Life Changing Moments: Accepting Neurodivergency with Dr. Diana Mercado-Marmarosh

Transcript

[0:00] One has to understand that the brain of somebody with ADHD is geared toward, what do you like?
And so for me, the patient interactions was my why, and I would get dopamine by interacting with that.
There are times in our lives that change the way we see the world.
Navigating these challenges can take insight, trusted confidants, or even a coach.
Let’s explore those moments.
In this companion podcast to Rx for Success, we will discover ways to learn and write our own success stories together.
I’m Dr. Dale Waxman, a physician coach with MD Coaches, and this is Life-Changing Moments.

[0:50] How often have we heard the expression, physician heal thyself?
Even though we know about and even preach self-care to our patients, we physicians have a tendency to place our health in the background until, all too often, a medical condition emerges that disrupts our professional and personal functioning.

[1:10] My guest today became intentional about first acknowledging a health issue and then placing it on the front burner.
As a result, she is now thriving professionally and personally and is successfully assisting other physicians with this condition to do the same. Dr. Diana Mercado Marmaroche is a family medical physician. She’s a clinic medical director and chief medical officer in Edna, Texas. She’s also the founder of Overachieve Life Coaching. The intriguing story of her path into medicine is chronicled in Rx for Success podcast number 127, which you can access on the MD coaches website or in your podcast app. Diana, welcome to Life-Changing Moments. I’m so glad to be here.

[1:53] Great. Thank you for being here. And I know that there’s a longer story here, but I really wanted to kind of hone in on the issue regarding your gradual discovery about ADHD. I wonder if you can summarize that for us. Sure. During my first year of medical school, I say everybody is everybody’s going through a life change because you’re trying to adapt to things. I come from immigration parents. I grew up in Mexico till I was 10. And English is my second language. And my roommate told me Deanna, I think there’s something going on, because I see you studying 80 or 100 hours, and it doesn’t seem like you’re retaining or your grades are not showing how much effort you’re putting in. And, and I was getting seats for the.

[2:42] First time or not passing some of my tests and I remember always being the last one to to finish all of my tests and any growing up.

[2:51] And I would just run out of time. And I would, you know, two thirds down, I would start putting C all the way down when the like, when time was up, and whatever I would get right. I mean, whatever I would finish, I would get right when I had time to do it. And so she said, I don’t know, you’re like anxious, because you, you feel like you really have to do good in this test, because you really want to succeed. Or maybe you’re depressed, because your dad just got diagnosed with cancer, or maybe there’s something else going on. So I got tested, and I got told I had ADHD, I had to do a neurological testing. And when I got that diagnosis, I thought like, I thought I was doomed. Because in my mind, what I had going for me was being the smart one and the perfect one in my family, meaning grades wise. And so if all of a sudden I got told that I had something that was not going to regulate how I could think, or not regulated at the right time that I wanted it to be around per se, I felt like embarrassed that maybe somebody would think that I didn’t belong in medical school. I didn’t belong taking care of patients because I wasn’t necessarily perfect. So there’s a little bit of hesitancy to acknowledge this at that time.

[4:17] Yeah. And I remember that when they gave me the diagnosis, they told me, no, you’re not depressed, you’re not anxious. And they told me you have your two years behind where your peers would be through their level of training. And you most people would have taken that personally or thought something about it. But I didn’t care about that part. I was like, whatever, I don’t care about that part. I care that you just told me I have ADHD. And I don’t want nobody to know that part. Like that’s how I felt. And I remember going to go get treatment, but they never informed me that there were like ADHD coaches out there that I could actually lean into and try to understand myself. They just gave me like, you know, five milligrams of Ritalin. And at that time, I was a first year medical student. So I didn’t really understand the pharmacological properties of a short-acting medication. And so I felt embarrassed that the medication would only last a few hours. And during those few hours, it was magical. I couldn’t think.

