Done with Grit: How to Stop Overfunctioning with Dr. Kathy Stepien

What do we do when the strategies which have worked for us in the past are no longer serving us? 

We have gotten so good at overfunctioning, and yet we are feeling burdened, depleted, and resentful of not just our jobs but the fertility journey. We also feel incredibly alone in our struggle.

In today's episode, we discuss the following:

• overfunctioning and how to recognize it

• mindful self compassion

• healing in community

• permission to rest

• trusting ourselves

• navigating uncertainty 

• why we need less grit to live our most authentic lives

Dr. Stepien has spent a decade helping women physicians take back their power. You deserve to take your power back, too. 

Guest Details: 

Kathy Stepien, MD, is a board-certified Pediatrician, Certified Coach, and Director of the Institute for Physician Wellness. In 2016, Dr. Stepien founded the Institute for Physician Wellness with the mission of helping physicians learn, heal, grow, and connect. Dr. Stepien's work is driven by a deep commitment to helping physicians, especially women in medicine, live empowered and fulfilling lives on their own terms. She believes in fostering a life where women can fully stand in their power and embrace their role as the authors of their own stories.

www.instituteforphysicianwellness.com

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://calendly.com/loveandsciencefertility/discovery-call

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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 and Science podcast. I am so honored to have an amazing guest tonight. It is tonight when we are recording. Her name is Dr. Kathy Stepien.

This is somebody I've wanted to connect with one-on-one for a very long time. And her work is just incredible. So let me tell you a little bit about her before we get started. So she is a board certified pediatrician, a master certified coach, and the director of the Institute for Physician Wellness. She founded the Institute for Physician Wellness with the mission of helping physicians learn, heal, grow, and connect. It's absolutely amazing. She does coaching, she has retreats.

And to think about the mission behind what she does, what she does, her work is driven by a deep commitment to helping physicians, especially women in medicine, live empowered and fulfilling lives on their own terms. She believes in fostering a life where women can fully stand in their power and embrace their role as the authors of their own stories. Welcome, Dr. Kathy. It's so wonderful to have you here. Thanks for having me. It's great to be here. And she's in Alaska, right? I was just learning. So just like me, still practices clinical medicine, her pediatrics practice serves understood populations, and also has this wonderful, wonderful coaching practice too. And so I think the combination of the two will really provide some insight in tools, real tools that we can use to help us get unstuck and navigate this fertility journey to get to the other side. So with that, I'd love to know your story in terms of your pediatrician working and something within you called for you to do something beyond with physician wellness. Can you tell us a little bit about that journey for you? Oh, I'm happy to share. I, it feels like the dark ages. This was at a time, it was in 2016, a time when we weren't really talking about physician wellbeing, like we do now. I think back then, many of us struggled in silence and we might reach out to residency friends or our sister at two in the morning or whatever it is. But so much of what we were, what physicians carry, we often were doing so in, in isolation. And I felt a need to bring, bring physicians together. I know I was struggling and felt that there's, that there's a need for us to gather, for us to connect. And I knew if I was struggling, I was not the only one. And it wasn't just about my struggle, actually. I had been leading retreats even before I went into medicine and through medical school and through my whole training and growth as a human being, I just found that connecting with other people, bringing people together is kind of a core to who I am, that I've always been a gatherer of people. And I, at some point as an, after residency and surviving all of that, got to a stage where I was really ready to do that, to bring physicians together.

So in 2016, I just decided. And again, people weren't talking about it like we do now. I'm like, I'm going to do this. And so I just put together some retreats and put out the word that I'm doing this. And it was, it's the rest is just history. It's been incredible. They have, you know, we, we started out just with a small retreat of maybe 10 or 15 and things have just exploded over the year. So it's really been a joy, an incredible time of learning and growth. And IPW has grown from starting out, just leading retreats to offering a whole wide variety of programs over the years of different training programs. I've done consulting for organizations on wellbeing, just the whole gamut. And along the way, I also learned about coaching and got coached myself.

And I thought, wow, this is something also that I'd like to be able to bring to support physicians in their wellbeing. So it's just been a wonderful 10 years, about 10 years, and so much growth and learning. And I get to meet incredible physicians around the country, even internationally, it's, it's just an incredible joy. I can tell you, I didn't start out thinking I would be doing this.

You know, I was going into medicine to practice medicine. And so the, so it's, it's a surprise to find myself this many years down the road. And it's a wonderful fit. I love clinical medicine.

And I also love this, this balance in connecting with and supporting women physicians.

Yeah, it's so beautiful. Thank you so much for sharing. You know, it's interesting. So it sounds like you actually did this work before you were a coach. Is that right?

