Preconception Health, Pregnancy Anxiety, and New Parenthood With Integrative Pediatrician Dr. Kirin Palmer

Download The Physician Fertility Roadmap- a 6-step, evidence-based plan to optimize your fertility over the next 6-12 months. 

https://support.loveandsciencefertility.com/The-Physician-Fertility-Roadmap

In this thoughtful and deeply human conversation, Dr. Erica Bove is joined by integrative pediatrician Dr. Kirin Palmer to explore how we can prepare for parenthood emotionally, physically, and mentally.

They discuss the impact of anxiety and scarcity mindset on fertility and early parenting, how emotional health during pregnancy can influence child development, and why building self-trust before conception is essential. Dr. Palmer also shares insights from the pediatric side of the fertility journey, including common patterns seen in families after infertility and how integrative pediatrics supports long-term child health.

The conversation expands into a powerful reflection on grief, resilience, and learning to hold joy alongside loss, as Dr. Palmer shares her personal experience navigating her father’s illness while building her medical practice and raising her son.

This episode is for anyone preparing for parenthood, navigating fertility uncertainty, or moving through difficult seasons while still seeking meaning, connection, and hope.

About Dr. Kirin Palmer

Dr. Kirin Palmer is an integrative general pediatrician and the founder of Pure Joy Pediatrics in Portland, Oregon. After more than two decades in medicine, she’s come to see joy as a steadying force — something that allows us to live with intention and authenticity, even in the middle of busy, complicated lives. Dr. Palmer believes that joy is found in the simple things: the colors of the sunrise, the sparkle in a child’s eyes as they talk about their birthday, the quiet moments that remind us we’re alive. Soaking in moments of joy is like taking out an insurance policy for the soul — it doesn’t prevent life’s challenges, but it gives us the resilience to move through them with grace. Her mission is to help parents find their way back to joy and help their children thrive one mindful moment at a time.

Connect with Dr. Palmer:

purejoypediatrics.com

Instagram: Kirin Palmer MD

Support the show

As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.

If you found this conversation valuable, book a consult call with me using this link:

https://www.loveandsciencefertility.com/private-fertility-consult

Follow us on social media:

IG: www.instagram.com/loveandsciencefertility

FB: www.facebook.com/profile.php?id=61553692167183

Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.

In Gratitude,

Dr. Erica Bove
Transcript:

