wiser self, including understanding that human needs go beyond just food, shelter, and minimal sleep.
Join us in this enlightening conversation as Maria shares her experiences and insights on how to remain emotionally present and honor your human needs, even in the face of life’s most difficult challenges.
Xinran Maria Xiang is a pediatric neurologist.
She shares her story and discusses her KevinMD article, “Finding emotional presence in a dehumanizing system: a physician’s journey.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today on the show, we have Maria Xiang. She’s a pediatric neurologist. Her KevinMD article is titled “Finding emotional presence in a dehumanizing system: a physician’s journey.” Maria, welcome to the show.
Xinran Maria Xiang: Thank you for having me, Kevin.
Kevin Pho: We’ll get into the article a little bit, but first off, just briefly share your story and journey to where you are today.
Xinran Maria Xiang: Yes. So I am a pediatric neurologist and a first-generation immigrant. I think the core of my story is that somehow, along the way, I got disconnected from what it meant to be a human being. I grew up in a system, in a family, where it was felt that in order to be safe, to be accepted, to be loved, you have to work and work. You have to point to accomplishments. You have to constantly be sacrificing yourself to help anybody who is not yourself. When I was younger, I got a lot of rewards from doing this. I got praised, and it just felt like that was the only way that you could get love as a child.
After we immigrated from China to the United States when I was little, it was even more built into my family that now you’re in a country that is not your own, per se, and you need to rely on yourself. Nobody is going to help you. No one is going to hold your hand. The only way that you will be able to survive in this new place is if you work, work, work.
So I think that really drew me to medicine in a way, because medicine really rewards this kind of mentality. The more sacrifices you make, the more rewards you get in the field of medicine. So when I entered medicine, I felt like that was the path: If I just follow the path and follow the rules, I will be able to get what I want. And I didn’t really know what I wanted. I knew that I wanted to succeed, because that was what was billed as the way to be accepted, and I think that really carried me through medical school and into residency.
Then, in my first year of residency, my intern year, my mother was diagnosed with stage 4 lung cancer, really surprisingly and out of the blue. That was another pivotal moment in my life. When she was initially diagnosed, she first presented to us in the ER. Of course, there’s a lot of confusion and a lot of emotions, and the ER physician pulled me out of the room and said, “Look, you are the physician for your family now, and your family needs you, but this is not the moment to focus on yourself.” I really think that he had the best of intentions, because here I was, the one with medical knowledge, and my parents had sacrificed so much for me growing up, and now it was my turn to reciprocate. The way I understood it was, “You are not allowed, you don’t have the luxury, to connect with your emotions. You need to be there for your family.”
So even though I did take a little bit of time to grieve throughout this process, I was really very focused on what the next thing was, what my family needed, and then my job. I still had four more years of residency to do. And somehow people always felt like I was so strong, because here I was, doing my job no matter what was going on in the rest of my life. Even I felt like, “OK, this is how life is.”
By the time I finished medical training, and I actually did a fellowship, so after a total of six years, my mom had passed away. In my mind, I had dealt with this whole process: my mom’s illness, my mom’s death, and the stresses of medical training. I felt like I had come out the other end. Then my daughter was born, and immediately I realized that things were not what I thought they would be. I felt very, very overwhelmed. Of course, everybody says new parents are overwhelmed all the time anyway, but with just little things, I felt like I couldn’t be present for the joyful moments or the tough moments. I always had to find some way to escape emotionally. For me, a lot of it was being on my phone, scrolling, or just thinking about something else that’s not the present.
The way that she operates, I guess, she’s very intuitive as a baby and as a toddler, and it was apparent to me that she deserved unconditional love and acceptance no matter what she did or didn’t do. Her whole job for the first few months of life, well, the first years really, was to get her human needs met, without doing anything in addition. There’s no doubt in my mind that she deserved love just by getting her human needs met and just by existing. So then I really had to think: If she deserved that, and I was once a child like her, then that must mean I also deserve love and acceptance no matter what I was doing or not doing, thinking or not thinking. That pretty much blew my mind. That was never how I thought about myself.
So that began my introspective journey. I ended up happening upon a podcast about grief. At the time, I thought that I had grieved everything, but I had such an emotional reaction to that podcast that I felt like maybe there was a lot of grief that I had never experienced and processed and allowed myself to move through, because I was just so busy all the time with work.
