Solving For Joy

Chrissie Ott MD (00:00)
Yes.

How we spend our time is how we spend our lives.

Kemia M. Sarraf (00:02)
Yeah. that's exactly right.

flex the muscle, right? Joy is a muscle to be flexed. think hope is a muscle to be flexed. say that courage is as well.

Certain things I will not debate. I will not debate my humanity. That's not up for debate. Right?

Chrissie Ott MD (00:19)
Yeah.

it is so easy for our brains to think joy is for the good times and trauma is for the bad times, but time actually is all inclusive.

Chrissie Ott (00:32)
You're listening to Solving for Joy. I'm your host, Dr. Chrissie Ott, a multi-boarded integrative physician and professional certified life and career coach.

Chrissie Ott (00:42)
This podcast is about joy, what it means, how we find it, and the creative ways people are solving for it in their

Chrissie Ott (00:49)
own lives.

I'm so glad you're here.

Chrissie Ott MD (00:55)
Hello everyone and welcome to today's I am very grateful and honored to bring my friend. Dr. Kemia Sarraf to you today Dr. K as she is well known is an internist the CEO of Lode star coaching a trauma-informed coach and public health professional

And she runs a small working farm in Illinois with her amazing husband of over 20 years and is mom to four sons. Kemia is one of my true inspirations in this field. And I have to tell you that three years ago, four years ago now,

She was one of the keynote speakers at the Physician Coaching Summit and the day that we spent talking about trauma-informed coaching has lingered with me in more ways So it is truly an honor to call her friend and to get to share a conversation here with you today. Welcome, Dr. K

Kemia M. Sarraf (02:05)
Thank you. you believe it's been that long? Sheesh, it feels like yesterday and it feels like decades ago. I mean, I guess time has been weird that way.

Chrissie Ott MD (02:09)
Mm-mm. I can't.

That's right. I remember meeting you. And then we also had the, you know, KFG group in common, which is a Facebook group for women physicians who have supported a beloved through a cancer you were way past the nadir of yours.

Kemia M. Sarraf (02:31)
I was coming on the back end. I was on the back

end of that and you were in the middle of it as I recall.

Chrissie Ott MD (02:35)
⁓ yeah,

that's right. I was just diving in. But it's so and fortifying to know that that community exists. If there's anybody out there who doesn't know and who needs that, ⁓ it exists. And it's amazing resource for people.

Kemia M. Sarraf (02:47)
Yeah.

Chrissie Ott MD (02:51)
We love to talk about joy and all the different ways people solve for joy. I'm really interested in bringing in ⁓ some really personal joys for you and also thinking about the concept of joy as it relates to your work in trauma-informed coaching and in trauma-responsive health education. So start with just

Kemia M. Sarraf (03:03)
Ahem.

Chrissie Ott MD (03:18)
What's been bringing you extra joy lately? What has been delighting you and bringing you meaning and alignment?

Kemia M. Sarraf (03:25)
The it's such interesting we're in because you would think, and sometimes it is, you would think that joy would be pretty hard to come by, honestly. When we look around and we see all that is being ⁓ dismantled, destroyed, harmed deliberately.

Chrissie Ott MD (03:47)
Yes.

Kemia M. Sarraf (03:47)
And a lot of the, I think the challenge is in facing down the deliberateness of it all. And.

You Savage, who's a well-known activist, once wrote that, while joy can feel irreverent, matters very, very much. And I'm butchering the quote a little bit, but you'll stay with me, I hope, which is that he used to say that at the height of the AIDS epidemic, we buried our dead in the morning.

We protested in the afternoon and we danced at night. And it was the dance that kept us in the fight. And I think that the lesson in that is that is the joy that reminds us why we do the things that we do. Activist burnout or activist trauma, which is really the more accurate ⁓ assessment of what's

is a very, very, very real and very frequent thing that I encounter, in much in the same way that I responder burnout and burnout and trauma, all of these things. challenge, I think, is to navigate the polarity of all of it.

holding the reality of what is right now in one hand and the hope for we are going to do, what we may do, what we can do in the other. So it's the work that's bringing me joy. It really is the work and the people because they're inextricablly entwined.

Chrissie Ott MD (05:19)
Yeah, there is lot to be gained we are doing the work that is the most meaningful to us. We are being of service to the greater good, how we understand it. And I really appreciate the, bringing up the paradox of finding joy in the dark times, which is certainly something that comes up over and over again. I think that it is.

a drumbeat worth listening to because it is so easy for our brains to think joy is for the good times and trauma is for the bad times, but time actually is all inclusive. It is a buffet of paradox and polarity at the same time.

Kemia M. Sarraf (06:00)
Well, and it's such a muscle to flex, right? I think we don't often maybe frame it up that way, but hope, joy, these are muscles that we flex in the same way the courage is a muscle that we flex. If what we're looking for is spun candy and easy, you know, cheap access to these things, now is not the time that's gonna happen. These are muscles that we need to flex and we need to flex them repeatedly.

because if we don't hold on to that part as we navigate all of gonna something essential about who we are. I mean, I think I'm more concerned about what it drives us to become if we lose that than even that I am

what we do in the meantime. I think it drives us to become of who we meant to be in the world.

Chrissie Ott MD (06:50)
It doesn't get more important than that, in my opinion. And you talked about the people, you know, one of your and truths that you echo over and over again is connection mitigates trauma. that's, you know, that was the one thing you hoped that we would remember from that day. it is certainly one of the many things that I remember that day, connection mitigating

Trauma requires us to notice other people, requires us to be present in our own bodies, requires presence, and keeps us from being isolated with whatever, you know, the mind of hope and fear and trauma is left with.

