Speaker 0 00:00:00 <silence> Welcome to the Heart Rate Variability podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness. Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability podcast is a production of optimal L L C and optimal h hrv. Check us
[email protected]. Please enjoy the show. Welcome friends to the Heart rate variability podcast. I am Matt Bennett. I am here with an incredibly special guest today. Um, Dr. Deborah Bourne. I will call her Deb from now on. And if that seems a little too informal, uh, Deb is one of my best friends in the world. Uh, we've been plotting how to change the world since I, I, Deb sat in a workshop of mine in an h I V conference, maybe 15, 16 years ago.
Speaker 0 00:01:00 Uh, just an old friend, collaborator. We've trained together. Uh, just, uh, somebody I am treasured to call a friend and one of the most brilliant people, um, I have ever met and transfers her brilliance to, uh, the real mission-driven work, uh, that she does. Uh, we connect around H I v, but also healthcare for the homeless. Um, just a range of topics including heart rate variability of our evolving shared passion. Uh, really happy, uh, she was, uh, a member of the innovation group, uh, board of directors. Uh, we call her, uh, clinical advisor, uh, medical director, whatever, she'll, whatever title. Uh, I just love working with Deb. So, Deb, welcome to the podcast. Long time coming. Uh, can you give our audience just, I can just gush about you for a whole hour, but just kind of maybe be more professional, uh, introduction of yourself other than me just gushing about how much I love you.
Speaker 1 00:02:04 Well, first of all, uh, that feels really great and amazing. I live with 18 and 21 year olds, or just, they don't treat me like this. <laugh>, uh, I work, you know, I revel in that. Um, so I, uh, am a physician and social worker. I also do, um, energy medicine, alternative medicine. I studied as an herbalist before I was a doctor, and I currently work for the Department of Public Health in San Francisco. I do health planning, so I do planning strategy around, uh, people experiencing homelessness in vulnerable populations. And a lot of our work around what's called traveling, which is our Medicaid, uh, initiatives in the city. But my love and passion is street medicine, which I, uh, do. Um, and also doing innovative programs with, uh, community-based organizations. So I, uh, have a wide range of experience. I was also a medical director of our large homeless clinic, Tom Waddell, for numerous years.
Speaker 1 00:03:04 And that's when I met you, Matt. Yeah. But I've, I've done various things. Um, we, we and I were saying, okay, what's gonna be our topic today? And I think I love, I, I do various things, but I think in the theme of all of this is what, what am I doing that's gonna be the best to serve? Uh, which is when I met you, um, and saw this is really a tool to help us, uh, serve the people we do our work better. So thank you to you. It was 2008, so someone did 2008.
Speaker 0 00:03:33 Oh, man. As, as we, we, we were what, like 13, 14 back then. <laugh>. Yeah.
Speaker 1 00:03:39 Very young.
Speaker 0 00:03:40 So, I mean, I know another shared, uh, it's hard. It says a lot about that because I'm gonna use the word passion, uh, to, to describe, uh, this 'cause I really believe it is for both of us is, uh, quality. Um, I know we both, wow, we can go, we can go out a lot of different directions about healing, whether that's energy work, whether that's neurobiology, whether that's, uh, polyvagal theory. Mm-hmm. <affirmative>, I mean, we could speak for days on all of those topics with a lot of passion. The, the other thing that really connected us was how do we know what we're doing is having the impact we want it to have? And there was always that struggle for me from, from the mental health side of things. Mm-hmm. <affirmative>, but also from the leadership side and the health and wellness of the workforce is, we know trauma and, uh, our shared work and homelessness and addiction, h i v that we, we often work with the folks that have been through just tremendous, almost unspeakable amounts of trauma in their life. Mm-hmm. <affirmative>. And, you know, I, I was, I, I remember excited to share with you, oh, we can actually measure the nervous system, uh, now. 'cause that was one of those things we hoped we were healing it. And I just kind of wondered if I could have you put your, maybe your quality, uh, hat on would be like, how does the ability to measure heart rate variability, your body's ability to handle, recover from stress, how's that kind of, uh, inform your thinking? Uh, now
Speaker 1 00:05:18 That's great. You know, it's interesting when you're talking, it's like, oh, I forgot to mention that I'm an addiction doctor. I'm a clinical researcher. I publish on population health and public health and, um, and, and I am, uh, you know, do quality work and I do quality improvement. Um, so I think at the end of the day, we have to push the limits of what we do to get and to go to what's we don't know. And we, it has to be measurable, reproducible, and we need to be able to have something concrete that we all, a language that we all understand that we're moving in a true north. So this is a pen. One of the things quality does is that everyone understands what the definition is of a pen. This is a blue pen. We can get into detail. And then when we're talking about it, it moves on and on. It, it's, it's, it's definable. Now, I do think everything's definable, even the woo, but, and we do need to go in the spiritual realm. You and I have had podcasts about spirituality. That's really important too. But at the end of the day, it needs to be measurable and reproducible. Yeah.