Yes. Yeah. Long before I was a coach, doing physician wellbeing. And I, I taught a lot about, about mindful self-compassion. I also teach mindfulness. I've gone through mindfulness-based stress reduction and mindful self-compassion teacher training, things like that. And I've been practicing mindfulness for a long time. And in the retreats, one of the things I brought to the retreats to share with other physicians is a sense of self-compassion. I think so many of us are, are so hard on ourselves and push ourselves in ways that can be, that we would never push a loved one. We would never say things to our friends and family that, but we say them to ourselves. And so when I learned about self-compassion, I thought, wow, I want to share that with other women physicians. And so I was focusing much of my work earlier on around that, as well as of a wide variety of topics that impact our wellbeing. But all of that happened well before I studied coaching. So amazing. I'm so grateful for that. And then you hear stories, a lot of people become coaches and then they do this thing, but it's like, it sounds like your journey was very organic in terms of you recognize your own struggles and your real calling to create community. And then you acted on it and then you were like, oh, there's this thing called coaching.

And I think that would integrate in. So it just sounds very beautiful. And I think, you know, mindful self-compassion, we do a lot of it in, you know, love and science. I think it's wonderful because I think it's like, it's like a muscle, like the more you, the more you build it, the more it grows. And then the more it becomes like you're sort of automatic, you know, you fall out of a yoga pose and you gently laugh at yourself instead of chastising yourself or something like it just becomes part of like the, the reactions. And then we can congratulate each other. You know, oh, that was a great mindful self-compassion thing to do. You know, today I found an email, like this crazy email that I can't believe I missed like six weeks later. And I just said, okay, mindful self-compassion, I didn't see it. There's nothing I can do now. Thank you so much for your patience. I don't, I don't, I don't know how I missed this, but here we are today on, you know, this day in July, answering this email, right? So you just, I think it just helps us feel better daily. And I'm so glad that you're able to provide that tool to the women physicians that you work with for sure. Thank you. It has really been, it's been a life-changing skill for me to develop and an understanding for me to develop earlier in my life. I was in my forties. I don't know how this happened. How do you hit 40 and not know that self-compassion is an option? Right? Like I, I learned in all my experiences in life before then about compassion for others. I'd studied empathy and did research on it while in medical school. Like I had, like I thought I understood compassion, but it never, I never had heard about the whole concept of self-compassion. And I'll never forget when I heard Kristin Neff speaking about it, who's one of the leading researchers across the country.

And she, I remember that feeling where my brain was just shifting and this almost this explosion in my brain, like what? That's a, that's a thing. I, I had this mistaken belief that I needed to be really hard on myself. And it was, it was because I was hard on myself that I accomplished such things, right? That I somehow made this cause and effect connection, which is totally the opposite of what the research shows. But so to have this complete mental shift in my 40s, I'm like, what? This is amazing. And, and I began to turn into, tune into that critical voice that I just realized I was offering myself all the time. And it took a lot to be able to begin to shift that.

I, I often thought, okay, I kind of got the ideas and in the beginning and, and started practicing that and reading about it and listening to things and all of that. But it has actually taken years to integrate it. And to the point where it's like, Oh, this is my new normal. It's so fascinating. We are so fascinating. We are, we are. It's so interesting how like, just a mistaken belief can create such suffering and a change in that belief can, can change my perspective on so many things. That's right. And like you said, it's a practice, like we practice it daily.

And if we notice we're like, Oh, you know, I, I noticed some self judgment, or I noticed that maybe there was that critical voice a little bit loudly, more loudly, then we can get curious about it. And then sort of rework that like, okay, well, maybe the next time this comes up, I could try, this comes up, I could try X, Y, or Z. And that's sort of how we forge those new pathways. But I'm obsessed with Chris and Neff. We talk about her a lot at Love and Science. I actually have been doing her mindful self compassion workbook, which goes along with her book. But it's so interesting.

And I recommend it to a lot of my clients, most of my clients actually, and I've been working on it for three years. I mean, that's the interesting thing because it's, it's such a slow, intentional process. And like to bust through it to do it, like, you know, netter style or whatever we learned in medical school, like that's it's not that it's like, okay, let's really let this seep in and integrate in and apply it. So I'm amazed. And also, do you follow Tara Brock at all? Do you listen to her? Yeah, I love I love her energy. I love so much of what she has to add as well. I think she's fantastic. You know, who else has done some fabulous work in mindful self compassion is Christopher Germer. And I've actually I spent a week on retreat with the two of them and then later went back and did another week of teacher training with them. And I just he he also has a book on it. I think it's called the the path to mindful self compassion or something like that.

Germer G E R M E R highly recommended I enjoy it. I think, you know, they're both just fabulous books. They're both fabulous human beings. But the books they put out there is just wonderful. So I encourage you and your listeners to check that out as well. Just some just some really fabulous work being done by by by good people. And the research around it is just profound. And it's just that's a life changing for me. So thank you so much for sharing. I think that's going to help a lot of people and me too. I've not heard of this author. I can't wait to to learn more, right? So I wanted to ask you about how you look at this notion of over functioning, right, with your women position clients, because I think we have gotten so efficient and so productive, like I think of myself, my chief of residency, like running a labor and delivery floor and looking at the strips and you know, I was at a very cute center and just all the all the things that my brain and then and then we extend that right fellowship and new attending hood and all the different ways that life presents complexities. And so, you know, how do we even recognize if we're over functioning and have sort of like love loving compassion for that part of ourselves? And then how do we start to shift to be able to let some of that go? Like what what does that look like? Great question.