Kemia M. Sarraf (07:33)
Yeah, you think it's helpful for physicians and other sciency-minded kinds of people to think about the neuroscience that underpins that, right? because connection itself can be challenging right now.

Chrissie Ott MD (07:44)
Yeah, tell us.

Yeah

Kemia M. Sarraf (07:51)
Connection itself can be challenging right now, and it's been

challenging for a while. But it can be really, really challenging when we have been or felt unsafe for a prolonged period of time. So really, if you think about, you know, sort neurobiologically, evolutionarily, we are hardwired in a couple of different ways. I mean, we are hardwired to scan for threat.

Now the flip side of that coin is we are hardwired to seek safety. We're hardwired to look for, assess those cues that tell me I am safe or I am not safe. And the challenge in all of this is that this really, really exquisite threat detection system that we have is not reacting to the moment. It's reacting to everything that has happened to us previously. So it's scanning my environment. It's picking up these very, very subtle cues sometimes. And it's making a decision nanosecond by nanosecond

second about whether I am safe or not safe. And if based on previous experience, the decision is that I am not safe, then I am almost instantaneously thrown into one of four sort of dominant responses, fight, flight, freeze, submit. You know, folks are very familiar with that.

The challenge with times like these is that all of us are scanning more diligently. We've upregulated our scan.

Many of us have had additional exposure to unsafety, unsafe environments, unsafe encounters that have further upregulated our scanning. simultaneously with that, like our set point for activation is being lowered. That threshold for threat activation is being lowered by this repeated exposure. mean, the dose makes the poison. And so,

Understanding that, recognizing that in ourselves allows us to begin to get curious. I think one thing I heard you say, right, like be in our bodies, notice what's happening in our bodies.

We oftentimes become very, very disconnected from everything that's like neck down. And medical school for those, you know, of your listeners who are our physicians, medical school kind of does that to put it liberally. Medical school, residency, fellowship, all of the training, right? I mean, we train ourselves to ignore embodied signals.

Chrissie Ott MD (10:22)
Yes, we do.

Kemia M. Sarraf (10:22)
We ignore the need to sleep, ignore the need to pee, we ignore the need to drink or eat or any of those anything. I mean, to this day, years later, I don't actually notice the signals that say you're sleepy. Great sleep hygiene, I taught myself that.

But my point in this is that there's a lot of value in reconnecting with what are those early signals my body sends because my body is sending me signals about how safe I feel long before my prefrontal starts to pick up on them, long before. And if I can cue into what my brain, what my system is picking up as unsafe.

early enough, I can actually get curious about it and say, am I unsafe or am I uncomfortable? Because our brains do read unncomfortable and unsafe the same way, especially if it's significant discomfort, especially if we've not experienced this type of discomfort before, right? For our med students or residents, this becomes really, important.

Chrissie Ott MD (11:11)
Hmm.

Kemia M. Sarraf (11:29)
Learner safety isn't about feeling OK all the time. It's actually about feeling very not OK sometimes because we're pushing you to grow. That's the job. We're pushing you to do things. That's the job. So it isn't about making everything safe in sense of I feel good, I feel OK, comfort, right? Comfort is the right word.

Chrissie Ott MD (11:38)
Right. That's right.

comfort. Yes, yes, yes,

Kemia M. Sarraf (11:52)
we misinterpret those two things and get activated, that's a problem. Also, sometimes because our threshold for activation, which I use in place of triggered, and we can come back to that later if we need to. But when we activation threshold, can start misinterpreting or mis-queuing what we're actually engaging with. I

to equate or complate the cute little fluffy bunny with a face-eating bear. And that's human. Yeah, that's a human thing. And then here's the real kicker, I think, right The real kicker impact of chronic uncertainty on the human nervous And it really can't be

Chrissie Ott MD (12:20)
Yes, conflation.

Kemia M. Sarraf (12:41)
the War College runs a nine-month course on how one maps and navigates Uncertainty, mapping uncertainty. Okay. Why does this matter? the impact of chronic high threat uncertainty on the nervous system is absolutely exhausting. It, again,

Chrissie Ott MD (13:02)
Yes.

Kemia M. Sarraf (13:03)
up regulates our scanning, it lowers our threshold, it diminishes all of the sort of the autonomic functions that we rely on that help us conserve energy. All of that falls by the wayside. It increases our cognitive biases, including negativity bias, loss aversion bias, and I think this is the most important part or damning part of the whole thing.

is it diminishes our brain's capacity to receive safety signals. I'm scanning more diligently, I'm reacting more explosively to whatever it is that I encounter, right? Small things become big, big things become huge, and my brain stops even picking up whatever signals may be coming at me that say I'm safe. This is a recipe for catastrophe. So,

Metabolically speaking, uncertainty is unbelievably taxing is a very ATP state. And you push people into very high uncertainty and you leave them there for a really prolonged period of time and the brain begins seeking an either or answer a binary. the reality is very, very rarely is the answer in the binary, right?

Chrissie Ott MD (14:21)
Right.

Kemia M. Sarraf (14:21)
Those days with

an absolute wrong and an absolute right tend to end in a body count. Other than that...

Chrissie Ott MD (14:26)
It is an energy saving cognitive

distortion that leads down very bad roads for relationships and for city, and countries.

Kemia M. Sarraf (14:30)
That's right. That's exactly right.

