[00:00:00] Speaker A: 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 LLC and optimal HRV. Check us
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Welcome, friends, to the Heart Rate variability podcast. I am Matt Bennett. I'm here with a real special guest today. I met Doctor Lauren Kennedy Metz at AAPB last year. And I don't know, like, you go to conferences sometimes and you meet new, a lot of new people, but there's occasionally somebody you meet that you just really want to become your best friend. And that is the best way I can describe my interactions with Lauren. And I was just so happy that she's joining the podcast today because I think after this interview, you will want to be her best friend too. If you're an HRV nerd and you're passionate about heart rate variability, she is your person. So, Lauren, welcome to the show. I'm so excited to have you on today.
[00:01:23] Speaker B: Thank you. I'm so excited to be here.
[00:01:26] Speaker A: Awesome. Well, I know a little bit about your background, but I would also like to learn more. How about just to start us out, just kind of a quick introduction?
What are you doing? Who are you?
Just a little background for our readers.
[00:01:42] Speaker B: Sure. So I can give you my background, maybe like academically. That led me to where I am. So let's see. Well, I grew up in the Boston area, and I ended up going to school in southwest Virginia for college. It's like a small liberal arts college, which was a little random, but it ended up being like the best choice I could have made.
I studied psychology and also creative writing and neuroscience, which also probably sound kind of random, but just really liked it. I wanted to take advantage of the liberal arts setting.
So, yeah, that was fun. I did some research, different types of research as an undergrad. So ultimately I went straight to grad school.
I stayed in Virginia, I went to Virginia Tech, and I completed my PhD in translational biology, medicine and health. So it's kind of like a choose your own adventure.
And the PI that I ended up working with was her background. Her name is doctor Sarah Parker. Her background is in human factors, in healthcare. So that was really my first exposure to human factors, which is an incredible field.
It was also my first exposure to heart rate variability while working in that lab because she joined as a faculty member with a grant that I kind of plugged into. And the one area that was the most interesting to me of that grant was the psychophysiology part of it. So that's how I ended up getting interested in heart rate variability in the first place. And based on her background, I was applying that to healthcare as a graduate student. So after four years, I finished, and I moved on to my postdoc at the VA, the veterans affairs in Boston. I worked with doctor Marco Zinotti, who's the chief of cardiothoracic surgery there. And after about a year, I moved into kind of a junior faculty role at Harvard Medical School. So I was doing mostly the same stuff, but it was just kind of a title change, and that worked involves very similar stuff to what I was doing in my dissertation, but bringing it into the operating room. So I was in the cardiac or recording cases, like audio, video recording, and collecting heart rate variability from the surgeons and, like, the anesthesiologists and the people doing the surgeries. It was so cool. It was really incredible project that I had the opportunity to lead. It was multidisciplinary, NIH funded, multi institute. Like, it was wild. It was really, really fun. I learned a lot, and I loved being in the OR.
And then I ended up back where I started. Basically, I learned that I wanted to be in a liberal arts setting. That's kind of where I felt the most comfortable. So when the position that I have now opened up at my alma mater, I applied really quickly. And so, yeah, I'm back at my alma mater, and I'm in the psychology department, teaching psychology and neuroscience.
[00:04:42] Speaker A: That's awesome. And meeting some of your students, too, at the conference.
The liberal arts spirit must be alive at roll note, because I just like the creativity around how they were thinking.
Some of their, the research that they were doing, just Washington, really spectacular.
There's something about that environment that really, it seems to be maximized in you, your students. So something's going right there at. Ronald.
Yeah, I would love to hear a little bit more, because you told me, because I had, like a thousand questions on it. But I think our listeners will be fascinated, too. The emergent, the ER, or, you know, the operation, the operating surgery.
Let's talk a little bit about that, because this is where I think heart rate variability can really look under the hood of what's going on in this situation. So I would love, I didn't want to jump in and interrupt the introduction, but I would love to just share a little bit more about that. Some of your findings just kind of the amazing thing that you did there. I got to share that with our listeners.
