The Care-Giver: Mary Beth Crawford, MD, FACEP, FAAFM, HMDC

[0:00] There’s not a universal perception of what goals of care and code status really mean.
There’s some people, including health care providers and physicians, feel that, you know, a DNRCC means that we don’t do anything and that we take away all that, and that is not true.
Welcome to the Prescription for Success Podcast with your host, Dr. Randy Cook.

[0:30] Music.

[0:54] Dr. Randy Cook, your host for the podcast, which is a production of MD Coaches, providing leadership and executive coaching for physicians by physicians to overcome burnout, transition in your career, develop as a leader or whatever your goal might be, visit MDCoaches on the web at mymdcoaches.com because you’re not in this alone.
And don’t forget that CME credit is available when you listen with us.
Just look for CMFI in the show notes to learn how. My guest today has had an interesting career arc from emergency room physician to hospice care.
The road she traveled to get there has had some challenges.

[1:44] So let’s hear Dr. Mary Beth Crawford tell her story. I am really looking forward to my conversation today with Dr. Mary Beth Crawford up in Ohio.
What’s the name of that little town where you live, Mary Beth?
It’s called Maumee. It’s Northwest Ohio, like Toledo.
I didn’t want to say it. It sure looks like Maumee. Yes, it is.
Dr. Mary Beth Crawford. It’s so nice to have you here. And I am really looking forward to the conversation. There are many things about your resume that have piqued my interest.
But as we always do, I want to see if I can get us started by hearing a little bit about what got you interested in practicing medicine.
Did you have relatives in the business or was it something new?
What was it that brought you to this field?
Well, thanks for having me, Randy. You know, my mother is a nurse. She’s 86, and she’ll tell you she’s still a nurse. She’s not retired, but she is retired. And my oldest, I have five siblings, and my oldest sibling is a physician, and he’s a pediatrician. And I’m not going to say he was a.

[3:08] Verbal inspiration, but he was an emotional inspiration for me. You know, I think residency he was rough and that was one of the times when he was advising me, but I also saw in him sort of the passion and the interest and the desire to help people.
So that was pretty instrumental in my decision-making process.
And obviously I had some events along the way that sort of started college with the idea that maybe I could get a nursing degree and go to medical school and help pay for my medical school with my nursing degree.
That didn’t last long.
That was an ambitious idea. Yeah, it was.
And particularly when I was playing Division I sports, probably not the best idea I ever had, but that’s okay.
Some really good friends came from it. So we did have an event the very first day of my college.
During orientation, one of my colleagues, one of the students had a cardiac arrest right in front of us and passed away. My goodness.
Turns out he had had a significant cardiac abnormality and he had pleaded with his parents to let him try to live a normal life, and they did. And so he did, you know, he had high school and he had a little bit of the orientation.
And again, you know, life is so precious, and there it was.

[4:23] And so those were some of my early inspirations, but I was okay not knowing 100%.
I just had the goal that that’s what I thought I wanted to do, and it just became more solidified as I journeyed through my college years.
Well, let me make sure I got the right picture. I was aware that you were substantially proficient tennis player to the point that you could go to know who it was, was it not?
On a scholarship. But on day one of freshman orientation, medical school was not necessarily where you thought you were headed?
I thought it was, but in the meantime, you know, I’m 550 miles away from home.
I’m starting a division one sports and trying to go to school and trying to navigate.
You know, I didn’t know anyone there.
It was before cell phones, before anything. There’s a lot going on in your mind there.
I bet.

[5:12] So I was, you know, okay emotionally with just letting things unfold and just working hard.
Well, tell us a little bit about what that’s like.
I think probably there are not many people in the U.S. who really understand what it’s like to play in Division I athletics.
And it’s not a chip shot, right? I mean, it’s kind of like having a full-time job.
Give us the details. Did you ever have moments when you thought, my God, how am I gonna keep my grades up, or this or that, what was that like?

[5:41] Well, you know, of course you worry about that, But I think I had some experience coming out of high school where I played four varsity sports and kept up my grades and lived life too.
So I had kind of prepared myself for time management well before college.
So once I entered into college, I think I just sort of settled into the routine of how to navigate time management, how to make sure that I’m, and obviously, and honestly, Division sports now compared to 1984. It, you know, obviously it’s very different. It was still a huge commitment and a full-time job, but it probably isn’t, wasn’t as absolutely intensely crazy as I suspect it is today. I think there was a little more flexibility, but certainly a big commitment and I loved it. Loved every minute of it. Made some really great friends and had some good success. And it, you know, propelled me not only to medical school emotionally, also helped me financially by giving me a scholarship for the first year of medical school.

[6:46] Senior year at Villanova, I gather you had decided at that point that medical school is what it was going to be Is that what I’m hearing? Yes, that is correct when I was a sophomore my dad and mom dropped me off at Villanova and, my dad was they were 45 at the time and.

