Episode 20

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Published on:

24th Aug 2026

S6 Ep17 The Myth of Suffering at Work

Diane Malaspina is a psychologist, performance coach, and longtime yoga teacher who specializes in stress and burnout recovery, nervous system regulation, and optimal performance. She coaches frontline medical professionals, military human performance psychologists, executives, and athletes, and has worked extensively with medical students and residents through Arena Labs.

In this conversation with Dan Dworkis, Diane makes the case for a strengths-based approach to burnout: instead of asking what's broken in the 65% of people who report burnout, look at what the 35% who don't are doing right. They cover reframing stress as a challenge rather than a threat, plus two of the fastest levers for shifting your nervous system in real time—sleep and breath.

This conversation was released in partnership with The Emergency Mind Podcast and originally aired on April 27, 2026.

If this conversation was useful, subscribe and leave a quick rating or review — it helps us reach the teams that need to hear these conversations most.

Transcript
Preston:

Welcome to the Teamcast.

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I'm Dr.

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Preston Cline, director of the

Mission Critical Team Institute.

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Here, we discuss all things

mission critical teams.

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These are teams of four to 12 people

indigenously trained and educated to

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solve rapidly emerging complex adaptive

problem sets where the consequence of

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failure is death or catastrophic loss.

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With my colleagues and our guests,

we bring you insights from combat

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zones to emergency rooms, dedicated to

improving the success, survivability,

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and sustainability of these teams.

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We grapple with how to prepare for

future events and how to develop

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language and frameworks to transfer

critical, often unspoken, knowledge.

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Whether you're on a mission critical

team or not, we aim to bring you

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the broadest range of topics and

guests as possible to help prepare

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you to perform when it matters most.

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Thank you for joining us, and

hope you enjoy the Teamcast

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Dan: Hi folks, I'm Dan Dworkis,

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Speaker: and our

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Dan: guest this episode

is Diane Malaspina.

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Now, Diane is a psychologist, a

performance coach, and a seasoned yoga

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teacher who's dedicated to advancing

physical and mental wellbeing.

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She specializes in…

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Okay, this is a long list.

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Get ready.

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She specializes in stress and

burnout recovery, nervous system

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regulation, sleep anxiety,

resilience, and optimal performance.

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And I met Diane as we were both doing

a project for the Orthopedic Trauma

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Association, and was totally struck by

the way that she was able to capture

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a lot of what can range from, like,

esoteric to unusable, and find a way

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to pr- package it into a thing that's

incredibly important and valuable

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around taking care of yourself as

you're operating in these spaces.

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So I'm totally delighted to

have Diane on the podcast.

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Diane, thank you for coming

to be a part of this.

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Diane: Hey, Dan.

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Thanks so much for having me.

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Dan: Absolutely.

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So can you give folks just, like, a

super high-level overview of, like,

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how you spend your time, and w- what

made you think along these directions?

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And then we'll pull and push from there.

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Diane: Sure.

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I spend the majority of my time

coaching one-on-one with individuals

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who wanna be great at something.

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Yeah.

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And that ranges from people who are

in frontline professions like medicine

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and trauma care, as well as people--

I've worked with psychologists,

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human performance psychologists in

the military, as well as attorneys,

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executives, and really athletes,

anyone who, again, wants to be great.

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Even parents who are just really focused

on wanting to improve their home life.

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And I also spend my time in workplace

settings offering seminars, workshops,

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executive level coaching to both

teams and individuals, and I also run

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some online programs for people who

want to be part of a community where

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these types of issues are important.

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And how I landed here really is

I got my degree in psychology.

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I went the academic route.

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I was a college professor.

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I love teaching and educating,

but my background in research

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was stress and resilience.

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And instead of looking more so at why

people don't cope well with stress and

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more of the mental illness model, I

really fascinated in the late:

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and onward into how people flourish

and overcome adversity in the face

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of challenge and stress, and that's

really what I'm passionate about.

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And I believe that everyone has

a level of potential that they're

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trying to get to, and there are

things in life that block us.

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And so working with someone like me is

about really becoming aware of what the

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reality is in terms of what's blocking us.

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Sometimes it's systemat- systemic

in terms of our environment.

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And there's things we can do, and

a lot of times it's things within.

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And when we start to cultivate a level

of presence, and that's where some

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of my yoga practices and mindfulness

practices come in- Um, aligning with

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Eastern philosophy of a simpler life

and living toward the middle path.

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When we connect with that and we

connect with deep down what's truly

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valuable to us and our goals, we tend

to find that space where we can meet

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the challenges that we wanna meet.

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Dan: I love it.

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I love it.

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Okay.

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So right away, you're probably already

understanding why I'm so excited to have

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Diane on this podcast because I, I think

this sort of strengths-based approach

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and positive approach as opposed to a,

"Hey, you're gonna get crushed by what's

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about to happen, and let's, like, put

the pieces back together after you've

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been crushed," I think is a really

important and often underused thing.

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Like, certainly this is not something

I was exposed to early in my training.

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I think we're doing globally a

better job of bringing some of this

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to folks earlier in the pipeline.

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But still there's a lot

of work to be done there.

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Diane, as you think about this, and I

don't know, maybe answer this from, like,

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back in time or now looking backward,

whatever you wanna do, like, what got

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you interested in that space of it?

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Like, how did you settle on the

strengths-based or what drew

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you to that sort of approach?