Speaker 1 00:06:22 And applicable. So how do you do that in heart rate variability is the tool for that. So just if I'm taking care of a patient with diabetes, I want to be able to help that person understand about their diet, about their stress, about things that actually can change their blood sugar. I want to know how they're doing with, uh, their daily sugars. If they're able to tolerate their insulin. All that is important. But at the end of the day, the measure that's gonna help me know and them know how they're doing with their health is something called hemoglobin A one C, which is a concrete measure. So, so we need to have these measures. And one of the things that I do, um, for the health department is I'm part of a health equity initiative where many of us are trained to be mindfulness and bio and, and, uh, HeartMath instructors mm-hmm. <affirmative> to take the concepts of how mindfulness, compassion, and emotionally int intelligence leadership can lead us to a more equitable system. Yeah.
Speaker 0 00:07:33 I
Speaker 1 00:07:33 Love it. So, I'm so grateful. I work in a department that understands and has looked at the research and the data around leadership trauma. And it's a part of a trauma-informed systems initiative because trauma is what leads us to the issues of inequity.
Speaker 0 00:07:49 Yeah.
Speaker 1 00:07:50 So if that's the case, what is the tool? And we are a nervous system, not, I'm a nervous system. We are actually, I mean, I believe in our spiritual wellbeing, but we're really, at the end of the day in a space suit of a bag of bones. Mm-hmm. <affirmative> and a nervous system. And what leads and moves us is our nervous system. My hand moved forward from my nervous system. My feeling of passion comes from my nervous system. So why wouldn't we wanna measure the nervous system? And heart rate variability is the tool. It's a hemoglobin A one C for the nervous system.
Speaker 0 00:08:25 And that's where I got so excited, uh, about, 'cause I was always jealous of you all in the medical arena. 'cause you got lab results, right? Like h I v if we were being, as a system, effective as a team effective of helping someone, we, we would get to the non-detectable viral load mm-hmm. <affirmative> like that. That was a, just a concrete outcome. Yeah. That was based on a lot of different inputs. Well, what's, but we gave us a quality measure. And now, like you said, well, let's
Speaker 1 00:08:54 Talk about that. So in 2008 when I met you, um, we was when the folk, actually, some of my colleagues put out, um, community viral load that was understanding the spread of H I V based on a measure, a population health measure of what's going on in a community. And you and I actually did work together on a quality initiatives on how do we teach community health workers to actually be the tools to help decrease the community viral load in their programs. And it was using a concrete tool like, take your meds, take your pills. All of that is important. How do you feel about your health? All of that is important. The work of the community health worker and the work of the consumers who were so courageous to do this was important, but we couldn't measure the impact on the individual or the community until we had this measurable thing.
Speaker 1 00:09:45 So you and I, uh, we like those measurable tools and, and it was a huge, it was a huge breakthrough, um, to have and bring a number into the advocacy realm. Yeah. Does that make sense? So I feel like heart rate variability, there's potential on so many levels, both in the terms of our equity work that we do with trauma in terms of the work we do, um, on trauma-informed care within a health system and with provider, um, wellbeing, burnout, all that stuff that we talk about. What's the politically correct term for burnout now over overwork? I, it's burnout. Uh, yeah. I think it's overwork.
Speaker 0 00:10:22 Yeah. And
Speaker 1 00:10:23 Over comp, over caring and overwork, I think is a term We'll look that up and come back to that.
Speaker 0 00:10:30 Yeah. Everybody just seems to still, still tell me that they're burned out. So I, I have kept that word. Uh, uh, I haven't left that one yet. Self care, we could have a whole podcast on why I don't use that term nearly as much anymore, but, uh, the burnout is gone. So, so I wonder just if I could, if I could kind of, uh, access aspects of, and I know that this is all whole within your approach, but, but from that medical perspective, uh, as you know, we've kind of been on another learning curve around heart rate variability. You know, and I know you've done a lot of work in, in different medical settings, including some, I just have a, a I'm a huge advocate for with street medicine mm-hmm. Uh, meeting people where they're at, uh, just kind of how, as, as a medical doctor, how H R V is, uh, informing your medical work in your medical thinking.
Speaker 1 00:11:27 Um, well, there's a, a, a couple things. Um, when you first introduced H R V to me, I was running a consulting, um, service at our safety net hospital. So a lot of people do healthcare from the homeless, have homeless consult service. 'cause actually, this was a consult service for all, um, complex social determinants of health. It's called social medicine. And when I, when I work in the encampments, you see this look in people's eyes of hopelessness because they don't have some premise of, of trauma. Thomas Hoover is, I'm a big fan of his, who talks with trauma, says we have the right to be and be safe. We have the right to become, to, to have a place that we or do our work, our gifts, and become in the world. And we have a right to be connected. Yeah. And when humans don't have that, you see this, this look of hopelessness. I mean, that's what causes despair. You, I, you know, we've all worked with folks that are suffering or people who are ill, or I was a hospice doctor, you know, people who are dying, who still have grace. Right. And the doctors doing, when I was a hospice doctor, I was the least burned out I ever was.
