Life Changing Moments: Setting Boundaries, with Dr. Miriam Zylberglait Lisigurski

Transcript

[0:00] Really, I feel like that’s part of our training. They told us that we need to fix, fix, fix, fix, solve, solve, solve.
But who fix us?
When do we focus on ourselves and how we can fix others if we are broken?

[0:19] 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.
I’d like to reintroduce Dr. Miriam Zilberglade.

[0:55] She is triple boarded in internal medicine, geriatrics, and obesity medicine, has completed a fellowship in leadership development, is a certified mental health ally and physician advocate, and recently a published author.
The story of her path into medicine, including retraining upon coming to the U.S. from Peru, is chronicled well in Rx for Success podcast number 130, which you can access, as always, on the MD Coaches website, or looking up Rx for Success in your podcast app.
Miriam, welcome to Life-Changing Moments.
Thank you so much for having me.
Well, really appreciate your willingness to come back and help us dig a little bit deeper to understand some really fascinating pieces of your journey.
The part in Rx for Success podcast that jumped out at me was your dedication to the well-being of other healthcare professionals.
And I just wonder if we can just begin there with, tell us how that emerged for you. How did that happen?

[2:06] Well, I am an educator. Part of my career, or almost all my career, I shared the time between being a physician and being an educator.
I always was in charge of medical students or residents.
And in some way that makes you be the mom of the group. That’s at least the way that I used to feel.
But initially I thought that this was just related to how much they will learn in medicine.
And I didn’t notice that I was also supporting their lives in general.
You cannot be a good physician if you are not a good human being.
I used to repeat that.
I then understood at that point what I was really doing until COVID.

[2:51] I feel like COVID created a big gap in the system and created also this compassion fatigue where we were seeing the real faces not only of the system but also of the leaders and our colleagues, our friends. And we started to see also this not only lack of compassion but people.

[3:20] Without their masks and being less polite and being more themselves. And sometimes being themselves was sadly not the best faith that we will see from them. And I started to notice abuse, and discrimination, neglection, and as a result, fear of retaliation and anxiety and depression and burnout. I didn’t notice that before or not in the magnitude that I saw. And truly, I felt that I was not prepared because being a physician or having a leadership position doesn’t make you a mental health ally or doesn’t make you a coach or doesn’t make you an advocate.
And I believe that physicians sometimes we forget about that, that we have a lot of amazing skills, but we don’t have all the skills.
So at the moment that I start training, I start discovering also that my knowledge was just very superficial, that I needed to understand better the mental health situation of my coworkers and that I needed to.

[4:36] And start implementing changes, positive changes, to be able to really help them.
So, if I’m hearing you right, there was a part of you that says, I hadn’t really noticed before, even though, you know, I’m an educator and I’m, you know, I’m taking care of people’s educational needs. And I’m also, you know, it’s not just educational needs, but whole life needs.

[4:56] And facilitate an environment for that. Do you have some sense of what opened you up to to an awareness that mental health is an issue.
What happened for you that allowed that to happen?
I believe a couple of things. Number one, I saw many of my residents struggling during COVID because of the change of schedules, the lack of support, the lack of their families, the fear and et cetera.
So I noticed clearly that they were struggling. here and there, I will know that someone has a problem, it was kind of individual cases, and I will be available to support that. But in this case was kind of collective, it was very obvious that the system was not working for them. And what’s scary, right? Because in the one to one situation, you can maybe be helpful and find ways to.

[5:56] Support. But when you’re talking about big groups, all of them are struggling and having a system that is not ready to to provide support or to fix the situation. So that’s when I realized that I didn’t have the tools either. And that I didn’t know exactly, okay, how do I fix this in a collective way?
Because this is not a one-to-one situation anymore. It was just so profound.
It was not, I mean, you can sort of manage individual, you know, through your other parts of your career, can manage them, and there’s one person here and there that’s going through some challenges and help them get what they need.
But this was everybody, this was, yeah.
This was systematic, this was really, It was around us all the time.
It was, you will see the situation in your families, you will see it with your neighbors, you will see it, of course, with your colleagues, with your mentees.
Doesn’t matter what you were doing with your own kids, it was really massive.
And none of us, we were prepared for that. Physicians are not physicians, educators are not.
So I’m curious, because before we talk a little bit about what that.

