Solving For Joy

Dr. Zarya Rubin: I’m like, “Well my gosh, but he’s okay, right? Everything’s fine?” And she just said, “No. He didn’t make it.”

That was the moment for me when I suddenly realized, “Okay. This is it. This is all you get.”

I actually didn’t know I was burned out at the time. I didn’t really have the language for it or the words for it. I just thought, “I don’t know… I guess I’m having a nervous breakdown at 35.”

Dr. Chrissie Ott: It’s just part of the refined unlearning that we owe to ourselves in this phase of life — like, yeah, I swallowed the whole thing, the story about productivity and salvation.

The truth is that joy is a moral obligation. It’s an inside job. Nobody’s ever gonna do it for us.

Dr. Zarya Rubin: It was a really big energetic shift for me to be like, “What do I want my life to look like — to feel like? How do I want to feel every day when I wake up? What kind of freedom do I want to have?”

Dr. Chrissie Ott: 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.

This podcast is about joy — what it means, how we find it, and the creative ways people are solving for it in their own lives.

I’m so glad you’re here.

Hello, friends. Welcome to today’s episode of the Solving for Joy podcast. I get to introduce you to one of my newest, sweetest friends, Dr. Zarya Rubin.

Zarya is trained as a neurologist — she’s no longer practicing that particular thing — and she’s also a functional medicine physician as well as a physician coach. And if you were lucky enough to be at the Physician Coaching Summit this year, you already know what kind of joy and presence Zarya brings. She has radiant, grounding energy, a ton of passions, and we are going to get into a little bit of solving for joy with Zarya today.

The talk that she gave at the summit was about the crossroads — or the intersection — of perfectionism and trauma. Zarya is a burnout expert. She has her own podcast and I will let you say some more about that, Zarya. But welcome to Solving for Joy. I’m so excited to have you here.

Dr. Zarya Rubin: Thank you so much, Chrissie. It’s such a pleasure to be here. And being at the PCS experience was absolutely — I will say it, I get teased a lot for using this word too much — but it was life-changing.

Dr. Chrissie Ott: Yay. Yay for that. So glad that you were there.

We like to start off by exploring how joy is showing up in your life these days. And I have a pretty big feeling about one of the things we’re about to mention. So go ahead — tell us about joy in your life today, Zarya.

Dr. Zarya Rubin: Yes. So I have a lot of joy in my life right now. The new love of my life is my tiny ragdoll blue point kitten named Mochi Donut. We just got him a few weeks ago and…

Honestly, this kitten is pretty miraculous and magical in that he hasn’t really disrupted our lives in a negative way. He sleeps all night. He uses the litter box. He doesn’t cause trouble with the dog. He’s just like a bundle of dopamine and serotonin and oxytocin. I mean, he really is kind of the cutest thing in the world.

I’m biased, but you’ve met him and you can also attest to the fact that he is probably an illegally cute kitten — like nothing on this planet earth should be that cute. So that has brought me a lot of joy. My 12-year-old daughter a lot of joy — even my grumpy husband a lot of joy.

One of my passions is singing. I sing in a local choir, the Portland Symphonic Choir, and we’re gearing up for our big Christmas concert this week. I also conduct a children’s choir and we’re getting ready for our little performance. It’s amazing to be able to share one of those passions with the next generation. My kiddo actually reluctantly joined the choir and she really loves it, so that makes my mama heart very happy.

And I’m also part of a group that’s organizing The Sound of Democracy protest that’s going to involve peaceful singing here in Portland. So those are the things that are bringing me joy right now.

Dr. Chrissie Ott: Nice. I rejoice in all of those. I mean, baby animals really are medicinal.

And I have to say, this is a ragdoll cat — and what I now know, that I didn’t know before, is, one, the softness is unbelievable. And when you transfer this cat, it’s like pouring a cat into someone else’s hands. He’s so passive and so sweet. It’s really, really adorable.

Dr. Zarya Rubin: Yeah, it’s kind of remarkable because cats are often very muscular, sinewy, slightly agitated, and on high alert. And he just relaxes. He lets you cuddle him. He purrs and purrs and purrs. It’s kind of like the unconditional love that you’ve always wanted from a cat but could never have.

Dr. Chrissie Ott: It’s kind of…

Is it actually a hypotonic state, neurologist friend? Do we have hypotonia — but without dysfunction?