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'Cause I, I think that's-- and

correct me if I'm wrong, but I

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think that's still the less common

sort of path through psychology.

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Diane: Right out of undergrad, I worked

at a psychiatric hospital, and this

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was in the mid-'90s where the model was

much more emphasis on medication as an

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intervention for psychiatric issues.

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Yes, there were some behavioral and

cognitive interventions, but I was

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again working in a private hospital

system, so it was-- I was seeing

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people come back over and over again.

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They'd get, uh, released, and then

they'd come back, and it seemed

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like a system that wasn't working.

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And I myself, as a young adult working

in the field, felt very burned out from

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it, felt very depressed from it, and it

started to almost, like, interrupt my

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personal life in that I was really focused

on how challenging not only the patients'

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lives were, but how it seemed like there

was a system that wasn't facilitating

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any opportunity to get out of the system.

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And so I actually didn't think

I wanted to be a psychologist

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for a few years after that.

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And then I ended up meandering my way

into the philosophy space, and then I

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found my way back to visiting an old

advisor in undergrad who really helped

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me see my own personal strengths and, and

suggested that I get a master's degree in

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education and developmental psychology.

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And what's cool about developmental

psychology, which I had studied in

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undergrad and then fell back in love

with in graduate school, is that

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it's really about understanding how

people navigate transitions over time-

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Dan: Mm-hmm

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… Diane: and how we all really

attend to where we are at

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different junctures in life.

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And it gives you the norms

and the averages of different

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developmental periods from infancy

all the way to elderly adulthood.

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And life is a lot of challenge

and suffering, and especially

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contemporary life is that.

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And so the reason why I got interested

in a more positive orientation toward

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wellbeing and toward thriving is that

we can look at anything, we can use

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burnout as an example, we can look

at anything that seems to be a more

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deficit-minded approach to looking at

mental health, and we can say, go into

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any organization and 65% of people

experience burnout But 35% don't.

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And what is it about the 35% that we can

learn from and that we can then start

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to generalize into the other 65% so that

we start to have a model of flourishing

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and really potentiating strengths

versus constantly trying to fix, fix.

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And fixing really isn't the key

unless it's a traumatic thing.

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And as, as an ER doc, we

have to fix some things- Sure

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where they become life or death.

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But if it's not life or death, if

we use a fix-it approach, that's

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not necessarily the way to lead

toward human motivation and bringing

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somebody to where they wanna be versus

dwelling on where they don't wanna be.

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Dan: So there's two threads

that really emerge from this.

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So one is as you're describing this,

like what are the strengths and

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systems and tools of this 35% that is

already thriving in these worlds, and

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what can we learn from them, right?

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And that's like a, um, I don't know,

building the foundation approach, for

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lack of a better word to it, right?

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What are the things we need to have in

place to, to make sure that we're doing

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okay and then starting to really thrive?

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And then on the other end of

it i- is, I'm gonna borrow this

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metaphor from, from Seligman in the

positive psychology world, right?

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This concept of growing roses,

which I've always loved, right?

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So he talks about if you have a

field that's full of debris and

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waste and you wanna grow roses, it's

not enough to take the weeds out.

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If you take the weeds out, then

you just have an empty field.

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You also have to plant

rose seeds and water them.

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And so there's this sort of like positive

idea of success thriving, where the

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way you described it, for people who

wanna be great, that's not the same

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as just removing the negative pieces.

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And th- those threads are

similar, but I guess I'm reading

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them as a little bit different.

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Am I reading that right or how

do you think of that model?

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Diane: Yeah, you're definitely reading it.

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The first part is if we understand

the foundational pillars of what

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makes that 35% be able to function

and thrive in a stressful environment,

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we're learning again how to generalize

that to the other part of the

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population who might be struggling.

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So when we think of, that's where I go

into a lot of, you know, what we talked

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about in the ortho trauma talk, a lot of

the nervous system regulation practices.

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So people who are in the face of chronic

stress, longtime stress that is starting

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to wear and tear on their psychological

system as well as their physical

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system, those folks start to be more

emotional, more cognitively depleted,

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and start to have physical symptoms

and that's very difficult to perform in

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any environment when we're facing that.

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When we look at the 35% who are doing

well, usually their sleep is dialed in.

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They're getting enough

quantity and quality of sleep.

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Their nutrition is dialed in, they

have a clear transition from work

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life to personal life, and that

they can find joy in their personal

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life, and they're connected to some

sort of purpose or value system.

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So even though they might have days that

are bad days, that feel stressful, they

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have tools and perspective that help

them to not dwell and ruminate on those

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bad days, but to keep moving forward

as day goes in and day goes out, right?

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And so

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Dan: they, they

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Diane: understand that there's a sense

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Dan: of work life and personal life,

and they can really separate the two.

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Diane: If we look at the analogy

between the weeds in the field and

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the roses that grow, it's true.

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So the other aspect of it is, okay,

so we take these different aspects

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of the people who are thriving in an

environment, and we help the people who

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aren't create the skills and take on the

tools that will help them to get there.

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And first we assess,

do you even want this?

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What is it that you want?

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What is it that is challenging you?

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And sometimes, really where it starts

oftentimes when we're looking at

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folks that feel like they're in some

sort of depleted state or frustrated

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state, when we're in a less positive

state mentally, psychologically, one

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thing that a lot of programs and even,

like, biohacking and an app can't

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necessarily attend to is really seeing

and hearing the person where they're at.