[00:05:59] Speaker B: Yeah, it was really fun. It's really messy. I mean, the. Or is a messy environment in a lot of ways. Like, I don't. Like. I don't know, physically and also just. Yeah, physiologically, if you think about all the things that are going on. And we. We talked about cognitive workload a lot, and we use that term more often than stress, I think, in the work that we were doing in the ORS, because there was more than just, like, physiological stress. There was the demands from the task, the demands from the team, the demands from the patient, all of these things that were factoring in. So that was kind of the starting point, I guess, of that project was just, like, trying to figure out, like, can we measure this? It's really messy, but it's really important because we're kind of operating under this definition of, like, there is a threshold somewhere, so we can only handle so much stress, and eventually, we're all susceptible to this sort of cliff of too much stress being overloaded and then experiencing a performance decrement. And if it's me teaching in front of a classroom and I have this sensation, then, like, whatever, my students are like, wow, she lost her train of thought, or it doesn't really matter. It's just like a momentary thing. If it's a surgeon operating on someone's heart and their hands are in this guy's chest, then it's a lot more serious. So the implications of high risk, high consequence, and. Yeah, like, the implications of that sort of cliff of reaching that point are much more serious. So. And no one had really collected data as far as we had known from the operating room. Usually it was, like, simulations or even high fidelity simulations. That's kind of the stuff that I was operating in during my grad school studies. So it was a new world, a naturalistic environment. Right? Like in the wilds. And that's one reason that I say it was really messy, because we couldn't really. There was so much we couldn't control for, but we were just. It really was kind of hypothesis generating, kind of exploratory. We were collecting data from the attending surgeon, attending anesthesiologist, primary perfusionist, and scrub nurse. And, yeah, we had this, like, really decomposed list that our collaborators at UMass Amherst computer scientists created of what a typical cardiac surgery should look like. So we had very discreet things like behavioral indicators to look for and to annotate, and then I would go back and sort of map those onto what was happening physiologically with the providers. So it was a really rich data set, lots of different types of data that we're working with. And kind of the culmination of that project was actually just published in the Journal of Thoracic and Cardiovascular Surgery. So we're really excited that that's out there.
[00:08:48] Speaker A: Nice. And this is the second podcast within a few weeks where we're talking about using, I believe, this one. I'm hearing HRV in real time in the field, the last episode, which hasn't published yet when we're recording this one, but we'll soon was looking at police. It was still a simulated, but it was, you know, simulations they go through as part of their training. And anyway, so, you know, there just seems to be somebody who's so focused on, like, getting artifacts out of readings and, and trying to manage technology in a way where we, we get, how are you able, knowing that HRV can be a very sensitive metric, how are you able to really isolate, you know, different things, you know, deal with artifacts, those sort of aspects of, I would imagine, collecting HRV data in an, or would, would like, put forth to you to overcome.
[00:09:52] Speaker B: Yeah, I mean, and you sound kind of like a reviewer that might have gotten back to us in our inner manuscripts, because that's, I don't know if.
[00:10:00] Speaker A: That'S a good association or you got published, so I assume it's not, you know, too bad, but, yeah, no, no.
[00:10:08] Speaker B: It'S, it is a good question. Like, and I consider myself to be like, very methods heavy methods oriented. And so it was something I spent a lot of time thinking about. And especially, like I was saying, I came from a more controlled environment, and so it was kind of like opening up a can of worms. And the fortunate thing was that I had spent a lot of time figuring out, kind of comparing different equipment and software and testing them out and going through this really in depth process.
So then when I got to this and joined this group in Boston, one grant was ending and they were proposing a renewal that was kind of an extension of that first one. And so I was there at a really good time because I had a lot of background and sort of, I think, expertise in that area of, like, how do we optimize the data that we're collecting and so we don't have to throw half of it out because the project that had wrapped up when I was getting there, they were using the polar H ten sensors, which is fine. I'm not like, talking trash or a great device, but there's a lot of data loss in an environment that has a lot of movements. There is a lot of movement artifacts, but there's also potential for data loss with a bluetooth disconnect.
But this is a really complicated environment to sort of sort out all of those logistics. So, yeah, I just kind of. I like that challenge. I put my head down, and I just figured out, like, what's the best possible way we can do this? And we were in the process of submitting this grant to the NIH, so we shot for the moon in terms of the grant proposal and budget justification, and it worked out.
[00:11:52] Speaker A: Yeah. Well, and I'm so excited that we're, you know, with the police folks.
They basically had a human observer writing down, like, everything the officer was doing. So if they. You know that the officers, you and I both know, most of you stand up, your HRV changes, right? You move your HRV changes here and there. So they were doing that. And I get really excited about this type of work, because if we find ways to get meaningful HRV data in real life situations, I mean, just think about what that opens up in every realm as a therapist, for a professional athlete, for police force, for teachers, for students. Like, all this stuff now really becomes, I don't know, it just, like, quadruples the amount of research that we can be doing if we figure out what I think is a very, very challenging, uh, problem to overcome. But the fact that, like, people are doing it, like yourself, uh, just gives me so much hope that we'll. We'll get there eventually.
[00:13:05] Speaker B: Yeah. It was also complicated by the fact that, like, um. I mean, I'm not going to get in the weeds of, like, the analytical problems, but, like, it was. There's a lot of, like, nested sort of relationships. So we're talking about a single operating room with, like, three attending surgeons, five anesthesiologists, a handful of perfusionists, a handful of nurses. And so at any given time, there's only a composition. Includes one of those, one of the surgeons, one of the whatever, you know, so, like, surgeon a could be working with a totally different team, like, five different cases in a row. So there's like. But within a certain case, if we're. If we're sort of decomposing this into phases, it's the same surgeon during the opening as it is during an osmosis, as it is during every phase within a single surgery. So there's always within inter person variability. But then the team composition is nested. It was just really, really complicated from an analytical standpoint, too, which is another reason that I'm really excited that this paper was accepted, because there was a lot of complicated challenges to have to overcome.
