276. From Burnout to Bliss: A Pediatric Critical Care Expert's Keys to Wellbeing with Dr. Greg Hammer

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00:02:49
Dr. Greg Hammer, what an honor and a privilege to be speaking with you today. Thank you so much. Oh, it's my pleasure. Thank you for having me.

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When I was looking at who I was talking to today, and I was, ooh, Stanford professor. Oh, no.

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We'Re all just regular people. I know, right? We all put our pants on one leg at a time, right? Exactly. But still, it's kind of, you know, my brother, he's an it recruiter.

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But he recruits like quants, like a lot of quantitative engineers that do different statistics for the New York Stock Exchange. So he's always on Stanford campus recruiting the college grads, and he has one class yet left to finish college to get his bachelor's degree. And I'm like, why don't you finish it? Right? So for him, it's kind of funny, because he went to college to party, right?

00:03:48
But when you talk to people in academia, it's a whole different. Yeah, yeah, it is. But on the other hand, in medicine, it's not that different from medicine elsewhere in the United States. Okay. So, yes, of course, we have students, residents, fellows, relatively complicated patients.

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But fundamentally, we do what other doctors in our specialty do, right? Plus teach and do research. Plus teach, right? And the research is a big part of what you do, right? Yes.

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So thank you. Thank you for what you do because we certainly need more people in the world that are committed to that type of work. All right, so I always love to hear how people get to where they are. So tell me your backstory, like, what inspired you to go to medical school? And now you published a book a few years ago called the Happiness Handbook for healthcare professionals, so I'd love to hear what inspired you to publish that as well.

00:04:51
Well, I guess I was not always interested in medicine. I went to college not knowing what I wanted to do. It was at a time when there were still hippies in the world and people living in ashrams and guys with long hair, and I became a vegetarian. And then I thought, well, I'm really into health and athletics and so on. I should learn about what I need to eat if I'm not going to eat meat.

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And so I started studying nutrition, and I got really interested in that. It's so fascinating. Oh, yeah. So I decided to do my major in nutritional biochemistry. And then I thought, well, going to medical school, the human body is pretty cool.

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That's what I'm learning, all this nutrition for how to nourish the body. So I decided to go to medical school. And then I got to the point where we do our rotations in different specialties, usually in the third year. Right? And I thought, wow, it's really fun working with these people who are in pediatric medicine.

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They don't have huge egos. They don't take themselves too seriously. That's kind of like me. So I decided to go into pediatrics knowing I would specialize in something. And at that time, it turns out that pediatric anesthesiology and critical care were a particularly good combination.

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It still is a great combination today because you have very complementary skills, and you end up using all your skill sets in both areas, both in the intensive care unit and in the operating room. But the training now to do all of what I did is so long that not many people do it anymore. So, in any case, I did a residency in pediatrics, and then I did a residency in anesthesiology, and then I did fellowships. Wow. Pediatric intensive care, pediatric anesthesiology with an emphasis on cardiac medicine.

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And so I finished all that and came to San Francisco, and then was recruited to come to Stanford and been here for quite a while. And in 2011, in recognition of the growing prevalence of burnout among doctors, Stanford formed something called the Wellmd directive. And I joined that because I've always been into physical and mental spiritual wellness. And I got asked to do a talk to a group of hospital administrators at their national meeting, and then another talk and another talk on burnout and wellness. And I had some sabbatical time, and I decided to write that book because, again, the prevalence of burnout continued to increase.

00:07:48
Other university medical centers and hospitals were catching on and beginning to form their own wellness programs. But I think Stanford was really on the forefront, as it is with so many. Exactly right. So here we are. Wrote the book, been doing lots of interviews ever since then, in my abundant leisure time.

00:08:09
As my biochemistry professor used to say, in your abundant leisure time, please learn this. Yes. So here we are, having a lovely conversation. Oh, my gosh. Now, have you ever experienced burnout, or did you recognize maybe it was coming on and that got you interested in it, or you just visually saw other people in your field becoming burnt out?