Hello, my loves, and welcome back to the Love & Science podcast. I am just so excited to have my beautiful friend, Dr. Kieran Palmer, on the podcast today. She is a friend, she's a colleague, she is an amazing integrative pediatrician. And today we're going to talk about a few things. We're going to talk about optimizing the pre-parenting state, and then we're going to shift into talking about... new parenthood, which I firmly believe every single person on this pathway deserves to be a parent. And so this will be relevant. And then also holding joy and grief at the same time. So by way of introduction, Dr. Kieran Palmer is the CEO and founder of Pure Joy Pediatrics in Portland, Oregon. where she takes an integrative approach to pediatrics. We love integrative medicine. We know that the outcomes are better. And she helps parents help their children thrive. She really
integrates families in her practice. And so welcome, Dr. Karen. It is so, so wonderful to have you today. Thank you so much. I am so happy to be here and to be of service,
just to answer questions and to help parents or pre-parents out there. Yes. Amazing.
So, you know, many of my listeners have never had a child before and many are on the pathway. And that is, that is the hope. That is the goal. Some of my listeners have had a baby before, but they're having a hard time building their families. And so that's the group that we have, you know, what have you learned in a rooted in your own experience of what it is to want to be a parent and how can we use this very precious time? Obviously we wanted to be pregnant a long time ago, but how can we use the time that we have to optimize our emotions, our bodies, our minds for the little one who's meant to be ours? Oh my goodness. That is such a great question.
And I think there's, I think there's probably many answers to it all at once, but, um,
cause I was. in that situation. You know, I didn't know if I was going to have a child and I
really, really wanted, you know, to be a mom. I think there's like this yearning. And sometimes
when you're not sure that it's going to happen, you're sort of in this mindset of scarcity and a
lot of worry and a lot of anxiety. You know, you may want to be a parent and not have a partner.
You may, you know, want to be a parent and be in a working situation where, you know,
We all know like we work short staffed a lot. We take call, we work overnight and all of those
things make our bodies and make us emotionally very like friable.
And it's certainly not the best case scenario for trying to be pregnant. It's also not the best
case scenario for parenting, especially if you don't have a partner or like a stable, you know,
stable household. And so I think the first thing is like when we talk about. I would just call it
the pre-parenting situation. So even before conceiving, you know,
learning how to sort of let go of the things that really kind of weigh you down.
Worry is like, I would say that it's very much a part of being a physician,
right? Like we're trained to worry about our patients. And I think when... when you are taking
call, for instance, and you fix somebody, you put a Band-Aid on it, you started meds,
you put them on, you know, pressers or whatever your specialty is.
When you're on call, like you kind of go to sleep, but you sleep with one eye open because you're
worried. And so our brain and our bodies get really used to worrying. And, you know,
if you're sort of preoccupied with. trying to conceive or trying to find a partner with whom to
conceive or trying to figure out like the resources to conceive if you're going to be a solo
parent, that adds to it as well. And what I see in my practice is that once parents go from being
pre-parents to actually being parents, that worry just kind of follows. You know,
it happened to me. I was worried about, you know, having the right partner. And then I was worried
about getting pregnant. And then I was worried about getting sick. Then I was worried about losing
the baby. Then I was worried about, you know, how I was going to deliver. And then I was working in
urgent care. So then I was worried once the baby had arrived, I was then worried about getting him
sick. And I do talk to parents on the other side of that threshold of delivering your baby that
pregnancy itself, I think, really kind of primes us to worry. And then we bring it into our
parenting as well. And when we worry, we're not really, sometimes we're not really focused on the
present moment of joy that's in front of us. We're worried about what's going to happen. And
sometimes you miss that moment of joy. So I think the first thing is recognizing that the whole,
like, Our whole existence as physicians or high achieving professionals, the pre-parenting and
even the post, you know, the after post delivery, the parenting part of it, it's all fraught with
opportunity to worry. That won't go away unless you start to figure out how to let it go.
I would say for me, like probably the best way to let go of worry.
Well, one is to recognize it's there, but two, to actually start practicing more self-care,
which. I think as a physician, I completely like throughout the window. I mean, like we have this
bravado of like, I don't have to pee. I don't have to brush my hair.
All I need is a cup of coffee and I'm like good to go. And like, so yeah.
Right. So like our professions kind of help us sort of throw the self-care out the window. But I
think when, and you're the expert in helping people get pregnant, but I think when you're, when
you're in the pre-parenting stage. it's important to take care of yourself because your emotional
and physical state are very much a part of like, you know, increasing the, the, the possibilities
of actually conceiving and having a healthy pregnancy. Yeah. So.
That was a lot, but. No, no. So let's talk about it. Cause I think of self-care as kind of an act
of defiance in our current culture. And, you know, like the bag that I bring in or like the shirt
that I wear, my socks, I like, I have a pendant for like really offensive socks.
And so like, I might be wearing my scrubs, but like high up underneath the scrubs is something that
like, I need to hear that day just to remind myself to be bold in the face of this,
you know, being counterculture really. And so. countercultural and so like for me maybe it's like
peeing in between patients even though i know i'm like already five minutes behind but i know that
that next patient is going to get more of me if i can like meet my bodily needs maybe it's i give
my trainee permission to do something with their bodily functions when they don't know that that's
possible and then it's like helping the next generation to learn like i sent my fellow home like
two weeks ago because he was very sick and i was like you know, you don't need to work, you need to
rest. And we got this and like those sorts of things, you know, helping other people do that, but
then also needing to do it myself, like making sure that I sleep as much as possible. And like,
maybe that research talk is gonna not quite have as many references in it. But like, that just has
to be I cut myself off at a certain time. Now, like, I think sometimes we think that we need like,
a whole week away for self care, we need like, you know, like even a weekend or like a whole spa