[00:14:19] Speaker A: Yes. Spectacular. Here's probably a non reviewer type question for you. Do you, after this, feel better or worse if you had to go in for surgery?
I'm assuming that's not in the paper, so I'll ask that. Would you feel better now, or would you be a little bit more scared to go into surgery?
[00:14:43] Speaker B: Yeah, that's funny to think about. I mean, I don't even know how to answer that. I want to say, from a human perspective, so much better, because not even research. Setting the research aside, I had such a cool opportunity to just watch open heart surgery. My whole job for three and a half years, I spent hundreds of hours observing people. Oh, my gosh. I'm not going to get into details, but it was so cool. And then they're so good at what they do. They spend decades training. They're literally experts in every aspect of what they're doing. And so the idea that, like, something stressful could come into the picture, it never resulted in anything. I mean, we had probably 70 something cases from start to finish recorded after these two grants were completed. And the morbidity mortality rates were, like, zero. I mean, they were the best at what they do. So in that sense, it was, like, inspiring. And I would feel great about going under the knife for cardiac surgeries.
[00:15:53] Speaker A: There seems to be something else. There seems to be an and there, you know, that I feel comfortable talking about it.
[00:16:01] Speaker B: No, no. It's just funny because, like, this was never part of the conversation for previous generations of surgeons. From my understanding, I don't have clinical training, but, like, how to cope with pressure and how to manage your stress was never really part of those training. So people are figuring it out on the fly. And this is kind of what drew me towards this area in the first place. The idea that you're doing this crazy thing in cardiac surgery, you're literally delivering this cardioplegia, this chemical that is stopping the patient's heart. You're killing a patient on purpose and then supporting their life through an extracorporeal system, like, closed circuit, extra body system. Like, it's mind blowing.
And to think that, like, that's what you're training for for decades.
But no one ever gives you explicit training on, like, how to manage your emotions if you're in the heat of it, or, like, how to make decisions when you're overwhelmed. Like, you're just figuring that stuff out on your own. That's crazy to me. And that they're still so good at it, even though they never received formal training. So, yeah, I think it's interesting because, like, it's an opportunity. Right. People are starting to warm up to the idea of, like, oh, I do experience stress sometimes, and I could see that it could impact my performance.
And if that is, like, people are open minded, that that's even a remote possibility, then we can start to actually consider interventions and, like, how do we mitigate that? Or. Yeah, so the whole thing is very exciting to me.
[00:17:30] Speaker A: Awesome. So when one of the things that I just. This is not.
I always let my guests speculate and did not attach something to. To research and more of an opinion I'd love to get from you as an expert, but one of the things is I do work with organizations around heart rate variability as the tracker of everything heart rate variability does. And for most jobs, you kind of mentioned this, that if you show up and your heart rate variability is 2030, 40% lower than your average, probably nobody gets hurt. Maybe your students don't get quite the best of you, but I'm assuming somebody like you would give it all to your students and crash afterwards anyway. So, I mean, we can manage that. You know, I think about these CERN occupations, though, like, the person flying my plane, the person doing surgery on me, the police officer going out for. For a shift, that there's so much, you know, at stake.
And what if a surgeon wakes up 40% below? What if the pilot wakes up 40% below? What if the police officer wakes up 40% below? You know? And I can say, well, the surgeon probably has to go in and do surgery. However, I don't want them doing surgery on me that day. Like. Like, it's like these industries would probably grind to a halt if we took this seriously. But at the same time, I don't want you flying my plane if your nervous system is crashing right now and you're not managing your stress well. So I kind of wonder, spending so much time with individuals and probably getting to know their HRV fairly well, too, like, what are your. And I won't make it about surgeons in general, but just these high risk professions.
What do you think, ethically, if we got data that Matt's not doing great today and Matt's scheduled to fly a plane across the country, where. Where do you sit with this? This has been a constant ethical dilemma that I'm not really sure what to do with. Because I also do want my plane to get me where I want to go at the same time. So it's a tricky question, but I'd just love to get kind of your thoughts on. We can now identify this person's not in a good state right now. What do we. What do we do with that in these high risk situations?
[00:20:02] Speaker B: Well, I think, like, the first thing is that is, like, kind of mandatory in that situation is a self awareness. So it's up to that person. Right. Like, you might not be able to tell just from kind of observing from the outside that anyone is going through anything physiologically that is concerning.
So there's, like, a self awareness piece that has to come first and then a decision that is, like, ethical, I guess, and responsible that has to come afterwards. But I. If, like, folks aren't actually recognizing that they're in a potentially dangerous state, then they're never going to be able to resolve it or do anything about it.
So I think that's kind of the first thing. And then in terms of surgeons, I mean, I don't know about pilots or many other populations, but, I mean, RMSD is, like, my favorite measure. Their RMSSD values were, like, in the single digits, real low, like, constantly. But that's not really their baseline. But, like, when they're in the or, that is normal. Right. So, like, it's mind blowing a little bit, actually, to think about that, but, yeah.