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Hmm.

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And that's where coaching is really

powerful, is being able to have

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the presence with the difficulty

that somebody's experiencing.

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We're not trying to fix it- Hmm … and

we're not trying to move past it,

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we're just trying to be with it.

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And we can be with it.

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What we know about emotions is

emotions, given the ability to

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release, move relatively quickly.

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And so instead of stuffing the emotions

in or trying to repress the emotions and

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act, work so much that we act like they

don't even exist, we give them space to

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release, and with that, the individual

can create some awareness, and then they

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start to have that agency to say, "Oh, I

might actually want to regulate my nervous

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system," which is a foundational pillar.

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"I might start wanting to connect

more with my values and purpose

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because that's important to me,

and that makes me feel good.

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And when I feel good, I perform better."

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Dan: All right.

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There's…

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Okay, so first off, if you're watching

this, you might have seen me smile through

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part of what Dana's saying, and that's

because I'm internally laughing as she's

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describing many things that I have felt

over the years of operating in spaces.

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And, you know, I think I have a much

better handle now on being able to

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observe that in myself, but certainly

was not even aware that was abnormal

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when I was really doing a lot of this.

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And so I think there's…

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As we think about building the foundation,

there is a conversation about what

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is it supposed to look like, right?

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'Cause, like, it's hard, and we know

it's hard, and it's supposed to be

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hard, but that doesn't mean that it's

supposed to look like destruction.

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And I think that gets

lost in there somewhere.

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That's where my little smile was

coming from in the middle of that.

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But there's a couple ways

I'd love to take this.

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I want to hit on transitions.

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I want to hit on regulating nervous

systems, and I want to hit on

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coaching, 'cause I think those are

all interesting pieces that are

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still underexplored in this space.

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And if it's okay, let's start with

the nervous system regulation.

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So I…

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That is a term that gets thrown around

a little bit, and some of the time when

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it's thrown around, it is in a Let's

politely call it a woo conversation where

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it doesn't seem to have a lot of grounding

in the reality of the spaces that a lot of

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people listening to this are operating in.

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And I think that it gets a bit of a

bad rap, and it also doesn't always

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help itself not get a bad rap.

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So I'm really curious to talk more about

it, 'cause I think there are some pieces

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of this that are super important, that

are super tactical and easy to get into,

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and also that have a lot of really deep,

important implications in everything

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from longevity and happiness to, like,

your ability to succeed at your job.

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Can you give us a 101 crash course

on, on what that actually means,

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and what are we doing with that?

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Diane: Sure.

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So I guess I'll start with this

concept called allostatic load.

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So allostatic load is basically the

wear and tear that we experience based

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on day-to-day stressors in our lives.

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And that wear and tear could be mentally,

could be physically, could be emotionally.

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Okay?

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And internally, we have a grand operating

system called the nervous system, and the

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nervous system has many branches to it.

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But when we talk about nervous system

regulation, we're talking about the

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autonomic nervous system, that part of

our nervous system that automatically

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controls all of our different life

processes down to heartbeat, respiration,

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digestion, levels of alertness,

and, and, and really around what's

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creating what we call homeostasis in

the body so that we can ultimately

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conserve energy and live longer.

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And what we have are two junctures

of the autonomic nervous system.

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We have what's called the sympathetic

nervous system, and in common

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speak, basically people talk that

about as like your gas pedal.

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It's the part that is like the

arousal feature, the part that

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activates us, that energizes us.

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If you're thinking of the safari, it's

the gazelle that's running away from the

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tiger, but the tiger is also running too.

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So I might bring that up a little bit

later about how anything that's charged

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and activated is determined, dominated

by our sympathetic nervous system.

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And our parasympathetic system is

our rest and digest, is the part

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of us that puts the brake pedal on.

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Dan: Oh, Diane, I just want

to interrupt for one second.

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Yeah.

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So if you're listening to this and you

are coming from a medical background,

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it's very tempting to zone out a little

bit when somebody describes the autonomic

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nervous system because you're like, "Yeah,

I remember that from whatever it is."

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I really want you-- I really want to

challenge you- Yeah … to deepen your

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attention to what Diane is saying here,

because the way that we, that you, that

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I, that we learned about the autonomic

nervous system is not necessarily the

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way we need to understand it in order to

actually tune in with ours and utilize it.

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Uh, like I really just-- I want

you to, like, believe me here for a

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minute and really dig into what she's

saying here, 'cause we don't often

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understand at the level that we need to.

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Okay, that's my plug and

soapbox, so please back to you.

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Diane: Sympathetic nervous system is

the part of us that keeps us awake,

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focused, on task, the d- the daytime

part of who we are, in a sense, right?

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All the things that we need to do, but

it's also triggered by stress, okay?

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And that's that intensity

that we can feel in life.

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The parasympathetic nervous system,

the rest and digest, is like putting

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on the brakes in our nervous system,

and that is the part that's responsible

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for the digestive processes, like I

said, for sleep, for recovery, for

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restoring us and regenerating us.

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Both are equally important.

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Both are important for our survival.

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And many of you know that if you're

in the medical world, just if you go

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into extreme, extremes, if you don't

sleep for a given amount of time, let's

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say a week or something, you will die,

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Dan: okay?

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Diane: Like sleep is actually a

survival behavior, as is activating.

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Running can also be a survival

behavior if something's chasing

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you and coming to get you.