This is exactly right. And yet when you think about how much uncertainty has been injected, how long we have asked people to swim in uncertainty, I mean, I just think back to COVID.

look being able to be in that mess of uncertainty for a prolonged period of time, that also is a muscle that gets flexed, right? I mean, there is capacity that we may have that can be increased in this, but at the end of the day, we are these biological creatures who just run out of ATP and some run out of it sooner. So just thinking back to 2020, right?

healthcare heroes, know, mask up to save everyone. I there wass a period of time, it was short, we almost don't remember it, but there was a period of time when we really came together to support, to protect, where there was some under...

Chrissie Ott MD (15:35)
Yes, I'm remembering the pots and

pans banging on the porches for that one moment.

Kemia M. Sarraf (15:41)
Yeah, I mean, there was a period of time, right? Now, fear, the initial, you know, fear drove us towards that. there was some period of time where that existed. And the challenge was, I think in public health, as is always true in public health, the messaging of this was very hard.

It was very challenging because people do want clear concrete ⁓ binary, right? Or they at least want clear concrete answers and steps. And the challenge with science is that science, by definition, doesn't have an answer. We are continually seeking the next thing.

And if you haven't been trained in the scientific process, if you haven't been trained in what underpins public health and good public health procedure and policy, this begins to look like a bunch of people who don't know what the hell they're doing that are telling us to stay indoors and mask up and right. The perception got very, very skewed why things kept changing.

not because people were idiots, but because we were all figuring it out at the same time, right? And what that meant. And so then what does the un, I don't want to say the untrained brain, but the brain that is unaccustomed to that level of prolonged uncertainty begin to It gets exhausted. And we saw it go into, I mean, listen, there were folks who locked themselves down and in and just

Chrissie Ott MD (17:00)
Yes.

Kemia M. Sarraf (17:19)
to extremes that were detrimental to their health, not just their socio-emotional wellbeing, but their physical health, because they weren't getting checked on things that needed to be checked on. And on the other side, right, we had folks who got diagnosed with COVID in the ER and deliberately coughed in their doctor's face. I mean, these are not made up stories. That's what happens when the brain's like, I can't take it I gotta get a rest.

Chrissie Ott MD (17:47)
And you know, this is reminding me of our current moment, prolonged moment of identity politics, because identification feels like certainty, which feels like a dopamine hit, right? And opposition to that identity or certainty has been evoking disgust and disdain and disconnection rather than curiosity embedded in connection. And that

does make it so hard to connect, which makes it impossible to mitigate that trauma. I mean, we can connect within a group, but then we're still swirling around in our echo chambers, getting more and more hits of that dopamine certainty identity

Kemia M. Sarraf (18:30)
The shortest distance between two people is story. It is very, very challenging for me to sit and bear witness to someone's story and feel disgust, disdain, all of those emotions that you talk about, those drivers, those things that drive us apart. And as you correctly point out, the challenge right now is how do we access that story?

Chrissie Ott MD (18:34)
Yes.

Yes.

Kemia M. Sarraf (18:55)
How do we access a story that is different than mine?

Chrissie Ott MD (18:58)
Absolutely. And we're recording this the week after Charlie Kirk was shot. And so this will play some weeks after that, but everyone will remember this week. They had somebody in their life who had a different response to this. ⁓ And it's been surprising to me to find out how differently we are being sort of fed information and pandered to and that they are

Kemia M. Sarraf (19:13)
Absolutely.

Chrissie Ott MD (19:26)
simultaneously opposing truths.

Kemia M. Sarraf (19:28)
I think that's a really, I like that framing and I wanna be clear in the same way that I was clear when 500 shots were fired at the CDC a few weeks ago, which we've already forgotten and moved on from, right? 500 shots. This was a domestic terror attack on the CDC.

Chrissie Ott MD (19:47)
I don't even.

I don't think I even heard about this.

Kemia M. Sarraf (19:59)
Naming things correctly is really, really important, right? Charlie Kirk was assassinated.

for the words he said, for the words he said, is what it appears to be, right?

the hallmark of America, the foundation of America is that, well, the things you say may make my blood boil.

Chrissie Ott MD (20:34)
will die for your right to say.

Kemia M. Sarraf (20:34)
You have the right to say

them as I have the right to my full-throated rebuttal.

And the silencing of that is a fucking tragedy. Every single time it happens. Every single time it happens, yes. And I think the thing that is really important that you already alluded to, and I would really encourage every single one of us to explore is, huh.

Chrissie Ott MD (20:52)
in whatever direction it happens.

Kemia M. Sarraf (21:07)
is the danger of a single story, frankly, is the danger of a single story because there is very much a single story that is being circulated in two very different I don't know how even to say that without othering us, but I am telling you that one newsfeed

whether that's a news newsfeed or a Facebook newsfeed or an Instagram newsfeed or whatever you want to call it, right? One newsfeed is presenting only a certain version and the other only a certain version.

it matters what we say. to be perfectly honest, I did know, I mean, I think the name, but I did not know much of anything about Charlie Kirk prior to his assassination.

Chrissie Ott MD (22:06)
me neither.

I had to look up who he was.

Kemia M. Sarraf (22:12)
Right. And because I do know that algorithms and churn, right, and echo chambers and confirmation bias all are going to lead to very, specific conclusions for me. They are not allowing me to come to my own conclusions. They are concluding for me and feeding to me. I was very aggressive.

about figuring all of reading, watching, listening so that my conclusions were actually mine. Now this is really important because I don't think we do this very often. But I also think that what can happen quickly is once I've decided that my position is right, particularly when it is a position rooted in my morals and my ethics,

I can begin to shut down the human being sitting next to me who is having a very different lived experience with

It is important to me that I stay in conversation with people whose lived experience is very different from mine, if only because I don't know how the story ends.