[00:21:20] Speaker A: Sympathetic kind of dominance kicking in a little bit because of the stress. Or do you think they're just. I mean, healthcare isn't well known for, you know, healthy workforce to begin with.
[00:21:34] Speaker B: Oh, yeah. Well, so we couldn't actually collect a lot of data about their health. Like, if they're on beta blockers or, like, things like that are employees as well. But. So that Irb didn't have us collect stuff like that. But. But it's. I mean, it's just a stressful environment. It doesn't matter, like, how healthy you are. Like, it's hard to be in a cardiac operating room and to be managing so many different things at once. I mean, there's so many different machines, different types of equipment. The patient could present with some sort of anatomical thing you weren't expecting. Even if you've looked at all of their scans and everything. Like, there's just so many things that could go wrong, and you're constantly, like, on your toes and trying to anticipate stuff and. But also working with other humans is hard. Like, it's literally the hardest of every single task. You could have to do, like, all in one. It's. Yeah. So anyway, I don't know. I don't know if, like, there's, like, really a cutoff where it's, like, this isn't safe to operate because they're probably below that cutoff all the time.
[00:22:40] Speaker A: That. That is scary and fascinating because they're good at. I mean, like you said, they. They seem to abate 100% with morbidity, mortality rates being what they were like.
Yeah. And yet, like, wow.
Wow. And that's where I, like, I wonder, because I would think. I mean, if I thought about the ideal state of a surgeon, which I have no expertise in this arena as well. So I'm just. I've watched er growing up is basically my expertise on this. But it seemed like you would want someone very regulated, very rmssd up, up. You know, like, you'd want somebody, like, zen out in the flow. And I don't know if those single digit scores would be indicating that, but it sounds like the outcomes is showing us that. Yeah, you can show up in the single digit RMSSD and big surgeon, which is really reassuring in many ways.
[00:23:48] Speaker B: Yeah. Well, the other thing that's, I guess I should maybe correct or reclarify, too. It wasn't, like, necessarily throughout the entire surgery, but part of what the work that we were doing was, since we could separate the surgery into distinct phases that were, like, universal across all of the types of surgeries we recorded, we could say, like, well, at first, we separated them into 14 phases in this paper. We sort of reestablished the boundaries. So there's, like eight phases, but then you could compare pretty directly. Like, what is the surgeon's physiological state looking like during intubation, which is like, 100% an anesthesia task. And then what are those both, like, when the roles are reversed, like, when the surgeon is, like, elbow deep doing his repair, and then the anesthesiologist is kind of on autopilot mode, like, vigilant, but not doing the primary task. So, yeah, we could really kind of drill down into, like, how does this evolve over the course of a surgery within a single person? And then the other side of it is, like, if we look at a certain moment in time, how do these roles compare to each other?
[00:25:01] Speaker A: Yeah, so, yeah, so I wonder if there's any more. I don't know if we can talk much about the data since hasn't been published, but just maybe like, 30,000 foot epiphanies that, as you spin, because I just knowing you a little bit, having a few conversations with you, as you were observing, I would imagine your head started spinning and thinking, what am I seeing? And I'm sure, again, just with my. Maybe you're not, but I'm sure that spinning did stop after you walked out. And you're chewing on this for years. Were there, like, did you learn anything about, like, human beings?
[00:25:40] Speaker B: And I.
[00:25:41] Speaker A: You know, I just, like, 30,000 foot, like, maybe that are too kind of grandiose for a research based, peer reviewed journal, but just kind of, like, what kind of epiphanies rose out of this really incredible study and time that you spent with somebody's kind of dead on the table for a second? You know, like, all this powerful stuff going on, and you're. You're witnessing this with a. A very inquisitive, analytical, and inquisitive and creative brain of yours.
[00:26:15] Speaker B: Yeah. There were so many different directions to go in. I don't think you could ever really exhaust this data set. I mean, I didn't even talk about some of the data we have, too. We had a sound level meter that was measuring the decibel, like, just the volume in the OR. And there we presented a few things. Looking into that data and how the volume, like, just ambient volume in the OR, was, like, kind of comparing over the course of the surgery to the heart rate variability of the different providers. So that's like a rabbit hole you could go down.
But also, it's funny because, like, the physical setup when I was doing this project, like, I was sitting outside of the OR and streaming the. What was happening inside the or? Cause it was Covid time, so I couldn't be, like, in the operating room. So I was sitting outside and had headphones because we had cameras and microphones and all this stuff, and I was watching it from, like, the next room over, and people would come out into the little hallway that I was sitting in and be like, did you see that? Like, that was so stressful for me. Please look at the data. My data at that point. And, like, constantly, like, everyone. Like, everyone knew me. I've been doing this for a few years, too. And so, like, people would just be like, oh, my gosh. That trainee was so annoying. Can we look into, like, what my heart rate does when I'm training people versus not, because it was a teaching hospital. So they're just, like, people just came to me with a bunch of questions and ideas, and I mostly just ran with them.
[00:27:42] Speaker A: That is awesome.
Yeah. Go. Go ahead. Go ahead. Sorry.