I think over functioning, I don't know that we would see it with our eyes as much as feel it with our heart, like that feeling of doing too much for everyone all the time, carrying the weight of the world, carrying the weight of everyone around us all the time, kind of being that person that everyone counts on and taking on more than what is ours to carry. So and you know that feeling, I think sometimes we can express it around the holidays, for example, with an eye roll of, oh, I've got so much to do or at the hospital or the clinic where there's this feeling of just one more, of course, there's one more thing to add to the physician's list, right? Like it's just always people always wanting more or getting a direction from administration. It's like this also has to be done. And it's like so there's like piling it on. And there's this felt sense with that, that it might be hard, it might be hard to actually describe it, but it is one that is I feel is there's tension, there's activation, there's physiologic activation around it, it's not a happy place. It's a heavy burden to be walking around with, you know, I suspect if we were monitoring, our blood pressures would go up and our heart rate would go up, there's this heavy burden feeling to it. And when we can tap into that, it's like, oh, well, what is this about?

Well, hmm, maybe some of this is actually not mine to carry. Maybe some of this is what I'm doing because this is what's been expected, or what I've been socialized to take on. But is it really mine to do? And do I even want to be doing it? Does it serve me? Is it in alignment with what I'm here to do in this lifetime? So I think that when we feel that heaviness, when we can tap into that activation, that triggering even, sometimes it'll come out maybe as some frustration of or, or some, some of the women I work with have shared with me this feeling of, well, they shouldn't do that. They shouldn't want that. They shouldn't need that. They shouldn't act that way. They shouldn't say that.

Right. So when we get into that, should the drama around other people's behavior and expectations, like, well, wait a minute, that's really pushing up against our boundaries. It's a, it can be a boundary violation and it'd be an indicator of, well, wait a minute. I'm showing up in a way that's not in full integrity that is over functioning. And here's an opportunity for me to, to look at that, to get curious about it and have self-compassion about it and decide, decide with full, with full clarity of, okay, how do I want to show up? How do I want to move forward?

Yeah, I think that's a lot of really good wisdom there. And I think you're right when you say that, like, to, to understand what it is, it's a felt sense rather than the cognitive sense. Because I think if we analyze it from our brains, all we're going to see is accomplishment and like, you know, like, like our, like that internal family systems, that cheerleader part of ourselves, like, oh, great, another paper published. Oh, great. Another committee. Oh, great. You know, you got all your mandatory is done on time. Like, you know, whatever it is that we pride ourselves about. Oh, even today, I mean, it's ridiculous that dopamine, oh, press gainy surveys came out. Oh, great. I'm on the good side of the numbers this time. But like, you know, like maybe two months ago, there was a negative, like, it's just, it's the whole thing is so interesting to think about. And so I think when we can feel it with our hearts to kind of understand, okay, what's left for me? Like, am I giving it all the way? And am I carrying the weight of the world myself? And what, what do I need? Because, you know, so many of us are recovering codependence. We have been so fixated on the needs of everybody else, but ourselves, maybe because we were displacing the attention on ourselves for various reasons, right? And so when we then shine that light back on ourselves and say, okay, what do I actually need?

What support maybe I need a secretary to help me with filling out some paperwork. Maybe I need, you know, an extension on something like, but we need to ask ourselves that question.

But it's only when we can recognize that discomfort in ourselves is something that maybe could shift that I think we can start to, to just even, I don't want to say get a handle on it, because it's not exactly that, but just have the awareness to then tune in to our bodies, tune into our intuition to start to shift, right? Would you say that's sort of, I think you're, I think you're spot on with that.

One of the things that I learned from Christopher Germer that I just love is I put my hand on my heart before I get out of bed in the morning, because I, I don't know if you're like this, but I tend to, the minute I wake up, my brain is on go mode. And, you know, I start with that list of all of the things. And so before I even get out of bed in the morning, before my feet hit the floor, I try to pause enough, I put my hand on my heart, and I pause and ask, what do you need?

What do you need, dear one? And I remember learning that from Christopher Germer, and it just was so moving. I'm like, are you kidding me? Like I ask everyone what they need. I, no one ever asked me what I need. And I never asked me what I need. So to be to, I started that a few years ago of this, this morning habit of doing that. And it's shocking. Sometimes it's, it's, well, today, I just really need to get more protein in my diet or something, or sometimes it's like, well, today I need to have that hard conversation I've been avoiding. Or today I need to, I need to set a boundary that, that I've been working to set, right? Or today I need to reach out and ask for some help on this, or take something off my plate. So sometimes it can be as a really simple answer. And sometimes it's a more detailed answer of something I've been avoiding. But that practice has been life changing for me as well. When we over function, when we're, when our whole lives are very externally focused in serving our patients and our loved ones, the, it's so easy to not even consider what our own needs are. And, and then just keep going and just keep over functioning. And we're so rewarded for doing that, right? We do that, that helps us get into medical school and helps us get into residency and everything. I mean, just, we are rewarded in a million different ways for the esteem of our families. And, you know, she's the one we can count on when there's a crisis and all these things.