Dr. Zarya Rubin: I mean… I often question that myself. I’m like, “Is this cat hypotonic?” But then he will leap and bound, and I sort of joke that he’s half cat, half capuchin monkey, because he will scale walls and curtains and things and have his little tiny face like, “You think I’m a cat? I am not. I am part gecko.”

Dr. Chrissie Ott: “I’m a monkey.” Oh my gosh, so fun.

Dr. Zarya Rubin: So yeah, he’s just a love bug. I feel like I should be offering cat healing ceremony sessions at my house. Come over, pet the cat, all your problems will magically dissipate.

Dr. Chrissie Ott: You know, you did. That’s how we randomly ended up at your house a little over a week ago — to say, “We’d like some cat time.”

Okay, and singing — what an amazing source of joy singing is. Let’s talk about that for a moment. When we open up our throat chakra and actually let music exist from our bodies, there’s so much beauty and healing in that. And the act of singing with other humans is really a high-frequency experience.

Dr. Zarya Rubin: Yeah. So I started singing at a very young age, probably when I was about five years old, in school. I went to a performing arts school back in Montreal, Canada. Singing for me was always kind of like math or English — it was just another class. It was part of my daily routine, but it was something more than that.

We had a very strict conductor who had come over from Wales — a strict Welsh choir master — but he really instilled in us a lot of dedication, commitment, excellence. We worked together really hard and we were able to tour all over North America and Europe, make albums, sing with a symphony. We got to go to Carnegie Hall when I was 15. It was a pretty peak experience for a young girl developing and finding confidence.

I didn’t even know about all of the scientific and neurological medical benefits of singing — in terms of vagal tone, activating the vagus nerve, the synchronicity of being in a group and having heart rate regulation, the fact that it can help prevent Alzheimer’s, depression, all of these things. I just loved it.

I didn’t realize until later in life that, wow, singing is actually really, really good for you. So I encourage everyone to sing. I believe that everyone can sing. There’s this African proverb: “If you can talk, you can sing. If you can walk, you can dance.” I fully believe that. People say, “No, I can’t sing, I can’t sing,” and with very few exceptions — there are some people who are truly tone deaf and that’s difficult — but most people can sing. It’s such a joyful thing. So I do encourage everyone to try it.

Dr. Chrissie Ott: I love that. I hear people say, “I can’t sing,” all the time, and I recognize it as a thought that I clung to since some time in the preteen era.

At some point — I think it was around my 40th birthday — I decided to start having birthday parties at Voicebox Karaoke, which is a private karaoke room. It’s so important to me that you have four walls around you and your friends, so you’re not just mixing with general public. I’m not trying to compete with folks who take karaoke seriously. I am here for catharsis and entertainment, my friends.

So around 40, and for many of the years between then and now, I have hosted a karaoke birthday party or a karaoke holiday party because it is such a release. It is such a fun release where we get to go be our silly onstage selves. Even if you’re inhibited or introverted, people find that it’s fun to hold onto one of the microphones, stay seated, and join in on one of those well-known pop songs. What does that spark for you?

Dr. Zarya Rubin: Well, I find it very interesting to see what people choose for karaoke songs — it’s often hilarious. It’s often very incongruous with who they are. You think, “My God!”

My husband likes to perform “Mustang Sally.” Go figure. He’s quite a serious surgeon, but he crushes — he kills. And I like to do a lot of ‘80s stuff and, of course, musicals.

He actually won the “golden microscope” — I guess they have this golden laparoscope or something — he does minimally invasive gynecologic surgery. At one of their annual meetings he rapped the entire opening of Hamilton — “My Shot” — and he won the top prize for karaoke.

I think we really need to make this holiday karaoke party happen. I’m in. I’ve got Wicked on the brain and I’m ready to “Defy Gravity.” I can do it.

Dr. Chrissie Ott: I feel like we have a date in our future soon.

I love that this conversation is taking its little meandering pathway through the world of singing and karaoke, because it just makes so much sense. And it would be incomplete not to mention what role tango played in saving you from a burnout episode.

Dr. Zarya Rubin: That’s such an interesting story.

My burnout story, in terms of leaving medicine, starts at the end of my neurology fellowship in academic medicine at Columbia in New York City. I was, in theory, at the peak of my career and performance and “success.” I had all the trappings of success. So, in theory, I should have been very happy and fulfilled — but I really wasn’t.