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But in modern-day life, what we

do is we overtax the sympathetic

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nervous system, and we under-use

the parasympathetic nervous system.

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The best way to regulate ourselves

naturally with the rest and

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recovery aspect, the parasympathetic

nervous system, is sleep.

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It's the ultimate recovery tool.

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Adult humans need seven to nine

hours, depending on the individual,

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and in that seven to nine hours,

it needs to be quality sleep.

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Now, some of you in the medical world

are thinking that's impossible, right?

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So there are different ways that

we can attend to those needs for

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somebody who works in a situation

that doesn't always allow for that,

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but sleep is the number one recovery.

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And then there's a whole bunch of other

things that we can do in our daytime

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wakeful hours that promote recovery,

basically a stem from the chronic on

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switch of the sympathetic nervous system.

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So what are sympathetic nervous

system things that we do?

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It's basically right when we wake

up in the morning and the busyness

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and the hectic nature of our lives,

whether we're focusing on something,

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problem-solving, engaging in a surgical

procedure, caretaking for another p-

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person, anything that we're doing in our

work lives, when we're exercising and

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we're getting our heart rate elevated,

when we're under an extreme amount of

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stress and our mind is really busy,

all of that is sympathetic activation.

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And what we say about modern life is that

we are sympathe- in sympathetic dominance,

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and over time, we have actual physical,

mental, and emotional repercussions-

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Mm … for being in sympathetic dominance.

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Hans Selye was the first

to really study this.

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If we stay in the stress response, the

sympathetic response for too long, we go

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into a state of exhaustion and basically

like a sense of fallout, and some

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people would equate that to eventually

being like in a state of burnout.

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Dan: Regulating our nervous system,

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Diane: which is a very popular term

these days, which might sound kind

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of woo, is really about caring for

yourself in a way so that you are able

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to contribute in the ways in the world

that you want to in a healthy way.

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Dan: I've, I've heard it described

sometimes, uh, i- in a sense of tuning

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your instrument and maintain-- Or

sharpening your chisel or tuning your

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guitar or whatever it is, where you're…

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I've never heard of a virtuoso

violin player who complains that

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they have to tune their instrument

at the beginning of the day.

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They just understand that keeping

their instrument in tune is part

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of their ability to produce music.

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But I think that There's a tendency

among, certainly in medicine and among

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a, a lot of the other high-performing

groups as well, to grumble about

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that or complain about that or be

like, "I don't have to do that.

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I don't have time for that.

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I'm not…

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Whatever it is, it, it is not enough

that I have to, like, maintain myself.

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Like, I have to go, I

gotta go back to work."

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And I think this is one area where,

like, folks in the military have

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a big leg up on folks in medicine

because physical training and recovery

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is really baked into a lot of that.

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And fire to some extent as well.

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There's always a concept of recovery and

PT, and that just doesn't really exist

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in medicine, and there's a lot of, "I'm

too busy," or, "I'm just gonna survive

351

:

off of this for a while" i- in medicine.

352

:

So a- when I think about regulating

the nervous system, in my mind

353

:

I'm thinking about, all right,

how do I maintain my tuning?

354

:

Which as you're correctly pointing out,

requires really focusing a lot more on

355

:

the parasympathetic system, at least

in the way that we're mostly designed.

356

:

So how do we do that other than sleep,

which could be the source of like

357

:

100 podcasts that we could get into?

358

:

Diane: Yeah.

359

:

One thing that seems rather

interesting but rather simple

360

:

is the exposure to light.

361

:

Mm-hmm.

362

:

So exposing ourselves to

morning light, exposing us,

363

:

ourselves to the sun going down.

364

:

If we work odd hours, just exposing

ourselves to bright light when we

365

:

need to alert ourselves, exposing

ourselves to dimming light when

366

:

we need to go into rest, actually

triggers our physiology to get us

367

:

into that more parasympathetic state.

368

:

And so what I would say is the

things I'm about to share are how

369

:

to work with your biology and your

physiology in order to naturally…

370

:

It's not so much-- I heard what

you were saying about these are

371

:

the things I have to do, and this

is how I have to allocate my time.

372

:

And it's like, well, what would it take

to actually go outside in the morning

373

:

upon waking up, and maybe you're still

multitasking in some way, but that you're

374

:

actually letting natural light- Yeah

375

:

go into your vision field, right?

376

:

And so there is time for that,

and it's more- Mm-hmm … about

377

:

managing energy than managing time.

378

:

There's also breathing practices.

379

:

Breath practices are the quickest

way to either upregulate or

380

:

downregulate the nervous system.

381

:

Of, in general, slow, deep breathing

is what starts to relax us, whereas

382

:

faster breathing that there's

little gap between inhale and

383

:

exhale step tends to stimulate us.

384

:

Think about if you're like

running on the treadmill, right?

385

:

That

386

:

Dan: kind of thing.

387

:

Diane: Movement

388

:

Dan: can also be a great way to prepare

389

:

Diane: us to rest.

390

:

Meaning that if we have excess

energy, we don't wanna do too

391

:

much movement before rest.

392

:

But if we let energy out of our body

through movement and then have some

393

:

downtime, that can help us to relax more

readily As a gentle walk can do the same.

394

:

Nutrition, what we eat, when we eat, the

types of whether we're eating protein

395

:

and carbs, and the timing of which we

ingest those things can support it.

