Ep. 56 How to Stay in Medicine with Dr. Bindu Akkanti

I'm Lacey Jones with Elevate the Individual. Episode 56 How to Stay in Medicine with Dr. Akkanti.

Hi, Lacey. Thank you for having me on this podcast. So my name is Bindu Akkanti. I am a mother of three. My oldest is 16, my middle is 13, and the youngest is six. Oh my goodness. And then I think the combination of a pulmonary critical care doc with the three kids and then mix in a dog, a ten year old dog, a three year old cat, Lucky and honey. And then my husband is a physician as well.

You guys are busy.

It's like my computer with multiple tabs.

Open as any mom operates, right?

Absolutely.

Okay, so for those of us who don't fully know or understand your position, why don't you go into that a little bit? What is that position?

So I am a clinician educator in the medical school. What that means is that I'm a full time clinician. I do about nine to eleven months of ICU. And then in that role, I have the opportunity to teach residents, fellows, medical students. I remember when I was very young that all I ever wanted to do was be a teacher. At some point, I think I was conditioned to be a doctor teacher. I think it happened within ages three and five. I remember vaguely showing my elementary school to my mother and going, one day I'm going to teach there. And somehow that image was flipped into when we were driving past the medical school. When I was little, I was in India. I remember suddenly that flipped into, when I grow up, I'm going to teach medical school here. So I think I've always just imagined this figure is that this teaching figure? And I think I idealized all my teachers growing up. I want to be like that. And I wonder if part of that was the ability to be impactful. You wake up in the morning and then you go do things, but in the process of that doing, if you can impact a classroom with that one thing that you teach, I think that has always been very profound for me. And then fast forward in medical school, it never even occurred to me that I could be good in private practice. For instance, my dad was a private practitioner. I worked with him during the summers. I would make money for him in terms of working at the front desk or cleaning the pharmacy closet with expired medications. That was my favorite thing, to make sure all the old meds were gone and doing his insurance stuff. But it never occurred to me that that's where I could see myself, because I always wanted to be in the classroom setting or in some form of teaching. But I think now that I'm older, I realize that you can teach anywhere in everything that you do. Right. You can be learner and a teacher simultaneously. I joke with my kids that if they ask me, what would you do, like, if you retired? I'm like, I think I'm going to teach the plants. Except they won't talk back. So you can't kind of understand where they're at in their own learning. But I think it's just who you are when you go to work. I get so much energy from my learners and my mentees, like, when they ask these questions that are simple, that are like that are almost like pure, right? Like they're from a baseline of no bias, I don't know anything. Teach me. And then those questions are like, I wonder why I wonder why we don't do that, right? Or things that we take. It like, this is randomized controlled trials, and they challenge that status quo. And I really like that. My favorite aspect of being a clinician educator, I think, is in the undergraduate classrooms, like the undergraduate medical education, like those first and second year med students, where you're tying in that classroom knowledge of biochemistry, genetics, cardiopulmonary physiology, and into disease states, and then you bring in patient experience from the humanity space. When you see those connections happening real time, visually through their eyes, right? You're like, yes. Now when those moments are really special. I remember when I interviewed for this job, me asking, will I have an opportunity to teach medical students? And my boss saying, absolutely. I mean, med school and to go through that every year. Every year I teach two courses. And to experience that is really divine. Because I think for me, teaching is as pure as it gets in terms of medicine, because it's just between you and the learner, right? There's no nuances, there's no billing codes, there's no RBUs, there's nothing. It's just pure. And I feel like when academicians are challenged, right, there's multiple being pulled in each direction. I tell them, I ask them, what is it that they're doing, somewhat of a hobby, like, that they are growing. That is completely their thing, their project, over years. And I feel like as you water that plant and it becomes a tree and you nurture it, I think it's that what feeds into the fatigue that you experience. I think that there is no question that there is burnout in anything, but there's burnout in parenting. We just don't talk about it, right? There is burnout in relationships. It's like a wave in all human relationships. But I think it's not necessarily what you're doing in that lane that I think feeds creativity. It's actually what you're doing away from those lanes that feeds into that. And I think for me, teaching is what fuels my creativity in clinical medicine and to be a creative teacher. I also travel a lot.

Yes, you do.