Speaker 1 00:12:42 So when I was doing some of the hardest work. So you see this look of hopelessness, man, and when I started the consult service, I was seeing that look in the hospital, and it was the eyes of my colleagues.
Speaker 0 00:12:58 Yeah.
Speaker 1 00:12:59 Because who they were when they signed up to be a doctor, a nurse or social worker, or an eligibility worker, that passion, that sense of being, that sense of becoming, that sense of connection that they dreamed and hoped for, and our yearning are important mm-hmm. <affirmative> as human beings, right? Yeah. The, the year we have them, because it's part of who we wanna become in this world. Right. These yearning, um, they were no, they're unable to achieve it.
Speaker 0 00:13:31 Yeah.
Speaker 1 00:13:32 The, and, and it wasn't because of the electronic medical record, which stinks. I have about 12 charts I have to write right, right now. And in that, that looms on me. Um, and it's not because, um, of the complexity of the patients per se, it was not having the tools, skills, and resources to get the work done. And so for me, as a medical professional, the first thing I think about is the instruments I use.
Speaker 0 00:14:01 Yeah.
Speaker 1 00:14:03 And, and how am how are these instruments functioning? Right? So my uncle, the other uncle got her knee replacement. His doctor used a robot to do the surgery. Super cool. Right? Yeah. And you know that before the surgery, they checked that robot, they checked how the robot was functioning, if there was anything malaligned, they adjusted it. If the machine needed is off, they compensate for what that little bit is off. Right. They don't judge the robot. Okay. It's off by angle. We're gonna work on compensating. Who checked the surgeon? How is the surgeon checked?
Speaker 0 00:14:49 Yeah.
Speaker 1 00:14:50 So when I was in the hospital, and me as a provider, who, how am I functioning? And I am the machine. Yeah. And I am the tool. And you know, we've talked a lot about, you know, we do motivational interviewing, training, you know, all of these things are tools for a provider to achieve a goal and an outcome. Yeah. But if the instrument we're using is not understood, their calibration and not adjusted for their calibration, we can't do our work. Right. So when you ask me how has this most help impacted me with medicine, it's really thinking about how do I work with myself and other providers for us to understand that we are the instrument. And that instead of just like, go take a vacation, self-care, blah, blah, blah. Self-care is making sure that you are taking control of the one thing you have control over, which is your nervous system.
Speaker 1 00:15:49 Yeah. So, you know, so, so that is really important. The second thing, can I, is that you wanna make a copy? Yeah. Can I follow up with that? That's my first, that's my first like, yeah. How do we use this? And, and then the second thing is, you know, I started to do the mindfulness work because I was like, I need, I, I believe in trauma-informed systems. This is a whole, um, you know, equity initiative. I'm here to help support equity of, you know, on all levels. How can I be an instrument of your piece? Sign me up. Yeah. This, I did this when I was like, deputy director of covid response. Okay. So I was like, tons and tons of stuff is going on. And I love the mindfulness. I love what it's done for me. I love what it's done for my colleagues.
Speaker 1 00:16:32 I love training. I love doing that. But where's the measure that this is really helping the individuals in our health system? So, so those are two things. I mean, I'm moving to the edge of how do we change systems to understand what needs to be done for the workforce. But if I, as an individual can't measure how my nervous system is today, and my heart rate variability was relatively high for me today. That's really good. Um, so I know I can do a little more. Like yesterday, my heart rate variability was really relatively low. I had a very long day of meetings in the morning. I went to see a patient that, with congenital syphilis, we had to get her to the third shot. I was nervous to get finding her and getting the shot. Then I was out in the street with my team.
Speaker 1 00:17:17 You know, we had, you know, the normal like violence and they can't, all the things. And I was like, okay, I know my heart rate variability is low, so I need to take breaks between patients and be mindful about that. I need to make sure I eat, I need to make sure I have water. And because I did such good, and I did yoga at the end of the day, and because I did such good self-care, knowing that my heart rate availability was low during the day, my heart rate availability is great today. Does that make sense? Yeah. So I really have this awareness now you hold, we all have the feeling, Matt, like feeling a little nervous, anxious, I'm not feeling right. But for me, data helps. So that, that, I mean, I feel like on so many levels in the pursuit of making sure that I personally, Deb, born in the best human colleague I can be, and knowing that that's the way that we're gonna get to help my colleagues and get, and, and help our patients is to help them feel better about themselves. Yeah. Hurrying variability is the tool. So I think that's the first and foremost.