day or whatever it is, but there's these small acts of self-care that we can work in during the
day that really make so much of a difference? What have you found, Karen, for your self-care,
like things that actually work that are doable? Well, so this is probably a little bit more.
If you have small children, it probably wouldn't work, especially because I'm a single parent.
I like to work out in the morning. And so I'm usually up at like 445, five o'clock and I work out.
And so that's really my form of. self-care right now because I have a 14 year old and he's going
to sleep in any way. He doesn't really know that I'm gone. And then, you know, I still have to wake
him up when I come home. Earlier when he was younger, during the pandemic, when the gyms were
closed, I would get up and walk the dog just in front of my house and just kind of go back and
forth. So you don't really have to do anything dramatic. You don't have to join a gym, but just
like getting out and going for a walk with the dog and kind of paying attention.
I actually learned this from Our mutual friend, Rashmi Shram, like you can just walk the dog and
that can be an exercise of mindfulness and meditation. And so it really can look,
it can look different depending on what's going on in your life. It could even just start with like
brushing your hair or like some, you know, some mornings when it was really, really hard. And
we'll, we'll get into a little bit more about, you know, finding joy through grief. Sometimes it
was just being grateful for a cup of coffee or. being grateful to, you know, to talk to one of my
parents on the phone or, and so those like little small acts of kindness to yourself can happen,
you know, at any point during the day. I actually was thinking this morning when I was working out
that I think I'll bring my jump rope and I'm going to clear out the chair in my office here and
maybe even set out like a yoga mat so I can stretch, you know, between patients or at lunch.
And then if it's nice and sunny right now, it's not, it's rainy and gray out here. But, you know,
take the jump rope out and just like do a couple of like jump ropes. So I think, you know,
integrating the person that we are outside of medicine with what we're doing during the day is just
it's a I love that how you said it. It's like an act of defiance. Yeah, that's amazing.
So so I think you and I both learn this maybe on the later side of things. And I think you said
that you see that people carry their anxiousness into their new parenting and their children. And
I'd love to talk about that too. What, what do you think we can do like, as like people who are
preparing to be pregnant or pregnant people specifically, you know, in terms of like shedding that,
shedding that worry.
I think it comes out of like a scarcity mindset, right? Like it's not going to happen for me.
It's not happening according to plan. It's not happening with the person that I thought it would be
with, or maybe I'm doing this on my own and I don't know what's going to happen on the other side.
Like, you know, some people, some people decide to be parents without a spouse or a partner, but
they have like, you know, like a very supportive family, but you still don't know what's going to
happen on your side of it. I would say as a pediatrician. I've seen many parents go through,
you know, different different forms of infertility and and they come out on the other side.
And like, I mean, I think I believe as you do that, you know, parents who want to be parents,
people who want to be parents really should be parents. And I think if we worry too much about it
not happening, that that can actually impede like your own emotional health, which.
when you do get pregnant is going to make it a little harder to be present with this baby that you
have on the other side. The other thing in functional medicine and integrative medicine that we
understand, and I'm seeing this more and more because I now know to ask the questions and I don't
really get to be part of the pregnancy journey. I get to be part of the post-pregnancy journey.
And I wish that we could speak to. you know, women who are trying to get pregnant before they
deliver that, that our babies feel our stress.
They do like, you know, hormones go across the placenta. And when we are stressed and anxious while
we're pregnant, our babies are feeling it too. So oftentimes I will see,
you know, mothers who were extremely anxious when they have their babies, they're anxious with
their babies. The babies are anxious too. And I say this from personal experience because I have
one, you know, I had a, I had a very healthy, like physical, physically healthy pregnancy,
but emotionally very anxious pregnancy. And I didn't know then what I know now.
So I'm actually speaking to me like 15 years ago, like,
yeah. Just rest in the knowledge that the best case scenario for getting pregnant is for you to be
as calm and let go of the anxiety that you're feeling about it not happening.
And just say, if it's meant to happen, it's going to happen. There's a pathway to parenthood that's
meant to be mine. And I think you're right. So number one, I heard you say the scarcity. mindset
and we get so rude and oh my gosh I only have two embryos frozen or oh my gosh like what if it like
we just plan five million steps out and that hypervigilance is not good for our good for our
fertility it just it's not so that's the first thing is how to get into a an abundance mindset and
sometimes we need a guide I mean I think you and I both have drank the coaching kool-aid as
sometimes we do need a guide Um, so that's the first thing is how to say, okay, there was a time
when I didn't know I was going to be a doctor, right? I was like, I call myself a young hopeful,
right? Like I just like, I did all the things that I studied for the MCAT. I took it twice and I
wanted so much to be a doctor, but I didn't know if it was going to happen. And for most of us, we
didn't know we had to like have the belief that there was a possibility it was going to happen. We
did the things and then, you know, here we are on the other side. And so I think just leaning on
previous experiences of uncertainty. And like saying, you know what, I didn't know it was going to
work out and it did. And here I am. So I'm going to do the things with that hope, understanding
that if at some point I need to pivot, then there will be a pathway. And then the other thing is,
you know, we are not taught how to feel our feelings. And I think you and I have both learned this
over time, but that's part of optimizing the pre-pregnancy state really is to say, okay, I am
feeling anxious. How can I process that anxiety? Or maybe it's a positive pregnancy test and people
are feeling. you know, really nervous that the other shoe's going to drop. How do I manage that?
Like all those different things. And so learning as a discipline, feeling feelings,
processing them, it literally takes 90 seconds to process an emotion. That discipline will help us
during pregnancy. And it will also help us as new parents. And it's always the question, right?
Nature versus nurture with this, like, but I think there's something to birth order, right? They
say, okay, for people who have more than one child, why is like the first child a certain way? And
why is this? It's probably because the parents, learn what's important and what's not important and