I think that all those things really bring in energy into me. And my latest task, I'm in the cusp. Like, right now, I'm ten years in, so I'm going into that next phase of academic medicine. And I really am struggling a little bit. Like, I could do full on science, like immerse myself. And it's great you can move mountains with science, but I feel like that's just wearing these sunshades where you're not seeing anyone else and you're just going into your little domain because a whole lot of men and women are experiencing I don't know what else to call it than fogginess in medicine. They too had that clear perspective, and now suddenly they're like, am I doing the right thing? Should I be doing something else than medicine? And I'm like, you just invested 13 years into your education. Why would you want to retire? What a travesty. But then part of me is like, but if someone did invest 13 years in a committed, fully committed task, should they not have the ability to choose their own path? At some point, if they're unhappy, they should be able to pivot themselves. But that gives me a great deal of discontentment. We cannot have these highly, highly skilled, highly humanistic, amazing people inside and out when they are with their patients and when they are with their learners. I see beauty. It's amazing for them to have that kind of high level skill set and they're dispersing it. But suddenly their own battery right, is suddenly going down. And so how do we keep men and women in medicine, right?

That's my question, okay? Because you talk about that battery, and I think that battery is related to our emotional independence, right? And having these experiences, having in your case, patients have experiences and residents having experiences and not fully taking on I guess what I'm trying to say is having that ability to allow them to have their experiences without taking it on yourself. And so you've been in this you've got a family, you've got parents, you're doing a lot, and you travel. But how do you separate that? How do you prevent yourself from carrying the emotional weight of your patients and your students?

I think one of the things that I have learned, especially over the last four years with COVID is the concept of finding the lost child, okay? Immersed within all of us is a child that is sometimes needy and sometimes wanting fierce independence and sometimes wanting to go all in and submerse herself without looking up. And if we can give that grace to a six year old that's living in our house, like my little one, why can't I show that grace to myself, right? If we have the mental bandwidth to recognize that every child and human being needs space then why can't I give that to myself and say it's okay not to be there? That 1000%. And it's okay to give your learners their space and for them to know that they can come to you. But you too are human, right? And then I can't give anybody my 1000% when I am at the 10% right?

Yeah.

I constantly speak about it. Instead of saying that I am this invincible, omnipotent mentor that will be there to back you up, I tell them that I am going on a vacation, I am going to be with my children from X to Z, and I'm not going to be available. And that if they need me, this is the time that I'm available for them. Right? And I'm very purposeful now, and I'm very intentional in saying these things out loud because what I'm trying to teach them is that it's okay to have boundaries, which I refused to recognize when I was younger, but now I openly say that. For instance, I'll give you an example. The American College of Cardiology, the Texas chapter, the Sccm, the Texas chapter, both of them have their deadlines in about ten to 14 days, right? In my younger days, number one, even for national conferences, I'm critical care. I do things boom. I operate under pressure. So those abstracts would go in the two to three days before. Now, I am 43 years old, right? So I need my vacation. So what I started doing was about ten days ago, I started those abstracts with my learners, and I'm mentoring about eight students, learners, putting these abstracts in. So I made them submit the information. So we sent out the drafts, and I just sent out an email this morning that, hey, we're meeting tomorrow on Zoom. These are going to go in, and I have my night shifts coming up. I will not be able to work on them, and I have a vacation the following week, so I will be basically radio silenced. So let's go all in and get them done. I'm telling you, five years ago, there is no way, number one, that the drafts were written, the learners had that kind of time to submit them ahead of time. And I work with a large group where they mandate that the drafts for abstracts go in at least two to three weeks ahead of time, for instance. And I think that kind of like verbalizing that I am human and I am going to have radio silence, and I'm not going to be available for you. If you want to be in tomorrow, you make time, meet me and let's submit them. And I think that's me taking care of my child within me, right? But the beauty of that is while you're taking care of you, you're telling your learners the path for the future, because immersed in all of them is a future teacher and a future leader, and I don't want them to go in all in, and within five years say, I am done.

Right.

I am out. We cannot the funnel is so wide right now with this holistic applications, we've been able to take some of not just the brightest, but the ones with the mostest of hearts into medicine. But the problem is going to be these kids are going to be extra empathetic, right? We're like fine tuning our admissions engine to get those people that have the brain and the heart and this humanism wrapped into one and it's great. So they are fabulous. But immersed in all of that is this human experience. And I am as much as I'm an advocate for bringing them in, we have to support that funnel at the bottom and I think we need to do a better job. And I'm hoping that in my little ways of creating those boundaries and fine tuning. What does it mean to mentor and tell them that there are deadlines? And I'm teaching you about these deadlines so that in your 40s your cortisol is not rising right before the deadline and that you are letting about five to eight people down because you didn't tell them ahead of time that, no, this will not impact any of our cortisol levels. We're going to do this in a very systematic way.

What I love is that you've had this experience, you've gone through life and like you said about five years ago, you realized something needed to change and so you made this improvement within your life. And I imagine that improvement had an impact not just on your students and patients, but I would guess it had an impact on your family as well.