[5:22] Yeah. So I’m hearing this piece where you’re reluctant to sort of take on this, identity, if you will, with this diagnosis, but also noticing that there was some impact in taking the medication. And so, did things finally kind of get titrated well for you so that you were able to function? So, yes and no. Part of it was, again, because I was so embarrassed about it, I didn’t want to tell them that it was working, but not as well. I was afraid they would even take away that. So, eventually, I did say, this is not lasting long, you know, and then they said, okay, well, let’s put you on 18 milligrams of Concerta and now finally I had like a leg to stand on, so to say, I felt like I went from having like 25 tabs open to five. So now at least I could kind of see it, but it still was not enough because if you are in, if we remember back, you know, family medicine, family medicine was my first rotation. My first year took me two years to do because they allowed me to split because I was going back and forth to go see my dad.

[6:31] And so by the time I got to clinicals, it’s 33 years in right. And family medicine was my very first rotation. And I remember I blunked it. Now I realized, oh my God, how silly that is your family medicine, you’re supposed to know everything. And here I am the first thing, right.

[6:48] And so yeah, that was the only class that I remediated. And later on, I went through like so many other classes. And then I came back and I did it again. I think I only did like a week or two weeks of remediation. And then I did fine because I had all the other experience or rotations that I had actually gone through. And little did I know that that’s what I would go into. And now I understand why family medicine was ideal for my ADHD brain is because I was so intrigued by not knowing what was coming through the door, everything was so novel, I could be seeing a two year old, I could be seeing a four year old, I could be seeing a nine year old, and all the conversations were so different. And of course, once you know diabetes, you can understand that. And you can explain that. But again, you personalize it. And I think that’s where then I realized that ADHD would help me thrive.
Interesting. So, the ADHD works well in an environment where it’s not the same thing, walking through the door, as I hear you say. Yeah. So, kind of back to that, somewhere in there in medical school, it did get better for you with respect to the treatment.
Is that what I’m hearing?
Yes, it did get better for me in respect to the treatment, but I think one has to understand that the brain of somebody with ADHD is geared toward, what do you like? And so for me, the patient interactions was my why, and I would get dopamine by interacting with that.

[8:15] And it was a combination of being in the right environment, doing the right thing at the right time. And yes, the medication helped. But it was also because I was aligned with what I really felt was my sole purpose. And now I can look back and extract that. But in that moment in time, I didn’t have that insight. All I knew was that I wanted to help people that I wanted to, be able to use my Spanish to connect to that people. And so that was driving me. So I, I remember doing my med school interview, I said, you give me the opportunity, I will outwork anybody.
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[10:13] Music.

[10:20] Hi, I’m Rhonda Crowe, founder and CEO for MDCoaches. Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
I really hope you’re getting a lot of great information. But if you’re looking for an answer to a specific problem, management or administration challenge, or if you’re feeling just a bit burnt out, like maybe you chose the wrong career, well, then there’s a faster way to get the help you need.
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Get the support you need today.
Visit us at mymdcoaches.com to schedule your complimentary consultation.
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[11:22] We’ll get back to our interview in just a moment, but right now, I want to tell you a little bit about Physician Outlook.
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[12:25] And now let’s get back to today’s interview. It sounds like there was a lot of adaptation.
There was also, I’m also hearing you say it’s not medication only.
There’s a lot of, a lot of insight.
There’s a lot of behavioral things. a lot of knowing the self about what works best for me as an individual.
And so we’re also not going to generalize about all people with ADHD here.
Yes, of course. Yes. And it’s a spectrum. And that’s the beautiful thing about it that now, of course, when I dived into it, and I learned that, that it’s a spectrum, and people learn differently. And now I can see how I was able to adapt to medical school and residency. And you know, it’s in interaction, and it’s in communications that I learned.
And for people with ADHD, sometimes everything is important, and nothing is important, meaning There’s only two types of times, now and not now.

[13:27] You and I are talking and do the most important conversation. And so when I was in class, I could not concentrate on the teacher because I wanted to look at everybody else. So what I would do is I would listen to the recordings later. And when I was running around Rice, I would be listening and imagining the data in different parts of the trees and remembering things. So I learned differently. And then I set myself up for success by meeting with a tutor, because I knew they had done really well to be able to be a tutor, and they could help me zone in. And I wanted to study. I didn’t want to look like a dummy when I went to them. So it was that accountability and that talking back and forth that I was able to gauge what might be important, because you know how it was to be a medical student when you go do an HMP, and you can talk to them for two hours. So I wanted to learn everything. And that was problematic with somebody with ADHD because they were like, you’re a good perceiver as we just want the most. And I was like, but that was important. Because everything is important.