Speaker 0 00:18:13 Awesome. So I wonder like as, as, as you and, and, you know, we share that the, the passion on the, the health and resiliency of the workforce as we know that healing is provided through our nervous system to help heal that, that co-regulation that Steven before just, uh, talks about. So, uh, beautifully. How, how do you, one of the things that I, I think we, we should talk about is healthcare was a mess pre covid, right? Right. We all talk about like, uh, it is a dumpster fire that it just seems like there's more gasoline. But even how we trained medical doctors, like, it's almost like you, we had to almost, and you know me, I don't use the word trauma loosely. We almost had to put a trauma level amount of stress on you while you were providing care early on in your career to prove you could do something.
Speaker 0 00:19:10 So it's almost a field that's inherently resistant, I would say historically, to, to looking at that surgeon as a tool that needs to be well-functioning to perform well for the patient. And as an advocate in this arena, I I, I see what you're doing as system change mm-hmm. On, on such a level of trying to interject science in saying, Hey, maybe we should look at doing this a little bit differently. Because here's all the data to show, right. We're destroying our workforce. I know you've, you've, you've got strategies in your head. If you're not implementing some of them already, obviously you're focusing on yourself, which is where it all has to start. What, where do you
Speaker 1 00:19:58 Well, and my colleagues, I mean, I do tons of work. Obviously my focus is on, uh, the, the workforce of my colleagues in a lot of what I do. Uh, and especially around covid. I mean, we can't even hire people. There's just Yeah. Yeah. People don't wanna do the work. And I, I work, um, unlike most people that are just, are clinic physicians, clinicians and clinician administrators, I actually do a ton of work with community, um, agencies and community programs as well as with, you know, doctors at the, at U C S F or at the hospital. I, I think answering your question in terms of just physician workforce, one of the areas where we have had regulation understanding that the person's being impacts care is around hours that residents can work
Speaker 0 00:20:44 Mm-hmm. <affirmative>.
Speaker 1 00:20:46 So when I was a resident, you, like, it was tough to work, you know, we worked a hundred hours a week, and if you didn't, you were a wimp. Yeah. And because there was a poor outcome with, I think it was a reporter's daughter, um, they put regulations on the sleep of, you know, like you had to sleep and you had to have hours and blah, blah, blah. And so it was like, that makes sense, <laugh>. But before that, you know, of course there was child labor too in that, you know, we had to change the laws around child labor and the workday. So That's true. That's true. We as a society, I mean, you know, we're, give us a break. <laugh>, you know, there's,
Speaker 0 00:21:19 You're the medical doctors though, like
Speaker 1 00:21:22 Yeah, I know. It's hysterical, but
Speaker 0 00:21:24 Yeah. Yeah. You're the people
Speaker 1 00:21:25 That do
Speaker 0 00:21:25 The research to tell us to get our hours of sleep at night. Listen,
Speaker 1 00:21:28 I have so much compassion for everyone. I smoked and did other things, you know, I understand that we all make the best health choices we can do.
Speaker 0 00:21:35 There you go. There you go. Um,
Speaker 1 00:21:37 So, but with, with so much compassion and no judgment, you know, we all we're, you know, this is a system that's trying to make the best decisions it can, given what it knows. Um, and we, it obviously doesn't have a 360 view when you allow people to work a hundred hours a week. And that's the standard. Right. And that it takes a law legislation loss of someone's life. And I'm sure there's more lives Yeah. Um, that are than lost because of that. So there, so it is no joke. I mean, you wouldn't use an expired med or Narcan that wasn't working to reverse an overdose. Why are we using the tool of the human that's not working too? So, um, so when I, you know, I, I've talked to you about this. When I trained as a social worker and I trained as an herbalist, it was a such a different concept. And as an energy worker, uh, in, in, I applied kinesiology myself as a tool is understood in the work. And I did a year long training with Gabra Monte on compassionate inquiry and being trained as a compassionate inquiry clinician. And, you know, course he looks at co-regulation. And what was so fascinating in all of this is to get the proof of the importance that the individual working with the other individual's nervous system is the most key component.
Speaker 0 00:22:49 Yeah.
Speaker 1 00:22:50 Um, because we cannot be with another person if our nervous system's not regulated and have a positive impact. We've all had the experience where someone walks in the room and you get a headache and you look and they're so hyper it's strung out. Right? Yeah. So, so, you know, we've all had that physiological experience and a lot of the work with co-regulation and with is measuring the biofeedback of another person. I told you we did this, I had six energy medicine clinicians. We were just working on each other having a good time. And at the end of our sessions, we all had the same heart rate variability except for one person. I mean, that's cool. But there's a lot of research out, out there looking at the nervous systems of other individuals. I just, I'm gonna about to read the greatest book map. This is a huge tangent. The mother tree.