I dreamed about leaving medicine every day, but I thought it wasn’t possible. I didn’t think there was a way to do it because, I mean, who does that? Who walks away from all of that investment — the time, the financial investment, the education, the identity piece, the life path of “This is who I am. This is what I’ve been doing for 15 years of my life”? It starts very young.

I just couldn’t see a way around it or a way out of it. Unfortunately, it took a really significant personal tragedy to snap me out of my stupor of “must keep going, must do this no matter what.” It allowed me the space to think, “Okay, maybe there is another way. Maybe I don’t have to keep doing this. Maybe I can find a way and walk away.”

During that time, I was really at a crossroads. I wasn’t singing when I was deep in medicine because it was too difficult to make that commitment to regular rehearsals and performances when you’re on call all the time and don’t have control of your schedule. So it was really difficult for me to not be singing and performing.

Something just said to me, “You know what? Maybe you should try tango dancing.” Totally random. I had never tried it before. I had been a bit of a dancer. I’d lived in Guatemala and learned salsa and merengue and all those dances, but tango was a whole other thing.

I was living in New York City — there’s a very big tango community there — and I started going to classes in Central Park and really fell in love with it. I ended up going deeper into it, kind of fell down a rabbit hole, eventually going to Argentina to study tango briefly — which is a whole other story.

But it really was a spiritual and emotional awakening, because tango is an extremely intense, passionate experience — musical, artistic, all the things. It was all the things that had been completely shut down for me and turned off in medicine. I was pretty much flatlined, dead inside, in terms of emotion and that emotional world and experience and ability to express things.

Tango really unlocked that for me. I think it was a big part of my journey out of medicine and recovering from burnout. I actually didn’t know I was burned out at the time. I didn’t have the language or the words for it. I just thought, “I don’t know, I guess I’m having a nervous breakdown at 35.”

Dr. Chrissie Ott: So many people don’t have the words for it. They just know that they don’t feel the way they thought they would when they started off on this journey.

I recently read Nobody’s Girl, Virginie Despentes’ memoir. There were a few phrases that really stuck with me outside of the arc of the story of horrific, horrific acts. One was “the compliant body and the locked-away mind.” She was talking about being groomed and sexually abused as a young person and young adult.

But in medicine, we also have a compliant body and a locked-away mind. We continually submit to the processes of systems that can be so harmful and draining.

What I love about the conversation around tango is that sometimes the compliant body is the place to start the intervention. A body doing tango is not in compliance with the system, right? Sometimes just making space in your life for the body doing tango — not being the compliant body — can loosen patterns enough that the mind, too, can begin to not be so locked away.

Creative solutions and joyful solutions — things that have meaning, alignment, and delight — can begin to arise and beckon us back to wholeness and an integrated version of ourselves.

Dr. Zarya Rubin: Yeah, I love that. And there’s also something magical about dance. I know you have a long history of dance.

Sometimes your body is just following the steps and the movements, especially if you are the partner who is the follower in tango. There are leaders and followers — traditionally men are the leaders and women are the followers, but there’s a lot of mixing these days. I was trained as a follower.

That went against every aspect of my personality — shocker. When I was first learning, partners would look at me and say, “Stop leading.” There’s even a term for it — “back-leading,” like backseat driving, where you’re trying to take over.

The act of surrendering and allowing someone else to lead you was so difficult for me, but also very healing in many ways, to not have to think of every single move — literally and figuratively.

Dr. Chrissie Ott: So how did you know? What was the moment when it became clear that this is not what you were going to keep doing?

Dr. Zarya Rubin: It was a bit of a lightning bolt.

Like I said, it had been building up for a long time. I was truly miserable in medicine. I had read House of God in my residency — the famous Samuel Shem novel that takes a dark, cynical view of medicine and his training at Mass General in the 1970s. I think if I had read that book earlier, I don’t know that I would have persisted or continued.

But there were red flags from the beginning. For instance, first week of medical school: I’m dissecting the cadaver. Everyone else is dissecting the cadaver; I’m just sobbing. The professor pulls me aside after class and says, “Are you okay? You must have had a recent death in the family.” And I said, “Nope. This is just how I’m made. I’m extremely sensitive, extremely empathic, almost to a fault.”