can, well, everybody, every kid is different, you know, of course, but I'm sure you see this,
especially in your families who have gone through infertility treatment. Can you say a little bit
about, you know, we know increased rates of postpartum anxiety, increased rates of postpartum
depression, what you notice in those people and what tools you have to help them?
It's really fascinating, actually. So what I see on the pediatric side of things,
if I have a family who's had a baby through a surrogate, right, so they had an infertility journey,
and we're not able to, you know, conceive biologically, or even like sustain a pregnancy through in
vitro. You know, families that have babies born through surrogacy.
or even their own like, you know, IUI or IVF treatments. It's so fascinating to me.
Like there's a lot of conversations about vaccines right now, but families who've gone through
fertility, infertility, they're like, do it all, protect this baby. Right. I think it comes out of,
and you probably see this just like the journey of like, you know, trying to.
you know trying to force those embryos you know trying to get those eggs out right like we put so
much into this little little baby we need to protect this baby from everything um and i'd say that
most families i see on the other side of it like besides like being like absolutely gung-ho about
making sure the baby's protected for every, every possible infirmity that we can.
They're so grateful for their children. Yes. It's such a,
it's such a beautiful thing. It's just like, I mean, I think that every birth is a miracle and I
don't attend deliveries anymore, but I just feel like as a pediatrician, when that baby arrives,
it's like. It's like the sky opens up, the heavens open up, and this magical gift happens.
There is like, I feel like there's like this pause in the room. As long as mom's okay and baby's
okay, there's like a pause in the room and everybody is just like, ah, like everybody's like
breathing, you know, and just soaking in this baby. So that's what I see is like, one,
they're very interested in making sure their children are healthy and keeping them from feeling
sick.
they're grateful for the children that they have. I think that sometimes,
sometimes families that have been through, you know, infertility on their side of it are very,
they're very nervous though about. keeping their children healthy. And so I might see them more
frequently. Oftentimes they need a lot more support. And I think it maybe comes out of this idea
too, of like, I was thinking as you were speaking, that when it's your first time going through a
pregnancy or as parenting, as a parent, when you're going through infertility,
you probably get to a point where you don't really trust your body. Right. And, and I think this
element of like self-trust is so important. And maybe again, like that comes out of the scarcity,
the scarcity mindset of like, I don't know if I can get pregnant. I don't know if I'm going to find
the right partner. I don't know if I'm going to find the right, you know, sperm donor or egg donor
or what have you. I don't know if the delivery is going to go the way I want it to. I don't even
know how I'm going to be as a parent. I want to breastfeed. I don't know that that's going to
happen. And so there's all these like, what ifs about what your body's going to do,
what it's capable of doing, because it's never done it before.
And that's just a really hard way to come into the whole parenting situation.
Because on the other side of your delivery, your hormones are going to drop and you're going to
feel like kind of a hormonal, emotional sort of bundle of nerves.
And if you've come through a pregnancy anxious. you're going to be extremely anxious on the other
side, but it's okay. Like I, no judgment here because I I've experienced that myself and I see lots
of families that do, but, but it does make sense then to think about who your team is on the other
side of delivery and making sure that the team that you have, your physician, your baby's
physician, that they've got you. Yes. And yes, go ahead, Dr. Karen. Go ahead.
So don't leave that up to chance. You know, a lot of times families who are expecting are just kind
of planning for the delivery. They want the best OB. They want the best REI. And they sometimes
forget that they need to find, you know, a pediatrician on the other side of that delivery that's
going to help support them and answer their questions. I think it's so important,
but I oftentimes see families forget that part. I think that's so beautiful. And thank you so much
for reminding us. I mean, I do think that we, again, I'll say it again, there's more postpartum
anxiety and more postpartum depression among women who have gone through the fertility journey.
And, you know, the worries continue as much as we do the emotional regulation as much.
There's so many things. And I think, you know, when I look at who I choose for my care team,
like my doctors, it's people who walk the walk, right? It's like people who understand. the self
-trust. A lot of these questions that we ask, I mean, there's sometimes not clearance or like, you
know, need perimenopause right now. Do I start the hormones? Do I not? I mean, I do hormones for a
living, but I want somebody who I know trust their own body and like knows limitations and,
and can really like have that intuitive sense of like how to help people. And so I think it's so
beautiful what you're doing in your practice. Can you say a little bit about integrative theatrics
and what that is? Because I think before you, I thought about, you know, functional medicine for
adults and integrative practice, but I hadn't. really thought of it as applying to children. So can
you say a little bit about that? Well, so, yes. So I'm a general pediatrician.
I'm board certified. You know, I'm a member of the American Academy of Pediatrics. Actually, I'm a
fellow, you know, did conventional pediatric residency. And I very much believe in,
you know, in what we promote. So, you know, regular wellness checks, vaccines, medication,
if you need it, if you're asthmatic, you need it. If you have an ear infection, we treat it. If you
have a pneumonia, we treat it. But what I found in the almost 20 years of pediatrics is that
conventional medicine, like there are ailments that children have that conventional medicine can
treat up to here. But then like beyond that, we just kind of go, just,
you know, if you have a constipated child, just live on Miralax for the rest of your life. It's
okay. It's safe. Right. And I started to think, gosh. When did humans get to this point where we
have to take vitamins, we have to be on iron supplements? I have teens and younger getting iron
infusions because they can't maintain their own iron levels and they're chronically anemic and
they're chronically constipated. I kept thinking, this just doesn't feel sustainable. When did we
as a human race get to this? And so my interest in functional medicine, I think,
came out of... Oh, a lot of things. You know, I lived overseas in South America. There are,
you know, there they drink teas and tisans and things like that that have medicinal properties. And
I was like, oh, yeah, OK, that's interesting. You know, I'm also Hawaiian and we have a lot of