Absolutely. I think that the way I interact with my three kids, especially in the last, I would say 21 to 23 after that one year of COVID being available for everyone because there you couldn't say I'm going to go into this space and I'm not available. That's when we were needed the most, right? Not just from our learners, but from the academic angle, but all of our friends. And I think every physician went through it was not a unique experience where your neighbors needed you. And in my case, I think one thing I didn't realize was, as you know, I was fairly active on social media during that period in the beginning of the COVID pandemic because I didn't know how else to reach out to people that were not getting vaccines but that were still in my network. So that was one of the times I jumped in. I'm like, no, you will get the vaccine. No, you should not be going out. Social media, how to take care of children and stuff. But a side effect of that was now I was available, right? I was available on a daily basis for the person that's on social media. Oh, let me ask Bindu this question. It was a simple WhatsApp messenger? And most of them were connected to me, right. At no other time will they ever need me for their personal issues. And so I would get phone calls that messages from India and all my ex fellows or previous their moms and dads that were sick in Eastern Europe, South America. So now that boundary which I never experienced that I needed was like, all the time. And then by the time I looked back and looked at my own kids, right at that time, I was doing my service, which was ECMO. We were very busy, and I would come home, and the kids were online schools, obviously, which meant very little school in terms of really being intentional. So I think it was during that 21 to 20, like, by the end of 2021, I had a major that switch through self coaching, right, that, oh, I need to do a better job communicating. What is it that the kids need? And I think I've noticed the greatest change not in them, but just in me. For instance, I had this intense fueled desire to want to drop all of them off for school every day. And I had not experienced that need before, right. And I think it was very difficult, obviously, with ICU days and stuff, but I had this constant barometer inside of me. I didn't drop off X on that day. Like, how do I make it up? And I think that's the preload, right? I'm a physiologist in my head. So that's the preload. That's what needs the heart needs to go in. And if you don't put in the preload, there is no output. So I think me recognizing, I mean, I've always had that as a mother, obviously you need to put in the preload to your children, but at no other time was that desire as strong. When I'm at the bedside or when I'm with my students, that's an automatic. Of course, when you do it, there is no halfway of doing it. We're going to go full in. But I think it was the same amount of that passion that I had. I have to drop off Sahib. Rain or shine, tomorrow morning, I will drop him off at school. And it's only like, the school is like 1.9 miles away, but it takes us 20 minutes to get there in the traffic, right? And it's just like, that's his preload. That's his preload that I'm giving him. And it was not the gift that I'm giving him, it's a gift that he's giving me. Right. Because in that 18 to 20 minutes we talk about, I was able to go through whatever I read in The Economist or what are the things that were bothering him, what does his school day look like? And I think my relationship with and similarly my middle one, her school is a long way off. I would ask, hey, can I drop you off? Like, instead of the bus? And the way I interacted with her, it was more like, for instance, with all three kids, the communication skills that I had. If you were to grade them right, like, of course I'm a great communicator, but communication is also about them communicating with you. Right. If you were to grade that, I think that they really blossomed, at least in my head, how they related to me when I changed the way I talk to them. Like, instead of saying, don't do this, their sudden light bulb went off. And instead of telling even at work, the learners, let's talk about what they should be doing, instead of talking about what they shouldn't be doing.

Oh, there's great parent advice right there, right? That can go a long ways in any of the conversations. And just what is so beautiful is that you've really developed your boundaries and your expectations and your wants and your desires in a way that you are balancing and like you said, feeding that inner child what it needs. The travel. You wanted to be an educator, you wanted to be a mother. Family is very important to you. And as you continue to move forward and work through I mean, you worked through COVID like these major bumps in the road that have a massive impact on certain areas of your life. And as you work through that and your experience, you're better able to show up for your family, you're better able to show up for your community. Which is what I love, is that as you've taken these self coaching tools and you've worked on your boundaries, you have also been able to continue in the medicine field. Whereas we've mentioned before, some doctors are fleeing from the medical field because they're like, no, I've done this for too long. I need to fill my bucket somewhere else. I need to step back.