Kevin Pho: Sure. And you talk more about your journey in your KevinMD article, of course, “Finding emotional presence in a dehumanizing system: a physician’s journey.” Now, you talk about those two pivotal events in your life, your mother with lung cancer and when your daughter was born, and they both required you to sacrifice a lot of what you had to do professionally. Of course, you had to draw your attention completely toward your family events. Tell us how the medical system prevents you from doing that. Talk about that tension between your professional commitments and what you had to do for your family.
Xinran Maria Xiang: Yes. So I think that medicine preselects for people who have very high expectations of themselves and for people who want to use objective data to measure their life. We want to point to things that are obvious, when we say, “Oh, we did this. Look at this,” to say, “This is how I’m doing in life, and I’m doing well.” And I think that when something unexpected happens that prevents you from following that path, it’s seen as somehow a burden, even though that’s not how I would have felt about it if I wasn’t already so embroiled in this way of thinking, in this system.
So at the time, when my mom was first diagnosed, I really just wanted to be able to go on with my life and go on with my work as much as possible, while doing what they needed, but not really letting it affect my work. So even though I felt this huge, overwhelming sense of obligation and guilt toward my mother, who was suffering through this, I also felt like, “Well, this is not what I’m supposed to be doing.”
Kevin Pho: And did you receive that pressure from your workplace? Did you feel some unsaid pressure from your work that you had to continue to put your head down and keep doing what you’re doing at work?
Xinran Maria Xiang: So my residency at the time, when my mother was first diagnosed, was actually very, very humane about this. They actually offered me time off, but I didn’t think that I deserved to take it, because I felt like I was supposed to be able to juggle everything. I know everyone says that, and then they’re like, “Well, that’s not true.” But it’s one thing to intellectually understand that you’re not meant to do all this at the same time, and it’s another to feel deeply in your bones that it’s safe to not do everything. I think that’s what I really struggled with: how it could feel so distressing to deal with some of life’s challenges by putting some of my work on hold, because I constantly felt like I was falling behind and not doing what I was supposed to be doing.
And I think that’s really part of my upbringing, and probably what a lot of physicians experience growing up: that they just need to follow this set path, and that’s the only way to safety. So I felt like it was, I guess, part of the system, or just that the system preselects for these people who don’t know how to feel safe otherwise.
Kevin Pho: Sure. You mentioned that you listened to this podcast and became introspective in terms of how you were able to process your grief. Tell us what kind of changes you made professionally after listening to that podcast.
Xinran Maria Xiang: Well, that was right before we actually decided to move as a family, and so I had an unexpected four months off. I was trying to get my next job lined up so that I wouldn’t have that much time off, and then, because of some paperwork issues, that didn’t happen. Initially, I was very panicked at this prospect. Of course, I felt like here I was, I had just finished maternity leave, and now I was taking another big chunk of time off, and now I had to reorient myself again. So again, that was initially a very threatening thought, but there was nothing I could do about it. I couldn’t make a job happen no matter how hard I tried. So at some point, I just decided to let things be how they were going to be, to surrender.
After I did, after I shifted my mindset, that really, I think, was lifesaving, in the sense that now I had four months where I didn’t have job obligations, and I didn’t have full-time child care obligations. So that was the time that I was allowing myself to fully connect with my body and connect with my emotions in a way that I had no idea how to do before. When people were talking about, “Oh, just breathe,” I didn’t know what that meant. I was like, “Of course everybody is breathing all the time. That’s not going to help me.”
But during this time, I really started to explore these mindfulness and somatic healing practices that are more body up, as opposed to mind down. When we talk about talk therapy, you really start with your mind and your thoughts, and then you let that affect your body. But the other approach is to start with your body, have your body experience a sense of safety, and move emotional energy through your body and process it that way, and in turn that affects your mind, your thoughts, and your emotions.
So I began to really explore these practices, and after four months, it felt much less threatening to start building my next practice, a little bit more authentic to my deeper, wiser self and less about what I’m supposed to do that’s supposed to give me this safety, acceptance, and success. So I would say that this is still something I’m exploring now. I just started my new job a few months ago, so something I’m also very curious about is not just how I become successful, but how I make this more myself.
Kevin Pho: How difficult was it for you to change that mindset?
Xinran Maria Xiang: Difficult. And I think that something else I’m exploring is what my ego says versus what my inner, more authentic self says. My ego would say, “Oh yeah, that was this big thing that I did. Look, I figured out how to heal myself.” But really, what it was, was every day a little bit in that direction. Initially, I didn’t even know that was what I was doing. I just followed my intuition about what I wanted to do with my time and what gave me a sense of safety and fulfillment, and I started there. So I think that a lot of times, I didn’t really even consciously know that that was what was happening, and that doesn’t mean that things aren’t changing. I think that’s really important: Your ego is going to perceive any little steps as pointless, futile, or not enough, and that actually doesn’t mean that nothing is happening, that nothing is changing.