[7:12] Was for you to learn how to be a mental health advocate and ally.
You know, how were you during that time?
And where did you get the energy to move more into that?
I am very curious and I have been always called very resilient, which probably I am. I don’t necessarily knew at that point how I do it.
But what I discovered during these difficult times is that, and this is a word that someone taught me two years ago, I didn’t even know about this word is that I have moral resilience. And moral resilience is the ability to pursue what is right, even if it’s inconvenient for for you. And for some reason, and I believe that this is something that I, I got from my dad. Finally, I discovered how I keep going. And I keep going thinking that I need to do something about something that is unfair, no matter how this is affecting me. And this has good and bad, right? This is, this is a complex situation, because sometimes you put yourself and that’s exactly what I did in a situation where where your well being may be jeopardized, because you are pushing so hard to get things done correctly.

[8:31] That you are forgetting about your own well being. But that’s exactly what moves me is try to make things right. And that’s how I I started this process of learning and finding out how I will fix the life of fathers. And that’s also how I discovered that my life was as affected as the life of all of them. And that was a slap in my face. I didn’t know that I was suffering. I didn’t know that I was struggling. I was so focused on others that I neglected myself, I neglected in some way my family, and of course my well-being.

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[10:29] Music.

[10:35] Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches. 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.
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[12:46] So moral resilience is moving forward even if there is some, even if you are struggling.
There is some, even if you are struggling, if I hear you right, is that?
Yeah, it’s doing the right things, right? Pursuing what is right, what is fair, even if it’s inconvenient, if it’s not easy, if Peace.

[13:11] Right, if you will maybe put yourself in a difficult position. And again, I believe it’s something very good, but it’s something very dangerous if you don’t set boundaries, clear boundaries. And I didn’t set the boundaries. I went for it without setting boundaries to make sure that I was okay. Do you mind saying a little bit about what you learned about yourself in that process, what did you discover?
I discovered that I don’t know how to say no, something that I am starting to learn.
I discovered that boundaries was not existent for me, sadly, and this part of not being able to say no but goes beyond that is really putting yourself in situations where you don’t have a safety net sometimes and that could have, as a consequence, negative outcomes for you or for those that are around you.
I learned also that I was using, as many others in the healthcare system, a mask that keep me smiling and looking like I am great.

[14:27] I’m feeling great and everything is awesome when things were not awesome and I was not necessarily doing well.
And something else that I learned is that my behavior can affect the behavior of others that I have more power that what I really think I have.

[14:48] And I discovered that the day that I started going to the clinic where I used to work with my residents, and not only not use the makeup or the nice clothes that I used to use before COVID, right, and the high heels, but I was using these awful scrubs and my mask in the face to try to.

[15:08] Protect myself and the hair, whatever. And I feel like when I remove the physical mask, right, the clothes and the makeup and etc. At some point, I didn’t need to use the emotional mask.
And I started to go to work emotionally naked and be myself. I had an awful night or I had a disaster weekend with my kids that are tired to be at home for the last five months without going out or, or I am tired. And at the beginning, I remember my residents being very confused because of the resilient and always happy Dr. Z was having bad days.
And how is that possible?
But what happened days or weeks later is that my office starts to be full of people knocking the door, asking if they can speak with me.
And when I removed my mask and when I became vulnerable in front of others, especially those under my care.

[16:11] What happened is that they felt so different and more safe to come to me and share their real struggles and to open up and to ask for help.
So being vulnerable opened the doors for others to be vulnerable.
And that means that it opens the door for me to help others in a different level.
And that’s when I discovered that that vulnerability gives you power, the power to help others.

[16:39] And it’s not a weakness, it’s a strength. It’s a very significant discovery in a short amount of time, Miriam.
Wow, wow.
I don’t know if it was short. For me, COVID was very long in many ways.
It compressed things, didn’t it? It compressed things, yeah.
So really, this is really, really, I wanna just highlight this.
There’s this veneer, if you will, that we have in our medical culture of invincibility and somehow we have honored that to the point where we, and we’ve modeled it and we have that expectation that we are to be invincible and no matter what, we’re putting the patients first.
And.

[17:26] Because of your exposure to the training, but also just, you know, it’s just, it was just hard during COVID to maintain that when there’s so much going on, that dropping into vulnerability, not only took care of you, but it allowed you to, others to be cared for as well.
Yes, and I believe that something that I gain with vulnerability is also the ability to remove this very heavy backpack that many of us, we have to take with us wherever we go, because we need to protect ourselves from others to know who we really are or how we really feel.
So we are acting and acting like everything is good and who take care of us and when do we get support and how do we ask for help?
I mean, and why you will be asking for help if you are perfect and a superhero, right?
So, in some way, that was, it was liberating.
Really allows me, I mean, to be myself without restrictions and that’s really freedom.
That’s the real definition of freedom.
That’s lovely, I love that, liberating. The thing that’s coming to mind is this saying that I’ve heard others say.