00:08:33
No, I have become burnt out to varying degrees over time. I think we all have, in and out of medicine burnout. I think the simplest way to define it is emotional and physical exhaustion related to chronic stress. So I've become very interested in chronic stress. What the physiologic responses of acute stress resilience, which sort of normalizes the physiologic responses associated with acute stress.

00:09:02
And if we're not sufficiently resilient, then acute stress becomes chronic. And what are all of the adverse physiologic consequences of chronic stress? And I think that life itself is chronically stressful. Yeah. No matter what your circumstances are, there are reasons that our lives are inherently stressful.

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And then I think the last five years have been off the rails in terms of stressful stimuli for all of us with the pandemic, with wars going on in the world that I think really affect all of us. There's just awful news around us all the time about innocent people being kidnapped, taken from their families, killed. So on top of our everyday stress, kind of worrying about our mortality, what's going to become of our kids, what's going to become of us? Focusing too much on the past, being imbued with a brain that is hardwired to have a negativity bias. So there are all kinds of contributors to chronic stress, even for those not in charge of taking care of other people's lives.

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Right? So, yes, I'm not sure I know anybody who has not been afflicted with what we call burnout at times. And so, yes, I certainly have been afflicted as well. Yeah, it's interesting because I found myself earlier this year feeling burnt out for the first time in my life. Now, I may have gone through it before.

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It was such an awakening to me because I've been on my personal journey for 34 years, and I walk the talk, which is why I do what I do, right. And I love talking with other people because there's not a lot of people I can have these conversations with. Right? My husband doesn't want to talk about it. Most of my girlfriends are like, they'd rather talk about what they did last night with whatever.

00:11:06
But the thing is, I felt like I was really happy and I was just living my best life. It's just what happened for me is I was doing too many things. I had a corporate job. I was managing this podcast. I have my family.

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I take care of my mother, who's aging. There was so much going on, and it was just really shocking to me because I was like, I'm a high performer. I'm a peak performance coach. I know what to do. I know how to turn that light switch back on, and I couldn't.

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And it was just, how did I get in this place? Because I didn't feel stress, right? I know what stress feels like. I've been in many situations in my life that are very, very stressful, and I didn't feel like that. For me, the telltale sign was I thought I was depressed at first.

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I didn't want to get out of bed, but I've never been depressed in my whole life. So when you're not feeling the stress, how can you prevent it from just like, bam? Because for me, it was like hitting a brick wall, and it was like, what the heck happened? I was just so unprepared, and I felt ill equipped because I had not experienced that at any time in my life. I think that's an interesting story.

00:12:26
I can't imagine what would be more interesting than your personal journey and how you got to that point. So I don't know why your friends and others aren't more interested in it, but if we had more time, and maybe it would have to be my podcast, which I don't have, I'd be asking you the questions about that, because I think it's quite interesting and how you hit that wall. I think that whether it's something that happens rather suddenly or kind of gradually builds to a point where it crosses some threshold and you can't really deal with life anymore in an efficient way that is associated with good health. We have to get back to the basics. So I try to keep my message both to myself and to others.

00:13:12
Very simple, the kiss principle. And I think that we have to focus on our physical wellness. And really, there are three elements, three legs of the tripod that really support our physical well being, and we have to focus on our spiritual wellness. You can call it mental or psychological. I think they're all pretty much the same entity.

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And for our physical wellness, it's really our sleep, exercise, and nutrition. So when we either hit that wall or we sort of gradually progress so that we're over that threshold, I would say that, first of all, focus on our sleep hygiene. And there's a whole very simple, probably well known list of issues to help us focus on that, on our sleep exercise. Because, again, when we're in that state of burnout, we're in this self perpetuating cycle of relatively poor sleep. We're fatigued, we're too tired to exercise.