She looked at me and said, “You might want to consider an alternate career path.”

My jaw dropped. I was so angry. “Are you kidding me? I have worked so hard to get to this point and you’re telling me I should do something else?” I thought I was going to be a great doctor because I care so much and all I want to do is care and help people.

But I quickly found out that that was almost more of a liability than an asset. That was tied up in a lot of complicated things — personal medical trauma and history that allowed me to be overly empathic rather than compassionate at a bit of a distance during my medical training. It took a massive toll on me.

The early warning signs were there. When I got into my clinical clerkships, I was fainting a lot in clinic and having massive panic attacks. That was brushed off as, “Well, you just have to learn to deal with it. Toughen up, soldier.” So I did. I pushed through it. But those alarm bells were going off. My body was basically saying, “This is not for you. This is not for you.” But I didn’t listen. I’m very persistent and very determined. I kept going, kept going, kept going.

Then in residency and fellowship, I was so exhausted, working insane hours, and, quite frankly, drinking a lot. So were all of my friends. Every weekend we would go out and get wasted. I can’t imagine that was the right thing to do, but that was the culture. We were so stressed out and so alienated from our lives — or I wanted to be alienated from my life because it was taking such a toll. That was the only thing I could do to numb the pain.

Luckily, it didn’t become a long-term problem. Now I don’t even drink. But it was definitely a problem in residency.

In fellowship, I kept thinking that at each stage it would get better or easier — because that’s what people tell you. “You just have to get through X and then Y will be better. You just have to get through Y and then Z will be better.” But that wasn’t the case. Getting through medical school, then residency, then fellowship — it was just getting worse rather than better. That was another massive red flag.

The real wake-up call came when I got a phone call late one night from my best friend from medical school. She called to tell me that her husband had been playing frisbee, collapsed on the field, and they rushed him to the hospital and attempted to resuscitate him. I’m freaking out at this point, but I’m like, “Well my gosh, but he’s okay, right? Everything’s fine?” And she just said, “No. He didn’t make it.”

That was the moment for me when I suddenly realized, “Okay, this is it. This is all you get. This is not a dress rehearsal. This is the performance. And I’d better be happy with my life, because I can’t keep living my life on some layaway plan — thinking and hoping that one day I’ll be happy — when I’m only getting more and more miserable.”

That planted the seed of, “I think I have to quit. I don’t know how.”

Then a couple of weeks later: tango dancing. A couple of months later: Argentina. That was in November. By December–January, I had decided to leave, and by March I had left. I told my program director, at the very end of my fellowship, “I can’t do it anymore.”

Luckily, he was very compassionate and understanding.

So I sort of jumped off a cliff without a parachute — and no regrets. No regrets. A little bit of regret that it took me so long.

Dr. Chrissie Ott: Yeah. It’s a bold move and it’s very counter-culture in medicine.

Our theme at PCS, of course, was having your own back. Standing up to culture with such an opposing position in the name of your own sanity, salvation, safety — really, it’s a powerful move.

Dr. Zarya Rubin: All of those things, yeah.

I mean, literally every morning I would stand on the subway platform and the train would come and I would ask myself, “Should I get on it… or jump in front of it?” I would make this little joke with myself, which was very much not funny given the high rates of physician suicide.

I knew I didn’t want to be a statistic and that I had so much to live for. I just couldn’t keep living my life that way. It wasn’t that I didn’t want to live. It was that I did not want to live like that.

So yeah, it was pretty dramatic.

Dr. Chrissie Ott: And now you’re still helping. You’re still a resource to people. How did physician coaching — and coaching around burnout — enter your life?

Dr. Zarya Rubin: It’s an interesting story.

I was at a crossroads after I had left industry. So after I left medicine, I ended up working at a tech startup and then in industry for a number of years to pay back my debts. I explored the world of big pharma and being an executive and realized that really wasn’t for me either. There was a reason I went into medicine and not business. That was a whole other adventure.

Then I had a baby very late in life, in my forties, and really decided to lean into that role. I had never expected to be a stay-at-home mom, but I was. On the one hand, I absolutely loved it and would choose that again — I’d choose my daughter over anything. But I was getting restless and bored. I felt like I had all this knowledge and experience and brain power and wanted to use it for good beyond just my one kiddo.