[14:34] And what I heard you say in the earlier podcast was a lot of this work is thinking through what really is the priority here. Because you’re saying everything’s a priority. It could be everything in your priority. I want to fast forward just a little bit, Deanna. So, you had this adaptation to it, you know, through your own adaptation, what you learned about yourself with the help of medication and some other in tutoring and professionals. And then fast forward, there’s a point at which you rethought whether you needed to be on medication or not. And it And it was actually because you consulted somebody different.

[15:13] And so that was a point, if I remember correctly, that you then went off of medication. Yes.
So after I finished residency, I got told, you’re in attending, go to the somebody else.
You can’t keep coming to the student health clinic.
And when I did, I, when I saw somebody else, I was like, well, I’m in Houston.
My mind any Baylor psychiatrist should be able to treat me because I thought adult ADHD is a common condition. And so I picked around that person out of a hat and I went and I took my neuroscience exam and I took my 18 milligram of Concerta and the physician and I can’t even remember his name at this point didn’t even give me more than two minutes of his time and said, you’re a physician, and you should know better, you outgrow ADHD.
He’s like, you don’t need medications. And he walked out. And I like, I was so ashamed.
And I told myself, I’m family medicine. He is a psychiatrist. He is a specialist.

[16:17] Yeah, so there was something about the message there that I’m also hearing there’s this kind of shame quality to it.
And I think that’s what kept me from asking for help for 10 years until the pandemic hit because I was so ashamed that I was going to ask for help again and somebody was going to say no.

[16:40] Yeah, I was just curious about whether this is sort of a return back to when you were first your medical student, that same sort of approach avoidance, if you will.
Okay, I’ve got this. No, I don’t. I don’t want to acknowledge it.
I wonder if there was a recurrence of that for you.

[17:01] Yeah. And when the pandemic hits, I just thought that everything that I was going through was normal because at that time I was a mom and I was a clinical medical director and the chief medical, director and I was doing all the things and I felt like, well, this is just life. This is meant to be hectic. This is the type of profession I chose. But then listening to podcasts, I was always trying to learn how to become a better adult in my mind. And I listened to somebody talk about life coaching. And it was a physician and she had a program. It was called empowering women physicians. Her name is Dr. Sonny Smith. And I joined it, not knowing anything about coaching.
And all of a sudden, they were like, well, you know, however you’re thinking about things, that’s gonna lead to some emotions. And that’s gonna lead to some actions. And that’s gonna give you a result. And I was like, what, what? You mean, like, everything I think is not a fact, just because I’m thinking it and they’re like, no. And I was like, well, what do you mean? Like my brain keeps telling me I’m slow. My brain keeps telling me I’m not good enough. My brain he keeps telling me all this thing.

[18:15] I see all these rewards. I see I was a chief medical officer. I see I’m getting paid. I see that people are writing wonderful reviews, but I don’t feel that. How come there’s a disconnect?
Yeah. And just to be clear, at this point, from that moment with the psychiatrist after residency, up until this moment when you were, I’ll just say it, you’re overachieving, but not feeling it, it, but not really feeling it, that was a kind of a period where you did not really attend to the ADHD.
No, I just kind of ignored it. I just told myself, he told me I should get over this. I have outgrown it.
So he told me, don’t acknowledge it.
Don’t even think that you have it. Like you got this far, so you’re just going to do whatever it takes.
And if it means working 20, 30 hours outside of work to mask how hard you’re working to close your 200, 300 charts, maybe that’s the small price to pay for being able to do what you love, which is to take care of your patients.
And the reason I never got fired, and the reason I was top 10 docs in Houston was because I love my patients.

[19:38] I would have to focus on them. And I was like, how come nobody recorded that?
Like, that was amazing. Why do I still have to go do something boring and type up a note?
And my brain would just keep telling me that I wasn’t a good writer.
And it was not until like a peer physician coach said.
Okay, so you’re not a good writer. That means you have failed an English class.
Like, and I was like, well, no, I never failed an English class. Well, then you felt like a Spanish writing class. I’m like, well, no, I’ve never done that either. Then where is that ever since that your brain is telling you’re not a good writer? I was like, oh, that’s what you mean.