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Exercise is one of those things that contributes to good sleep. So now we're not sleeping well and we're not exercising. So our sleep is further eroded. And our nutrition, I call it nutrition as opposed to diet, because I think it's really the foods we eat, the way we eat, when we eat, and also, I think our nutrition involves supplements and even potentially drugs. So all of those things become sort of out of focus.

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We're fatigued, we don't exercise. We also don't eat well. I can tell you that in medicine, we're on call, we're underslept. We pass a nursing station. There's a box of lovely seized chocolates there.

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We're feeling low. We pick one up, we get a temporary burst. We have this kind of sugar hunger when we're post call or just generally underslept. So we tend to eat sugary, more refined foods.

00:15:17
Yes. And then that further erodes our sleep, and we crash after we have that sugar high, and then we don't want to exercise. So these are all kind of self propagating things. So when we're feeling like we don't want to get out of bed or we're just burnt out, we're tired, we have very little energy. We don't feel like going out to one of these pret thanksgiving or thanksgiving get togethers.

00:15:42
The thing to do, really, is to refocus on the basics of our physical health. Sleep, exercise, nutrition, and kind of step by step, get us back on the rails, good physical health, and then we can focus on our mental health or our spiritual health. And I talk about the fundamentals of that, as well. Yeah, that's so true, because what I ended up doing was I just put everything aside in my life, and I was like, okay, I have to focus on my corporate job and my podcast. And so that's what I've really focused on this year.

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And as a result, my podcast started having massive success this year because I was only focusing on that. And a month ago, I left my corporate job, and so now I'm doing this full time. So it proved to me how instead of being, I'm kind of like a squirrel, and I'm like, oh, let me do this. Oh, let me do that. But you don't finish one thing, right?

00:16:39
You got to finish what you start. And then once that's going, then I can do all these other things that I want to do and bring into my business. Right? Absolutely. Yeah.

00:16:50
Well, congratulations on finding your focus, and it sounds like you're doing what makes you happy. Yes. And you've kind of cut out some of those other things that are just distractions. Yeah, for sure. So, let's talk about your book, because I want to hear.

00:17:09
It's just interesting because it's very specific to the healthcare professionals. So what is it that people who read this that are in the healthcare profession, what do they get out of the book? Well, first of all, in a way, I kind of regret the subtitle of the Happiness Handbook for healthcare professionals. Really, it's about the gain practice, gain without pain. Okay.

00:17:36
I think the readership is mostly people outside of medicine, and most of the tv, radio, and podcast interviews that I'm doing several times a week are not related directly to the medical field. So this is really, again, I go back to my experience with chronic stress and how it affects everyone. And so in the book, I do talk about our physical well being. There's chapters on sleep, exercise, and nutrition. But in the main part, the book is really about what some might call mindfulness practice.

00:18:11
And it's based on what I think the four fundamentals of happiness are, and they constitute the Gain acronym. The gain in the title is in capital letters, and it stands for gratitude, acceptance, intention, and non judgment. And I kind of whittled it down to what I thought were the most essential components of happiness and tried to come up with an algorithm that I could remember. I love Deepak Chopra and others, but I just can't remember the ten ways of this or the seven steps to that or what have you. And so I got it down to four, and I think that's all we need.

00:18:52
And those four elements are very much interrelated. So that's really what the substance of the book is about. Can we dive into each of those? Sure. Just a few minutes on each?

00:19:03
Yeah, that'd be great. Yeah. I think it's a great time of year to focus on gratitude, but gratitude is intrinsically essential to happiness. We may know of someone who is poor and happy or physically challenged and happy, but we can't even really imagine someone who's ungrateful and happy.

00:19:25
They can't exist. Like, you can't be bitter and grateful at the same time. Yes, granted, sometimes we're grateful, sometimes we're not. But I think the fundamental idea is that we all have much for which to be grateful. We have people in our lives that we love, we care about.

00:19:41
They care about us. Most of us have a roof over our head, so to speak. There are some who are living in war torn areas that are not able to be grateful for having a roof over their head. But that's a very tiny percentage of the population, especially in the United States. We have food to eat.