[7:03] Healthy guy and He wasn’t feeling well. And so he ended up being diagnosed with with non-Hodgkin’s lymphoma and given six months to live by the time his diagnosis was made at age 45.
Misdiagnosed for a while, but you know, again, that was pre, you know, getting a CAT scan back then was incredibly difficult and not very common.
At that juncture, I still wanted to go to medical school, but I wanted to come home to be with my dad.
And he basically said, you know, Bethy, why would you want to come home?
You know, you’re out there, you’re going to school, you’re playing the sport you want to play.
For me, please just stay there and they did allow me to have a vehicle and I could, it’s a long way, but I would drive back and forth whenever I would have a weekend and got a few speeding tickets along the way, but you know.
I did have the opportunity. A college kid needs a few.
Yeah, well, you know, those mountains and the downhill, it just, it was a little tempting. So all of those things, you know, He ended up doing.
Better than expected and surviving and so my I think my pivot at that time was yes I’m going to medical school, but I’m no longer gonna pursue medical school out of state I want to get back into the state of Ohio and be closer. So medical school At the Ohio State University.

[8:18] Yes So when you got there Was it anything like what you expected or was it a complete bundle of surprises? What was medical school like for you?
Well, I was pretty happy to even get in And I think really, you know, my grades were fine, but they weren’t astounding.
But being an athlete, a division one athlete, I think definitely helped me.
So I felt very fortunate to have that opportunity. So I was extremely driven to do my best.
Was it overwhelming? Sure, as every person that’s ever gone through medical school, you look at the amount of material you have to learn and test on over a short period of time. And you don’t think it’s actually possible.
And somehow it is, and you power through it. And I did learn that, again, this was back then, we didn’t have computers, we didn’t have all of these things, and you just sat in big, large classrooms of 250 people or whatever in a dark room, and you prayed you’d absorb something while you were in there, and then you had very little time for anything else.
So on occasion, we had a service that was every day where somebody would type out the notes, like they’d tape record the professor, and then they’d type everything out and they’d hand it out.
And so there were some classes, I knew I wasn’t really getting as much out of it being there and my grades were okay, but I thought, you know, I’m just gonna try this.
So there were just a handful of little classes that I stopped going to and I would go work out or play tennis and my grades came up as remarkably.

[9:40] 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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[10:42] 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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That’s a really great deal on this stunning publication.
And now let’s get back to today’s interview. You know, I’m always interested at what point you decided what you wanted practice to be like.
I know early on it was emergency medicine. Is that something that you settled on quickly or did it come later?
No, Randy. at all, actually.
So back in that day, emergency medicine was sort of what, it was began in 1979. It was rare.
Yeah, it was in the 80s. They didn’t even have a board at that point, did they?

[12:16] Correct. And so they did not allow us to rotate in the emergency room until, you know, fourth year.
So I didn’t get an opportunity to go there till fourth year, October, I think it was.
And so I kind of, I loved everything, but I got married in second year in medical school.
And I wanted to start a family.
And so I, a lot of different types of.

[12:40] You know, residencies just, they appealed to me but they weren’t going to be viable option for a family. I had chosen at that point, my best option was internal medicine and so I began to interview around this different states in internal medicine and then in October I.

[12:58] Had a rotation in the emergency room. The residency director was actually my attending that day and again I’m just a medical student, right, and he took me under his wing and was was teaching me things, and then a patient came in in cardiac arrest, and nowadays they call it the Lucas, but it existed back then.
And the attending physician allowed me to be not just kind of involved, he allowed me to intubate and put a central line in, which I did successfully in this patient, and I was hook, line, and sinker.
You got the adrenaline rush. I did, I did. I’m really disheartened and embarrassed to say.

[13:34] I don’t remember if the patient survived, but I do know that it changed the trajectory my career. Well, I’m going to ask you something really personal at this point, and you’re free to wave me off if you like, but every interview I have, somebody says something that catches my attention. And what caught my attention was, is that during medical school, you decided that you were ready to start having children. Well, talk about that for a minute.
I really want to know what was in your head.
So the father of my children, he and I met the very first day at Villanova.
And we were in the same orientation group, ironically.
I had a boyfriend at the time who was attending Duke University.
But over time, you know, my dad got sick, life just changes, and so eventually I began dating their father during college.
And we became very close and we had, you know, sort of an idea that we wanted to be together forever in theory.

[14:34] And so, at the end of college, we had to make some decisions, one of which was, you know, I was going to medical school in Ohio and he actually joined the Peace Corps, so that was a big deal.
So, he was going to be gone for a few years to the Dominican Republic.
And so, we had a long-distance relationship, but we still seemed to care deeply about each other and then he ended up coming home. At some point I think we got engaged in the Dominican Republic maybe after my first year of medical school and that was a story in and of itself. So yes and then we got married after my second year of medical school. So you know family, I come from a big family, I love kids, I love family, I just I knew I couldn’t have children in medical school because because I really didn’t have.