[18:55] We are, after all, human beings, not human doings. Yes, but I have been a doer all my life, and I describe that in my book.
And when I was talking about this with one of my good friends, Sogol, she’s a physician, a pediatrician, and also a coach.
She was telling me, it’s time for you to stop doing and start being.
And at the beginning, I had no clue what she was talking about.
That with this idea of solving problems, of not paying attention of how I feel, because we are maybe scared of discovering that we are in pain and we cannot function if we are in pain, right?
I have been a doer. I do, do, do, do, do.
And I don’t know what to do in one day that is free. I find another, you know, experiment or adventure just to keep myself busy because I didn’t know what to do with myself.
Now I started to practice a little of mindfulness and meditation, and I am getting extra minutes, right? Every extra minute is a celebration that I can be me and I am not doing.
But really, I feel like that’s part of our training. told us that we need to fix, fix, fix, fix, solve, solve, solve, but who fix us?

[20:19] When do we focus on ourselves and how we can fix others if we are broken?
Yeah, very nice. Yeah, right. So, you know, I wanted to, you know, along those lines about sort of your own self-awareness, there was another really, really interesting point in the podcast when you were sharing lessons that you learned from your children. And I want to, if you’re If you’re okay with this, I’d like to play back this point that just really jumped out at me.
And I think that our listeners will be able to identify with this as well.
And just to set it up, you were chatting about how your children are teachers for you.
And in this particular case, it had to do with your cell phone usage.
So I’m just gonna play that little segment for us to kind of review.
And they remind me that I am too much on the phone, or that I should, oh, yes, my little one is really very upset with my phone.
He actually, he goes and he hides it, including the garbage. That’s funny. Yes.
And he will come directly to me and ask me, Mommy, if you have a phone, why did you bring me to the world. You should not stop me. Oh my goodness. Yes.

[21:46] Yes, that’s true, sadly. Yeah, I had the same response as Randy, oh my goodness. And first of all, how old was your son when he said that?
Six.
Wow. Tell me how you responded to that at the time. Oh, I tried. Really, I try kind of minimize it and explain to him that, I work in my phone, it’s not that I am playing. And then he got upset because I work too much. So, I didn’t give him the right answer either. But I mean, he’s right. And I have been thinking about this. The problem is that especially when we used to work before only at work or office hours, right? And we didn’t have phones that are so amazing that allow us to do many things.
We will come back and we will start being human beings, normal moms and dads, and work will.

[22:49] You know, be on hold till next day. Right now, we really are connected to our work continuously.
It’s like, sometimes I wake up 3am and I have emails, I start answering them.
And the question is, okay, where do I set the boundaries? And I feel like I need to and I’m trying to and sometimes I’m still failing on that. But for example, Ari had his door, a sign that says you cannot come with phones in my room. So I cannot go inside of his room with a phone now.
So he’s actually helping me to set the boundaries with my phone, which is embarrassing in so many ways. But yeah, I need to set boundaries and I need to learn that to be present. My husband and I, and this is not my merit, this is complete merit of my husband, we have been taking parenting classes to learn how to do things. And we are doing now these special times where we have a specific time with each of our kids individually for good quality of time. We are trying to do, those things different.
Is it easy? I will say no, it’s very difficult.

[24:12] For me, especially, it’s very difficult, but I need to be present with my kids, if not, what?
In the future, they will remember this and I will regret it, and I don’t want that.
I, for sure, I don’t want that.
I really appreciate your candor in, you know, that this isn’t easy.
You know, you have a long period of your life leading up to this moment where you have a way of doing things and a way of being present for lots of different people, lots of different things all at the same time.
I love this image of your son helping you set the boundary and, you know, there’s all kinds of emotions that come up as I hear that story.
And I also wonder, in addition to what you’re learning in parenting classes, what are some things you’ve done, you know, to set boundaries?

[25:03] So a few things, for example, I have the days that I don’t see patients, I have certain days that I will not have any video chat or anything scheduled.
So I know that that day is just, you know, a free day. So I can try to find a way to relax, etc.
I started to set days that I go to walk with a friend and is, you know, my 30 minutes walk, but it’s my activity.
So that is protected time. Trying to make sure that I am doing some mindfulness days or activities during the day.
So I block those moments to try to regain some energy and reset.
I still have a lot to go.
I have still a lot to go because my brain functions very fast. I am like that.
So I need to find ways to calm down my brain and tell my brain, hey, time to be just present.
I just started to do art. I bought an activity where I do art with crystals.
So it’s very interesting, but I do it like breathing in and out and it relax me. So it’s helping.