[00:27:46] Speaker B: Oh, I was gonna say, like, my interest from, like, that kind of hooked me in this area very early on in grad school was in biofeedback.
So that's always been, like, kind of my, like, lofty.
Maybe it's not very feasible at this point in time. Like, one day, once we understand these processes and how they are occurring well enough, maybe we could introduce something like biofeedback, ideally in real time. Like, that would be so cool. And so we actually did kind of like a proof of concept using the data from the cases that we've recorded. And so some of the folks that we worked with, we published this, like, last year. I think there's kind of a proof of concept of, like, could we get, like, a real time team wide indicator and present that information back to the team? And so that would be my, like, ultimate kind of application of all of this.
[00:28:43] Speaker A: That is so awesome. I wonder. I would love to hear what you think about the sound, because one of the things that I've been, and this comes from reading something or listening to Stephen Porges somewhere along the line, and I've just been obsessed with it ever since, is that kind of low grade ambient noise can be a trigger. The sympathetic.
And then I'm, you know, haven't been in mental health. We have, like, white noise machines, which seems like really ambient noise. I'm like, oh, God, were I triggering somebody with the white noise machine with that? You know, I'd love to hear what, what you were seeing with that, because it's something that I, you know, with therapists, I get now, I hesitate to almost mention it because I know a lot of them use, especially working in offices, they use the wise, the noise machines, and nobody really has, you know, much control of there by a highway, and stuff's going by all the time. So I'd love to hear kind of. What were some of your insights about the noise and the stress levels?
[00:29:49] Speaker B: Yeah, I think we were expecting that. Just, like, as noise levels elevated, so, too would physiological arousal. And that's not what we saw. For the most part, it's kind of the opposite. But I think it also kind of makes sense if you think about how a surgery progresses. So there's the one phase that's just the most insanely out of this world demanding is the surgical repair.
And it has to be very quiet in the room during that because so if you're thinking about, like, a graft, you've probably heard of, like, the bypass graft. That's kind of bread and butter cardiac surgery. They're taking a vein out of someone's leg and literally stitching it onto the surface of their heart. Like, you can't even, like, see the stitches with the naked eye. It's so hard, it's so meticulous. And they're wearing these crazy magnifying glasses on their heads, and it's just like, there's so many things going on in that moment that they can't. You could, like, hear a pin drop in the room and they would probably get pissed if they did so.
So it's really quiet during that period. But it's also the most stressful time of the surgeries. It's very tense at the same versus, like, there's a lot of. There's two primary team wide phases. That's like putting the patient on the bypass machine and then weaning them off of the bypass machine. There's like, you have to coordinate those activities really closely within the four team members. And so there's communication happening, right? You have to be able, you have to announce, like, we're coming off pump, and the anesthesiologist is watching this and the perfusionists are watching this and they have to be communicating it. So there's kind of a lot of noise, but it's not necessarily associated with a lot of arousal. So it's. It was seemed, it was a little counterintuitive, but I. One of the other things we were looking at was like, just like spikes, because, like, sometimes if someone drops an instrument, like a piece of metal onto a metal tray and it's very loud, then we're getting over 85 decibels really easily, even if it's just for a moment in time. So I think that's a kind of future direction that would be interesting to look at in this dataset to be like, isolating those moments where there's just a sudden momentary spike in noise, and then they, like, just trying to see what's happening behaviorally, also physiologically, socially, all of those things. So we don't have a lot of definitive kind of data about the noise stuff at this point, but I think that's the next step, probably.
[00:32:26] Speaker A: Awesome. So I also wonder, because there's certain arenas where acknowledging any sort of weakness, including that you're stressed out, is just culturally not accepted. And for whatever stupid reason, healthcare has one of those. I mean, I find physicians I work with just like, you've got a master, you got a doctorate degree in medicine, like, can you take? But even their training, when they talk about their training and how, like, it is almost trying to destroy, if I were trying to destroy somebody as a human being, it would kind of be. And I think we're getting a little bit better on this, but it would be like a medical residency. Like, we're working 448 hours. I'm like, what science would this support any of this for the physician or the resident and the people they're treating? Because it's like a zombie giving medical care after 48 hours of no real sleep. So I wonder, like, as you. It sounded like you got real interest from some of the team that was in there.
Do you feel like this might be an entry? Because I would. I've known a few surgeons, and they're not.
Not really touchy feely, I guess.
Not going to tell you they're stressed out.
You know, all that sort of mentality that for some reason gets instilled in healthcare workers.
So I wonder if you saw any doors opening to these conversations as you had data, because I would assume they'd be very interested as they're having somebody's heart maybe actually in their hands and you're measuring their heartbeat.
Were there doors that might have opened there for talking about the wellness of the team themselves?
[00:34:34] Speaker B: Yeah.
So it's funny that you mentioned that. Is the connection still good?
[00:34:39] Speaker A: Yeah, I think we're good.
[00:34:40] Speaker B: Okay. Okay.
So when I started out doing this for my dissertation, one of the projects that I ran was interviewing folks in the hospital. It wasn't necessarily surgeons, but I just got a smattering of.