[15:21] I didn’t have the resources as far as health insurance, et cetera, back then, so I knew I had to wait till residency. But I was strategic in what residency programs seemed to be most friendly toward the reality of A, a female resident, and B, a female resident who wanted to start a family.
Dr. Darrell Bock And so take it from there, through training in emergency medicine, we were actually talking about the fact that emergency medicine residences were relatively rare, but apparently they had one at St. Vincent’s.
Yes, it was a big program. I think there was 12 residents a year. I think there were only two or three of us women in the program, but it seemed definitely family-friendly. And it was local, obviously, where I’m from, and they had the Life Flight program, and I was still an adrenaline junkie back then, so that certainly had its high points. And were there more children during those years?
So, I am not recommending this to any women physicians that are listening.
Definitely not recommending it, but my life unfolded.
I became pregnant during the first year of residency and that was prior to the hours restrictions taking place many years prior to that. So it was, you remember the hours, Randy, I mean, it was a lot.

[16:42] Yeah, I was told that it was a privilege, and I just…
You know, I just did it. Yes, yes, yes. The fact that you got to go home at all for a two or three day period was a gift.
So yes, the first pregnancy I had, unfortunately, resulted in a miscarriage and I was on trauma service my first year and I found out I was pregnant and then I started having some complications.
But I’m a female and there’s not many of us and I don’t wanna burden my teammates, my peers.
And so I actually, again, not recommending this to anyone, but I did see a physician, we did confirm it, and then I continued to work through it.
And I did not miss any time.
And then, you know, you kind of, you know, you navigate that and you realize that the reality is pregnancies don’t always result in a live birth, right?
So I wasn’t, I was, you know, very sad, but I wasn’t devastated by any stretch. I was young.
And so we ended up getting pregnant again. And I think he was born January of my second year, early January, but I became, again, the hours were not ideal, and it was not wise to be pregnant.
Again, not recommending it. So I became, you know, I had complications.
I had preterm labor, and then I ended up with preeclampsia and really, really rough delivery.
He is now 29, almost 30 years old, and despite the complications of the pregnancy.

[18:11] And despite what his placenta looked like, He’s turned out to be just a really good human being and he’s had great opportunities for education.
He went to Georgetown, he just graduated from Princeton Graduate School.
He and his girl been together for nine years. They live in Boston and he works in global health and non-profit.
Wasn’t a wise thing to be pregnant, but it all worked out. So it sounds to me like if some female emergency room physician came to you and said, what do you think about having multiple children during your residency that you, looking back on it retrospectively, you’d probably say it’s not the best?
I would definitely at least encourage them, unless there was a significant age issue of concern, I would encourage them to wait to the third year when the schedule’s more. Sure.
I was pregnant, again, I was about six months pregnant when I graduated from the residency program, and I did not want to graduate late, so I went back to work pretty early with my first one, probably earlier than I should, ended up with some postpartum sepsis, but probably didn’t take off more than two weeks total in that year.
Again, not recommended, but that was just me wanting to power through it and not feel like I was getting any advantages that my peers weren’t getting.
You’re sounding more and more like a surgery resident to me. Ha ha ha.
Maybe in another life, but this one not. Ha ha ha. So you had two children during your residency.

[19:39] Is that right? Well, I was six months pregnant when I graduated from residency.
I see. And of course went right to work.
Yep, the day after graduation, yes. I had a little bit of an issue because the boards were scheduled at the same time as my due date, so I did wait a year to take my boards. And unfortunately, there was no other alternative. I couldn’t get my money back if I ended up going into it, so that’s why I didn’t. And then, you know, you’re young and you just think you’re absolutely invincible. And I’m working and I have two kids under the age of two, and so I’m like, okay, well, you know, when I’m off, I’m gonna be with them. I’m gonna be that mom and I’m gonna do everything. And well, that was fine, but I was working 200 hours a month, which was probably not wise, but that’s what, you know, that’s what it was back then. And really didn’t study like I.

[20:32] Needed to study. And so, I sat for the boards, you know, when my kids were whatever, one in three or whatever. And I got my results back and I was like devastated. I missed it by one point. And I said, okay, regroup, regroup. I got a family to take care of and this is what I want to do in life.
So, now what? And my now what was I told their dad, I said, I got to go away. I got to take a class somewhere and I can’t be around the kids because I just can’t focus. So I did. I went out and I took a board review and it was the first time they had it was a big board review that has been since one of the best and it was the first time they had had it and they said well hey since you guys were our guinea pigs if you want to go to the other board review right before the exam you can and there’s no tuition, you just have to pay for a year.
Travel in your room. So I was like, yeah, I’m gonna do that. And so, as you know, when you are in the midst of learning and teaching yourself, you become a better teacher, right? So it’s pouring all of this information into me in order to perform well on, not just in the emergency room, but on this test. And so not only did I do much, much, much better on the exam, but I also was attending in in the residency program and got teacher of the year award that year.
So it was an ironic nature of that.