[26:24] But I want to say something also about what my kids said and his reaction when he’s not upset.
And it’s very interesting because sometimes he comes to me and he’s like, mommy, I know that you are saving lives and I am proud of you.
So it’s very interesting that when you talk with your kids, when you interact, when you share, when you tell them, like I am struggling on this, right? And I am very transparent with my kids, with my two kids.
It’s like, oh, this is so hard for me or this is why I do things. So.

[27:00] They also learn about you and they also learn about life. And I feel like being vulnerable and not perfect in front of my kids is also an opportunity for them to learn that they need to be kind with themselves, not only with mommy, but also with themselves.
And that it’s OK not to have an A every time. And it’s OK to make mistakes and that you can learn.
And it’s an opportunity, you know, to to create strong relationship with your kids. And I, I am very clumsy, I am the part, the type of person that will go against the wall, even if the door is open. That’s me. It’s very funny. I don’t know why I do it. But that’s me. And I drop things very easy. And I will say to myself, Oh my gosh, I’m so clumsy. And I will have my oldest boy saying, Mommy, don’t worry, it’s okay that you are clumsy. I love you the way you are. And so so we we need to learn to be kind with ourselves, we need to learn to be vulnerable and human beings in front of our kids, because they will surprise us. And they learn with us and we learn from them.
And I thought is something that I also learned from all this process. My kids are my mentors.

[28:22] I love this and I, you know, the other thing that comes to mind as I’m, as I’m, we’re talking Miriam, is for your children to be saying the things that they are and the insights that they bring and their caring of you. I’m just going to say that says a lot about your parenting, your, you and your husband, and we’re not talking with your husband, but, but I’m just imagining the environment that they’re growing up in.

[28:47] It’s a crazy house. Don’t think that it’s a perfect place. It’s a crazy house.
Oh, sure. Of course. With a lot of love, with a lot of trying.

[29:00] We try, we fail. Sometimes we don’t fail and we celebrate and they see us working together.
During the difficult times, they know that we try our best and that we do this as a group or this is a team, we, you know, repeat that this is teamwork. And I give credit to my husband because again, I am the I am the doer. And he’s the one that keep us with, you know, with the like, close to earth and reminding me and reminded us that we need to be together and we need to help each other and that we, you know, that we need to be instead of only do.
And so, you know, one of the things that’s coming up for me as we’re talking is your attentiveness to yourself and your own well-being and your own learning about how you are with others, with your co-workers, with your children, with your husband, and how you are professionally.
And that you are, you know, what’s coming up is this idea that you are applying your mentality of I’m working on myself in the same way that I work with my learners and I work with my patients.
There’s some self-study going on here and I…
I wonder if I could ask a coaching question, something that comes up.

[30:26] Earlier you said, I’m still a work in progress and I have a ways to go.

[30:32] And I just am curious, do you have a picture of what it looks like when you have accomplished, the boundary setting and you’ve gotten to this place of, for lack of a better term, balance, I don’t really care for that term, but that you are in a place where it’s more settled, it’s never going to be perfect, but what does that look like for you?
Peace, peace, because I live under a stress trying to achieve things. I still have this mentality of I need to do things, if not perfect, if probably I already understood that perfect doesn’t exist, that’s something that I learned, but I still try to be the good mom, the good doctor, the good teacher, the good doctor, the good advocate, you know, and I need to understand that, yes, I will be able to do it. But every I need to be present in each situation without.

[31:33] Having this feeling that I am fighting, or that these spaces are competing. So I’m always here, but thinking about there. And I need I believe that the most important boundary that I need to learn is how I am here, I’m fully here, so next I am there, fully there, and I don’t feel guilt.
At that point, I will feel this peace of mind that I am not cheating, I am not guilty, I am not removing the space from something else.
So, yes, peace of mind. I hear you, and I can identify with that, and I’ll bet you a lot of our listeners can identify with that, too.
Can I actually be fully present with whatever’s happening right now.

[32:19] Instead of a patient ahead or a patient behind.
Can I drop in? And yeah, I heard you say that you are doing some practice in mindfulness.
And I know that that’s a part that helps me get better at that.
I’ve not arrived fully yet, but it helps me get better at that. So thank you.
I wanna ask one more question that I’m asking all my guests now going forward.
It’s about meaning, because I think, especially with well-being, and especially what we’re learning with physicians, is that the more people are engaging in what’s meaningful to them professionally and their whole life, the less likely there is the burnout and the dissatisfaction.
So what would you say, Miriam, is bringing you meaning to your life now?
I believe, I will say that it’s more than belief. I am sure that what is bringing meaning to me is being able to share my story, not only with colleagues, It’s bad.