00:20:01
In general. Things could be worse. We can be grateful for all of the relative health and wealth that we have. So it's important to recognize that and really to bring our focus toward our gratitude. And I think, of course, thanksgiving is a classic time of year to do that, but I think we should do it every day.

00:20:22
Acceptance is really the acknowledgment that there's pain and discomfort in life. We can't just be grateful and pretend that there's nothing outside of the realm of gratitude that causes us pain. For example. Right. The game practice, which is a three or four minute meditation in the morning and then sort of a lifestyle, includes focusing on something that's painful or uncomfortable, and bringing it closer, bringing it into our heart, and learning to accept it fully.

00:20:58
There's a formula in my book. Suffering equals pain times resistance. We love formulas. In medicine, pain is there. We've lost people that we love.

00:21:08
The pain is there. But if we resist it rather than accept it, our suffering is increased. Yes. Intention means that, to me, our brains are wired in ways that tend to lead to our unhappiness. We all have a negativity bias.

00:21:25
The majority of our thoughts are rather negative. It's in our DNA, right? It is. I think it's literally, if not in our DNA, it's in our epigenetics. Okay, so our DNA is our DNA.

00:21:39
It's the same in every cell in our body. What makes a liver cell different from a skin cell are factors that turn genes on and off called epigenetics. Epigenetics, right. I think that we've inherited elements of epigenetics that were adaptive in our forebears 75,000 years ago when they were sitting around a fire trying to keep their family warm and in a cave where there might be a saber toothed tiger lurking outside the cave. Right?

00:22:09
So, being wary, sort of worried about the future, what's the worst thing that might happen that may have been adaptive, may have helped them live longer, have more offspring? Those genes that code for those epigenetic patterns of dna modification propagated in the population. And here we are with those epigenetic factors that are embedded in the way we think. And it's no longer adaptive to be constantly worried. There's not constant threat around us.

00:22:41
Right? So we have to have intention, we have to have a plan if we're going to let our negativity bias let go of it, let go of this constant distraction with the past and future, and be present and positive. And the good news is, our brains have this wonderful quality called neuroplasticity, and we can actually change the way we think if we have intention, if we have a plan. So that's the I and gain, and the end is just non judgment. And we all know how judgmental we are.

00:23:15
We judge ourselves most harshly, but we judge others around us. We judge the world around us when it doesn't comport with our apparent wants and needs. And we don't see things clearly when we judge them. And so things don't have to be good or bad. They just are.

00:23:31
And we can teach ourselves. And again, neuroplasticity comes into play. We can learn to drop judgments and actually be happier. Right? And I think all these four elements of gratitude, acceptance, intention, non judgment are tightly interwoven, and we can really learn to embrace them all and be happier people.

00:23:54
That's the good news. I love it. I love it. And everything you said is just incredible, because the way things are today, they don't have to be like that tomorrow. Yeah.

00:24:07
We're not going to change the way we think overnight. Right? But there are data showing that if we take baby steps in the right direction, pretty soon, after weeks and months of a daily practice, we can look back and see how much happier we are. And there's a wonderful study, if I can go on for a few minutes, about it, called three good things at Duke University. The short story is that by simply thinking of, with or without journaling it, but thinking of three good things that happen during the day, every night before you go to bed doesn't take any time.

00:24:42
You're turning down the bed linens. You're thinking of three good things. Like, I had a wonderful conversation with this woman during her podcast. I played with my dog. It was a beautiful day in northern California, and I had a wonderful dinner with friends.

00:24:59
I think of those things before I go to sleep. And what the researchers have shown is that practicing that for a number of weeks actually makes us happier for long periods of time, even after we're not technically doing the practice anymore. And so this is a perfect example of having a plan, having a practice, and having measurable benefit from it with regard to our happiness. Yeah, well, the thing is that, oh, my gosh, I totally just lost my train of thought. You were saying?