And it's like, Oh gosh, you know, it's all, it's a lot to hold up. Sometimes, you know, there's like that Atlas in access and you see like the image of holding up the world. There was a point as, as a new attending, when I actually just had this moment and I saw myself, I'm like, I cannot hold up the world myself anymore. And I think you're so right to think in terms of communities, because when we can express these things together, when we can mirror our own experience, when we can decrease the burdens from each other, really, when we can spread it out and diffuse it, I think that's really where our power is. It's not in going it alone. I mean, yes, we can learn these individual tools. We absolutely can. And those are incredibly useful, but I think the reinforcement of those tools, the kind of network of roots, so to speak, I think that can really, the power really takes off when it's in community. Yeah, it does. And I think it is through community that we change the culture of medicine, which is really where we are at. We are a movement in medicine changing the culture of medicine. This is not okay. This is not humane. It's not good for patients. It's not good for physicians. Something needs to be done differently. And we are part of that. We're that culture of change that's happening so that the physicians who come next after us are adopting an entirely different medical system, a different culture of medicine.

Absolutely. It's so powerful. It's so, so powerful. So I'm thinking of my listeners who are mostly female physicians who are balancing often a full-time load of patients and in fertility appointments, sometimes not at their own clinic. And so when I think about over-functioning, and this is not to call out anybody in particular, but I'm imagining that many people listening to this right now are like, "Oh my gosh, my to-do list is insane and I get up at 5 AM and I drive to the fertility clinic and then I do rounds." Or whatever it is, what can you say about somebody who already is high functioning maybe, and then has this giant life thing happen, needing a commitment, like the infertility journey on top of it. How do you approach somebody like that in terms of saying, "Okay, well, what has to give to make this sustainable?" Because the infertility journey is not usually weeks. It's not even usually months. It's usually something that spans, unfortunately, years of people's lives to both their families. And so it's the marathon and not the sprint. And I just feel like my people are the ones who have it all piled on to try to make it all work. I think that a journey with infertility can feel so isolating and so lonely. And connecting with other women physicians who also have some version, some story around that as well can be so affirming. And connecting with non-physicians who are in similar paths.

And then connecting with women physicians who might not be struggling with fertility, but also know what it's like to be a woman in medicine juggling it all. So there's different spaces for that. But I think the key to it is the connection, is the honesty of this is what it's like to be me. This is what it's like to be this incredible, smart, compassionate human being that's here helping other people and feeling vulnerable, having to live with uncertainty, having challenges that we can't solve by doing what we've done in the past, which is work harder. So in the past, I think for most of us, when there's been challenges like, well, you just grit it out.

You somehow just work harder and achieve, you're just going to accomplish. And I think when we're on a journey that includes infertility, that strategy, that gritting it out is not helpful.

And so to recognize that we're just a human being, having a human experience, and that includes joy as well as sorrow, and that we are not the only one. And to be able to connect really human to human with others in that sense of community, and then also connecting with ourselves, allowing ourselves to be merely human, not these super women who are over functioning and have no room for our fundamental needs, to really stand in ownership of our need for everything that we as a human being, having this human experience need.

Yes, that's so beautiful. And I think, what you said, connecting with others, connecting with ourselves, I think about myself as like now I'm like mid-career, right? But I think of myself as a new attending. And I remember just the comparative suffering like, oh, how many days have you been without a shower? Oh, this dry shampoo is really holding up. And I do treasure my friendships during those years. And I think that that was a particular phase of life. Although when I think back to some of those conversations, I'm like, is that really a badge of honor? Not showering, how long can you go without blow drying your hair? I don't even know, but it's almost like a culture of comparison and comparative suffering. And then when we start to shift it culturally, then it's like, oh, good for you, you set a boundary. Oh, good for you, you did X, Y, Z.

One in three female surgeons has infertility. It's one in four female physicians, one in three female surgeons. And so one of our clients recently said, I'm taking, I'm on call the 24 hours after my embryo transfer, and I'm going to find a way to do a call shift. You know, people don't ask about this. It's a man's world, but I need, I need to know I did everything I could to allow this embryo to stick. And I said, that's fantastic. And then about three weeks later, another client, another surgeon said, and guess what I did? Because we share wins of the week, right? Our support groups, she said, I got coverage for the 24 hours after my call shift because so and so did it, you know, and it's like, we can actually, it's like contagious when we were like, oh, she can do that. Maybe I can do that too. And that's how we shift the culture, right? So if we change from this comparative suffering to comparative self-compassion, it's like comparative self-compassion.