But most of them ended up being surgeons. And I was kind of trying to run by, like, if we were to imagine a biofeedback intervention that could help you to manage your stress, which was really my interest. Like, what should it look like?
What should the modality of the delivery be? Or, like, all of these sorts of things. But all of those questions are really predicated on the acknowledgement of stress. And so those conversations were, like, non starters at first, because surgeons would tell me I've never been stressed, and they're, like, so serious. They'd be like, I know they believe it.
[00:35:31] Speaker A: They believe it, right?
[00:35:32] Speaker B: Like, never, like, you know anything about the human.
[00:35:37] Speaker A: And, I mean, you hold people's hearts in your hands.
[00:35:40] Speaker B: It's like a sign of weakness, and it's like, it's equated to incompetence to admit stress or any sort of, like, whatever imperfection. And so that then also, a lot of those folks that were sharing those things with me said, along the lines of what you were mentioning of, like, residency, you know, they would be doing some task. Maybe it's simulated. Hopefully it wasn't a patient. And their attending would be yelling at them or, like, degrading them or something like that. And, like, they had to get thick skin. They had to just, like, deal with it. And so they would say, yeah, I'm not stressed because I was trained under constant stress. But they also admit, as a sidebar, that, like, that's not acceptable anymore. So if a lot of the attendings nowadays who have been in practice for, like, decades, it was, say, if I were to treat my residents the way that I was treated, I'd be fired. So that's a good sign.
[00:36:35] Speaker A: I'm so glad you're hearing that, because I heard for a while, well, I had to go through it. Why this is how you become a healer, is by destroying yourself psychologically. Break it. We gotta break you in order for you to be able to heal people.
[00:36:52] Speaker B: Yeah.
[00:36:53] Speaker A: Well, I'm glad maybe that is retiring.
[00:36:57] Speaker B: Yeah. And so I would say also with this group where we did this really cool project, one of the key things that really led to its success is that it was led by the chief of cardiothoracic surgery, Doctor Marco Zinati. And so he was the one saying, we are fallible. We are not inhuman. Right? Like, we are all susceptible to these momentary weaknesses and things like that. So he really, like, he led, he modeled that, and he's the one that sort of fostered this acceptance because I couldn't do it. Like, a psychologist being like, I think they're stressed. Like, they get out.
So it had to come from one of their own. And it was like, a really, I mean, that's rare. It's really rare for someone to admit that and someone in a leadership position to admit that and then, like, rally the troops. And so this project, it took years for folks to get on board and for them to even submit it to an IRB because no one really trusted the premise of it at first. And so, like, literally, I think it was like, five years of Doctor Zanati and another nurse kind of, like, eating away, like, trying to, like, wedge their way in. And then by the time I got there, it was, like, already established. So I just stepped in and everyone, it was fine. I didn't really have to do that hard legwork, but it's not likely that that would really happen somewhere else without that culture.
[00:38:27] Speaker A: Right? Exactly. Exactly. So I wonder, like, coming out of this, the research, I wonder kind of what other questions are driving you now? Now, your professor, your students are doing some amazing research.
You know, that I just started just nerding out totally about at the conference, just kind of like, you had this amazing. I mean, I really hope your study changes healthcare. Like it opens. It just gives data where it just fills this void. I think of what's out there in such an amazing way. So you, you've been a part of this, I hope, world changing study. Now you're settling in, you're kind of back to your liberal arts home, getting comfortable.
What thoughts are on your mind? What's your work look like now? What would get you excited?
[00:39:30] Speaker B: Yeah, it's a little different now because the setting is so different and I'm not like, so before my office was in the hospital, right. It was really easy to just kind of spitball ideas and get people on board once they were interested in the project. So it's different now in that sense. So I've kind of shifted instead of thinking like, exclusively about surgeons, they're a great population to study, but I'm thinking more along the lines of, like, any human that experiences stress, which is every human except surgeons.
Never.
[00:40:10] Speaker A: You almost studied a sub population of humans by their own words, right?
[00:40:17] Speaker B: Yeah, yeah. So I guess, like, the idea that I'm operating under is I'm thinking about like this mixed methods approach of like, collect kind of similarly to how this project was working in Boston. But the idea would be like collecting physiological data while people are just doing their job. So not intervening at all, just observing, making some ethnographic notes, maybe, whatever. And then the qualitative part would be bringing that data to those folks and asking, oh, like, during this period of time, it looks like your arousal is increasing. Were you stressed? Were you excited? Like, what was happening? So getting that sort of explanatory side and using the quantitative and the qualitative then together to derive some sort of very tailored specific intervention for that group specifically. So it's like if you were to take that whole thing that I said and apply it to surgeons, the outcome would look really different than if you were to take that whole pipeline and apply it to a student or a police officer or whatever. So I'm thinking really about, like, what are populations that experience stress that I can observe, that we can like, work with to develop some sort of intervention for stress management. And, yeah, right now I'm starting this work actually with bartenders.
That's recent.