I started trying to craft a life for myself. In the past, I had always been asking, “What kind of job do you want? What kind of career do you want?” Now I shifted the question and started asking, “What kind of life do you want?”

It was a really big energetic shift for me: “What do I want my life to look like, to feel like? How do I want to feel every day when I wake up? What kind of freedom do I want to have? Do I still want to be there for my kid — take her to school, pick her up, be there for all the events?” She has a lot of challenges — mental, physical, medical. There’s a lot that goes into that parenting role, and I couldn’t really outsource it.

So I thought, “What could I do that would still be helping people and allow me a lot of flexibility in my life?” Coaching just kept coming up again and again. People said, “What about coaching? What about health coaching?” And I was like, “Health coaching? Oh, that’s like woo for people who aren’t doctors. I don’t know…”

But I gave it a chance because the universe kept putting it in my path over and over again.

I went back to school and trained as a health coach at IIN, the Institute for Integrative Nutrition. It was amazing training. I loved it. I learned so much that we did not learn in medical school but I wish we had — I think we had like an hour of nutrition in medical school, and this was a year of it. It was really eye-opening and enlightening.

I coached in that space for a couple of years and realized, “Okay, this is great, but I want to do more than just tell people to drink water and eat greens and get eight hours of sleep.” So of course I went back to school again and did a three-year training program at the School of Applied Functional Medicine.

Functional medicine felt like the next logical step — to take the health coaching one step further and go deep into root cause medicine and puzzle-piecing: Who is this individual person? What are their circumstances? What’s their history? What’s their life like? What are their stressors? What’s their diet? All the things. Then put that together to create a solution and a preventive path toward healing some of the patterns we see on the way to disease.

We call it “dis-ease” in functional medicine — that place where you don’t quite meet the lab values and diagnostic criteria, but you’re on your way there. Why not close the barn door before the horse is out?

Patients often come and say, “I’m having this and this and this symptom,” these very vague symptoms. In conventional medicine, we’re trained to say, “If it doesn’t meet threshold, if your labs are ‘normal’ and your symptoms are vague, I can’t really help you.”

I wanted to help those people. A lot of the people having chronic stress and burnout issues were in that category. That felt like an underserved area, because that’s often deemed “mental health,” not “medicine.”

For me, after everything I went through with trauma and burnout and then being diagnosed late in life with complex PTSD, I also ended up with autoimmune disease. I know that’s not unrelated. So I wanted to address some of that and those dynamics.

Did I answer your question? That was a long path. You’re like, “How did you get into coaching?” and I’m like, “Well…”

Dr. Chrissie Ott: Yes. I don’t remember the question, but that was awesome.

I’m so glad you did all those different trainings. I know they weave together and make what you have to offer in the world more powerful.

I’d love to have you share a little of the wisdom you shared at the summit, where we were talking about midlife perimenopause and patterns of perfectionism — and how this trifecta can be so, so hard to resist and pull out of.

Dr. Zarya Rubin: Yeah. Happy to share about that, because it’s something that’s near and dear to my heart.

Of course, I’m going back to get even more training specific to menopause and perimenopause care — because I can never get enough school. But I noticed in my own life, being a perimenopausal woman (truth be told), and in my friends and my patients, I kept seeing these patterns in very capable women.

These high-achieving, brilliant, type A, perfectionist women — they’re physicians, lawyers, professionals in some way, or they just work really hard — are hitting midlife and the wheels are coming off. Before, they could sort of do all the things: keep all the balls in the air, spin all the plates, juggle all the things, and somewhat sustain this unsustainable life of not getting enough sleep, maybe eating like crap, maybe drinking too much wine, parenting, working, doing all the things.

Then you hit midlife and all of a sudden it all starts to unravel. Brené Brown calls it the great midlife unraveling. I call it a bit of a midlife wreckoning — with a “W-R-E-C-K.” It’s a midlife reckoning, but you can get out of it without being completely wrecked.

So what happens?

I decided to dive more into the physiology of stress and the HPA axis — the hypothalamic-pituitary-adrenal axis — which is this feedback loop that helps us navigate and mitigate stress. When it’s working well, it’s like: stressful event → hormones released → amygdala → adrenals → cortisol → feedback loop → shut it down. All good.