And I fully believe that I cannot possibly ever hope.

to move the story or growth for anyone in the direction of love, peace, acceptance, joy, kindness.

if I am unwilling to be that is a very, very, very privileged position I am able to take. I want to say that because that's important. This is not something everyone can, needs to, or is expected to do. I have no expectation. is something that I am sometimes more willing and more able to do than other times.

but is important to me because when we lose dialogue, we lose.

Chrissie Ott MD (24:38)
Yes. It calls me to say too, resolving difference is not the goal. Relating across difference is the goal.

Kemia M. Sarraf (24:45)
No.

There's a difference, yes, yes, there's a difference between dialogue and debate.

Chrissie Ott MD (24:53)
Yeah. Yes.

Kemia M. Sarraf (24:55)
Certain things I will not debate. I will not debate my humanity. That's not up for debate. Right? My full full your full personhood, my personhood. That is not up for debate.

Chrissie Ott MD (25:01)
Yeah. Yeah.

Kemia M. Sarraf (25:09)
Dialoguing, however, has to be a part of our experience because all genocide begins with language.

And if I allow myself to think that I am exempt from that.

I'm lying. All genocide begins with language and it is the language of other.

Chrissie Ott MD (25:33)
powerful. That is a powerful

Kemia M. Sarraf (25:37)
And it's a really, really, I think it's a pretty short, it can become a very short path when fear and disgust and disdain all get crowded in there with it.

Wow, that got dark. Where's the joy?

Chrissie Ott MD (25:56)
That got deep and dark.

But you know, it's good to grapple. It's good to grapple in this conversation because we also live in this 24 hour period where we're going giggle and enjoy connecting and hug someone hopefully. And that also exists. so deeply understanding the darkness.

without being swallowed by it is what I hope we can vision of in this conversation. We can't, know, Pollyanna our way into joy in the midst of this moment. We have to be an integrated resource for ourselves, for the people that we impact, the people who

need to see another human grappling and including joy despite many reasons to be downtrodden.

Kemia M. Sarraf (27:00)
Yes.

I think that that language of other.

over there rather than we us, rather than the language of connection is a pretty short path to hate.

And when you couple hate with fear, and there's more than enough of that going around right now.

Nothing good comes of that. That is a combination that will have

doing things and justifying them in your mind.

Germany, at the beginning of Hitler's rise to power, was filled with Germans who did not agree with their whole chest with what he was doing, did not fight with their whole chest what was happening. You know what we call those people today?

We call them Nazis. Right? So I think that that becomes the question if ever wondered who you would be in have very, very dear friend who is a descendant of formerly enslaved Americans and there a mental exercise I know they have done at times like who would this person that I'm engaged with have been?

Chrissie Ott MD (28:04)
See you

Kemia M. Sarraf (28:28)
in the day, right? Who do I think I would have been? Who would I have been? Who would I have wanted to be looking back at those times? are my actions today, yeah, am I, are my actions today in alignment with who I want to be?

Chrissie Ott MD (28:39)
Right.

quietly complicit or inaction.

Kemia M. Sarraf (28:52)
with a story I want told about me at the end of all of this? And the answer to that is in my life, always no. Because I have visions of superhero dumb. And it's good to have at least that thing that you're shooting for. Because another truth is that we just become more of what we do every single day.

Chrissie Ott MD (29:12)
Yes.

Kemia M. Sarraf (29:13)
and become more of who we are.

So the invitation is to choose carefully, right? I have, by the way, in case you're wondering, I don't know if this is video or not, but I have two mugs of coffee in front of

Chrissie Ott MD (29:25)
What is the difference between the two?

Kemia M. Sarraf (29:28)
One is colder than the other.

Chrissie Ott MD (29:29)
That's hilarious. Coffeeed

up.

Yes.

How we spend our time is how we spend our lives.

Kemia M. Sarraf (29:40)
Yeah, that's exactly right. So flex the muscle, right? Joy is a muscle to be flexed. think hope is a muscle to be flexed. And I would say that courage is as well.

Courage is a muscle to be flexed. I think most of us probably have some thoughts somewhere in our heads that when called upon, there will be a moment of great valor, right? Like we will step up and behave as we intend in the critical moment. And I think that's foolishly romantic. ⁓

Chrissie Ott MD (30:22)
I agree.

Kemia M. Sarraf (30:24)
I think that courage is a muscle that is flexed in a thousand small ways leading up to the big moment when we make a decision about what we're worth and what our beliefs are worth.

Chrissie Ott MD (30:40)
Yes.

I'm enjoying that we went here and feeling also.

what I imagine many listeners might be feeling, which is a swirl of like, but what can I do? Right? But what can I do? We know that posting our thoughts on social media is not the same as activism. that we can be in echo chambers and we can do, know, values signaling is what I'm gonna call it rather than virtue signaling, but.

we can signal and we can try to communicate and we can also join people in the streets. We can put our bodies at risk, especially those of us who have privilege to do so.

I also acknowledge that that sounds pretty frightening for people who haven't done that much before.

Kemia M. Sarraf (31:33)
And we can support food banks. And we can knock on a neighbor's

Chrissie Ott MD (31:35)
Yeah.

Yep.

the

Kemia M. Sarraf (31:39)
It adds to or detracts from a collective whole. And I think that that's actually really, really important because I think it's one of the places that people get stuck.