Speaker 1 00:23:37 Yeah. It's just, it's uh, written by this brilliant woman, I can't get her name outta my head, the mother tree, about how the forest talks with and interacts with each other and she like traced carbon molecules and, and what makes us grow better and interact. And it's this co-regulate and it's this interaction co-regulation. So this came out of a conversation saying, when I put my plant in my house plant next to other plants that are growing, it grows more. Like how does that work? Yeah. So, um, so I, I think that, you know, we do need to focus on how we do the health, the how healthcare is caring for itself and how we measure this tool. And quality improvement, I believe is a way of getting there. You know, things have changed since we, we met in 2008. Quality, you know, everyone's talking about quality and trauma.
Speaker 1 00:24:26 It's not a big deal. And you and I were like on the fringe. Yeah. Um, so, so that's important. However, um, it's really difficult to, um, do things when you're blaming the instrument for being wrong. So let's go back to the machine with my uncle. If, if I'm blaming the machine for being broken and then it needs to go and fix itself and jog some more and relax at the end of the day, you know, or don't check your emails on the weekend, that machine, you can't blame the machine. Right. Just like you can't, like if I, one more person tells me to be like, work, whatever the things that I learn these self, like these, um, you know, burnout classes, it doesn't really help me. And I, I took a training 'cause that's during Covid on with in Stanford has a great program for physicians who are wellness officers because that's a lot of, some of the work I'm doing. So they let, so San Francisco, let me go. It was this interesting training and there was so much talk and research about how do we help the system be well, right? Yeah. How do we do it? And it was still back to fixing the MR and other things as opposed to there was no talk of heart rate variability. It was really interesting. Yeah.
Speaker 0 00:25:37 Well, and it's fascinating 'cause I, I wanna explore that that analogy you use with your the knee surgery. Because on one hand, like I I, one of the, the ethical issues you push up to and I ethical, I think let's just call it that 'cause it sounds okay. But, but this ethical issue is, okay, would you allow a broken machine to operate on somebody? And I think the answer is clearly no way. Right. Because that's going to get the hospital sued. I mean, you know, we, we, we know that there, that's a driver and, and it, you know, nobody's feeling good about that. I don't care who, how bad you look at the healthcare system. Nobody's gonna feel good in the healthcare system about turning on a machine that we know is gonna cause harm. However, we may get data that that surgeon who's doing a similar operation, may I, I'm not gonna use the word broken, but might be 30, 40% under their heart rate variability all time monthly. So, so what do we do? What do we do with that physician? That surgeon
Speaker 1 00:26:46 Who's,
Speaker 0 00:26:47 Who's not, I'm not gonna use the word broken, but who's impaired? We've got data that the surgeon's impaired and he is got six surgeries on the schedule today. What, what do you think? Healthcare, it's one of those industries. Yeah.
Speaker 1 00:27:01 Well, some of it is culture change. Um, and that, you know, we get sued on, you know, you, you have to do practice standard of care. But when I first, uh, became a medical director, if you had a cold and you were sick, you just went to work. Like, I literally gave people, um, pertussis whipping cough because I went to work. I'm like, I just have a little cold now. Now with c it is in the workforce that if you even have a sniffle, which before you'd be like, what are you wimped to go to work? Man, we know that that surgeon with a runny nose cannot go perform surgery. Right. That surgeon's gonna stop himself. Yeah. Right. Because, and we used to have the screening and the temperature and all those things for covid, but now we're like, listen, if you have a cold, you will spread it to your colleagues and you give it to others. Right. Remember the doctor who pushed Handwashing ended up in a psychiatric hospital in the 1800. Sometimes I feel like him, I like
Speaker 0 00:27:52 Great story. If Google Yeah. Yeah. If you have not read it <laugh>.
Speaker 1 00:27:56 I, I am <laugh>. So, so, you know, so that is one thing that the system has changed that we've asked people in the workforce business and, and healthcare, that if you're feeling Ill please stay home. Yeah. And it's finally landed. Yeah. Right. I mean, with H one N one, I used to get like, you know, it couldn't keep people outta work and we were spreading everything. So, so, um, that's one thing. So I think that we, we do in starting to tip to under that understanding that our physiological health impacts others Yeah. In our workplace. So that's number one. The number two is, is that I think, um, having a level of internal ethical awareness for ourselves. So my, my kid's dad when, um, had gotten some shrapnel in his eye, uh, something in his eye and, um, he went to go see a doctor and, uh, get it checked. It was coming back the next morning to get the thing removed. And it was at the emergency room in New York City. And I said, listen, when you go back the next morning, make sure that the person's had a lot of sleep.
Speaker 0 00:29:03 Yeah.