It's not comparison, but it's like encouraging self-compassion, encouraging choices that affirm our humanity. And I think it's just, it's a wonderful, wonderful thing to be surrounded by people who share those, those ideals and make it happen. I mean, that's the beat of coaching as you make these things happen. Yeah. The way you said that about affirming our humanity, I just, I love that. And I think that in community, we can do that. There can be, there can be guilt around that or shame or judgment of that. Well, if you really cared, blah, blah, blah, right. Fill in the blank. Because remember, we're walking into, into, into an institution that does not put that as a top priority. And yet we know, and I've said this a million times, everyone wins when physicians are well, right? Everyone wins. The physicians, of course, win, but our patients win. The whole, all of humanity, our communities that we're serving win when we are our best self. So the fact that we have had up for negotiation, whether we sleep or not, whether we have washed our hair or not, or anything else, like the fact that that has been negotiable in the past is not okay. And to make it non-negotiable, like, look, this is what I need to be able to be the physician that you need. Period. No explanation, no shame, no judgment, no guilt.

And I think that that in community is where, where we really can create those new cultural norms and continue to improve and change medicine really for the better. I think as more and more women have entered into medicine, women have contorted themselves to fit into medicine. And I truly believe that medicine needs to change, to fit all people of all genders. And, and we're better for it. I, the outcomes are going to be better. The patient, the patients are going to get better care.

And, and we of course are going to be better. So it's no small thing what we're doing. And to be able to support one another as we're doing that, it's, it's a beautiful thing actually, to be able to contribute in this way and, and recognize that as we are declaring things for ourselves and each other, we really are helping medicine. We're not being selfish. We're not being cold toward our patients. Of course we love our patients. We wouldn't be here if we didn't, right? We're just asking that we're not miserable when we're doing it. Yeah. And it was so interesting even to, I think about today, right? I was seeing patients in the office and doing procedures and, you know, I had a moment where I just laughed for a long time with a patient and her husband because it was just so funny, but I don't think I could have had that lighthearted moment if I was exhausted or bitter or resentful. Like I wouldn't have been coming from that open energy to allow that humanity. And I think that's where the healing happens. I mean, you know, it seems that female physicians with infertility are not getting pregnant at the same rates as people, you know, non, non physicians. And it is so interesting. I don't think it's just deferred childbearing.

We need to really study this, but I think a lot of it is the, those quote unquote negative emotions, the shame, the guilt, the self doubt, the stress, the cortisol, all those things. And so I think we're even talking about changing the physiology so that we can, we can allow this creative process to happen, but it doesn't happen unless there's this collective buy-in that makes sense. Right. Yeah. Did you hear about the work that came out recently that women physicians die younger than male physicians? I did see that. I did see that. And then also to women who are not in medicine and what a, what a heartbreaking, what a heartbreaking situation.

Like I know that we, we, we care and we're here contributing in such incredible ways and to recognize the chronic stress that the impact I it's probably chronic stress is one of the contributors that, that may impact our own wellbeing in a million different ways. It's really now I was such a big piece when that came out. Yeah. I think it's, it gives, it gives me pause to think about, okay, well, how am I living my life and how can we create communities of people?

And this is about sustainability too. It's not just about like getting through the day or the week or the month, but it's about having meaningful careers for as long as we want them. Right.

Exactly. Exactly. So I tell my clients, you know, if they're in this season of life, that's extra busy with fertility appointments or things like that, you know, maybe go down and it's hard because again, there's not coverage, you know, people are paying for these very expensive treatments out of pocket. So finances are sometimes it's a stretch, but you know, if somebody say is an ER doctor and they can go down a per diem with a, you know, just a fewer shifts per month, that gives them more autonomy and flexibility. You know, say I have people who, you know, are ER doctors, there's actually been, I said what year, but there's more movement to like reduce overnight call actually for people who don't want that because it's been shown that that's a stress even on pregnancy as well in pregnancy outcomes. And so I think, you know, we're making, we're making slow gains. I think it's just like, I want to hear more about what you say in your work about giving ourselves permission to rest. We don't need to earn the rest. We can take the rest. So maybe this is not the most productive academic season of our lives.

If we don't want it to be right, if we want it to be then fine, then we put our energy there. But something does have to come off to have this. It just can't be like this plate. That's like a buffet that mounted upon, mounted upon, mounted upon. That's not, that's not any sort of quality life. Like something has to come off temporarily to be able to make it all work. And I think just acknowledging that, that we are not just these machines that keep piling things on, but we have to really be intentional about our time, our energy, our attention, and then ultimately the sustainability. And so many people say, oh, I really regret not, you know, doing another IVF cycle because I was so worried about these work deadlines or whatever else. I tell people, if you had an appendicitis, it would have been a non-negotiable. So just pretend you have an appendicitis and you're going to be out for two weeks and then it's just done. But, but I think this notion of how can we start to give ourselves permission to not, I guess permission not to over function, permission to function well and not have that burden that's not sustainable.