[00:41:49] Speaker A: You're like, you know, you were in hospitals, now you're in bars.
[00:41:54] Speaker B: Yeah. So craft brewery bartenders, that one's like underway. It's actually been really exciting. I started analyzing some of the data yesterday and it's kind of cool.
And then I'm going to try. So, I mean, I did my PhD in this area, and so I still. My PhD advisor is still here. She's still doing her work, really amazing work. And so I'm probably going to try to actually partner with her soon and get back into healthcare. She runs, like, an incredible simulation center that's operated by the hospital in this region. So I'm probably going to try to get back into healthcare through sims early days and then maybe, like, expand it.
But, yeah, otherwise. But if a student comes to me with a really cool idea that has something to do with, like, psychophysiology and heart rate variability, then we just go with it.
[00:42:48] Speaker A: Yeah, I mean, that's so cool to have that.
What's your experience? I mean, I've been trying to get students that I've been successful lately, and it just kind of like, you know, because I. There's some people with more white hair than I have walking around the HR world, but I realize I'm not the youngest person in it. If I'm the youngest person in the room. You better go the hallway and get some younger people at this point. But what do you see about this with a generation that grew up, you know, with smartphones? Not just with, you know, a mobile phone or a cell, but, you know, that. That, you know, they may have always had this amazing computer on there. They've grown up with technology.
What kind of, what do you see? Kind of their reaction, their excitement around heart rate variability. Besides having a great advocate for it, like you as a teacher, that's got to really help. But what kind of, what do you see their interests being?
[00:43:47] Speaker B: Well, the other thing that they have going for them is that they grew up with biofeedback, like, on their wrists. Right. Everyone has a smartwatch, so they're all aware of their stress state or their heart rate at any of point in time. So that actually makes it easier for me. Right. It's a selling point. It's a little more accessible for students to be interested because they're familiar with it, whether they know it or not.
Yeah. So I don't. I think that the. It's a relatable concept to get on board with, and it's also just, like, intuitive. I mean, an EKG waveform is so beautiful, and it's really. It's just like a nice thing to look at, an easy thing to read, to understand, to analyze. And so I think it's. Yeah, I think students like that. It's like, kind of an, it seems like a lofty parameter, but it's not EEG. Like, you don't need like, really crazy software, and it's more, a little more relatable and they can tie it into the stuff that they're interested in. So the three projects that I had going on at the same time last semester were completely different, but they were all very tied to their, those students individual interests.
[00:44:57] Speaker A: Yeah.
[00:44:57] Speaker B: So I think that's the thing. It's like flexible, it's relatable, and it's easy to get excited about it, I think.
[00:45:03] Speaker A: Yeah, I like that because our stress response and everything else that HRV is an indicator of, like, I like to drink kombucha, not alcohol, but like a kombucha drinking game around Google, HRV and anything. And it's kind of harder than not to find something that there hasn't been a study on. And that's what I love about, like, what the sense I got from talking to some of your students is, and you just, you gave words to it. They, they have an interest in this and then they can work with you to bring HRV into, whether it's video games or other exciting things that might be going on, that they're studying, things they're interested in. And really, now that we've, you know, the generations that before me really helped define this, I have to tell some people new to HRV, I don't need to prove this, you don't need to fight me. A brand to prove heart rate variability is a valid measure. Like, we've done this work is there, go do your own meta study review.
But now it's like they're filling these gaps in an incredibly innovative way. And it just, ah, man, it just brings joy to my heart that there is enough space to run.
And then they've got teachers like you. You know, I talked to the, you know, Professor Moss, Steph, other Gerberts, like, like there's just these great professors that get the next generation excited, and then that's where I love to see what, what's going to be coming next out of this energy that you are all fostering in your students.
[00:46:47] Speaker B: Yeah. And so one of my student that was at that conference graduated, and she's starting her master's program now in experimental psychology. So I don't know if she'll be using heart rate variability, but there's a chance, there's a pretty good chance.
[00:47:02] Speaker A: We keep our fingers crossed.
[00:47:04] Speaker B: Yeah.
[00:47:05] Speaker A: I always like to ask my guests, and I want to say on our first episode, because I really hope to have you back. I got a nerd out with you about the bartender study. Once you're ready to talk about that data, I'm sure there's a million rabbit holes that we can dive into. But as somebody who, I just love how you think about heart rate variability.
Where do you see us going with this? Where do you see us 510 years out, technology developing?
You may have answered that in some way, shape or form already, but where do you see if you can fast forward ten years with all of AI progression? Like, I think we're hitting a new, especially around data, like, a whole different reality, which is, I think, from our perspective, incredibly exciting. Maybe from the world ending perspective, who knows? But, you know, from our. It's going to benefit us on the way out if it takes that way. But just kind of like, what? What are you excited about? Where do you see us going, you know, in the. In the future?