[21:54] You know, the interesting thing about that story to me is, you know, we could talk for a long time about board examinations and I was actually very deeply involved in coming up with a board examination for chronic wound care physicians.
And the problem that you run into is that you don’t know where to set the bar, where to draw the line. And I’m wondering if the test itself got better and fairer as time went along.
I know in the exam that I was helping design, we certainly felt like it got better, but we employed psychologists and learning specialists and things like that to help us identify which which were the good questions and which were the bad questions and those kinds of things.
But I guess what I’m asking you is that even though this failure to pass the first examination, could it possibly have been just because it was really not a very good test?
You know, I think that when I took it subsequently, I think it was pretty much the same.
I do think that the instructors at the board review course were instrumental in me learning.

[23:03] To read the question, you know, and focus on, you know, kind of the killer foil, so to speak. And testing has never been my huge, you know, standardized testing, not my best trait, but I have four brothers and they were all national merit scholars, and I seem to get the athletic prowess a little bit more than that, but I think just learning and accepting this is the way the test is at that point and these are the things that I can look at and knowing the material all made it much more feasible for me. But I do appreciate your efforts and your team efforts in trying to make better tests because I don’t feel that always these standardized tests really predict you know solid physicians or whatever specialty they’re trying to you know the testing is for whether it’s a physician or business or whatever I think just improving that so that it’s more real life and practical is important.
Well, I learned quite a lot about, as I say, the psychology of learning and the psychology of test-taking as a result of that experience, and I don’t even know if other specialty organizations are even going to that kind of trouble or not.

[24:15] But it turns out that there is quite a science to creating questions that are actually capable of telling us who is qualified and who is not.
Anyway, we’re not going to talk about tests and me anymore. You have a great deal more interesting stuff ahead of us that I want to know about.
And so you’re not doing emergency medicine anymore. I’m interested to know how long you did it and what made you decide to move into what you’re doing now.
So, um, I worked at a teaching hospital, uh, level one trauma center for the first like eight to 10 years of my career.
I loved it.

[24:58] Um, was again, one of very few, if not the only female. And I just had a sense, um, unlike when I first started, like I’ll be there forever.
I just had this sense that maybe this wasn’t the right place for me, um, longterm.
And by that time, I had gone through a lot of other things with my personal life as far as pregnancies.
I had had a total of three miscarriages before I hit the age of 40. Oh my goodness.
And the first one was in residency.
I was not aware of why. The next two ended up each having a.

[25:36] Chromosomal abnormality that was not compatible with life. And so the miscarriages were like maybe 14 weeks, 14 to 18 weeks.
So kind of rough, but you know, still again, nature, you just, you can’t, you know, things happen, life happens.
So then I got pregnant again around the age of, well, probably right around 29 or 30.
And this time seemed to be going well. and so I had two little kids at home and I was very pregnant looking. I call it my morning after belly after the first two and I have a, you know, you’re working and you’re showing and I was around Christmas, near Christmas time and I went in for my routine appointment and I had had a normal triple screen and everything was fine and the ultrasound tech was like, hey, you know, Mirabeth, do you want to see the baby? I was like, sure, yeah, let’s do.

[26:29] It. And she didn’t have to tell me. I could tell the baby was in hydrops fatalis, so things were not right. And it turns out my baby had trisomy 21, had an AVSD, had a unilateral kidney, was basically in heart failure and dying. And that was rough beyond imagination because, you know, shit, I saved lives for a living and here I have this baby inside me and I can’t help her. And she’s, you know, she’s hurting and so that was really, you know, we ended up delivering her. She lived, you know, a few hours at 28 weeks and died. And so yeah.

[27:08] That was really hard. And you know, you think your kids don’t know even though they’re little, they know. So even though we didn’t talk about it, my oldest one started having a little bit of issues in his little preschool thing.
And what I learned was they are a lot smarter than we can credit for. They we sense our emotions and so we started talking about her, we named her, we called her our baby angel and then everybody, you know, sort of began to heal from that. Wow.

[27:35] And that was rough. I did try to go down to part-time. I thought that would help me kind of regain my mental state because I was a little bit, I was a little down.
But really what I learned was going in part-time means you work full-time hours and you just get paid less.
So that didn’t last long.
I went right back into full-time. And so, you know, I had to make this kind of intentional, or we had to make this kind of intentional decision, you know, and I kind of had this conversation with him and we said, I’m more frightened to never take the risk of having another child than to risk something like this happening again.
And so we went ahead and we got.

[28:13] Pregnant again and Had another my third boy and then two years after that had another boy And right about that time was when I was feeling this thing like I’m not in the right place at the you know, I’m still in emergency medicine, but I just didn’t feel like it was somewhere I was gonna last a long time and one of my nurses was working part-time in the ER and was like hey, you know Dr. Crawford, I think you really like this.