If I can't do everything, then I can't do anything. And I am just gonna be the first one to put my hand in the air and say that I can fall into that, right? But the reality is that we can start really close in with the next encounter that we have, with remembering that every single person around us, just like me, is scanning just like I am.

and that every single person around us, just like me, has a nervous system that has been in overdrive for a pretty long time. Maybe this is assumptive. Maybe this is an overgeneralization. Let's say it's 80%, even if it's 80%, even if it's 60%.

I would say we're all safer if I don universal precautions and behave as if and then decide how I'm going to show up. How am I because I can't control all the things out there. I am a really at the end of the day, have zilchow power. I can choose how I'm going to show up for the next person and the person after that and the person after that, whether I'm going to be a cue of safety for them.

Chrissie Ott MD (32:47)
Yeah.

Kemia M. Sarraf (33:13)
or whether I'm gonna further heighten their nervous system, further activate their nervous system. So those kinds of things I think also matter.

Chrissie Ott MD (33:24)
As a witness to you being in the world, I will reflect, take this moment to reflect that you have a established practice of being a cue for safety, a place of warmth and resource. just want to acknowledge that.

Kemia M. Sarraf (33:36)
Mmm.

Well, thank you. And so I would ask you, because this is maybe instructive, what do you notice? Because those things, they're not accidental.

Chrissie Ott MD (33:58)
Right.

Kemia M. Sarraf (33:59)
Right? So what are the things that you notice? Because when we name the things we notice that make us feel safer, when we're explicit in that way, not only then those become the things that maybe we put into practice, but that also tells the people around us, what cue safety? Right? I say be a cue of safety. People are like, what the hell is this woman talking about? Be a cue of safety. Okay, I'll walk around with a white flag.

Chrissie Ott MD (34:24)
Yes. I would say that there are expressive facial expressions, expressive cues, warm eye contact. There are other body language signals too probably that my nervous system recognizes, but I might not even always be able to vocalize. vocal modulation. There's pacing.

there's attention, like how one attends to the other.

So those are things that come to mind as I think across various interactions, knowing that this is your practice in the world and it's really important to you.

Kemia M. Sarraf (35:06)
Yeah, good noticing.

Chrissie Ott MD (35:07)
I have ⁓ experience

of being a resource and warmth to people. And I also have experience of having people perceive me as intimidating. And I don't wish to ever be intimidating. It makes me smile and laugh to think what a goofball I am at karaoke and that people could possibly find that same person intimidating. And also it's true based on what am I doing with my own

Kemia M. Sarraf (35:17)
you

Yeah.

Chrissie Ott MD (35:37)
nervous system signaling how safe do I feel in that moment. What is happening in the invisible world of power dynamics in these moments.

Kemia M. Sarraf (35:48)
Yeah, what a beautiful noticing that is right there too, right? Because what I heard you call in is that power and privilege come into play as well, right? And when, one of the things that I notice is that when I, when I am feeling less safe, when I am feeling less comfortable, when I am

Chrissie Ott MD (36:00)
Yes.

Kemia M. Sarraf (36:11)
under threat for whatever reason, right? It doesn't necessarily have to be face eating bear threat, right? It can be professional threat. ⁓ It can, whatever. I fall back to Professor Serov. I can get really, you know, together and I can go into like neuroscientific mode and we're gonna talk about the, you know, you know this, we know this, we recognize professor mode and

Chrissie Ott MD (36:37)
It's... we don a whole other

body and sit differently.

Kemia M. Sarraf (36:41)
Done, yes, I send my body double in, right?

And actually, much in the same way, I had to retrain myself to notice what was happening from here down. Actually, that had become such a familiar persona for so many years, because again, that's part of our training in academia, that it really took me some time

to notice when to step into it, because sometimes it's worth stepping into. Sometimes, but I want it to be a choice, not a default. I want it to be choiceful and purposeful, not because I am afraid, but because I am deliberately trying to convey something in that moment. And part of unlearning or relearning, right, that pattern,

was a little sticky note that I had on my computer for a long time. said, default to your humanity.

When you're teaching, when you're speaking, when you're whatevering, default to your humanity. If I do that, I am much less likely to do harm.

And that, that's our whole ethos, do no harm. Lead with that, and for me to lead with that, that means I have to remember to default to my humanity, not my professorship, not my doctorship, not my whatever ship, defaulting back to humanness.

Chrissie Ott MD (38:01)
⁓

That is such a pithy potent ⁓ pivot also for identity politics, right? Default to your humanity. If you the far left or the far right of any given experience default to your humanity, we're gonna meet somewhere in the middle if we all default to our humanity.

Kemia M. Sarraf (38:13)
Yeah. Yeah.

I heard someone say the other day, I love humanity, it's humans I don't like. And I thought about that for a while and I thought, I get what they're, I got what they were driving at, right? And it was a joke that was, you I thought the reality is, I really like humans.

Chrissie Ott MD (38:32)
Yes.

Yep.

Kemia M. Sarraf (38:47)
I mean, it comes back to that the shortest distance between two people is story. In public health, we go to where the humans ideally in in the second responder work that we do, right? We go to where the people are, we don't expect them to come to us. And when you go, you are instantly transported into their story. And that's such a valuable, privileged

opportunity to connect and to grow and to stay out of that danger of a single story as well.

Chrissie Ott MD (39:22)
It really is. Speaking of story, tell me about the turning point for you. How did you enter this force field of trauma informed I'm going to use the word radicalized you. What is that story?

Kemia M. Sarraf (39:39)
It's a long one. ⁓ Well, it's a long one and it's a thread that runs through my life. So I'll try to pick a few key moments. I think it's important to say that I went to public health, I got my master's in public health before I went to medical school. I didn't understand this was important until several years after I completed residency actually. And what dawned on me,

Chrissie Ott MD (39:41)
Okay, what's the podcast length version?