And I think everyone's going to answer that in their own way. We are all carrying different things. I think you would write to, to consider that perhaps something needs to move down in the priority list and not recognizing that it's, or not saying that it's forever, but for this season, for right now, these other things are of greater priority to me. And this is where I'm going to put my time and my talents and my treasures. And that there's room for different seasons of our lives. That if something that moves down on our priority list is really a priority, it will come back up to the top of the list when life allows for it. But to get very clear on what really matters to us, I talk a lot about core values and values alignment and placing, looking at our priorities and our interests, and they're going to change across the lifespan they're supposed to change. And so looking at that and recognizing, okay, if this is of greatest priority, there's no weakness in saying that's less priority right now. There's no, there's no like false or weakness by any means. I think it's really empowering actually to be able to stand in our truth and say, how wonderful I'm going to put my time and my focus here, even if that means I'm not focusing as much over there. That's fine. I'll get to that someday. Yeah. Right. Trusting ourselves that if it's important that it will happen when it's meant to happen. Trusting ourself is a very, it's a very big piece of it, isn't it? Especially when we're dealing with something like infertility where there can be this worry about what's wrong, what should I be doing? What could I be doing?

This questioning. And to be able to trust ourselves in all of that and be with ourselves, walking through that with ourselves. Always, I think about walking ourselves home. We're walking beside each other through literally in community, but also as ourselves, walking with ourselves through all of this, through the roller coaster of it all. Yeah. It's so true. So many questions, so many doubts, so many fears and anxieties. And I think one thing I like to tell my client is, okay, well, let's look at the data. And so far, so good. So far, so far in the cycle, everything has gone the way that it should. And so sometimes we just need to take those little steps and remind ourselves what is actually going well, and then just keep moving forward. And then we would get to the next milestone. If it's not optimal, then we pivot, we figure it out. But I think so often we disregard what's actually going well because of the fears of what might happen in the future. And so just that that's where the mindfulness comes in as well as to stay in the moment, stay in the present moment. Connecting with the breath, I think is so powerful. And being in the present moment, because in this moment, all is well, right? It really is. Yeah. In this moment, everything is okay in this very moment. And I think that's just such an important piece, because our brains have evolved to future travel and past travel. And so to bring us back to this moment and recognize, oh, in this moment, this is what is here right now. And it can be hard, because we're really good at future, like worrying about the future and replaying, like, you know, going through everything in the past. So to come back to this moment is, it's also a skill, right? It's also something that is part of the challenge of being human is being able to do that for ourselves, the gift of coming back to this present moment as well.

That's right. And I think about, you know, coming back to over-functioning, I think, you know, a lot of the over-functioning is like these stationary bikes where we're not even getting anywhere, right? Like, it's like these rumination loops, these worries, these fears. And sometimes if I look at like, I do a time audit or an energy audit, I think, okay, where am I spending a lot of my thoughts? And are those thoughts serving me? Are they, you know, productive? And so sometimes getting a handle on the over-functioning is really shining light on the thoughts and the feelings and just having that awareness. And if I want to worry about my taxes over and over and over again, okay, fine. And then I'm choosing to spend my energy that way. But if I'm like, wait, no, I have my appointment with my accountant, like we're going to go through it. Like I know my checklist, it's going to be, then I only allot the amount of energy to that, that actually is needed, like the bare minimum to get through that thing. Because I think so many of us compulsive, perfectionistic people, a lot of that burden comes from the overthinking and the over-analyzing and the over-energy. And so if we can strip that down and remind ourselves, oh, wait a second, I am making sound medical choices. I've got my A team. This is a very thoughtful treatment plan. Because it's like, we all commit to this treatment plan. And then it's like, but what if this, but what if that? I heard on social media that there's this thing. And all of that, I think, contributes to that burden of why it feels so heavy. And so stripping it bare and saying, okay, well, what are the essential parts that I need to spend my energy on? How can I get rid of that, which is not serving me? We have to recognize it first, but then consciously let it go, which is not easy, but it's a skill. And then say, okay, well, maybe this burden isn't as heavy as I thought it was. It's that emotional weight that I was carrying with it and all that extra energy I was spending, all that resistance, maybe even, we talked about that at the beginning, what am I avoiding that I think can contribute to that frenzy of over-functioning? Because it's so clouded at that point. It's so interesting that we are not logical creatures. I think we want ourselves to be like all the time. But we really are just human beings. And that includes all of this mental chatter that is so unnecessary at times, and so not helpful at times. And so to be able to say to our brains, okay, brain, thank you, help, you know, not helpful. Thanks for trying to keep me safe, but not really what I need right now. We've adapted these patterns for reasons. And at some times in our lives, they may serve us. And we know you, I'm sure you and your audience know about the negativity bias and that we're always scanning for a threat to our security and safety. And so of course, the brain is going to be offering you, you know, offering us, you know, anxious thoughts at random times. But then also coming out of that, that mental chatter and settling into the body and, and allowing the reassurance of the body to send messages to our amygdala that we really are okay in this moment. Like in this moment, we're okay, that, you know, we're breathing, we're, we're doing what we're needing to do, we're, we're, our fundamental needs are met. And to be able to like actually feel that, I think so many of us, myself included, we kind of run around in our head separated from our bodies. And, and I know in, in residency in particular, like just ignoring sleep and cues for needing to use the bathroom or, or hunger, whatever it was the just to kind of ignoring those body senses. And so we get really good at that, I think in medicine, and so be able to, to not only turn toward our thoughts, but also turn toward our body, our feelings and our body sensations to create a home, a safe place for ourselves in the spite in, in, in the setting of uncertainty, and in the setting of all of life's challenges, you know, or all of life's stuff, good and bad. And to create this home, this, this place that we want to be is, can be profoundly helpful for, for all of us as we're moving through this, through this wild ride we're on. It is so, so profound, my friend. Thank you so, thank you for sharing that. I think, you know, we, this notion of home, right, we are walking each other home, we are finding a safe home in our bodies, in our minds, in community. Like I just, I think there's nothing more powerful in, in the feelings. They're all there for a reason, you know, so we can thank them, we can honor them, we can process them, we can feel what we feel in this moment. And I think that's, I think that's a lot of the power of what we do is really getting those tools to be able to do those things in the moment, because it's a learnable skill, just like, you know, doing a neck retrieval is a learnable skill, like whatever, you know, things you do in your practice, like it's a learnable skill. It's, it does require confronting that emotional side that we so often ignore during our training. But I think the fertility journey brings all this stuff front and center. And so I say, okay, well, this is just the access point. This is what the universe is giving you right now. And so that's where we're gonna, that's where we're gonna dive in. And then somebody's like, oh, in my marriage. Yeah, yeah, your marriage too. You know, but I think it's just such a wonderful thing. So I want to make sure that I ask you about your book, which you are writing. And I think, you know, something about grit in the title, did you say that there? There's a good, so if you could please share a little bit about the concept of the book and why you chose to write about grit, you know, in sort of just any wisdom that you want to share from from your writings, I think it could really benefit our people for sure.