medicinal herbs that, you know, we kind of grew up with as well, knowing that, you know, Hawaiians
use these things for different ailments. And then when. And actually a friend of mine nudged me and
she says, hey, let's do this together. And I was like, yeah, what is functional medicine? And I
really thought it was like the territory for naturopaths, but not for medical doctors. And I found
actually that there was a very large organization in Seattle, in fact, where. Many of the
practitioners are medical doctors. And then I also found an integrative pediatrician who's a
medical doctor who is a Stanford fellowship trained. And I was like, oh, medical doctors are
starting to do this. And really, it sounds so fancy. But really, what we do is we get down to the
root cause of why you have the symptoms that you're having. So in conventional pediatrics,
we say, yes, your child is constipated, have Miralax, drink more water, take more fiber, and we'll
see you next year. In functional medicine, we say, okay, yes, let's treat the constipation,
but why is it happening? You know, is your child very selective about what they eat?
You know, nine times out of 10, they are. Well, why are they selective about what they're eating?
What's going on inside of their gut? So it's very like gut focused. getting to the root cause of
why you're experiencing this symptom rather than just kind of discharging you on Miralax for the
rest of your life. And so it's, I find it extremely rewarding.
I have figured out how to convince even like three-year-olds to get their blood drawn because we
find all sorts of things when we do that. And like lots of surprises,
like, you know, kids with celiac disease who have no symptoms and they're kind of pre.
I would say almost pre-celiac, but they've got positive antibodies and their TTGs are normal.
I've had children that I never would have suspected were pre-diabetic, you know, abnormal or they
have normal BMIs. But so just lots of things that related to the nourishment we put into our bodies
or the nourishment we give our children and finding out that maybe they're not feeling their bodies
the way they should. So I honestly. think the bottom line with functional medicine and integrating
it into pediatrics is just kind of getting back to the way we eat as hunter gatherers, like whole
food. I think of fermented foods as like an added food group. But the hard part is like when your
child's eating chicken nuggets and mac and cheese, like how do you get them to eat, you know, a
salad and vegetables and all the things. So that's kind of, that's my world. I help parents get to
that. Right. So they don't have to be on pills and vitamins and all these things forever and ever
and ever. I mean, there's so many things. I mean, you know, like I have a kid with psoriasis,
which is like stress mediated. And it's like, okay, well, you can take these drops and these creams
and everything like that. Or maybe we can start to understand the stress and the flares and all
those things. And, you know, I think we don't always, kids are like little people, right? We don't
always like think about them, but they are people. Some, a lot of the attention I think that we
spend doing integrative health for adults, I think really we need to be spending,
you know, towards children and, and like, you know, yeah, go ahead. So we're going to say. Well,
so, so one of the things that occurred to me, um, because you know, we're always, I'm always kind
of evolving and, and, and figuring out like, how do I do this better? But one of the things that I
heard from some of our colleagues was, oh my goodness, in my practice with adult patients, we can
reverse diabetes. We can reverse hypertension. we can reverse obesity and how are we doing it?
Sometimes it's with medication, but a lot of it is lifestyle changes. And so then I thought, wait a
second, if we can reverse it in adulthood, then we really need to be doing a better job in
pediatrics of like preventing that progression. Right. Yeah. Yeah. You're so smart.
And I love what you do. I mean, if you don't follow Lecker Curren already on Instagram, we'll put
all of our stuff in the show notes, but it's really creative and really like. I wish I lived
closer. I really do because I think you're doing it right. And I would be so excited to have you in
my world as a pediatrician. So I will just say that. We're in each other's world as friends. That's
right. That's, that's right. And colleagues. Okay. So I want to shift a little bit because you,
over the last couple of years, I had a really, really hard couple of years with your father getting
sick and, and ultimately dying. And, and I. When we've had conversations about this offline,
I've been so moved at how you have grieved his loss. And also even before that,
how you readjusted your life when you knew that his situation was terminal to be able to spend as
much time with him as possible in the middle of running this busy pediatric practice, in the middle
of being a single parent. So I was wondering, because so many of our listeners are dealing with
really, really hard times in their life right now. infertility perhaps is like the first truly hard
thing that has happened and like life altering, devastating, horrible thing that has happened. And
so I think, you know, when I was an intern, my chief said to me, you know, as long as you have your
perspective and your priorities in mind, like everything else is going to be okay. And that's what
I think you did over the last few years. And so could you please share a little bit about your
journey being a daughter to your father, who I know you adored and, and the choices you made and,
you know, We can talk a little bit about joy and grief at the same time, but set the stage. Give us
some context if you don't mind sharing the story. Okay. So I might get a little teary.
Yeah. Yeah. Yeah. I've got my Kleenex here. Do you have your Kleenex?
I am a total daddy's girl and I'm the oldest of eight.
My parents split up when I was 11 and they both remarried, but I was the oldest.
And yeah. And my dad was always like,
like just the, just a prime example of being like the best,
like emotional and physical state that he could ever, that he could be in at whatever age he was
in. He was just so much fun. And he had this like sense of adventure. And he was sharp,
sharp, sharp. And I remember thinking to myself, like, I really hope dad lives into his nineties.
That was his goal. He wanted to live, his dad. passed away at 85. And so his goal was to live till
at least 92. And he really thought that he could make it. And then, and then the pandemic hit.
And actually, I mean, I think if one thing I would say is perspective is everything.
So sometimes I think that as a physician, you know, we think that we're one trick ponies that all
we can do is like physician. And regardless of your specialty, This gift that we have of being
physicians, it's so powerful. Like not only does it help our patients, but it has the potential to
help our families too. To the point where like, I almost think that every family needs either a
physician or a nurse to advocate for, you know, whoever it is that needs it.
And so... 2020, he was diagnosed with like a rare form of,
it's a pre-leukemic state, myelodysplastic syndrome. And he and I kind of got to the conclusion