396

:

As well as just mindfulness practices.

397

:

So slowing down, writing down if we

have a busy mind and a lot of things

398

:

that are making us feel more alert

or unable to sleep, we can write down

399

:

those thoughts and put them away so

that we can, like, rest our living.

400

:

It's not about always doing more.

401

:

It's about managing the energy

that we have in such a way.

402

:

And for very busy people that feel

like they don't have time, I really

403

:

like the microdosing approach to

recovery where it doesn't have

404

:

to be a long bout of recovery.

405

:

It could be as little as one to

two minutes of just slowing down.

406

:

And that's really what the

nervous system responds well to.

407

:

It's think of the analogy of,

like, building muscle or think

408

:

of the analogy of, like, high

intensity interval training.

409

:

It's that we, when we're under periods

of high load, which is, let's say, an

410

:

intensive work experience, we use a small

bout of recovery in order for repair.

411

:

And that works at the tissue level

as well as the psychological level.

412

:

And thinking about can I take a

moment to pause and drink a glass of

413

:

water in the midst of what I'm doing?

414

:

Can I take a moment and

take five slow breaths?

415

:

That in and of itself can be really

powerful to interrupt the constant on

416

:

switch of the sympathetic nervous system.

417

:

Dan: Yeah.

418

:

I think what you said about this

is a story about working with

419

:

your biology and your physiology.

420

:

That's, it's ridiculous to say this out

loud, but I think when I was training and

421

:

when I was starting I tried to pretend

that none of that applied to me, right?

422

:

Oh, I'm just gonna smash through

everything 'cause normal human biology

423

:

and physiology, that's not for me.

424

:

I'm an ER doctor.

425

:

I'm blah, blah, blah, blah, blah.

426

:

And of course, that's not true, right?

427

:

It's a ridiculous thing to

say, but it's the zeitgeist of

428

:

how we operate a lot of times.

429

:

So that interesting challenge of like

where are you fighting against your

430

:

biology and physiology, and where could

you in- instead align yourself with

431

:

it to take a more jujitsu approach

to it, for lack of a better word,

432

:

and find the way that the body and

physiology are already moving and align

433

:

yourself with that is really powerful.

434

:

I…

435

:

Oh, please.

436

:

Diane: Yeah.

437

:

What, what I just wanna say really quick

is like, I, I say this, it's, it, it

438

:

doesn't sound very elegant, but it's true.

439

:

Like, some people subscribe to the

myth of suck, you know what I mean?

440

:

Like- Yeah … it's the

this has to be hard.

441

:

This has to suck really hard.

442

:

This has to be like, have

to be in a state of hell-

443

:

Dan: Mm-hmm

444

:

Diane: to earn the badge of merit

in some way- Oh, sure … for

445

:

doing what I have to do.

446

:

It's really a paradigm.

447

:

It's really a paradigm of switching

to, hey, maybe if I manage my biology

448

:

and my physiology and I start to

rest better and actually care, you

449

:

were talking about the instrument,

like what if you are the instrument?

450

:

Mm-hmm.

451

:

If you're the only instrument

that you truly can tune.

452

:

And if you're the instrument that

you can tune, what if, what, how

453

:

much better do you do the things

that you need to do in life?

454

:

How much better of a surgeon are you?

455

:

How much better of a physician are you?

456

:

How much better of a companion are you?

457

:

Dan: I love it.

458

:

I don't know that we can title

this episode The Myth of Suck.

459

:

I feel like I'll get dinged on Apple

if I do that, but I, man, that's, I

460

:

actually think that's probably the best

thing to describe what it is that we're

461

:

digging into 'cause you're totally right.

462

:

And not only is there a myth of that,

but we perpetuate that myth, right?

463

:

We like tell other people that myth,

and we're like, "Welcome to the club.

464

:

It sucks here.

465

:

You're gonna suck now."

466

:

And you're like, what are you doing?

467

:

Like, why are you teaching that as a

skill set versus what you're describing,

468

:

which is yeah, you wanna have a really

long, successful career of doing this,

469

:

and that requires maintenance and upkeep

of you as a human being, and learning the

470

:

skill of tuning into yourself of that.

471

:

And what a better way to, to

prepare people than being like,

472

:

"Yeah, this is gonna suck.

473

:

Good luck."

474

:

Yeah, that's really-- I love that.

475

:

Maybe this is a wonderful time to switch

gears into transitions, 'cause I think

476

:

this is actually like when you were

talking about some of the transition stuff

477

:

with the orthopedic trauma group is where

this really started to come clear for me.

478

:

All right, what does this actually mean?

479

:

And one of the big ways that we

can, I think, make a very conscious

480

:

decision about either embracing

the myth of suck or exploring, I

481

:

don't know what the Violin tuning.

482

:

I don't know.

483

:

We, we need some better name for the

other thing that we're talking about

484

:

here that's not the myth of sock,

but this choice between these options

485

:

is at these moments of transition.

486

:

So I'm gonna turn that over to you.

487

:

Go wherever you want with it, but I

think transitions are a huge thing

488

:

that, that a lot of us struggle with.

489

:

Diane: Yeah.

490

:

When we think about the way that our

days go, people describe it like this.

491

:

It's like they, they…

492

:

alarm goes off when they wake up, and

then they hit the ground running, right?

493

:

And then they're running all day from

this to that, often multitasking all

494

:

the way, feeling flustered, and by

the time they get a chance to sit

495

:

down for a moment, they don't have the

motivation or the energy to do anything.