In perimenopause, the system starts to go off the rails and fail a bit because of hormonal fluctuations. Estrogen, which normally acts as a beautiful buffer for this system — keeping things in check, keeping everything flowing, keeping cortisol at bay — starts to tank. When estrogen drops, that buffer is no longer there.

What you get is a system that is more hair-trigger sensitive. Smaller stressors evoke a bigger response, and you don’t have as much dampening or negative feedback. The stress response remains activated. Cortisol levels stay up. Smaller things cause stress more easily, with a bigger reaction and for longer.

That’s kind of a recipe for burnout right there.

Then you add the sleep deprivation that happens with burnout and perimenopause — that’s another strike. We’re getting to “three strikes and you’re out” here.

Then, like you mentioned, if you are someone with perfectionistic tendencies and/or a history of childhood trauma (and I think they often go together), perfectionism taken to an extreme really is a trauma response. It’s a response of constant hypervigilance and the need for safety and control and navigating and mitigating and saying, “If I can just do everything correctly, then nothing bad will happen to me. I’ll be safe, people will like me, and I can keep the wolves at bay.”

Trauma creates this hypervigilant response that’s there all the time. Your baseline cortisol levels and HPA axis activation are heightened in people with a history of chronic trauma. You’re already at a much higher baseline level — and then you add perimenopause.

Perfect storm.

I like to say perimenopause doesn’t necessarily cause burnout, but it sure does unmask it. It’s like pouring gasoline on the fire.

Dr. Chrissie Ott: Yeah. Wow, that’s a lot. It’s like an accelerant.

That is so much to think about together. I love that — I don’t think I’ve ever put them right next to each other the way you just did, and the way you did in your talk at the summit. It makes so much sense. It’s so validating. I hope it’s helpful and sanity-bringing for women out there who are like, “Yeah… that tracks. Of course I’m not feeling my best.”

Dr. Zarya Rubin: And we didn’t even talk about mood.

There are so many hormonal dynamics. It’s this delicate dance between estrogen, dopamine, serotonin, oxytocin — and progesterone with GABA. Once progesterone starts to tank, your GABA is no longer working for you. That’s your “chill” hormone. Your sleep is going to be crappy, your anxiety is going to ratchet up. When you’re anxious, everything becomes more stressful and you can’t function.

Then you’ve got a million things going on. You’ve got your to-do list. It starts to feel overwhelming and you can’t cope.

And a lot of it is real. The demands of midlife are real — being the sandwich generation, balancing kids and aging parents, maybe being at a high level in your career. All of it. It intersects into this insane Venn diagram, and at the center is this amazing woman who is trying to hold all the threads together as they’re being pulled apart while she’s on fire.

Dr. Chrissie Ott: Yeah, it’s like a Venn diagram with this very small pinpoint at the center — and then the bottom drops out.

There are things to help. What are the steps once we identify these converging patterns? Obviously, talking to a skilled clinician about HRT, if that’s part of the response…

Dr. Zarya Rubin: Yes, exactly.

I think you first have to allow yourself that moment and that permission to recognize, “Okay, something is going on here. This is not okay. This is not sustainable. I can’t keep doing this.”

I often use the analogy of the check engine light.

You’re driving your car, the check engine light goes on. Maybe it just flashes on for a moment and you think, “That was weird. Probably nothing.” You keep driving.

Then it comes on again and this time it stays on a bit longer. You might still ignore it and say, “Okay, well it went off, so it’s fine.”

Then it comes on again and stays on. Now it’s bright, it’s solid, it’s not flashing anymore. It starts to drive you crazy, so you take some duct tape and tape over it.

I think that’s what high-achieving, intelligent, high-performing, perfectionist type A women are doing in perimenopause and burnout. They’re putting duct tape over the red alert lights in their lives.

So step one is: open your eyes and say, “Okay, this is not okay,” and give yourself permission to take a step back and seek help.

Now, as you mentioned, that might mean seeing a practitioner who is familiar with and well-versed in women’s health and hormone replacement. Absolutely. If you see someone and they maybe run a single-point lab and say, “Your labs are fine,” or, “You still get periods, so you’re fine,” — go see somebody else. That’s not an answer.

Your labs can fluctuate day to day, week to week, month to month. It’s all over the place in perimenopause. So that one data point is an accurate representation of one moment in time, but it doesn’t reflect what’s going on every other day.