Yeah.

Kemia M. Sarraf (40:06)
was just took a, approach than my colleagues who went to medical school first, right? Medical school is about the patient in front of you. Public health is about the context, right? And so for me, was always about the patient in context. And I just didn't...

Chrissie Ott MD (40:18)
Yeah. Yeah.

you could see the forest and the

trees.

Kemia M. Sarraf (40:24)
Yes,

and I just didn't know that that was different. honestly, I didn't see that that had informed my experience differently than many of my colleagues. So then in the early aughts, ⁓ we had now moved to central Illinois and I was in the process of sort of building up and out a...

public health intervention that eventually turned into a nonprofit organization around child health, family health, wellness, community health and wellness. And I was doing research because that's what one does, right? what was sort of what was the data showing us about the childhood obesity epidemic? Is it as straightforward? The answer is no, because nothing ever is. Is it as straightforward as too much TV and

you know, too much. I think at the time it was, we were just blaming sugar in television or whatever. Okay. And I came across the ACES study, which had its birth in an obesity clinic. So the original researcher, one of the original researchers, Dr. Vince Felitti, was an obesity physician in California, internist.

Chrissie Ott MD (41:25)
Mm-hmm.

Kemia M. Sarraf (41:37)
So that's how I stumbled across the study. I mean, it was like one of those, ⁓ moments, right? And I just remember thinking that. And so I went on to become, and by this time SAMHSA, Substance Abuse Mental Health Services Administration had recognized the power of this study. It was a very powerful study, frankly.

Chrissie Ott MD (41:40)
Yeah. huh. huh.

Kemia M. Sarraf (42:00)
and had begun to implement this as a public health initiative sort of writ large, but really had developed sort of those SAMHSA principles of trauma-informed care, trauma-informed practices. And I went through all of that. became a trainer, the whole thing. And for the next however many years that I ran H Kids,

it was central to what we did, right? So our programs were based in trauma-informed best practices. Our board was trained. Our staff and volunteers were all trained. We did this over and over and over again. So it had become sort of the ARI breathe. And that was about 13 to 15 years that it closed it in 2018.

what became apparent to me as I was sort of reading everything I could read, learning, evolving the practice and what it meant to teach this as well as what it meant to be this or become this, which is actually more to the point. I got that language from Ibram Kendi he talks about becoming anti-racist. There's no being, there's no finish line, right?

What I really tuned into was the fact that so many organizations, institutions, et cetera, that claimed to be trauma informed, what it really boiled down to, parboiled down to was that there had been a training, right, a knowledge acquisition, the exchange of some knowledge about trauma and trauma-informed practices. You know, the basic trainings that were being taught back in the day were, you know, a couple hours. And, and,

It was a boil down to basically a list of do's and don'ts that applied to them. So immediately you're othering, right? Them, whoever them is, them the client, them the patient, them the whatever, right?

I want to be really, really clear here, I'm not dismissing or diminishing that because the field of trauma is younger than me in many ways. But the arc of this has been pushing towards this idea that it really has to be, in my opinion, has to be about

recognizing that it's not about you, it's about how we are engaging with each other. And that, again, coming back to I am taking these things and saying it's just those people over there, and not recognizing and acknowledging, it's actually me too, right?

Chrissie Ott MD (44:31)
100 % penetrance.

Kemia M. Sarraf (44:33)
I thank you, right, that I have the same nervous system, that I have the same scanning for threat, be it social threat or physical threat, that my hard wiring is the same as everyone else's, then I am really just clinically distancing myself and saying, yeah, you people over there, let me come take care of you. It's very paternalistic and it's not as helpful as it is when I say, we are all the walking wounded.

including me. And there is an opportunity for those wounds to become incredible sources of wisdom if I can skill myself to that transition. And so this concept, which seems to be everywhere now, but this idea of it being beyond trauma informed. And I started talking about, look, we need trauma responsive engagement.

And this was back in 2015, 2016, which was about the same time that I got tricked into attending coach training. And this is the truth, verifiable. This was fairly early in Joseph's diagnosis. My eldest son had been diagnosed with acute lymphoblastic leukemia.

Chrissie Ott MD (45:42)
you

Kemia M. Sarraf (45:55)
And it sort of, as that does when it's your child, it sort of brought a screeching halt to a whole lot of things. And Joseph is fine, dear listeners. ⁓ And there was a very extended period of time where I stepped away from everything. I had the privilege to do that. My husband's a physician as well. And so we were able to be okay with me being home to take care of him. And as my dear friend, who's also a physician, said, run a damn ICU out of your living room. It wasn't quite that extreme though at times.

it felt it and she banged on my door in February of 2015 and said I've talked to Jeff he's home this weekend you and I are going on a trip in February where are we going we're going to Baltimore Baltimore in February really she says you need CME we're going to get CME I'm like there's not CME in Hawaii or something she says come on we're going to we're going to Baltimore

I may have argued with her a little longer and finally I think she won me over with the promise of room service. So I trundle off. Now it is a testament to how underwater I was. I didn't even ask her what kind of CME we were going after, right? I'm just like, whatever, room service, zombie. We get to Baltimore and show up and it's a very small group of nine and we get started in this.

Chrissie Ott MD (46:55)
you

Yeah.

Kemia M. Sarraf (47:18)
and it is a coach training intensive for physicians.

And I grabbed my girlfriend at the first break and dragged her outside and I said, what have you done and why didn't you tell me? And she says, see that look on your face, that look? That's why I didn't tell you. your ass back in there, Sarraf and learn the things. What I will tell you about that experience was it was quite life altering for me.