496

:

Maybe they scroll on their phones.

497

:

Maybe they zone out to

Netflix or whatever.

498

:

But so these simple, what seemingly

simple asks, get outside and get fresh

499

:

air to regenerate, take a few five slow,

deep breaths, seem like a nice idea,

500

:

but they seem impossible in the moment

But transition is the window to actually

501

:

open up that possibility for change.

502

:

And it's actually, if we use the car

analogy, if we use the sympathetic

503

:

nervous system as putting the foot on

the gas, and we use the parasympathetic

504

:

as putting the foot on the brake, we

don't drive our cars slamming down on

505

:

the gas and slamming down on the brake.

506

:

And so what the transition is learning how

to calibrate the amount of pressure that

507

:

we put on and take off in life, right?

508

:

And so the transition is really

that slow ability to ramp

509

:

ourselves up into something.

510

:

And think about it, if you were involved

in, like, a 10-hour case, you can't

511

:

be going full throttle for 10 hours.

512

:

That would be really taxing you.

513

:

You would be doing your best work, one,

with a team that also supported you, but

514

:

two, being able to moderate your amount

of focus and energy and attention so that

515

:

you can sustain that for that 10 hours.

516

:

And it's the same thing

when we think of transition.

517

:

So if I'm coming off of something

really intense that did maybe take

518

:

my performance 10 hours, how can I--

I'm not gonna go from high intensity

519

:

coming off of something that was

really required a lot of focus and

520

:

stress and maybe even a little bit of

nervousness, anxiety, and then all of a

521

:

sudden slam on the brakes and pass out.

522

:

And so what we wanna do is we

wanna think about how do we slowly

523

:

put our foot on the brake pedal?

524

:

And so that becomes where I, what

I talked about in the talk with the

525

:

Ortho Trauma Group is, okay, what's

the last hour in the OR look like?

526

:

Mm-hmm.

527

:

What does the commute home look like?

528

:

And there's these just little windows that

we can take into microcosms of our day.

529

:

Instead of just saying, "I get out of

bed and hit the ground running," it's

530

:

like I get out of bed and I start to have

a ritual for how I enter my day, and I

531

:

have little points in the day where I

have a moment, a protocol for pausing,

532

:

and then I have a ritual for how I

leave my work and enter into my personal

533

:

life and eventually into my sleep time.

534

:

So it's

535

:

Dan: more about,

536

:

Diane: I like to think of it more about

slowing down the mentality around it, even

537

:

using the words hit the ground running.

538

:

It's like we, we have such a

semantics around it, right?

539

:

What if we just purposefully choose

to listen to slow music on our

540

:

commute home or listen to nothing

and not stimulate ourselves?

541

:

Dan: Yeah.

542

:

Yeah.

543

:

I think about it sometimes, you know, like

super nerdy medical way as we're thinking

544

:

about people who are on ventilators.

545

:

First off, if you just slam air into

them and don't give them the chance to

546

:

breathe out, their lungs explode, and

that's obviously quite bad for you.

547

:

So you need a balance of inhale

and exhale, time when you're

548

:

pushing air and time when you're

letting the body regroup to it.

549

:

And like we understand that and we

tinker with it and we obsess over

550

:

getting the ratios right, and we obsess

over get- but we don't actually do

551

:

that for ourselves in the same way.

552

:

We don't allow ourselves the chance to

exhale and to go back and forth to it.

553

:

So the way you're describing, if you had

a 10-hour case, are you on the whole time?

554

:

Like, there's a lot of times in the

ER where your instinct would be like,

555

:

yeah, you're on the entire time.

556

:

But that's not like, that's

not really true, right?

557

:

Like very rarely are you at 1,000 for

the entire time There are times you're

558

:

moving back and forth between rooms

where you have two patients who are

559

:

coding or you have a, a kid with a

challenging airway and you move directly.

560

:

And there are times when you have to

sprint and sprint, but it's really

561

:

not the way it always works, right?

562

:

Usually there is the chance to exhale

and to slow down and to treat yourself

563

:

like you're treating your patient for it.

564

:

And j- just to continue this, like, long

rambling talk about airway stuff, if when

565

:

we take somebody off of a ventilator, we

allow them the chance to wake up slowly

566

:

and start breathing for themselves.

567

:

Sponta- like an SAT and an SBT, right?

568

:

A spontaneous awakening trial and

a spontaneous breathing trial.

569

:

We don't just take the tube

out and be like, "Good luck.

570

:

You're probably fine now."

571

:

We allow them the chance to ramp

back up into their normal life.

572

:

And I think that we don't-- I certainly

have not always done that for myself.

573

:

I have definitely done the slam into a

brick wall version of it and then wonder

574

:

why it doesn't feel good or I don't

feel like myself or anything like that.

575

:

And it, it-- I'm always fascinated

by how we-- all of this stuff only

576

:

applies to other people and not to us.

577

:

Diane: For the sake of

vulnerability, it applies to me too.

578

:

I had burnout three times before

I was able to really dial it in.

579

:

And so what you just shared, Dan,

which I thought was so eloquent, was

580

:

like you had this, like, awareness,

this aha moment between your real

581

:

life and how that relates to you.

582

:

And maybe I'll transition us

into coaching a little bit.