You can be put on HRT when you’re still getting periods. It has to do with fluctuations, hormone levels, symptoms, your medical history, et cetera. It’s complex — but it’s not that complicated. It’s very doable and accessible. You just have to see the right people.

That’s the gold standard. But there are so many other things you can do as well.

The basics — you’ve got to go back to the basics, and they are not sexy.

Sleep. We all think we can get by on less sleep than we truly need. “I only need six hours; I don’t need that much sleep.” You’re functioning — but at what level, and at what cost? I think we all have a massive sleep debt. I don’t know the numbers, but if you add it up, it’s ridiculous.

Getting enough sleep is foundational. When I work with people, if they’re not sleeping, I throw everything else out and say, “We’ve got to get you sleeping first.”

If that means supplements — I love my magnesium, and I take these sleep gummies that don’t have melatonin in them and I’m a huge fan. They’ve got GABA and passionflower and some mushrooms — I love the mushrooms. They’re fantastic.

You don’t necessarily have to have a prescription sleeping pill — I’m not really a fan — or even a lot of melatonin. Melatonin can be great in small amounts, but it’s over-prescribed and overdosed. People are taking 10 mg of melatonin a night, which is crazy. You should start with like 0.5 or 1 mg.

Then, other basics: drinking enough water. We don’t drink enough water. (Full disclosure: I’m drinking coffee right now.) Make sure you’re fueling your body with things that serve you and not sabotage you — not tons of highly processed food, additives, preservatives, fried foods, unhealthy stuff.

Alcohol was something I really had to cut out in perimenopause because it wasn’t serving me. My sleep was terrible. I’d wake up with a hangover after one glass of wine. I was like, “This is not worth it.” It has to do with estrogen levels, metabolism, liver function, detoxification. All of that shifts. Then you’ve got tannins, histamines — it goes on and on. It’s complicated, but the simple solution for me was: stop drinking alcohol.

Also: get outside. Fresh air, vitamin D, a walk in nature. You don’t have to go to the gym and do hardcore cardio — which is only going to raise your cortisol further and deplete your adrenals and exacerbate burnout. But that’s what a lot of women do: “I need to go to the gym and go hard to get the stress out.”

In the end, that’s not going to serve you. It will sabotage you. So find gentler ways to exercise: yoga, walking, swimming, light to moderate weightlifting — those things are important.

Then of course: community. Finding your people. Finding other women who are going through what you’re going through — there are a lot of us out there — and creating community, sisterhood, bonds, connection. It can make you feel less crazy, less alone, less like you’re having to manage it all by yourself.

That’s why I’m creating a community for women with burnout and perimenopause. It’s not quite launched yet, but I’m hoping to launch it in the new year.

Dr. Chrissie Ott: Stay tuned. Watch this space.

I think that is wonderful and exciting — a place where you can have a great, positive impact on so many people who need information and community.

Dr. Zarya Rubin: Stay tuned. Yeah, absolutely. Because it just wasn’t there. I was like, “Where is this? Where was the help when I needed it?” It wasn’t there. Nobody was talking about this. At least now a lot more people are talking about it. People are talking about burnout. People are talking about perimenopause.

It’s hot. It’s trendy now. We’re cool.

Dr. Chrissie Ott: Yes, yes. We Gen Xers have made menopause trend.

Dr. Zarya Rubin: Yes, we’re at the vanguard. We’re always the trendsetters.

Dr. Chrissie Ott: That is awesome. Thank you for sharing that with us — especially for people in midlife who are facing this trifecta, this powerful Venn diagram of multi-generational life demands, career demands, and personal physical changes all at the same time. It’s so important.

Dr. Zarya Rubin: It’s a big deal. I think the number one demographic for women physician burnout was age 45–54 in the Mayo Clinic Proceedings study. And in other studies that look at professionals outside medicine, perimenopause is the age when women start to burn out and leave their jobs and careers, because there are no accommodations, no provisions for that.

Dr. Chrissie Ott: They’re just trying to find joy. They’re trying to survive and they’re trying to find joy.

Sometimes leaving is the pathway to finding joy. But sometimes it’s about finding your community and the clinical resources you need.

Dr. Zarya Rubin: Yes, yes. And finding something outside of your job or your family — something that is just for you. Something you love, whether it’s knitting, watercolor, kayaking, cats, singing in a choir — something that makes you happy that doesn’t serve a purpose other than to make you happy.