Speaker 1 00:29:05 'cause you know, you're going in the morning this like safety in the hospital. Right. So he went there, it was the same doctor that saw him the night before. And he said, when's the last time you slept? He said, 36 hours ago. And he said, would you mind not doing this on my eye? Yeah. And the guy said, the doctor said, you know what, that is a really good idea. I never thought of that. Because when you're a resident, this is back to your other question, right. We're pushed and his attending was pushing him to get the stuff done. And you're just like, on an aton of trauma. And after 36 hours, I don't make very good decisions.
Speaker 0 00:29:45 I, I mean they, I mean, like, that is so that should be illegal based on what we know about sleep deprivation and
Speaker 1 00:29:53 Right, right. But everything, it's now everything. It's
Speaker 0 00:29:55 Six hours,
Speaker 1 00:29:56 It's now. But you know, we're we, yeah. Someone told me this once, you have to have the consumer aware and know what to ask for. So this was a informed consumer Yeah. Who communicated with kindness to a doctor that was receptive and they had a different person be the surgery, the procedure. So, so we have to let the workforce, where the consumers are gonna make a change and make the best change. This is all before, like, is it ethical? Not ethical. Yeah. So if you're, like, today my friend was gonna do this web, you know, do the, the podcast with you, she was, you know, not feeling great. She wanted to be her best self to be able to do this. We need to give ourselves a break. Like, I'm not feeling my best self. I check my heart rate variability. And it was really YOLO yesterday.
Speaker 1 00:30:48 I could have said to my colleagues, I'm really not in the place where I can be your physician on the street in the Tenderloin in San Francisco. I'm not feeling right. And I have data to prove it. And that's my, didn't get enough sleep. I have a cold. Right. 'cause I need to be there. 'cause there's safety issues. Yeah. So, so then I need to extract myself or do what I did yesterday. I know that I have the wherewithal to take care of myself. Mm-hmm. <affirmative>. So if that surgeon has a really low heart rate variability, they know I don't perform. I've had an experience where I don't perform very well. Now our heart rate variability that's low amount doesn't mean you can't do your job. Exactly. You're still gonna be functioning, you're functioning, functioning, functioning. It doesn't say you're not functioning. It just says that your nervous system might need a different kind of support today. Yeah. Yeah. And that today's not the day to climb Mount Everest. Right. It is definitely a day that you can go to base camp. Yeah.
Speaker 1 00:31:41 And you need to take rest along the way. So the heart rate variability is not to measure something being right or wrong. It is data for the individual to know if where they are in time and space and in their own continuum. I always like the hero's journey that we teach with. Yeah. You know, we're on a constant journey with our nervous system. Um, and some days our heart rate variability is low. Some days they're not. I need to do more biofeedback training. Before I went out yesterday, I did a bunch of breathing. You know, I did a longer session. Um, so that that is where when we're gonna, if we can go in those arenas, we're not gonna get to an ethical issue. Like, that guy shouldn't do surgery. However, at the end of the day, they did need to change laws for those doctors to not work 36 hours. Yeah. Six days in a row. Yeah. Right. Because we weren't able to regulate ourselves. So I don't know if we're gonna get to that and heart rate variability if it's understood. Heart rate variability is not like you have a temperature of 102 and you shouldn't go to work.
Speaker 0 00:32:39 Yeah. Yeah. Does
Speaker 1 00:32:41 That make sense? Exactly. Yeah.
Speaker 0 00:32:43 And so let me ask you this, 'cause I I, does
Speaker 1 00:32:45 That answer your question?
Speaker 0 00:32:46 It does, it does. I just think it's really interesting in an industry, hypothetically, and this would be a whole different book, we could write hypothetically, is about helping people be healthy. Uh, maybe more about managing costs in some scenarios. But, you know, uh, that health is just like the amount of unhealthy behavior by the folks who are supposed to be helping others realize and achieve health. It is just like, it's so funny that it was outside legislation that forced the medical community to act in healthier ways. I just think that's a great story about modern healthcare. We've got some room to improve. If we wanna look at
Speaker 1 00:33:34 Well, we can put that. Well, you know, I would love to put that in the parking lot and go back to one concept if we could, which is the first step. Um, and it's part of optimal. And, and the app is, is compassion and understanding the role of compassion in order to have any level of change.
Speaker 0 00:33:53 Yeah.
Speaker 1 00:33:54 And that includes change of our nervous system, change of our behavior and change of the system. Yeah. I have compassion for the healthcare system. I've seen who I've become. The first time I wrote a prescription, I cried. I'm like, this is not an herbal herb. Right. Um, and, and I love antiretrovirals. I love buprenorphine and I love, you know, meth. I love what I we can do to help people with Yeah. With pharmaceuticals. Uh, I don't like the companies, but you know, I love the tools that the, that I have Yeah. In, in, in my toolbox. Um, and, but I also have compassion because at the end of the day, we are human. Yeah.