583

:

And that's what the coaching relationship

does, is that I consider myself, in

584

:

a sense, the one who listens and the

one who observes the patterns that are

585

:

happening and that I'm hearing about.

586

:

And just through this engaging

conversation, we get to a point where one

587

:

side of the tables pauses for a moment

and this level of awareness shows up.

588

:

So we're not looking-- I'm not

really expecting fast change.

589

:

And I, I don't wanna just have one

coaching engagement, and not just because

590

:

I wanna have a career, but what I want is

I want for this to be something that over

591

:

time becomes something that's so crystal

clear to the person that I'm working with

592

:

that they're like- Oh, this makes sense.

593

:

This is my paradigm.

594

:

This was a paradigm that I've

been living off of, hit the road

595

:

running, for all of my life.

596

:

And right now I'm in this space

where it's not fitting anymore.

597

:

Yeah.

598

:

It just doesn't fit anymore.

599

:

And how do I know it doesn't fit?

600

:

I have some physical

things I'm working through.

601

:

I have some goals that I

can't seem to quite get to.

602

:

I'm noticing mentally

I'm not where I wanna be.

603

:

And so in that space between

the famous Viktor Frankl quote

604

:

around the space between stimulus

and response- Yeah … right?

605

:

It's true.

606

:

It's that in that place where we start

to feel that tension of, gosh, there's

607

:

something here that feels like a tension

and I'm not really where I wanna be,

608

:

is an opportunity for me to explore.

609

:

And so when you work in a coaching

relationship, it's that self-awareness.

610

:

So I spend a lot of time on self-awareness

because I'm not here to fix you.

611

:

I'm here to help you see how you

can be the way you wanna be for you.

612

:

And I might offer some, you

know, here's some evidence-based

613

:

practices that work for this.

614

:

I've got a huge toolkit.

615

:

So if you don't wanna go there,

we can try there until we find

616

:

that right tool that you're like,

"Okay, hey, yeah, I can do that."

617

:

And then it's also anchored

into what's your schedule like?

618

:

Where will that f- what's

the reality of your life?

619

:

Where will that fit in?

620

:

Where do you think there

might be a barrier to that?

621

:

Where do you think you could

be successful with that?

622

:

Dan: The other day I was getting coffee

somewhere and I was watching a, a medical

623

:

student, I assume a medical student, go

through a thing that all of us have been

624

:

through at some point before which is

memorizing the branches of the brachial

625

:

plexus, which are the nerve cluster that

goes through your axilla, your armpit.

626

:

And, you know, it's one of the things

that you hit early in anatomy and you're

627

:

like, "Oh my God, this is impossible.

628

:

How am I ever gonna remember this?"

629

:

And y- you stretch your

brain to remember it.

630

:

And, and I remember so clearly being

that person, like writing that down

631

:

obsessively over and over again.

632

:

I don't think I could still do

it if I, probably if my life

633

:

depended on it, but we'll see.

634

:

But, but we teach everybody coming

in the brachial plexus and we don't

635

:

teach them the skill of listening to

themselves, like you're describing.

636

:

And th- there's a double-edged

sword to that, right?

637

:

Which is that as you go through

the process of becoming a doctor,

638

:

and like from my time working

with other groups, I know there's

639

:

parallels to this in other fields,

but I'll just speak for my own path.

640

:

Like, you actually do have to change

into a different type of human being.

641

:

There's stuff that you have to

stretch, and it doesn't just stretch

642

:

and go back to its normal shape.

643

:

It actually changes into

being a different thing.

644

:

And the process of growth and

transformation is uncomfortable

645

:

and has elements of chaos and

hardship to it that will not and

646

:

should not be taken away from it.

647

:

So there's a balance in there between

this is hard, this will change you, you

648

:

will not be the same after it, but that

doesn't mean you should ignore everything

649

:

coming out of your body and your mind.

650

:

And I think those things get bundled

up as one concept too frequently.

651

:

It's like, "You don't

know what you're doing.

652

:

We're gonna break you and

rebuild you as a doctor."

653

:

But somehow we also need in there to

be like, no, you also have to carry

654

:

with you this sense of who you are as a

human and how do you listen to yourself.

655

:

And I don't think that we've

always done the best job of that.

656

:

And frequently now, at this stage

in my career, I'm often talking to

657

:

folks like you're describing about

how do you know what you're feeling

658

:

and what you're going through in this?

659

:

And how, like what is your

skill of listening to yourself?

660

:

And I just don't think

it has to be that way.

661

:

We probably could teach people some

of this earlier on in the pipeline.

662

:

I don't know what that looks like

'cause I've never seen it, but I

663

:

have to imagine that we don't have to

destroy that skill and then rebuild

664

:

it sort of the way that we're doing.

665

:

I don't think I have a question in there.

666

:

I'm just talking out loud

as I'm thinking about this.

667

:

But I, I have to imagine that Either we

need people to go through coaching very

668

:

quickly after this transformation stage or

through it or during it, or I don't know.

669

:

What have you seen for that?

670

:

Diane: Yeah.

671

:

I ta- as a coach, I…

672

:

Much of my work is specialized with

healthcare providers and especially

673

:

frontline healthcare providers, lots of

surgeons, physicians, nurses, the gamut.