[28:38] You know community ER in Maumee, well I had already happened to be living like two miles from there already, so I was like sure. So I kind of did some moonlighting there and seemed to be a really good fit. So I left my first job with you know nothing but like, hey thanks this has been great, I love you guys, what a wonderful experience. Gonna be a little bit closer to home and kind of change gears after four kids, right?

[29:00] Needless to say I was busier than ever at the new job as I was kind of I guess in a way allowed to, I was definitely given more freedom and encouragement to flourish and be involved in things. So I started, I became the the EMS medical director of like 18 entities. I was asked to be on the county emergency medicine, emergency medical services policy board which is made up of mayors and then chiefs and I was the only physician just to try to help give guidance to the commissioners and we created just an absolute wonderful and incredible nationally known EMS program and it just was a really huge part of my life. We created a chest pain center that I was a director of, heart failure center, stroke center. I was chairman of the emergency department. You know I was very involved and and I loved it. And then somewhere along that way we had a fifth child. My only girl.
So, and I didn’t pivot from emergency medicine for quite a while. I had some life-changing events that I didn’t see coming when my youngest, who’s now 19, was three. My husband at the time, we had been together for 20 some years and married for, you know, whatever, 19, and I didn’t know it was going to happen. People say you don’t see it coming and other people think, how could you not? Well, I didn’t.
And so I had a big life change at that time.

[30:29] And had to adjust and adapt and learn how to become a single mom and work and I had a- Single mom with a lot of children.
Yeah. And a very demanding job. Yeah, so I was blessed with finding my tribe and the tribe sort of evolved over the years because a lot of them grew up and went to college, et cetera, or graduated from PA school.
But I had wonderful people in my life helping me. And at the same time that their father had sort of made some decisions and, and, and, uh, Went a different path. My five-year-old son at the time was being diagnosed with autism. So it was it was a lot, There’s no doubt. It was a lot. So but again, you know, my goal was, Okay, this is what I have didn’t ask for it didn’t want it But this is what I have and I can’t fix it. Unfortunately.

[31:21] Try just was not gun was not fixable and so now I just got to learn how to do this and, With the help of a lot of people we were able to you know, navigate navigate things and I just kept learning and learning and learning and my children are you know my greatest teachers. They’ve all done amazingly well.
We are incredibly close. All the kids are close. They’re all over the country. My one that was diagnosed with autism I kind of was like not confident. I knew there was definitely something wrong but he didn’t fit into a box you know. He had I had signs of different things.
So I ended up taking him down to Nation Children’s Hospital in Columbus and I said, look, I’m not looking for a label.
Can you just help me help my kid?
And so we had different cognitive behavioral therapy, different things, and he is graduate.
They told me initially he would never graduate from high school, he’d be my dependent his whole life.

[32:18] He’s graduated from high school, he’s graduated from college, he works as an executive manager for Target and just bought his first house.
I’m just astounded at how many times I keep hearing that story.
Really warms my heart.
We were just beginning to talk about autism when I was an undergraduate, back at about the time they discovered FIRE.
You know, during all these years, there were so many people that were told, well, you know, this is gonna be a dependent forever.
And you and others have proven that it just doesn’t have to be that way, right?
I’m sure there are some, I certainly have friends that have autistic children that have not, and they’ve had all the therapy and all the everything.
And so I think each person is unique and different, but I think if you at least try, some of them can really beat the odds, so to speak.
So now, was this about the time that you decided to segue into hospice?
Yeah, it was getting close. So it was probably seven years ago.
So my daughter would have been like in her teenage years.
And so, you know, I was only had one or two at home and I love what I did.
Just didn’t want to keep doing it at the speed and the intensity that I was doing it and during this time frame before that too, my hospital, my community hospital was.

[33:40] Taken over by a large health care organization, you know. I don’t know what that means.
Yeah, and so there was a lot of, you know, that uncertainty really can wreak some havoc with people in your hospital, in your institution, and so there was a lot of angst as it was sort of evolving and, you know, I’d been through so much in my life, I was pretty comfortable in having conversations about how to navigate through uncertain times and how to focus on the things that really matter and how to build and create and grow and learn together. And so I was sort of talking to a lot of my administrators trying to really build them up and encourage them, the ones that were struggling, and they said, you know, Dr. Crawford, could you do a book club? And I said, I don’t know what a book club is, I said, but I know how to give a PowerPoint.
And so I started doing, you know, PowerPoints, the administration, medical staff, and then, you know, it just kind of grew from that sort of into a, you know, I’ll call it motivational, inspirational, you know, I want to call it not speaking, I want to call it conversations, okay, where, you know, you just, you go out to different entities, whether it’s the, you you know, NAMI, Organization for Mental Health, whether it’s the Lucas County, you know, Housing Board Authority, whether it’s, you know, the Red Cross events, whether it’s, you know, Wear Red, whether it’s, whatever.