That’s the principle Eve Rodsky talks about in Find Your Unicorn Space. It’s a fabulous book. She talks about how men are traditionally very good at carving out time for their own pursuits, and women are not. We feel guilty.

When we have downtime, we’re cleaning the house, looking after the kids… We feel obligated to be busy, to be productive, to be doing something “of value.” Otherwise it doesn’t count. We don’t count. We don’t deserve rest.

I think reclaiming rest as radical resistance — we’ve got to do that. And then reclaiming your time to do something that has no impact on the world, your family, your finances, your job — that is just for your own joy.

That’s very impactful. We’ve got to remember to do that and find that time.

Dr. Chrissie Ott: That is medicine I dispense regularly to my coaching clients. And it is, again, very counter-cultural. It’s antithetical to the Protestant work ethic. It’s just part of the refined unlearning that we owe to ourselves in this phase of life — of, “Yeah, I swallowed the whole story about productivity and salvation.”

And the truth is that joy is a moral obligation. It’s an inside job and nobody’s ever going to do it for us. Delight is an incredibly important part of that equation.

Dr. Zarya Rubin: And it’s contagious. If you can spread joy to others, that’s an amazing gift as well. I mean, yes, we check all sorts of labs and different levels and vitamin levels. In functional medicine, we also check for vitamin J — which is joy.

Dr. Chrissie Ott: I love that. What a beautiful note to end on.

Thank you so much for being with us, Dr. Zarya Rubin. For people who are curious about connecting and following you — we can tell them that you have a TEDx talk, and we can tell them about your wonderful podcast, Outsmart Burnout. Where would you like them to find you?

Dr. Zarya Rubin: Such a pleasure.

Yeah, absolutely. You can head over to my website, which is just drzarya.com
. You can also find me on Instagram at @dr.zaryarubin. Just connect, send me a note, follow me, send me a DM or an email — I respond to all of those personally.

Dr. Chrissie Ott: What a pleasure. Thank you for being here, my friend.

Dr. Zarya Rubin: Thank you. It was awesome.

Dr. Chrissie Ott: For those of you listening, if something in today’s conversation resonated — if you found yourself recognizing your own exhaustion or feeling seen in a new way — I want you to know you’re not alone, and you don’t have to navigate this season in isolation.

If you are a physician coach looking for community, mentorship, and a place to ground your coaching practice in joy and sustainability, I’d love to invite you to the Physician Coaching Collective. It’s our professional home — a space where we come together three times a month for coaching mastery, business strategy that actually feels aligned, and community that tells the truth with a lot of heart and laughter.

Our December calls are coming up this Wednesday, December 3rd: Business Coaching with Vanessa Calderon. Thursday, December 11th at 5 p.m. Eastern: End-of-Year Accounting — The Self-Concept Edition, led by yours truly. And Monday, December 22nd at 1 p.m. Eastern: The Energetic Quality of Our Emotions: A Tool for Coaching with Shideh Shafie.

If you can’t join us live, every session is recorded and available on playback in a private podcast, so you can catch up when it works for you.

For those of you craving something deeper in the year ahead, I’m super excited to announce that I’m offering ROAR 2.0. Applications are now open. It’s my small, curated, year-long container for clinicians and practitioners who are ready to reclaim their brains, their power, access their joy, and raise their voices and vibrations.

It’s a different kind of work than PCC. PCC is community and professional space, while ROAR is deeper, identity-level work that shifts how we move through life. They complement each other beautifully — and you’ll know which one is meant for you.

There is a live call about ROAR tonight, December 2nd at 5 p.m. Pacific. Feel free to register, learn more, feel the vibe, and ask any questions that might come up. And if you can’t be there, just reach out — I’m happy to make sure you get a recording of it.

As always, if this episode and Zarya’s story speak to you, it would mean so much if you left a quick rating or review.

And as always, I’m a doctor, but not your doctor. Please don’t let any of this substitute for actual medical or professional advice.

Thank you, as always, to Kelsey, who brings the podcast to life with so much creativity and heart; to the small dog that I’m holding right now; and to my precious wife, Su. And to you, dear listener — may you offer yourself the grace you so generously offer others. May you listen to your body with tenderness. And may you find small, steady moments of joy, even in the middle of the mess.

I’ll see you next time on Solving for Joy.