674

:

What I would say is true, it, it, it's…

675

:

There's something about the culture,

the upbringing and the culture of coming

676

:

into healthcare where I think the energy

is so outwardly focused on the patients

677

:

and on doing the right thing and making

sure that you, your incredible amount of

678

:

knowledge transfers into the care that

you're giving, that there is a lack of…

679

:

You just make this transition

of being outwardly focused

680

:

versus being inwardly focused.

681

:

But what I've had the honor and

privilege is to hold the space for

682

:

people in these one-on-one settings

where deep down there is something

683

:

that doesn't feel aligned for them.

684

:

And there is this…

685

:

What I love about working with healthcare

providers in particular is a deeper

686

:

mission and deeper purpose that they have.

687

:

And while they may not prioritize their

own self-care- Once you reorient them to

688

:

that, they then get really excited about

it because you guys are high achievers.

689

:

Dan: Hmm.

690

:

Diane: As a group of-- especially

when I work with physicians,

691

:

like to do well at things, right?

692

:

It's true,

693

:

Dan: yeah.

694

:

Diane: You're the-- you're elite.

695

:

You're, you're, you're the top.

696

:

If you think about it, who

goes to medical school?

697

:

Like 1% of people.

698

:

I mean, it- it-- you're elite

in its own, in the own path

699

:

that you are able to get into.

700

:

It's very difficult, right?

701

:

And so it starts when you're early in

the career, and it maintains that level

702

:

of pressure and high stakes throughout.

703

:

But I think that what I love about

working with such intelligent

704

:

people is all you have to do is help

steer them, their compass- Mm-hmm

705

:

inward.

706

:

But I, I-- one of the-- some of the

work that we did at Arena Labs, which

707

:

was really impactful, was working with

med school students and residents.

708

:

And so I think that there is

starting to become that drive to get

709

:

into this earlier in the process.

710

:

It's just not widespread.

711

:

Sure.

712

:

And that, too, as, as many people in

your field would say, there's something

713

:

going on in the culture as to- Hmm

714

:

why we're not there yet.

715

:

Dan: Yeah, totally.

716

:

D- Diane, this has been amazing.

717

:

Thank you so much for digging

into this with me and for

718

:

sharing all of this with us.

719

:

I wanna give you, as we're

transitioning out to the next thing

720

:

here, a chance to challenge people

to take something away from them.

721

:

And to give you a slight moment to

think about that, I'm gonna give our

722

:

normal disclaimer, which is that our job

723

:

Speaker: here is

724

:

Dan: to take the best of what everybody's

already learned about applying knowledge

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:

under pressure and bring it to everyone.

726

:

Nothing we do here is medical advice.

727

:

And for myself and my guests, all

of us represent only ourselves and

728

:

not anybody that we work for or

with while we're here doing this.

729

:

So Diane, what do you wanna, what

do you wanna challenge people

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:

with as they walk away from this?

731

:

Diane: Yeah.

732

:

I think it would be really great to

reflect on the course of a day, right?

733

:

And how you're navigating

stress in your life.

734

:

Are you viewing the different stressors

that you're encountering as a threat-

735

:

Meaning that the perception is you're

in fight or flight, there's negative

736

:

emotions, your heart rate rises, you

feel like you need to avoid something

737

:

or you can't get through something.

738

:

Or are you navigating it with

the perspective of challenge?

739

:

Meaning that you still are getting

your heart rate up, but that it's

740

:

something that has the possibility to

help you grow and make you stronger.

741

:

And does the stress that you encounter

in your day provide you with energy,

742

:

tend to bring you into more focus

into what you're doing, tend to get

743

:

you into a problem-solving mode?

744

:

Or is it more, is it like an approach,

meaning that it feels like it's

745

:

challenging and you want to approach it?

746

:

Or does it feel like a threat and it feels

like it's something you want to avoid?

747

:

If you're navigating a lot of threat

signals, I would say do some deeper

748

:

reflection and definitely think about

ways that you can support yourself,

749

:

whether that's working with somebody

or whether that's working on regulating

750

:

your nervous system based on some of

the tools that I shared with you today.

751

:

Dan: I love it.

752

:

And I, I have to imagine after listening

to this that folks are gonna be very

753

:

excited to talk to you more about this.

754

:

If you are, uh, listening to this and

you're somebody who wants to work with

755

:

you, Diane, or a program that wants to

bring you in or something, how can they

756

:

reach you and how should they find you?

757

:

Diane: Yeah.

758

:

Thank you.

759

:

I have a website.

760

:

It's my name, www.dianemalaspina.com.

761

:

That's the best way to

get in touch with me.

762

:

You can leave me a note, you can send me

an email, and I would love to connect and

763

:

learn more about ways to work together.

764

:

Dan: Awesome.

765

:

Diane, thank you so much

for being a part of this.

766

:

Diane: Thank you, Dan.

767

:

It was a real pleasure.

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About the Podcast

Teamcast
Mission Critical Team Institute Teamcast
Dr. Preston Cline, Dr. Dan Dworkis, Dr. Art Finch and Harry Moffit of the Mission Critical Team Institute share research and explore the questions vexing the most elite teams in the world, from Special Operations soldiers to Firefighters, from Trauma Medics to Professional Athletes, and from Astronauts to Tactical Law Enforcement.

About your hosts

Coleman Ruiz

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Co-Founder and Director of Performance, Mission Critical Team Institute

Preston Cline

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Co-founder and Director of Research and Education at the Mission Critical Team Institute
Senior Fellow, Center for Leadership and Change Management, The Wharton School, University of Pennsylvania