[35:04] You know, there’s a lot of, there’s medical stuff, but there’s a lot of really good opportunity to really speak to people about how, how to live.
You know, we’re so disease focused, and that’s fine on certain things for prevention, but think we need to simultaneously be you know health focused. So I started doing all of these types of things and and and so when this pivot changed I was doing the motivational speaking and I was you know engaging in some other things and at one of my talks one of the someone came up to me and said you know hey Dr. Crawford I’m so-and-so and I work for this hospice organization we’d love to see if you’d be interested in being our medical director. And I was at the time thinking about exiting my partnership for my group and just going out as an independent contractor to kind of…
Make my own schedule. So it was perfect timing. Yeah. So I ended up you know taking on that team hospice physician position and it was pretty small and I was working in three or four different ERs crafting my own schedule and you know really really liking it and enjoying it and learning about hospice and and then we had a few um there were two other doctors and uh doing the hospice thing and one had some type of a medical issue and left abruptly like like that day and then.

[36:19] And then the other one was no longer working for them.
So then all of a sudden I went from a little bit to now two offices and multiple teams and a medical director and not just a team physician.
And so I kind of tweaked my ER shifts accordingly, still loving everything, and then COVID hit.
And my hospice population exploded, and you went from one ER shift and you have a solo.

[36:46] One doc in the ER, where I would typically see anywhere from 45 to 60 patients in a 12-hour shift.
And we went from that to then 40, to then 30, to then 20, to then like four.
And one of the hospitals I was at was a designated COVID center for that region.
So I thought, you know, you guys don’t need me. Meanwhile, my hospice is just exploding, because you know.
It was just, it was a lot and we had an opportunity that no one wanted to try to get these people out of the hospital and get them comfortable and, you know, what we all, my nurses, my team, and I’m sure many others throughout the world, witnessed was unimaginable.
And we just tried, I tried to get everybody to focus on what can we do to help.
So we were able to help a lot of people.
And so eventually I just was like, you know, now I’m the medical director at three or four places and I have 300 and some patients Maybe I don’t need to be in the ER at all. So I just sort of stepped down Well, I was just gonna ask you do you find that?

[37:53] You look around and and you feel like you’ve discovered something that you didn’t really know, Existed and yet it feels just perfect. Is that where you are? Yeah, you know, I I did know it existed actually, I was a huge advocate of goals of care conversations in the ER.
Yeah. Um, you know, because we were, so we’re the community hospital that I work at. I mean, the amount of, you know, skilled nursing facilities and ALs that are around us, like, I can’t even count how many there are. So, you know, our patient population was very advanced disease processes, elderly, you know, sick, and no one was having these conversations with them. I shouldn’t say no one. It wasn’t as common as I felt it should be. So we actually, created sort of an advanced care planning committee at the hospital so that, as I’m sure you know, there’s not a universal perception of what goals of care and code status really mean. There’s some people, including health care providers and physicians, feel that, you know, a DNRCC means that we don’t do anything and that we take away all that, and that is not true. And so I was just trying to, if a health care provider is that far away from really understanding goals of care and code status, how can I expect my patient population to understand it.

[39:14] So, you know, it was just an opportunity for us to try to slow things down and really have conversations.
And so, you know, I would, I would take time to call, you know, the daughter in Colorado or the, you know, brother in Florida and have conversations with these really sick people because honestly, and the literature is clear with certain disease process, certain age, plus disease process, better outcomes are when we keep the people out of the healthcare system, out of the ICU, out of, you know, without all these invasive treatments.
There’s plenty of statistics to back that up.
A lot of statistics, yeah. So, well, and my father passed away on hospice 12 years ago, so, you know, I had the exposure personally and professionally. I was inspired and propelled.

[40:01] To be an active voice to help people make, you know, number one, think about things, right? Have those conversations over a cup of coffee or a glass of wine not in the hospital ER room, right? Or have them with your doctor in the office, but don’t have them at the time of crisis.
And that’s what I was seeing happening over and over again and so I still think it happens more than it should but I know you know things have changed over the years. They’ve started to reimburse for those conversations in the office so I do think we’re making some headway but boy do I think there’s a lot of room to go not only with goals of care and code status, but just with hospice.
I mean, you know, you look at the news and you saw the president, previous president of the United States going on hospice at age 96, Jimmy Carter, and everyone like, oh you mean hospice isn’t for the last 72 you No, hospice is not for the last 72 hours of life. So I just think there’s a lot of education because, man, I have some just, I feel like I’m making a big difference in patients’ lives.
Can’t fix everything, can’t change things per se, but I can certainly, with my team, meet people where they are at and help them manage their emotional, their spiritual and medical situation.
I don’t think there is anything about that and is it not just an amazingly gratifying thing to do?