[33:21] With the community in general, because what is happening to physician is happening to all of us really is this burnout. We speak a lot about the healthcare workers, but really, you will find it in teachers and lawyers, no matter where you go. And I feel like if I share my story, if I share in some way my struggles on my attempts, and, you know, with vulnerability and without shame, and.

[33:49] If I show that even if you can be in a high position that doesn’t make you perfect, or a superhero, but you are still someone in process, probably that will reduce the stress of others probably will create this safe environment for others to be also vulnerable to identify their own gaps to identify if they need help from others, right? Because sometimes it’s not only I I mean, it’s not so easy to do it by yourself, and you need support from others and to identify if this is just something that is relatively normal, or it’s crossing the line, and is now a medical condition, and the support that they need is deeper, and maybe they need medication or a doctor to be involved. And during this process to reduce the fear, to reduce the sensation that you feel ashamed of needing others or that you will be retaliated. Mental health is health. Your brain is part of your body, the same as your liver and your bones and your heart.

[34:55] We need to reduce stigma. We need to feel less embarrassed of talking about our feelings and not being perfect. And someone has to start, and as many others in the healthcare system, I am adding myself to the group of, you know, I’d rather to be vulnerable and share my story if that could save a life, motivate someone, and if that can set an example for my kids to have a better quality of life than the one that I have been living, I believe that that’s my meaning and that’s my mission.

[35:31] Well, thank you for that. It’s, and I, there’s so many people that benefit from what you have brought to the world, even before you really became really intentional about being vulnerable.
And then with this, really bringing that human side of medicine to medicine, which has been sorely lacking. I mean, there’s certainly have the humanness, but not as much as perhaps, is important to have. So really appreciate your contributions.
Thank you. And I believe that we have the human is against or for others, but we have been forgetting to be human with ourself. And that’s really what is lacking. And we need need to.

[36:20] Go back to ourselves because the truth is that we cannot help others if we are not in a good shape.
And we need to start, you know, it’s the oxygen, you know, the mask. It’s like we repeat that, we repeat that, but we should need to, we need to start applying that. Get your oxygen mask first.
And I think so many people don’t really know what we mean by that. And in your storytelling today, and in other storytelling I know in your book as well, it’s really you talk about what that is for you and what that is for me to be putting my own oxygen mask on, because it’s going to be different for everybody.
And so, thank you again for that contribution and thank you for your willingness to come back to the MD Coaches family of podcasts. So, Dr. Miriam Zilberg, thank you again so much for being with us today on Life-Changing Moments.
Thank you so much for having me and thank you for doing this and allowing people to feel better, be better, you know, and to share stories.

[37:28] As I think about this conversation with Dr. Zilberglat, the saying, physician heal thyself, comes to mind. While we’ve all heard this, unfortunately, the adage doesn’t come with any instruction manual. Through self-reflection and observation.

[37:44] Miriam has come up with some powerful discoveries that we can all do, starting today, to begin healing ourselves.
Here is a summary of some of them from our conversation.
1. We cannot help others if we are broken. 2.
Allowing yourself to be vulnerable creates a few pathways toward healing.
Here are three that we discussed, eh?

[38:09] When vulnerable with ourselves, we have the opportunity to recognize patterns that are self-damaging.
For example, Dr. Zilberglate became aware of her default mode, which is to just keep doing things, even during her downtime, and this was making her unwell.
This led to her realization that she needed to set boundaries and be intentional about her time.
B, vulnerability gives you power to help others, Because being vulnerable opens the doors for others to be vulnerable.
This contributes to creating a community of well-being and mutual support, which is sorely lacking in healthcare professions.
C. Our children are powerful teachers and mentors, and we can model vulnerability with them too.
3. A third discovery. It isn’t easy to transition from doing to being.
One way to begin being successful at it is to be intentional about setting aside time for the things that matter and that help us reset.

[39:15] I hope you enjoyed this conversation as much as I did. I also hope that you will take these lessons to heart. If, however, in your journey of doing so, you encounter some difficulty finding pathways to your own self-healing, consider consulting us at MD Coaches. Our coaches have all been there so we can relate. Even more, we can assist you on your way to a thriving and more meaningful life. You can find us at MyMDCoaches.com. Thank you for listening and be well.
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