Kevin Pho: Tell us what kind of resources you turned to in order to help you shift these mindsets and shift your perspective. Is this something that you read books about? Did you learn on the internet? Did you get coaching? How did you find these processes?
Xinran Maria Xiang: Great question. So of the resources I’ve come to turn to, I mentioned a couple of them in the article. Breathwork has really helped me connect with my body and therefore my intuition, my deeper self. That was something that I had heard about just randomly, through popular culture, but I never really explored it, because it just felt like that wasn’t something that was going to help me. That was my instinctual ego talking, and I really had to truly give myself the chance to learn about it.
So I didn’t do any formal coaching. I listened to a podcast that I felt like I resonated with. One of the other podcasts I would listen to is Glennon Doyle’s “We Can Do Hard Things.” She talks with a lot of authors and thinkers, and they talk about their healing journey. So a lot of the things that I heard about, I heard from her podcast, and then I looked up some books that were talking about mind-body connection, which was a big one. I think I talked about some of the books in my article. So those books I really just found either by researching myself or by hearing from various authors in their podcasts.
Eventually, I did get a therapist, and that was a few months into my time off, because there’s a huge wait list, and it’s really hard to just get in with somebody. That was definitely more of the traditional talk therapy, and I felt like if I had just done talk therapy, I don’t think I would have had as much progress in that period of time.
So other than breathwork, I do EFT tapping, which is where you go through a series of acupressure points on your face and on your body. Some of it is here, at the side of the eyes and under the eyes. That was not something that I had learned about in medical school or beyond. I did hear about it from my therapist, and then I got an app, and they just lead you through it with a series of affirmations. You’re also acknowledging where you are in the moment, followed by a series of affirmations as you are tapping through the points. So it’s meant to be more of an integration of safety and calmness in your body with these thoughts that you have, whatever they are, no matter what they are.
What else? Oh, and then I started trying cold plunging, which is also very popular in pop culture, and something I played around with a few years ago. Then I stopped during pregnancy and postpartum, and then I really got back into it as part of my daily life. I think that’s really important, because once you’re working, you don’t have these big chunks of time in your day where you’re just doing these mindfulness practices. So I started incorporating it into my daily shower. I’m showering every morning anyway, so now I just end it with a two-minute cold shower.
The trick is not to just suffer through the cold shower. The trick is to really consciously relax, or consciously tell yourself, “This is uncomfortable, but at the same time, I can relax into it. I don’t need to recruit all my stress responses to deal with this uncomfortable sensation.” And I think that helps translate to the rest of my life and the rest of my day. If there’s some emotional discomfort, I’m more observant and say, “This is uncomfortable, but I also am able to breathe through this. I have other resources that I can turn to to help me stay present in it.” And that’s how you move through discomfort without it being an extremely traumatizing experience.
Kevin Pho: Now, if you were to replay your professional career from the beginning again, tell us one or two specific things that you would do differently.
Xinran Maria Xiang: Really good question. I think that a foundational thing is to just trust myself a little bit more and not listen to what everybody is telling you. And I think that now, if something doesn’t fit with what brings me meaning and fulfillment, I can trust that, and that’s more of a redirection, that I can try something else. Just because I had been a child growing up and had to follow what I was told to an extent doesn’t mean that as an adult, and certainly by the time I got into medical school I was fully an adult, I can’t trust my adult self.
And I think that taking the time each day, and just the opportunity, through either one of these mindfulness practices or something else that lets you connect with your deeper self, would have been much more beneficial from the get-go, so that I didn’t necessarily get to the point where I was experiencing all this emotional burnout. I think that can be really challenging as a young adult, to trust yourself in your body.
Kevin Pho: And Maria, my final question: Tell us some take-home messages that you want the KevinMD audience to come away with.
Xinran Maria Xiang: Yes. So the takeaway is that increasing our capacity for growth and leading a more fulfilling life doesn’t just come from willpower alone and from exhausting ourselves every day. It comes from the opposite: a softening, and connecting with our true selves and our bodies by honoring our human needs, resting, and processing our daily stress, both from the body and from our minds.
Kevin Pho: Maria, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.
Xinran Maria Xiang: Thank you. Thank you so much for having me, Kevin.
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