Chrissie Ott MD (47:36)
You

Kemia M. Sarraf (47:48)
And I will fully, fully, and I've said this on other podcasts, fully admit that really coaching had evoked the largest of eye rolls from me prior to this. I mean, just like pop them out of my head and skittle across the floor kind of eye roll, right? And what I learned to my everlasting benefit, I was gonna say to my shame, but actually to my everlasting benefit is that I don't know shit about anything.

Chrissie Ott MD (48:03)
you

you

Kemia M. Sarraf (48:17)
And it was about time

that I really figured that out again. It wasn't the first time I had been taught this, but it was almost like, it was like I had all of this vision here, but somebody removed so I could have the vision on this side as well. There was this entire skill set that I realized, professional skill set I wanna add, that I realized I didn't have, that I didn't even know existed.

and that by God was gonna make me a better doctor, mother, wife, friend, clinician, all of the things. And it was very pivotal so much so, well two things, the woman who trained me now is one of my partners, because I was like, you gotta come and do this with me. And then called one of my childhood best friends from the airport on the way home and I was like, I gotta tell you what I just went through.

Chrissie Ott MD (48:53)
you

Kemia M. Sarraf (49:12)
and sort of offloaded all of this. It was really shocking.

So I decided that I was going to very bespoke-y, side giggy, whatever you want to call it, just work with physicians. I was just going to do this little tiny, what I hoped would be helpful to my colleagues around physician burnout. Because this is 2016 now, I'm accredited. And I'm like, OK, burnout's a thing. We were hearing about it. I was seeing it, that's for sure.

And so I started doing a little bit of coaching and I'm like, honey, that ain't burnout, that's trauma. And it was just one of those things that was so clear to me, so clear to me. And more important than that, because you don't name other people's trauma for them, so you don't tell them, you just let them come to it. But you can kind of get the background and the understanding. What really became very clear to me was that I was having...

some good success in this paradigm of coaching largely because I didn't realize I was doing it, right? So I'm bringing all of these coaching practices and skills, but I have, you know, already 15 years of trauma responsive underpinning all of this. And it was working. It was working really well to the point that I was starting to get some calls from hospital systems saying, hey, can you teach us how to do this?

And because I always know now, not before, I know what I don't know. I reached back to the woman who trained me and said, hey, know, I'm being asked about this. What do you think? This was a couple years later. And I remember I was sitting in my basement because I heard this like gasp as I'm explaining to her what it is that I'm doing now. Antoinette is a absolutely brilliant coach. She spent her career in the coaching industry.

has coached in some of the biggest places and developed all kinds of programs around this. And she said to me, I remember that she said, this is what's been missing. is what's been missing. This is gonna, oh, I'm in kind of thing. So that, oh, we got a thing. This will change everything. Yeah, no. I mean, the medical field was still very resistant to coaching at this time. Now we're 2018, 2019. And the coaching industry is like, yeah, screw you.

Chrissie Ott MD (51:22)
Mmm.

Kemia M. Sarraf (51:37)
That trauma word smacks of therapy and that ain't what we do, rightly. They are correct, right? But sort of breaking those two walls simultaneously felt at times like it wasn't gonna happen. COVID did it for me. by the, yeah, well, by the end of 2020, there was this,

Chrissie Ott MD (51:57)
Lucky break.

Kemia M. Sarraf (52:05)
new recognition and understanding and willingness to sort of step into the impact of traumatic stress exposure. And I really want to be clear about this because the thing I worry about now isn't that people are unwilling to recognize and see and name, right, traumatic stress or trauma. is now that everything's becoming trauma. And that's not right either.

Right? It is not a weapon to be flung. It is not an excuse that you throw out there that excuses bad shenaniganing. It is none of those things. And it is also not something that you throw out in an attempt to make your life easier. Right? Traumatic stress exposure and trauma are not the same thing.

Chrissie Ott MD (52:49)
Yeah, thank you for that balance. ⁓

and

Kemia M. Sarraf (52:55)
And there's a moment between the exposure and the, you know, not a moment, but there's a period of time between the exposure and the embodiment where we can choose what we're gonna do if we want to disrupt it. That's where all the hope is as far as I'm concerned. That's the joy in all of this. can, ⁓ I don't know how much I'm allowed to swear in your podcast, we can do something about this.

Chrissie Ott MD (53:17)
You can swear, Kemia. It's totally okay. can just... Yes, thank you. Yes, no holds barred.

Kemia M. Sarraf (53:20)
It is not fucking inevitable!

It

is not inevitable. And, and loves of my life in all walks of life, my students, my residents, my colleagues, my children, my friends, my siblings, my all of those things. Hey, traumatic stress exposure is gonna happen. So let's skill ourselves for what we do when it does. The job is hard, the job is supposed to be hard. Medicine is supposed to be hard.

Chrissie Ott MD (53:30)
Mm-hmm.

Mm-hmm.

Yes, we.

Kemia M. Sarraf (53:54)
It is supposed to be hard. We

are signing up to expose ourselves day in and day out to traumatic stress. That's the job.

Chrissie Ott MD (54:08)
Yeah, it is a choice.

Kemia M. Sarraf (54:10)
It is a choice and, and, right, the fact that we made that choice and that decision doesn't mean, right, that becoming traumatized, having trauma and that trauma becoming embedded in us is inevitable. The challenge is helping to recognize, okay, look, traumatic stress exposure is inevitable and I need to do something with that exposure in the moment. I often say, listen, if I'm running a code, you don't want me feeling my feelings.