together because my dad was an accountant, an engineer, and he literally like, he mapped out and
graphed his CVCs over a period of six years. And it was interesting.
He says, Karen, I think I just, I kind of see my bone marrow is just kind of slowing down. It
literally is like, like just a straight line. He goes, and this is not sustainable.
And so, you know, he asked me what you should do. And I said, I think you need a really good
hematologist. And long story short, he was diagnosed in March of 2020 and started chemotherapy.
At the beginning of the pandemic. And I think the timing, like on the one hand, you could think the
timing was the worst it could possibly be. But I think the timing was the best it could possibly be
because it, you know, it forced me to make a decision. And what I decided was I live in Portland,
Oregon, and dad lives in Jacksonville, Florida. And I'm a single parent.
And at the time in Oregon. I wasn't too happy with it. You had to quarantine every time you
traveled. And I was like, you know what? Like this thing has an overall survival rate of three
months. We're just like, I learned from dad. We're just going to go for it. We're just going to do
it. And we're going to deal with the consequences, whatever they may be. And so my son and I
started to travel to visit dad from March until June. I think we traveled like twice. The airports
were completely like silent. There were no people. Really, the airplanes were empty.
It was it was really surreal. And so we visited him and then he went through chemo and then he had
a stem cell transplant, which made him really sick. And and at the time,
it was interesting because Oregon was so shut down and Florida was not that I could actually see
like two different existences and figured out a way to reconcile them. Anyway, I'm making this
long. Sorry.
But yeah, so I just decided like at the beginning, like we're just going to go for it. This is how
my dad lived his life. Like if you live your life without taking measured risks,
it's much worse to like live with regret than to take a risk. that you've kind of factored in all
the things and you've determined like, yeah, it's risky, but it's worth it. And so, and so that's
what we did. In 2022, I lost my job. I was part of a small group practice and,
you know, through a difference of opinion, you know, found myself having to pivot.
And it was... You know, I looked at all of the choices. I had seen some of the large hospitals
furlough or fire their physicians and thought, I don't want to work there.
I didn't want to work in urgent care because, again, like I'm a single parent, I didn't want to
leave my son alone. night or on the weekends. And so I decided that I would start a practice.
And my dad was very much a part of like, you know, figuring out the financials and super, super
encouraging. Even before I left my last job, I actually put a photo of my dad and I up on my
computer. And I thought, every time I looked at it, I thought,
when he passes, how am I going to feel about this? I'm so glad that I had it up because it,
It's like my dad's with me and like I take him into the patient rooms with me because it's a
picture of me and my dad on my on my wallpaper. And so I think just from the very beginning that
the pandemic forced us to think about what was important and how and how to hold on to this this
very important relationship to be there for my dad to advocate for him. I mean, it just.
Yeah. I think it's just about like prioritizing and not being afraid of taking those risks for the
things that. Yeah. So you would take, you would take like a red eye, right? You would work Monday
through Thursday. Let's like spell this out for our listeners. So, so when I started my practice,
I decided that I would work half days on Mondays. So we started. one o'clock in the afternoon.
I'm here all day Tuesday, Wednesday, Thursday, and then Fridays we work till midday. And so it made
it really easy. I figured out this sort of cadence of like, if I could take off on a Friday,
and we would fly, you know, a red eye Thursday, show up on Friday, be kind of tired on Friday,
but be there all day Saturday, Sunday, and then fly back on Monday. And I would take my son with
me. So, so, so really, I only needed like five days. more or less,
you know, sometimes I would cancel a day of clinic. And at the beginning, I mean, this is like
letting go of the things you're afraid of and like taking, you know, measured risks. I didn't have
that many patients. So it wasn't like if I took off a Monday completely, or maybe even a Tuesday,
I didn't really have anybody beating down my door. And I set up my team so that there was at least
somebody answering the phones. And I've done televisits from Florida before. Yeah,
great. So it was actually perfect that I hatched my own practice because it allowed me to have some
flexibility and to think creatively about how to solve problems for dad and how to solve problems
for my patients. But yeah, I mean, there were times where I sat in his dining room taking
televisits while he was like sitting there watching TV. And it just was nice to be in the same
space together. Yeah. And how long did you exist like that?
How long did you do that until he ultimately passed? About three years. Three years.
I mean, I've even done televisits from, I was never in the ICU with him because if he was in the
ICU, well, we were in step down together. We were in the ICU together. Yeah. I've done televisits
from the ICU as well.
And the beautiful thing is like the same energy and passion that I have for advocating for my
patients. I very easily was able to turn and like use to advocate for him.
Yeah, we did it. I still am not sure like how we did it. I do have coaches in my life.
And so I think that that was also really helpful to like give me some perspective.
Yeah, I think I had one coach actually say to me, she's like, I think sometimes you're buffering,
you know, you whenever whenever you have like a big project in your practice, sometimes you buffer
to say, well, you know, I'm thinking about dad. And and so there's this nice balance between like
managing the projects in the practice and then also being present with my dad.
And then also to like the finances behind it, too. Right. Like it's very easy to. Um,
to think like, am I going to have the re cause I I'm in solo practice. I'm a general pediatrician.
Like I don't do procedures. And so there's also that part of it too. If I don't work and see
patients, then like who's going to pay the bills and, you know, and all of the, all of the money
that goes into flying back and forth. But, um, yeah, it was, it was a delicate balance,
but we did it. And, and I think too, like, because he had this rare, um, diagnosis with a three
month overall survival rate. You know, it was very easy to say,
well, I would much rather spend the time and the money to see him as much as I can and to have my
son see him as often as he can. Because I think I would regret it if I just said, well, I don't
think I can cancel a day of patience. I don't think I can afford, you know, an airplane ticket.
So, yeah, I kind of think of it like throwing yourself out of an airplane and going skydiving.
You're just like, we're making a decision. We're just going to do it. And pull the chute when you
need to. And so, you know, to be honest, like when he passed in June of last year,