I think I have an excessive amount of grit that has not served me well.

And I think I'm not the only one. If you look, I don't know if you had this, but when I was in in grade school and middle school, we had this thing in gym class where you could earn the Presidential Physical Fitness Award. And you had to do like certain number of pushups and climb a rope and whatever. One of them was the bent arm hang. You had to hang on to like a monkey bar where your chin is above and you couldn't let go. And I would love to do a study if I could go back and look, it's like, okay, the people, the women who were able, the young girls who were able to hold that and were not going to let go, even though their arms were on fire and they were shaking, they were just not going to give up that level of grit. Like, oh, yeah, those are the ones who went on to go into medicine. Those are the successful ones. Those are the ones who, you know, worked 30 hour shifts or went for however long, but, you know, without just ignoring the muscle to fire or whatever it might be. But I do, I have seen in my life that I've had an excessive amount of grit. And I thought that grit has been wonderful. It's reinforced in our culture.

Grit is a wonderful thing. And I think that is true to a point. I think for most people, grit is a wonderful thing. I also think that there's a portion of us who are lean toward excessive grit that really doesn't serve us. So the title of the book is Done with Grit. The working title is Done with Grit, Unwalking Ourselves Home. And it really is based on this idea that yes, grit can be helpful, can serve us, but at some point, excessive grit is harmful.

And we are socialized and rewarded for the excessive grit that's connected with over-functioning.

And there's here's an opportunity to turn toward that and set that down and recognize that we've been carrying things that are not ours to carry. And as we do that, it really opens us up to showing up and living in a different way that is so much more joyful and authentic and fun. So that's what I'm that's what I'm writing on. The book is out for submission and I'm hoping will be published in 2026 so your readers can look for it someday. I can't wait. The other word that came to my mind is you were saying that is free. Yes. We're just shackled by all these expectations and responsibility for other people's relationships. And I think it'd be really fun to write a list of all the things that are not mine to carry. And then just do some visualization of letting them go because you're right. We are so overly responsible and a lot of that is not ours to carry.

It's just not. And it makes sense of how we got here. Of course, of course, we've adopted this and we've carried this. But there also becomes an opportunity to look at that. You're right about feeling free. It's very liberating. There's a grief associated to it and we realize like, wow, I did all of that and why? But I think there's also so much joy. There's so much joy and liberation and freedom and sovereignty that is about really showing up authentically in this beautiful life that we have and living in a way that is so meaningful and honors how precious it is that to be able to be intentional and to be able to say no and say yes clearly without all of the mental chatter and drama around that, because we're standing in such ease in alignment with this authentic self. That's so true. I absolutely cannot wait to read your book. I say this a lot. I say everything in moderation. Sure, grit and moderation, but most of us don't have grit and moderation. We need- No, we probably wouldn't be here. It has served us well, but to what end?

Right. And then it's like, well, then what can come in? Maybe some self-compassion. We let go of the grit and then maybe the self-compassion can rush in and the love and the freedom and the joy and all those things. I absolutely cannot wait to read it. I think it's going to be such a treasure for the world, really, and especially female physicians who live by these tenets.