[20:13] Brain can sometimes lie to you. Okay, I got it. And then that’s when I realized, okay, so ADHD, that’s just a neutral fact.
It’s whatever I want to make of it that’s gonna make the difference.
I can think this is the worst thing ever, or I can think this is a gift.
How can I step into it and own it and not be like ignorant about it anymore?
How can I then step into it through curiosity?
Because maybe it was my ADHD that allowed me to be so outspoken.
And I impulsively already said what everybody else was thinking and they call me a leader for that, right?
And maybe it was my ADHD that allowed me to speak up and say, no, I think that’s wrong.
I don’t think you need to be, you know, sending us 10,000 messages when you can address it from the get-go if we create a system.
And so I started to see that maybe my ADHD What is?

[21:15] Was a gift. It was the reason why I didn’t give up after trying 10 times to get the results I wanted if the why was aligned with what I wanted. And I wasn’t so judgmental with everybody around me because I knew I had struggled through things. I knew internally that we probably all were trying our best. It just kind of looked hard. And I knew I didn’t purposely want to be late to meetings.

[21:42] And it’s just, I wanted to do one more thing, one more thing.
And so I started to realize, okay, instead of like judging myself for it, or ignoring myself for it, or telling me it didn’t exist, I realized there had to be more to it.
And that’s when I went down that rabbit hole, and I started to learn that, you know.

[22:05] Those irregularities in the left temporal region and the limbic system system can really impair comprehensive thoughts and processing and it can really impair language and it can, and because I could get overwhelmed, you know, if my nurses came and asked me five questions or they pulled me out of the room through that task switching for something that was not important, I could then become frustrated because I thought I was almost done with that patient, but you pulled me to sign something that was not irrelevant in this moment, like this order could have been done after I walked out of the room. Why was I pulled out for that? Why was I pulled out to ask if I’m wanting to see a patient that’s 40 minutes late? Like, I started to see that I had to set some boundaries for me and for them. And I had, and I started to see that my time blindness didn’t have to be a time blindness, that I could use a timer to tell myself, hey, 10 minutes are up. Like, do you need something? Have the person knock on my door and ask me if I needed something. But that awareness didn’t happen until I started to.

[23:21] Ask myself if there was a better way. Until I started to say, okay, if investing with a peer physician coach gave me some insight that maybe I am doing better, but I had two or three physician coaches tell me, Hey, you’re all over the place, girlfriend, why don’t you go try medicine again?
Like, I see that you’re running, I see you’re meditating, I see you’re doing different things, but why don’t you just try again? And I realized, okay, I asked myself, well, I do trust two or, three psychiatrists that I send things to all the time, let me talk to one of them and see what they say. And it was the most beautiful encounter.

[24:07] You know, I just want to kind of reflect, what a journey for you.
What I really wanted to highlight for our listeners was this real significant shift.
It’s 180 from shame about a diagnosis all the way to embracing it and saying, how has this been a gift to me?
What are the strengths that this has created? It certainly created a lot of achievement and top doctor in your area and all the accomplishments.
There was a cost as you started to reflect and there’s a huge cost.
I think one of the things you said in the earlier podcast was that you were chronically behind in charts as an example.
And so I don’t want to go back there. I just want to kind of move us forward regarding this, um, this sense of, of embrace and what do I do with this?
And I do want to acknowledge this and how can I now move my life forward?
I’m curious, you know, you mentioned some coaches and you mentioned the coaching program that you were in were helpful in forwarding your, uh, acceptance.
Who else was helpful for you?
Yeah.

[25:22] When I started to realize that I should try to do that, I started just looking for CME ADHD stuff.
I started to look for that and I started to then realize, okay, what about an ADHD coach?
I went and I actually signed up for six months of private one-on-one coaching, and then I also signed up for a group coaching for ADHD.
So I went from being somebody who felt like I had no time to all of a sudden doing all these things and finding the time.
And then that’s when I realized that I had to be intentional with understanding me because if I didn’t understand me.