I really I wasn't able to take time off because, you know, my my practice really needed me to be at
the helm. And I have to say that I think probably as a CEO, I was not as present as I needed to be.
But I was also grateful to like just kind of come back and start seeing patients again. Because I
had been, I think it was just easier to go back to the routine. And that was like a sort of
buffering too. Like I much preferred seeing babies and three-year-olds rather than sitting at
home, just grieving. I think I'm grieving in pieces.
I think, I don't know when I'll stop grieving, but you know, every once in a while, I just, I'll
hear something that reminds me of him. He taught me so much. I don't know how one person could
teach me so much, but I'll hear a song or I'll see something and it reminds me of him and I'm
grieving a little bit. So I think grief is like this roller coaster. There are moments where you
are really kind of missing this person. And then there's moments of joy,
you know, like I. I enjoy walking my dog and seeing him be, you know, silly. I enjoy watching the
cherry blossoms as they're coming out. And it's almost like when you're grieving,
if you can reach for just something that's so beautiful and enjoy it for like a split second or
like a sunrise or sunset, we have beautiful sunrises and sunsets without horizons here.
There's always like evergreen trees in the way. But if you can, if you can enjoy those moments,
I think it kind of helps you, kind of steals you for like the moments where you really kind of feel
like you're grieving.
I never feel like there's a, I don't feel like grieving is a bottomless pit. I just think there's
just moments where I experience it. I, you know, I thought twice about. He passed in June of last
year. And I thought twice about spending the money and the time to go out to, you know,
a conference in October with one of our business coaches. And I knew that I needed to go because I
just felt like my spirit and my soul, like just needed to be restored.
It was, you know, near the ocean in South Carolina and Myrtle Beach. And it was so good for my soul
to be there and to connect with, with you, with. You know,
with other other women physicians that I really kind of value and cherish who've helped me through
this whole thing. And that would be like another suggestion is just stay connected.
I think sometimes when we're going through a hard time, like it's very easy to kind of involute and
not reach out. But I know there's so many other women physician friends of mine that knew what was
going on because I was. you know I'd share and and so I never felt like I was alone and that I
didn't have you know friends that could back me up and then when we saw each other in person it was
so it was so nice to just like connect and feel supported and to feel like I was you know part of a
part of a family really and so you know some people I think when they're grieving the loss of a
parent or a spouse Or, you know, in your case, many of your patients might be grieving like a
miscarriage because, you know, that's a different type of thing that you're grieving,
right, is the potential life and the dream that you're holding space for.
It's so much easier if you do it and you're connected with,
you know, friends and feel supported.
Yeah, I hope that's helpful. No, I think so. And I think, you know, when we let one emotion in,
we let another emotion in, right? And so like, that's one thing I learned in residency, which I
mean, I've shared this before, like to survive residency, I had this very restricted zone of
emotions. And I said, you know, in my integrity, I'm going to take care of my patients and I'm
going to protect my junior residents. But like, other than that, to survive in New York City as a
Vermont girl, you know, it was a very different time. But I realized I can keep out the criticism
from the attendings and whatever else, but I also am keeping out the joy. And I think the same
thing is true that when we're grieving infertility, miscarriage, recurrent loss,
other things, sickness of a parent, death of a parent, if we can allow ourselves to grieve that, if
we can do that in community, if we can do that with supports, that also, those channels, that also
is when we can open ourselves up to the joy and the connection and the unexpected support. I don't
know if you remember, Karen, like you, I'm sure you do. Like that, that night that we got to sit
together at dinner at that conference, the other woman right next to you at the table was talking
about the loss of her own father. And like, that was so healing and we have to share our stories.
I mean, we just, we have to, and there's so much healing in the telling. And, you know, my own
father is still alive. There will be a day when he's not. And, you know, leaning on you and our
other beautiful friends like that. That just helps me honor my own human experience and just know
that like, it can be hard, but we're not going to do it alone. I would say that like a beautiful
example of how this is done is so our mutual friend, Rashmi Shram,
she lives in Chicago. And you know, there were like, there were times where I would go to visit my
dad and I would say, I need to just like spend a hundred percent of the time with my dad. But the
reality was, is like, I would go with my son and When my son and my dad were together, it was like
I was like the outsider. They were like tinkering. They were building things. And I was like,
these guys aren't going to miss me if I go for a walk on the beach. These guys aren't going to miss
me if I go see my friend. And so honestly, like every single time I traveled and my dad was getting
medical care in Houston, like I would look up a friend.
And like I looked up Tamara Beckford, she and I connected like towards the very end when he was
very, very sick. And it was just so healing just to like spend an hour in her presence,
just like the joy and the love that she has. And just it meant so much to me that she.
came and just spent some time with me while we were there. I was, we were there in Houston for like
a week or I have another friend in Houston. We went out and drank boba tea together and just like,
just talk like moms and women. And then in Jacksonville, Rashmi, this was the one that really stood
out.
I had called her ahead of time and dad was in the ICU. He was really sick. He was really,
really sick. And I don't take care of adults. So like my general.
medical training and my pediatrics came in, but she says, Karen, what can I do for you? And I just,
you know, like when you have somebody that you love, that's so, so sick and you can't predict the
outcome, it's hard to even like think straight. And I was like, Rashmi, can you just like come and
rescue me from the ICU for just like an hour? And she goes, can I bring you anything? I was like,
How about some tea? So, so she, she comes to the hospital in Jacksonville. I,
you know, I come out of the ICU. Dad's going to be okay for like an hour. We get in the car, we
drive to the waterfront and just like walked and talked and had some herbal tea.
And it was like, just so good for my soul. It was so restorative. We did,
you know, did nothing but like connect and have a cup of tea. It took an hour. I had been there for
like an entire week, but just like that, that was like an act of like kindness on Rashmi's part.