Speaker 1 00:34:36 And our nervous system and our belief system and our experience and our ancestors come into play every time we do our work. And so I know that there's like, why is the system like that? Well, I could spend all my time talking about the Republican party, or I can say, let's get stronger with who we are now. Do you know what I mean? So, so I I don't, I think it's an interesting question and I can tell you it is because of trauma that the health system is like this. Yeah. It is a traumatized system that's traumatizing. Just like when I look at a patient, hurt people Hurt people.
Speaker 0 00:35:13 Yeah. Yeah.
Speaker 1 00:35:15 So as trauma experts, it is just this trauma system that's not a caring system that's hurting people. Hurting people. Does that make sense? So I know that on an individual level and, and you know, I I I wanna say I deal with this every day. 'cause the humans I work with haven't done great choices. Yeah. And I need to find as much love in my heart to help heal the person who's doing the abusing versus whatever. You know, I sometimes, I don't even wanna know what you did, but I do know that you were all a child. So you once all once a child and you can, you know, you get to that place with compassion. So I think just like with optimal and a lot of the work with mindfulness, we know compassion and compassion doesn't mean you forgive someone for being wrong. Just like when my friend's H R V was really low, my first response to her was, I'm so happy your nervous system was able to show that part.
Speaker 1 00:36:12 Yeah. And be vulnerable. Like it's super, uh, I was reading, I, I like, I like to read cheesy, like Hy Highland, like warrior books every once in a while just to get like fat. Like, and you know, these tough warriors cannot show their vulnerability. Right, right. Like the tougher we are. And, and it's, uh, you cannot show your vulnerability. And as a doctor, we're trained in a system that we're not supposed to show our vulnerability. And we're always right. I mean, there's other issues with this, which is why I don't like you calling me doctor and all these other things. Like how do we get to an equitable system? You know, another story I know I've told you before that really opened my eye for why heart rate variability is, is important. And it had to do with one of my favorite addiction fellows. It actually was another thing that inspired me to start to like work with providers in their belief system, um, in their nervous system, is my favorite addiction fellow that I was teaching.
Speaker 1 00:37:07 Um, early on. She was like our second fellow we ever had. And she was working with me and she said, I went to this motivational interviewing training and I loved it so much. I learned so many things. I get how to ask the questions now that I didn't ask before. I, I mean, I totally get it. She said, Deb, but I have a question that I didn't really understand and it's lingering with me. What do you do if the client, if the patient never wants to stop using? Yeah. And I'm, I'm working with her as a harm reductionist. Right. So she, I'm in a harm reduction clinic. I'm gonna needle exchange Yeah. Where I am doing my clinical work. So it's not even like typical come to an office <laugh>, like we're out there where people are still using and that's where I'm training her to do work.
Speaker 1 00:37:54 I forgot to say that. And I was like, oh my goodness. So her nervous system gets triggered when the person can't make a change. Her amygdala's getting hit and she doesn't have the capacity to be able to identify that her paternalism is her stress response, which is just as bad as the stigma person saying, this person shouldn't use drugs. Right. Her paternalism is like, I know best for you, you need to stop. Yeah. Right. Because she didn't have the resource. Part of the resource is to have compassion and open it even more. Right. Open her inside and space and <inaudible>, you know, we've talked about this with meditation, like opening it, opening your space more and our consciousness more. But that she had to have the nervous system that could be okay with that uncertainty. And when our nervous systems are not healthy, Matt, we are very black and white.
Speaker 1 00:38:55 So she was someone who was so evolved that she was wanted to do this work. Yeah. Very challenging work. Wanted the tools to do the work, wanted people to feel better about themselves, wanted to stop suffering. And at the end of the day, she was causing suffering. But from my perspective, because even when she was having conversations, it's like, it's okay if you're still using. And she was really putting out this energy that I'm not successful as a doctor if I can't get 'em to stop using. Stop using. Yeah. And they're not successful as a person. And that was always in the space in her nervous system. Does that make sense? So her heart rate variability would be the first place as her health code, whatever. Let's start with you. Yeah. And how's your nervous system stay? Because I can't have a conversation like this unless you're feeling okay about you as this helping. So it really gets down to our own internal biology. And of course the nerve, you know, heart rate variability has to do with amygdala, has to do with all of that.
Speaker 0 00:39:53 Yeah. So let me, let me wrap up because my, my goal is to get you on here about once a quarter. So, uh, okay,
Speaker 1 00:39:59 Good. I gotta go to clinic.
Speaker 0 00:40:00 There's so many doors we could walk through, uh, for hours at time. I
Speaker 1 00:40:03 Time hope I'm answering the questions you wanted about how this has impacted me. Yes.