Chrissie Ott MD (54:39)
That's true.

Kemia M. Sarraf (54:40)
Compartmentalization is incredibly useful and powerful, right? And, and if I don't know what to do.

Chrissie Ott MD (54:42)
Yes, yes, yes, yes.

Kemia M. Sarraf (54:52)
And that's the part we're not taught. What do I do after? What is okay for me to do after? What do I get to do after? What do I need to do after? It's different for different people. What's available for me to do after? What am I seeing other people? Right, what am I seeing other people do?

Chrissie Ott MD (55:02)
What's available for me to do after? What's the menu even? Like if I've never even seen the menu.

The people around me, especially a generation above me tend to never ever, ever show that it ever impacted them at all. So is something wrong with me that I am feeling this later on and I don't know how to discharge this trauma from my body.

Kemia M. Sarraf (55:24)
Yeah, yeah.

And guess what? They did feel it. I have been in rooms. I have been in rooms. I will never forget this, and I'm not gonna disclose any names here at all, but I will never forget being in a room with one of the gods, right? I mean, we know the gods of medicine. We know them when we encounter them in the hall. We knew them when we were walking the halls as residents. We know who these people will never forget being in a room.

Chrissie Ott MD (55:28)
Yes.

Mm-hmm.

Absolutely.

Kemia M. Sarraf (55:52)
And this was a room that they had chosen to enter into because they wanted, at the very end of their career, approaching 70, the very end of their career wanted to reclaim something, their words.

And you know what, when invited into story, what they went back to? A story from their intern year. A story from their intern year that they had carried forever. Forever with them. And the pain they had carried with them forever. There were no mistakes in this story. There were no, nothing.

done inappropriately or wrong in this story. This wasn't a, I killed this patient and I've always, none of that. Just, they lost a bit of their humanity because they didn't have anywhere to go to process the pain of that encounter. And so we tuck it away and we think that's what we're supposed to do. And then we tuck away the next one and we tuck away the next one and the next one.

and the next one, and the next one. And it's like these thin layers of veneer that we put on over until we're just shellacked.

We're hard. And then our students break themselves against that. And our patients break themselves against that. And that is not why we went into this.

Chrissie Ott MD (57:19)
Mm.

No, that is tragedy.

that is tragedy.

Kemia M. Sarraf (57:33)
So how do we unshalak ourselves? Deshalak, deshalakification. I don't care how we term it, right? we cannot expect that the people around us or the people, particularly the kids, they're not kids, they are grown ass adults, but in my brain they're kids, right? That the kids know how to lead, although they sometimes are better than we are.

Chrissie Ott MD (57:38)
Yes, solve it.

Kemia M. Sarraf (57:57)
Or at a ⁓ minimum, they recognize they need something. Somebody give me something, right? Because I want to hang on to my humanity. It's very, very important that we model and we offer opportunity. Boundary vulnerability, okay? This is not falling apart and bleeding our pain out all over the place. That's not what we're calling for. But a beat, taking a beat to say...

That was really hard and that one really hurt me. And I'm gonna take a minute or I'm gonna take a little bit of time. Would anyone like to grab a cup of coffee with me? We don't have to talk about it. I'm not asking you to feel your feeling. I'm just telling you, I need a beat. We just started to model it, right? And we're putting them in choice. I am not about forced processing. We don't force ventilation. We don't force processing.

Chrissie Ott MD (58:39)
Yes.

Yes.

Kemia M. Sarraf (58:56)
We can model it though gently and repeatedly and invitationally and in doing so, particularly when you're the intimidating one, right? Which every attending is, when you are the intimidating one, you've just offered a path, an option that is different than shellacking.

Chrissie Ott MD (59:07)
Yeah, you're the leader.

Kemia M. Sarraf (59:21)
Dechalacification, I think we should trademark it.

Chrissie Ott MD (59:22)
Hmm.

Dechalacification it is. ⁓ Thank you for all of the places that this conversation just went. Kemia, so wonderful. Wonderful to hear and just have discourse with you learn as always. It is a pleasure. So glad that you were out there spreading this work.

Kemia M. Sarraf (59:46)
Right back at ya.

Chrissie Ott MD (59:50)
May this ripple out and impact everyone who needs to hear a message of encouragement and clarification today.

May it be so.

Chrissie Ott MD (1:00:03)
Thanks again to the one and only the fabulous Dr. K. What an amazing conversation. I'm so grateful to have gotten to have this conversation and also to share it with all of you. If you would like to learn more about Dr. Sarraf's offerings, please check out loadstar, L-O-D-E star PC.com where can find out about trauma-informed coaching resources, consulting resources and True North.

her very own coaching certification program. Next week, I am delighted to be joined by my friend and another extremely accomplished woman and physician coach, Dr. Sarah Seidelman. Cannot wait to see you there.

Chrissie Ott (1:00:49)
And if you're a physician coach or coaching curious, the Physician Coaching Summit is coming up. We would love to see you there. Details are at the physiciancoachingsummit.com.

As always, a quick note before we go, I'm a doctor, but not your doctor. This podcast is for education and connection only and is not to be construed as medical advice. Please speak with your own clinician about your specific situation.

Deep thanks as always to our fabulous producer, Kelsey Vaughn, to Su, my partner in all the adventures, and to you. I'm so glad you're here. You're the reason we make this show. Thank you for spending this part of your day with us.

Chrissie Ott MD (1:01:27)
Have a wonderful week, everyone. Be kind to each other and may we all keep solving for joy. See you next time.