[41:25] Absolutely. I tried desperately not to make this program about myself, but I will mention to you because I think there is a parallel.
I practiced general and vascular surgery for about 45 years, I guess, before I got trained in chronic wound care and got introduced to an entire population of people that nobody really understood exactly what they were supposed to do.
Many times, these are wounds that may never completely heal and then there are some times they will heal if they’re attended to properly, but the training and the science about how you get there is just kind of non-existent in all those specialties that we were dealing with before.
And to be in there doing that was just remarkably gratifying, because as you say, the first thing that you notice is just how grateful the patients are.

[42:25] Absolutely, and I think that population for you, they were probably underserved and ignored.
And so I thank you for doing that.
Yeah, and it’s not because people don’t care. I’m not trying to…
Say, oh, the rest of the medical world is just a bunch of bad guys.
At least up to now, I don’t think we’ve really trained people to deal with things that can’t be wrapped up in a couple of weeks and assigned an ICD-10 code and send a bill.

[42:59] And that’s my rather selfish and long-winded way of coming to a point where I can ask you, is this the most gratifying thing you’ve ever done?
Oh, I’ve had so many things in my cards. No, it’s not a fair question. Oh, you know, is this one of the most? Yes, you know, I’ll just share a.

[43:18] One simple, Patient interaction a young woman in her 50s with cholangia carcinoma, And again doing all the things trying to treat and she was in the medical field, And so she was knowledgeable and she and her husband, you know, obviously appropriately doing all the treatments being very aggressive It was not going well, you know, malignant ascites, malignant pleurofusion, Her malignant ascites was it had four or five different organisms as did her malignant pleurofusion. She was on all these antibiotics she was very very very very very sick and nothing was working and, So she actively in discussion with her spouse Actively asked the health care providers to please stop and let her go home with hospice, And they didn’t think she was going to live but a few days and so I had the opportunity to meet her and her husband at their home and have many, many conversations and constantly tweak for symptom management and constantly just, get their opinion, talk with them, make sure we were, you know, in this particular case, very shared decision-making, right? She lived for six months and as I kind of indicated before she she lived until she died.
She was able to take trips, she was able to see the birth of another grandchild, she was able to go out to dinner with friends, she was able to actually plan her own funeral.

[44:42] She was able to share just absolutely very inspirational and very humorous interactions between her and her spouse and it was refreshing to see that not only that, but the fact that listening to patients, whether it’s hospice or anywhere, tweaking things, adjusting, and continuing to have that open communication line, resulted in such a, the best of a horrible situation.
Right.
And so the fact that I can have that experience in my lifetime, that’s priceless.
And I’ve had, obviously, priceless things happen in my ER. I still have a patient from probably 20 years ago who sends me Christmas cards every year.
So, yeah, it definitely is very, it is a privilege to be able to take care of people and meet them where they are.
And our job is a privilege. And for me, that takes a little bit of the sting of all of the rest of the challenges that healthcare, I mean, healthcare is not easy.
But when we keep our focus on, you know, my focus is, and my entity, hospice entity, has yet again been bought and sold.
So there’s a lot of unknowns, okay? Yeah, and as I tell my team like let’s just keep the focus on what’s important which is I want to make sure all of us are taken care of.
I want to take care of my team, make sure they’re healthy, make sure they have what they need.

[46:11] And that allows us to give the best care to the patients and their family.
Dr. Darrell Bock Well, Mary Beth, this has just been a really inspiring conversation for me. And I can’t tell you how grateful I am that you took the time to be with us. That said, we’re at the point in the program where we should do what we came here to do and that’s get me out of the way. So, audience, I’m going to close my mic for just a few minutes and Dr. Mary Beth Crawford is going to share with us her personal prescriptions for success.

[46:45] Well, thank you, Randy. I really appreciate our conversation today. You are just a pleasure to chat with and thanks for the opportunity to share my thoughts. You know, I guess I’ll simply start by sharing my idea of what to me success is. Success to me is not a title I have. It’s not how much I have. It’s about doing what I love to do, doing what I’m passionate about, and loving doing it, even when it’s like challenging and messy. And success to me also is about being who I truly am and loving who I am just as I am with all the sort of, and I think over the years I’ve sort of broadened that into what I call a sky mindset, which really allows me, I picture it as when I’m flying in an airplane and you go up above the clouds and maybe there was a storm and so there’s lightning and storm and all these things but you’re way above it, you’re way above the challenges, you’re way above all the kind of noise of life and man right there that’s where I find this really peaceful and flexible mind state that allows me to foster this like state of being with things.

[47:52] Just as they are without trying to resist and without clinging to them and without letting them overwhelm me. And then I think, okay, what now what? What can I do now? What can I do to help? What can I do to adapt? How can I grow? How can I learn? Because I always want to learn. Some other things, maybe just, you know, the fact that a lot of us are really big goal setters and big achievers, particularly in medicine. And I just, I guess I want to suggest that one of the things I’ve learned that brings me much more happiness and contentment is that I go ahead and I like create and I nurture all my intentions and my aspirations, I really let go of any specific expectations, or at least I hold them very loosely.
And that really allows me a lot more peace and contentment. And other things that really particularly in my life with a lot of things between, you know, the loss of marriage, loss of an intact family, the loss of, you know, pregnancies is learning that my circumstances and my experiences, they don’t determine my happiness or how I I live or how I feel.
It’s my responses and the narrative that I tell about my circumstances that determines my happiness, my contentment, my enoughness, just being enough.
The other things I’ve learned over the years, particularly probably when I was, you know, in the early stages of my single parenthood and it was really rough and I’d go out to dinner and maybe the waitress wasn’t so great and I thought to myself, you have no idea, I don’t know what’s going on.