Speaker 0 00:40:07 Uh, but I'd like to end on, if I could personal experience, because you work in this system as well. Yeah. You've worked in this system and have been a big player in the San Francisco public health arena during the, you know, this huge pandemic that we've been through. Uh, San Francisco, obviously one of those like here in Denver that homelessness has be hit. The crisis, housing crisis, all that stuff. How have you found this for the end of one that is dead born? Well, how has this sort of give this information, this data, you know, what impact has it had on you?
Speaker 1 00:40:47 Well, on me personally, and, you know, since I've met you in 2008, I've been on the journey that I do not wanna be the problem. Mm-hmm. <affirmative>,
Speaker 1 00:40:57 I don't wanna be the problem with my client patient. I don't wanna be the problem with my colleagues. I don't wanna be the problem. And I've been the problem <laugh>, I don't wanna be the problem with the newspapers or the mayor's office. I don't wanna be the problem. Right. Because I'm here to, I'm here to decrease suffering. Mm-hmm. <affirmative>. Right. And now I realize my suffering, you know? Yeah. Is part of that too. So, so I'm here to decrease suffering. I'm here to help all human beings be safe, feel pur, you know, have the sense of purpose and connection. So that's what I'm here on earth to do. No question. And I, um, have done everything from the biggest woo to the most concrete, like exercise, whatever. I've done it all. Yeah. To be able to get, have a better nervous system. And since really getting diligent personally with the heart rate variability stuff, with the biofeedback work, um, with really, like, because we're working on a book together, I'm like, okay, what are the concrete things that can impact my health and how does it feel inside me because I am this instrument.
Speaker 1 00:42:06 And when I saw, and it's really changed when I after write my uncle like two months ago, he, when after his knee surgery, I'm like, oh my God. Like I am the instrument. Like when I got that. So it's personally changed me. And I am more efficient, I am more productive. I'm definitely more fun to be with. I mean, I'm always pretty fun. And, and I see that and it gives me that space, just like I was saying with this fellow to have compassion when my colleagues or the patients, I have so much more space to not be reactive and then use my best self, which is my brain, my being. So I think of all the gazillions of things I've done, having this tool, like, no, no kidding. And it's not an advertisement or an infomercial. It's been really helpful. It's been great because I show the heart rate variability and I actually have my, um, strap on.
Speaker 1 00:42:57 I bring it, I work with therapists, weight program, harm reduction therapy center. I work with case managers. Other things, every once in a while I'll start checking their thing and, uh, stuff. And when I do body work, I check clients before and after so they can see the concrete change. Like they can get that data. So I'm using it there. And you know, with my folks on the street, I'm, I'm, um, I have not, I mean, I, I have checked people once in a while, but I haven't been using it like before and after. Um, and after people stop using or how they feel when they get into the housing. And I like, that's the next place we need to go because, uh, you know, one of the things that's interesting and I'm so excited about, I wanna talk to you about this. When people go inside, like, I go on a vacation, I go once to go visit my mother.
Speaker 1 00:43:45 My heart rate variability was fine. I did okay. And even when I went on vacation, but when I came home, my heart rate variability pted Hmm. <laugh>. And I'm very curious what happens when you're on the street and what's your heart rate variability and if we track it when people get out. So I haven't, I, there's so much potential for us to be using it within our, um, interventions. And a lot of my teams, like H R T C, I'm gonna start to work with them, um, on after their therapy sessions and, you know, I, to be able to put that in that space. Um, so it's really, it's really exciting. But I know for me personally and the folks that I've, uh, started sharing this with my colleagues, um, they we're, everyone's excited. There's no one in the world doesn't like take my reading. They wanna know. And, um, but you still have to do the work, the reading's just a, a space and time. Right. Right. And, and you know, I was checking my heart rate variability for a year or so before I was like, okay, now I gotta do the work.
Speaker 0 00:44:41 <laugh>
Speaker 1 00:44:43 <laugh>.
Speaker 0 00:44:43 Awesome.
Speaker 1 00:44:44 I thought I was doing the work. Okay. So I hope that answered your question. This was fine. Yes.
Speaker 0 00:44:47 Well, this has been a great, uh, I, I have been just privileged, honored, fortunate to have you, uh, a part of my life and a part of this journey as well. And so I'm so excited to introduce you to our audience. Like I said, we, we've got a lot of doors that, that we can walk through. Uh, that's the great thing about, uh, being a friend of Deb is conversations never get boring and you don't ever have to have the same ones twice. So my friend, they,
Speaker 1 00:45:17 I do want this to be Matt. One other thing, I have a dream that heart rate variability is with blood pressure. Yes. And housing status screening. <laugh>. Let's do this.
Speaker 0 00:45:26 Let's do this. So thank you my friend. I'll put a little bit of information about Deb in the show notes, but you can always find
[email protected]. Uh, Deb, thank you so much, uh, for joining the show. And, uh, to our listeners, uh, thanks for joining us and we'll see you next week.