00:25:33
Well, the three good things practice, simple thing we do, it can be the gain practice. They're not mutually exclusive, but taking baby steps toward rewiring our brains leads to enduring greater happiness. And that's the good news. And I think that's wonderfully exciting. Yes, it totally is.

00:25:56
So thank you for repeating yourself because I was like celebrating your wins, just celebrating the wins that we have. Because I know when I was going through my burnout stage earlier this year, I found myself standing in front of my keurig watching the coffee drip, going, I didn't do this yesterday. I didn't do this. I didn't do this. I didn't do this because that's how my brain works.

00:26:19
I like to beat myself up, and I think most of us, and I tell people like it is. If I'm going to be this podcast host, Happiness self podcast, I'm going to tell you like it is because my life isn't rainbows, butterflies and fluffy kittens and sparkles and all of that. No. So when I recognized it, I was like, oh, my gosh, what are you doing? So now I focus on everything that I did right for the day, and here I talk about it all the time.

00:26:49
But when you're in that mode of burnout, depression, whatever, stress, it's hard to keep that light switch up. Right? That's why we just take baby steps. Right? Exactly.

00:27:01
Starting to get out of the bed in the morning, and we're getting a little older, our back is a little stiff. Maybe we have some sore joints. And we focus on that and we think about it, and then we get up and we go to the commode and we empty our bladders. And so I say, and this is kind of maybe TMI for some people, but when you get out of bed and your back's a little sore, think about the miracle of the human body. Think about all the things that are working perfectly.

00:27:33
And when you go to the bathroom in the morning, think about how miraculous it is that your kidneys have been working all night, filtering your blood, taking out substances that would be toxic if they accumulated, sending them down this little tube that sort of rhythmically contracts down to the bladder, where this fluid is accumulating. You don't have to get up. Most of us, ten times a night, it's being stored there conveniently and at your will. You can get up and just relax, and all the muscular components work in harmony, and out comes this fluid, and you're getting rid of all this toxins and how beautifully that system is working. And take the attention away from the little parts that seem to be aching.

00:28:21
I mean, even when you're standing over your coffee maker in the morning and you're starting to have these negative thoughts, and we all do. Not necessarily in front of our coffee maker, but just in general, what a miracle it is that I have this machine that didn't cost me an arm and a leg, put this little pod in it, press a button, and there's my morning cup of coffee. What a miracle that is. Who invented this? Yeah.

00:28:45
Think of something positive. Yes. I love it. I love it. Because here's the deal.

00:28:51
When you were talking about the way our body works, when you start focusing on the gratitude of how well your body is functioning, there's got to be some connection there, Dr. Hammer. Right. There's got to be. Right.

00:29:06
Of course, not all doctors have the mindset that you do. So it's just a delight to speak with you, because I do have many friends that are in the medical community and are doctors, nurses, things like that. But it's all science, science, science. Because when you're talking about spirituality or the mind body connection, it's hard to measure and it's hard to study. Right.

00:29:37
Thanks to Stanford and universities like yours, they are studying this, but it's hard to quantify it. Right. But there's got to be that mind body connection.

00:29:49
Mean, like everything we're talking about relates to that mind body connection. Yeah, I got to grab a book real quick because we're going to talk about this real quick. Okay. Sorry. Had to look away for a second.

00:30:01
Are you familiar with this? No. You can heal your life. Louise Hay, she passed on a few years ago. But this book, I don't know when she wrote it.

00:30:15
This is probably a republication. But basically what she does in here is there's a glossary and every single problem she puts a probable cause and a new thought pattern. So, for example, bronchitis, probable cause is inflamed family environment, arguments and yelling, sometimes silent. And then she gives you a new thought pattern. I declare peace and harmony within me and around me.

00:30:43
All is well. But it's like that for every single condition. And it's just interesting because even my son has some physical issues. I'm not going to go into it. But I said to him, I pulled it out and I said, this is the probable cause.

00:30:57
And it's the fear, a financial insecurity fear. And it makes total sense because of his dad was ripped away from him at the age of 13 and went away for seven years. Right. And it was just him and I. But that makes sense.