[49:20] She could be going through something horrible, maybe she’s a single parent aren’t working five jobs, maybe she’s, I have no idea.
And so I always try to believe to stay open.
You don’t know what people are going through, you don’t know their story, and to avoid judgment, and respond with kindness.
So that waitress that was like really on a struggle bus and I didn’t know what she was going through, she got a tip that was probably the same as what the cost of the dinner was.
And my kids always thought I was crazy and I’ve taught them over the years that we just don’t know and we have so much to be grateful for. And that simple point of responding with kindness, it’s good for the world as a whole.
Not only does it help me, but it might change their entire trajectory of that person’s life, and it’s good for the entire world.
A lot of things I’ve learned over relationships, my children are my greatest teachers.
And with their help over the years, I think I have a PhD in humility.
And one of my sons, Rigby, he has taught me in a very specific language, the hey mom, you know, sometimes if I call you, I just need you to listen and be there.
So I guess it’s important what I’ve learned to just simply be present and listen, particularly in your close relationships and resist the urge.
To solve or fix everything and everyone. Sometimes you gotta just let it be, and they figure it out themselves.

[50:42] And I remember, you know, whether it’s hospice or emergency medicine, home, my, the reality is, absolute reality is that anything can happen to anyone, at any time and for absolutely no reason.
And whether we think we are or not, we are not. No one is immune to that.
So, I really focus on appreciating and embracing each day, each breath actually, for the miracle and gift that it is.
You know, I have a big mindfulness and meditation practice and it really has drastically changed my life.
And just remember, those are really simple things. It’s, you know, two minutes in the shower, it’s 30 seconds of just focusing on your breath.
It’s really the simplest of things that make the biggest difference, particularly when they’re done consistently or frequently.
So I guess to end, Randy, I’ll just share my mantra in life, which is today is really a gift, and tomorrow is not a given.
So I focus on being aware, being intentional, and really watering and healing my relationships in real time, like daily, you know, don’t wait, just do it daily, much healthier.
And I try to really just listen with curiosity, with a specific intention to understand, not, to be heard and to be kind and generous and love deeply always, because life is short.
So why not live it well?

[52:05] And again, Randy, this has just been so much fun and I love just the conversational approach.
I love what you and Rhonda and MD coaches are doing.
And I appreciate your time today. Well, you are very kind and it will come as no surprise to you, I hope, that I have really enjoyed the conversation.
What you’ve delivered to us in the last three, four, five minutes.
It really warms my heart. There’s so much wisdom there.
And I can’t thank you enough for being here to share that with us.
Before we go, I do want to give you an opportunity to let our audience know where you can be found, if you would like to be contacted, where they might see you, appearing at events and things of that nature, please let us know.

[52:54] Sure, you know, I really don’t have much of a social media presence, I’m kind of a, nothing against it, I think it’s great.
I have a lot against it, and I’m glad to know that there is one more person on the planet who feels like I do about social media.
Yeah, I mean, I do have a few. With that absolution, my dear, go ahead and tell us what you have to say.
So, if anyone wants to share a story or contact me for any reason, my email is simply Crawford Marybeth at iCloud.com which is C-R-A-W-F-O-R-D-M-A-R-Y-B-E-T-H at iCloud.com. More than glad to have you know anything if you have comments, concerns, if you want to reach out, share a story, anything because I think really you know life is great and when we think about the fact that we all have this like shared humanity and we can bring some humor and humility into it, it’s just a lot of fun. So yeah if anyone wants to reach out to me and I don’t have anything in the books yet, per se, but trust me, it’s coming.

[53:54] Dr. Mary Beth Crawford, this has been absolutely delightful. Thank you so much for being with us on The Scriptures for Success.
Absolutely. Thank you, Randy. Thank you so much for listening with us today. If you enjoyed the show, you can help us reach more listeners by leaving a rating and a review, especially on Spotify or Apple Podcasts. And And if your app doesn’t have that option, just leave us an email or a voicemail through SpeakPipe at www.rx4successpodcast.com.
You can also help us by becoming a Patreon member.
That link is in the show notes. And we hope you’ll also follow our companion podcast, Life-Changing Moments, with Dr. Dale Waxman.
Special thanks, as always, to our producer, Craig Clausen, our promotions manager, Marianna and to Ryan Jones, who created and performs our theme music. Remember, be sure to fill your prescription for success with my next episode.

[54:55] Music.