That's one of my missions is to free myself and then to free the other people so that we can live our most authentic lives. Because that's freedom. Freedom to me is yes, autonomy and all those things, but it's really living in alignment with values like you said and living as authentically as possible. And the fact that that can be done in the context of an uncertain fertility journey, that can be done in the context of a harsh medical culture. We can do these things at the same time.

We just got to be clear. We got to learn how to speak up for- We got to figure out what we need.

Like you said, you asked yourself that the first thing in the morning, figure out what we need and then how we can use our voice to ask for those things. Right? So yeah.

Absolutely. And you mentioned the concept of uncertainty and I think that being able to navigate life with uncertainty is part of our shared humanity. When I was in residency, I was in a bicycle accident and I had a concussion and a bunch of injuries that took me out for nine months. I had no idea if I was going to- My concussion was severe enough that I really lost a lot of my cognitive faculties. I couldn't concentrate. I couldn't read. I felt like my brain was on fire. Any sound or smell or just too much stimulation, I literally could not process. And it was day after day and month after month of living with this, like literally in the uncertainty of I don't know if I will ever get my cognitive faculties back. There's no guarantee in any of this and just having to be in this place of uncertainty. It was one of the most difficult experiences of my life to know that there was nothing I could do that my brain was going to recover or it was not going to. And there was nothing I could do to make it better. There were a lot of things I could do to make it worse, but just to be present in that nothing but uncertainty and to dwell in that place. And it was absolutely one of the hardest times in my life and one of the lessons for me that has impacted so much of my work as a physician and recognizing that many of our patients and many of ourselves, each other, that is part of our shared humanity that we often walk in uncertainty as do our patients. And there's no promises. There's things we can do and we do what we can, but there's no guarantee in life of anything. And it's a hard place to be that it is part of our shared humanity. Yeah. Thank you so much for sharing that. That must have been so hard and just walking day by day and it's like that surrender that we talk about. How can we surrender? And if something's truly out of our control, that's also not ours to carry, right?

So just hoping- And I hate the idea of surrendering. It's like, I don't want to surrender. It's like, I just want to work hard and fix things and do this. And I can do that. The letting go part, the surrendering part, I'm like, are you kidding? No. And being mad about it and kick and scream about it. Yeah, that's it. And like you said before, that grit work harder. It just doesn't work for the fertility journey in some ways. It's actually counterproductive. And so it's like, how can we find that sweet spot of hoping for the best and letting go at the same time? And I think that's one thing I love to help my patients and my clients with, because I think it's one of the hardest things, but it is sitting in that discomfort of the uncertainty and saying like, it's going to be okay. No matter what, I will have a meaningful life as a parent, not as a parent. I will find my pathway to parenthood if that is what my heart's deepest desire is. It might not happen with my strong plan A, but it might happen a different way that maybe that little soul that's meant to be, mine is going to come in. I don't know. I'm not the creator of the universe. I am a guide and I help my people find their values and their voice. But a lot of it, like you said, is the uncertainty.

And I will also say that the uncertainty is a lot more tolerable when we come and share that together.

And we come together. Absolutely. And this is where when I talk about connecting with each other and then connecting with ourselves, I absolutely believe that that uncertainty in some ways almost becomes bearable. When we connect with each other and connect with ourselves, it's not, we're not just like alone in the tundra. It's like, okay, yes, there's uncertainty here and a whole range of other emotions. But we're not alone in it. And in many ways, that makes almost everything more bearable in life. And there's beauty and lessons in that for sure.

Yeah. Oh my goodness. We could talk for hours. This is so inspiring. I want to be mindful of time.

Is there anything else you feel that our listeners should hear about, know about, pay attention to anything else that's on your mind that sprung out of our conversation?

Well, boy, we've talked about a whole range of topics. I think that it's important for all of us to know that we really are not alone in this path that we're on. And it can feel so lonely.

And we can have a whole bunch of stories around how broken we are, and how things should be a certain way. And to recognize that even those stories and even our experiences were not the only one. And I see that time and time again in the women I coach with and the retreats that I lead, that there's this shock and realization of, wow, I thought it was just me. And to recognize that we really are together in all of this, even in those times that feel pretty lonely, that we really are together much, much more than our brains might tell us. And to lean into that. Oh my gosh. So, so beautiful. That times a million percent. I've never conceptualized a million percent, but in that way it rings true because we are stronger together. We are never alone. Oh, I'm going to meditate on that tonight. Well, Dr. Kathy, thank you so much for coming to the podcast and sharing.

I know my listeners are going to want to know where they can find you, where they can go on retreat with you, all those things. And we'll put this in the show notes, but just tell us where can people find you. The easiest way to find me is on my website, the Institute for Physician Wellness. So if you just search that or search my name, Kathy Stepien, MD, you'll find me. And there's all different, all different things you can look at on the website about how to connect.

And then of course I'm on all the typical social media stuff as well, Facebook and LinkedIn and Instagram, but go to the website. Amazing. And we'll make sure all the people can easily find you. Thank you again for sharing. This has been such an inspiring conversation and lots of food for thought, my friend. Until the next time. Thanks for having me. Bye-bye.

- You're welcome.