00:31:14
And he's been focusing on that and really paying attention. And you know what? His physical conditions are getting better. The things that he's. Because of the mind.

00:31:26
Well, whether or not. But not everybody's going to buy into that, right? Not everybody's going to buy into it. Well, I think the important message is that whether or not we subscribe to a particular medical condition, being linked to particular emotional, psychological factors, the fact is that almost all medical conditions are made better by our thought processes being optimized. And that includes sleep, exercise, nutrition, and also being more present and more positive and having an intentional practice to continue to make progress in the right direction toward happiness.

00:32:14
So that helps all physical conditions. I think some of us might not quite agree that problem is caused by a particular psychological problem, but in the entirety of it, we can all improve our health, clearly, by the way we think and act. No question about that. Yeah. Of course.

00:32:37
No, absolutely. And I always like to share the story about my father where he had bladder cancer. They removed his bladder. A year later, it came back as bone cancer, stage four bone cancer, and he was given three months to live. At the same time, he was diagnosed with borderline diabetes, and so he eliminated sugar.

00:33:02
I was also pregnant with my son at the time, so this was in early 2000. And long story short, he lived 16 years, but there was a combination of things there. He improved his diet. He was so grateful. I tell you, I spoke to that man almost every day for the 16 years he was here.

00:33:24
And every day he would answer the phone and be like. I'm like, how are you doing today, dad? Any day above ground is a great day for me. And he just had this new lease on life. And I tell you, I think the combination there gave him 16 years, and he didn't die of cancer.

00:33:40
He beat cancer four times. Yeah, well, I've had cancer also. And I think that silver lining is that you do appreciate every moment. That's right. I'm in all likelihood cured, thankfully.

00:33:55
But I retain that positive attitude about every day being a gift. And I've got a friend who says I'm on the right side of the grass today. So very similar attitude, and I think it's important to embrace that. That's part of the gratitude practice. Yeah.

00:34:14
Oh, my gosh. I could talk to you about this for hours, but I want to respect your time and my listeners, because I know they're used to this only being so long. But is there anything else that you'd like to share with the audience? Dr. Hammer, before we finish up, I.

00:34:29
Would just like to emphasize to everybody who's listening that this negativity that we experience and maybe even depression, this is something that we all have. This is not your dirty little secret. We all have brains that are wired to be relatively negative. We have this negativity bias. We remember the negative tend to forget the positive.

00:34:50
There's stories about that in the book. And also our brains are very distracted. If we close our eyes and try to just relax into the present, our minds quickly go to something in the past future. And when we go to the past with our negativity bias, it's often with shame and regret. Right.

00:35:07
And the future often is fear and anxiety. So this is the way we all think. So please don't think that this is your individual, dirty little secret. If people knew it, they wouldn't want to be your friend or what have you. This is normal human wiring, and the good news is our brains have this quality of neuroplasticity and we can change the way we think and become more present oriented, more positive and happier people.

00:35:36
I love it. And I love how you said you categorize it as a dirty little secret because there are times, right, you have these negative thoughts and then you shame yourself for having the negative thoughts and it becomes this perpetual cycle. And yeah, embrace it, make friends with it, love it, and move on. Yeah. Oh my gosh.

00:35:58
Dr. Hammer, thank you so much for this call today. You are amazing. Thank you for the work that you're doing in the world and keep inspiring some of those young medical students to keep moving forward because we need them. We need them.

00:36:13
Thank you very much. It's wonderful to be with you. All right, thank you. And thank you everyone for listening today.

00:36:29
What a great conversation. And thank you again for listening today. If you're enjoying the content, please subscribe, like and review. And if you're eager for more content, go to glow, happiness solved and join our exclusive membership portal. I also invite you to follow me on Instagram and Facebook at coach Sandee Sgarlata.

00:36:49
Again, I am so grateful for you and I hope that you and your family are healthy and safe and that your lives are filled with peace, joy and happiness. Take care, everyone.