It was an act of kindness on my part to like enjoy the sunshine and a friend's company for an hour.
That's so beautiful. And she was a part too of your ultimate decision to travel to be with him.
So you could be with him at his moments, his final moments. And like,
that's just so beautiful. Yeah, and I almost canceled on her. You know, I had put together and I'll
put it out because you're in there too. But I think my soul was searching for answers and was
searching to be restored before he passed. And so a month before he passed, I started to put
together this. the Joy Reset Summit. And I interviewed you.
And I interviewed Rashmi also. And she was the last interview that I did. And that was June 11.
It was nine in the morning. And my dad was in the ICU again. And she and I talked about like
mindfulness. And, you know, and when we got off the call, you know,
she and I just talked as friends. And I said, Dad's real sick. And I'm going to travel tomorrow.
And she goes, Karen. you have been preparing your whole life for this. And she said,
if you intuitively feel like you need to go today, then like follow your intuition.
And so it was just this beautiful, like very overt nudge. Right. Because she knew what was going
on. And I was like, you're right. So I got off the call and I was like, please call my patients and
reschedule this afternoon's patients. I'm going to be on the first flight out tonight. And we did a
red eye. And oh, my goodness. Thank goodness I listened to her and myself. And I think that's
really where like the self-trust comes in is like. Like, I think we all kind of have like this
knowing like this inner knowing, but we can buffer and we can cover it up and we can explain it
away. We can rationalize and say, you know, I don't have the money. I don't have the time. But but
if you do all that and you ignore this, like inner knowing of like, it's going to be OK. You're you
know, you know what to do. And I did. And, and it was all fine. Like none of my patients were
upset. My staff wasn't upset. And, and it got me, you know, 24 hours,
24, very important hours to just help him wind down and for us to all be okay with what was going
to happen. And I think the thing I was most, I'm going to say worried about was missing his time of
death. I wanted, and he wanted me to be there and I made it.
you know, because I have really good friends like you. I have really good friends like Rashmi who
like helped me kind of get this perspective and to, you know,
to let go and to follow my intuition. So, and I think the same is true within the fertility
journey. I mean, sometimes people know they need to do another IVF cycle, even if their partner's
not on board or sometimes people know, you know, like what, what they, they, they know what they
want, but they're afraid of it because Maybe it inconveniences patients or maybe it's a little more
expensive. But that's one thing I love helping people do is to tap into them. that inner knowing
with this fertility process, because it's so important. And we have those whispers. We can shut it
down, like you said. But any bad decision I've made in my life has been when I ignored that whisper
of intuition and ignored it. And so now I'm in my 40s. I'm getting better at being like,
oh, that voice. OK, I hear you. I'm not going to shut. And sometimes it's not like an impulsive
action. It's like. I'm going to sit with this. I mean, obviously you, you needed to go and you knew
it was time sensitive, but, but we need to find, we need to listen to that voice and we need to
develop that muscle of self-trust so that we can lean in and do the things that are most important
for us. Well, and it also like leads into that point of like being connected and actually like
being connected with friends to the point where like you can make yourself a little vulnerable and
share with them. Because if you don't do, if I hadn't done that. Roshni wouldn't have known.
Yes. Yes. To nudge me, you know, and you wouldn't have known, you know,
to, to, to, you know, to talk with me about, you know, how do we,
how do we find joy through grief? Cause we talked about this before. We talked about it. Yeah, we
did. Yeah. And so, you know, I have this beautiful, the joy reset summit,
which is really meant for, and something completely outside of my practice, which is really meant
for mostly women going through hard times. And it came out of me needing that,
that wisdom and those teachings. And so when he passed,
I use every single tool that I learned out of the joy reset summit. to come through on the other
side. And I still use it and it's something I need to share it. Um, um, but it's still something
that I use to this day because, um, yeah, it was a minute and, and you're, you're in there and
you're part of it. And I'm so grateful. The timing wasn't right yet, but when the timing is right,
you release it and then we'll let everybody know. Yeah, for sure. Oh my goodness. But this is such
a beautiful and rich conversation. Dr. Karen, is there anything else you want our listeners to hear
about? pregnancy planning about, you know, shedding anxiety, layers of worry,
joy and grief. I mean, gosh, there's so much we can take from this conversation. I would say, I
would say just, just know that it's never too late. So even if you were anxious during your
pregnancy, don't worry about high cortisol levels on your pregnant, during your pregnancy and the
impact on your baby, because everything is fixable, right? It's when we think it's either this or
that. I kind of live in the and like, yeah, you can be anxious in your pregnancy and it's still
going to be okay.
And, you know, and that's what I'm here for is like to catch parents on the other side of the,
the, the infertility, the delivery, and to be on their side and say, Hey, I'm here. I can help you
decode what's going on with your baby. And it's okay. Cause we really, it's, it's really hard to
break a baby. We just really kind of need to support you as a parent and it's, it's never too late.
So regardless of. how you're you delivered regardless of how anxious you might have been or worried
or you know all the things like we can still fix it it's gonna be fine yeah yeah and to have
somebody like you who understands who's walked the walk to support you in those early days and as
as the kid grows because there is gonna be a kid if you listen to my podcast every single person
who has a desire in their heart to become a parent will become a parent and you know you're in
portland oregon like i said if i lived closer you better believe i'd be knocking down your doors
but dr karen does it differently and Better. And you need to go look her up and go find her.
But also your social media is really wonderful. So can you share with people where they can find
you on socials? Yes. So it's my first and last name, Karen Palmer MD on Instagram. Um,
the name of my practice is pure joy pediatrics. So we have an Instagram pure joy pediatrics and my
website is purejoypediatrics.com. And I'm also on Facebook under Karen Palmer MD.
So just my name, if you search it, you should be able to find me. And, um, yeah, we're doing, we're
doing such fun, rewarding work out here in Portland. So amazing. Thanks,
Dr. Karen. I'm so grateful to know you and to my loves until the next time. You know how much I
love you. Bye.