[00:48:15] Speaker B: Well, I'm thinking about, like, the stuff that I was the most heavily involved with all this or stuff. And I mentioned biofeedback would be great, but I also think. I think this is an area that that group is exploring right now, too. But the idea of, like, projecting cognitive or physiological states based on previous and current data. So really using real time stuff to anticipate. Right. Because it's one thing to be aware of your current state and to react to it, but if you know, for example, that you're approaching that threshold, what can you do ahead of time to not.
To not get there? And so if we can use whatever we're learning now and whatever we've learned in the past to sort of reliably anticipate what could be coming down the road in ten or 15 seconds, even if it's, like, not for you. I mean, so one of the things that, this is kind of a sidebar, but one of the things that drew me into this area of biofeedback was watching these simulations where emergency medicine residents were shown, like, a stoplight indicator, traffic light indicator of their stress. And they were like, I know, like, I know I'm at 85% and I'm in the red zone, but what am I supposed to do about it? So they actually didn't like having that information presented to themselves. And I think that that's probably true of a lot of people operating in that really high risk, high consequence setting. So something that we talked about at the VA and Harvard was maybe it's an indicator that represents the surgeon's stress level that the surgeon doesn't have to see it could be equally informative for the rest of the room to know when their levels, his or her levels are getting really dangerously high because that's like a queer indicator, like don't interrupt, don't open and close the doors, don't take a phone call, like, and so especially if you can project it out, then again, that might be useful maybe not for the individual whose stress it represents, but for the people around them to know about.
[00:50:20] Speaker A: Yeah. Well, if you like, you know, I share your passion for biofeedback. Like, if there is that momentous to take a few breaths, like if there is a way to catch that, that's where knowing that there are MSSD's in the single digits just as a alert to say, hey, if it's possible, can we all, because I know in some parts of the surgery it's impossible to do that probably. But is it now or before we start this next? Yeah, could we just take the. Some, maybe some. Well, if they're doing their rf breathing rate, they're not breathing together. Like, you know, just to take a few, a minute, if that's even possible, to take four, six breaths, low, slow breaths to help regulate. I think that that would be a fascinating, I've been nerding out as the listeners know about introspection and I almost hear what you're saying. It's like predictive introception. Like, not only am I aware of my state, but I'm aware of my near future state. How do I interrupt that? And can heart rate variability buzz something or send something that would allow them to intervene before they hit that spot? Yeah.
[00:51:50] Speaker B: Yeah. There's a group in Switzerland that's doing really cool work. It's not necessarily related to, like, breathing or coping or stress in any way, but it's, they've implemented the stop protocol and it stands for something. I don't remember what it stands for, but it's like led by the surgeon and it's the surgeon's opportunity to say stop. We're going to assess, get on the same page and anyone can request to stop at any time.
[00:52:15] Speaker A: That's the biggest.
[00:52:17] Speaker B: Yeah. Like, there's psychological safety built into this fabric and. But if that, if you could do that sort of stop protocol, but then, like, fold in some sort of, like, let's also just take a deep breath.
[00:52:30] Speaker A: Yeah, exactly. And give them that skill set and then maybe convince them to practice some biofeedback out. So they built that, that strength even though they've never gotten stressed out in their life.
[00:52:43] Speaker B: Right.
[00:52:43] Speaker A: You know, just, just to do a little work, be a good team member, because we'll. We'll want the nurses to do it and the text and everybody else, so just be a good teammate. Yeah.
We know you never get stressed.
[00:52:57] Speaker B: I know. It's so unbelievable.
[00:52:59] Speaker A: It is. It is. And they know this about themselves, too. That's the thing that they will kind of own it in a proud way, which is like, you are silly. You are silly. Well, my friend, this has been in a remarkable study. Like I said, I feel like there's multiple rabbit holes. We could.
I hope you come back and bring some of your students along, maybe throughout the year. They're doing good work, but I saw them pop up, and I wonder if, for our YouTube watchers, could you show your tattoos to.
[00:53:35] Speaker B: Oh, yeah.
[00:53:36] Speaker A: Yeah.
[00:53:38] Speaker B: Okay, so this is my husband's EKZ.
Mine is on his forearm.
[00:53:45] Speaker A: That will bring joy to all the HRV nerds that listen to this podcast with that, and I hope my wife doesn't listen to this episode, because I don't have. I don't have hers on mine. So that is spectacular. That is spectacular. So we'll put some information about Lauren in the show notes. But, my friend, thank you so much. And the door is always open for you or your students to come back and share the amazing work you're doing. I just appreciate you, your energy, and can't wait to read the paper.
[00:54:20] Speaker B: Yeah. Thank you. Thank you so much for inviting me to do this. This is really fun. And I'll take you up on the follow up with students. I've already told some of my students, you got to prepare for this because we're good.
[00:54:33] Speaker A: Good.
[00:54:33] Speaker B: Yeah.
[00:54:34] Speaker A: It should be part of getting that a little. Maybe I should credit. Maybe I could get extra credit. That's awesome. Well, thank you so much. And for our listeners, as always, you can find show notes, information about Lauren and
[email protected]. dot Lauren, thank you so much. And as always, I'll see her by next week.
[00:54:52] Speaker B: Thank you.