[26:08] Then sure, I was gonna be somebody’s agenda, but I was not in my own calendar.
And so I realized that planning was important, that taking inventory really was important.
And I kept looking around and I couldn’t see physicians saying, I have ADHD and this is what helped me.
I almost kind of became a mosaic. I integrated what I started seeing helping me.
And then what I started seeing from my ADHD coaching and from what my physician coaching was saying.
And even though they were giving me advice, the ADHD person that didn’t have, was not a physician, she didn’t understand that there was different levels of executive function that was, even though she was saying just batch things, she didn’t understand that batching prescriptions was different.

[27:05] Like I couldn’t just go into and do the batching of the in basket. She didn’t understand that I could easily go down a rabbit hole just with one lab, because then I’m looking at prescription, looking at the last lab, looking at that. So then I realized, oh, she means executive function by task. How much energy is this taking me? Okay, so then I have to do instead of looking at each lab, because my EMR was not the best. I said, print out all the stuff. I’m going to look through them looking for what are the A1C above 9. Instead of going into each patient’s chart, I had to set up a system to be like, okay, I looked at 20 laps in 10 minutes. These five need a follow-up in one to three weeks because their A1C is da-da-da-da-da, or because this one, I had to figure out that if I didn’t do it a certain way, I was going to get myself. So then I started seeing, okay let me think what am I doing before I walk into the room? What am I doing while I’m in the room? What am I doing when I walked out of the room? Where can I shave a minute? Where can I stop a distraction from happening before it happened? Can I have a binder with all the common handouts that I give so that I don’t have to keep leaving the room looking for that handout?
Like I started thinking of ways and then I said I wonder if there’s more like us.

[28:25] They just not talking about it because I wasn’t talking about it because I was so ashamed.
I wonder if there’s more like us.
And so then I started to think, what if I can create a program that could offer CME credit that way they can get the employers to help them help themselves.
And then I’m not gonna in my program, I’m gonna Yes, I’m gonna say I have ADHD, and they’re welcome to work with me.
But if those physicians don’t want to disclose, they don’t have to.

[28:53] And then they can still come and get tools and hacks and techniques that are evidence base so that they can help themselves instead of just paying the price or deciding to leave medicine because they haven’t created a system that supports them. Yeah, it’s a beautiful gift to the world. And so I’m really glad that you recounted that story so listeners can hear. Not only did you accept, embrace this diagnosis, but all the the things that you learned about it and then learned, Oh my gosh, I wasn’t alone.
Some other people were suffering when I was going through all this as well, and they’re still out there.

[29:36] And how can I be helpful? So now you’re bringing, not only you’re learning about you, but you’re learning about ADHD and with their intimate knowledge of what it’s like to be a physician, really helpful to those who are also struggling.
Really, really applaud you for all of that. Dr. Deanna Mercado-Marmarush, I really appreciate you taking the time to revisit our MD Coaches family and be on the podcast today. I just want to say that I get to see you on video, the listeners don’t, and you’re radiant. And part of that radiance is coaching is about illuminating. And so you are illuminating through your work, through this podcast, through your, you’re going to be giving this talk at Texas Academy of Family Physician through your own coaching of other healthcare professionals with this issue.

[30:31] You’re illuminating an issue that for many people is dark. And so my gratitude to you, and I’m sure there’s many that are grateful to you for, for bringing that forward. So thank you again for being with us today. And thank you for having this safe place to share and to help each other and empower each other because like you said it’s the ripple effect.
I don’t mean to become a better wife or a better mom, but I’ll take all the ripple effects from it, right?
Right. Here are my takeaways from this conversation.
Number one, those of us in health care tend to be others-focused first to the exclusion of our own well-being.
Number two, you are your most valuable asset. It is a worthwhile investment to attend to your health because, as our guest said, you are the most important patient in the room.
When one takes care of themselves first, they ultimately become even more patient-focused.

[31:37] Number three, attending to our health and well-being by uncovering diagnoses that we harbor can be a very vulnerable experience, one that can even unleash a feeling of shame.
When feeling powerful emotions like that, it is helpful to remember that we are not our diagnosis.
We are human just like everyone else. Number four, being open to others’ concerns about you may end up being a pathway to a proper diagnosis or a deeper insight.
In either case, it can ultimately lead to being a better you.
Finally, another way to put this last point is, be open to having your blind spots illuminated.
One of the best ways to do that is through the confidential conversations that occur with a trusted coach.
For more information about our coaching services, please visit MyMDCoaches.com.
Thank you for listening and be well.

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