You have to recognize what must have happened for people that were in love with this idea of being a doctor since what is it? The data shows that most of us have formulated this kind of dream to be a doctor between the ages of five and twelve, right? So for them to have had essentially a lifelong dream, but only to be used for a very short period, the only explanation is self preservation. Right? But I am going to argue that I think we've been looking at it as an outcome measure. Like, oh, I'm going to study, I'm going to study hard. I'm going to be this doctor. Instead of really looking at it and going, what do I need to do to sustain myself in this field for as long as I can? I remember maybe like second or third year in when I was working in the I worked in one ICU. I literally looked at the long ICU and I was very exhausted that day. Very like at 1030, I'm struggling to complete notes on time. And it's not because I was less efficient or anything, it's just there was a lot of work and this concept of, oh, I wish I can get tomorrow off or something came into my mind. And the alternative thought I had this was three years in. So seven and seven and a half years ago, I was like, what am I saying, this is the greatest joy I've ever felt in medicine. To be able to show up with all this skill set and alter lives with this unimaginable team that I have. I work with two very high caliber team. One is our pulmonary critical care team. This like almost 30 to 32 faculty with really amazing skill set. And on the other side I have this advanced heart failure, which is like cardiologists, CV, surgeons, perfusionists, nurses, social workers, like huge team, right? I was like, how can I have this? I refused to even have that one thought. And I think it was like I was maybe 34 to 35 years. And I just immediately woke up the next morning. I was like, I need to travel. What has happened was it just occurred that I was going so fast in this one lane that I did not do due justice to the same profession by having enough breaks. And I didn't even about this family or nothing. I was just like, if I'm going to be a wholesome physician, I owe it to being a physician that I take care of myself. Not the institution, not my mentors, not my students, that I alone can invest in me and my travels. And at that time my dad had it was probably about three years that my dad had passed away from brain cancer. And my father before he was a physician. And I have to take this side route to talk about him because a lot of my thought work was fueled by that was he used to work Monday through Saturday evening for the longest time. It took me a lot of convincing where he stopped doing like the Saturday night shift. So he would come home on Saturday night at 09:00 p.m. And then would continue to work some Sundays just to immerse himself. And he was an immigrant. He started here working around 44 years of age. So in his head there was not that much time to build his wealth, right? And my brother and I were in state schools. We were like, what are you working for? We used to be like, just take off. We were very comfortable. Our first home was like 2300 sqft in Austin. We're very comfortable. And I never understood. And he used to tell me, he's like, but I love patient care. So finally we were like, but you need to enjoy yourself. So he stopped working on Sundays and Saturdays. He stopped closing the clinic at like 12:00 maybe when he was 47. And towards the end of his career, we were like I asked him, he's like, I want to travel, I want to travel. So he had an issue with his clinic. So he decided to retire and he started traveling. The first stop on his world tour, he was going to just travel for the rest of the time was India. And he lands there. He has his meal with his family, and he's going to the next town, and he has a seizure.

Okay, first stop. Yeah.

And this village nurse like, minimal training. Well, I wouldn't say training with clearly a wealth of experience. Gets an IV, gives him Ativan to stop a whole grandma seizure in the back of the car, and they send an ambulance, and they call me from India in the middle of the night, and they're like, well, there's this ring enhancing lesion, and it's like, 02:00 A.m. Here. I'm like, Ring enhancing lesion for my father. Really? And they're like, we're thinking of doing, like, a hemicraniectomy and taking this thing out. I was like, you shall not touch my father. Not because I didn't trust him. I was just like I didn't believe that he could have anything. I got on the flight the next day, go there, get a first class ticket. That's the only time I've ever traveled back from India in first class or to India. Brought him back. I had, like, an injection, an adobe if I needed, because it's deathly expensive to travel back from India in an air ambulance, right? I was like, I'm a critical care physician.

I got this. Thank you.

I got this. Right? So we come back, and it's Glioblastoma. We get him into MD. Anderson. He gets it resected, and he has radiation. And I asked him, what do you want to do right after radiation? You have to do it, I think, for six weeks. This is now ten years ago. He's like, I want to travel. I was like, really? He's like, yes. I already booked my ticket. So my mom and dad, on the last day of radiation I think radiation ended at 12:00. He made me pick him up from radiation. We go straight to IAH, and he went on his first tour, and then he went almost 33 countries in that first year after his diagnosis. And the second time it recurred, which was 16 months later. I mean, there was a massive MCA stroke, and then he went on hospice. And to this day, I really feel like with every blood cell in my body, that after that moment on, I had to become twice the doctor, twice the educator, and twice the person that is living life. I don't know if that makes sense. So when I travel, I travel very intentionally, guiltless that I'm doing it for my dad, right? But I'm really also doing it for me. I belong in medicine. That in is so important. But to belong in medicine, I need to charge my battery in the best way I know how. For others, it may be something else. For me, it was. I just went to Galapagos in February. I went to Costa Rica. I think in May I'm going to New York City. My kids just vacationing. We just booked our like, I want to show them Bangkok, and for Christmas, I'm taking them there. I will be working hard right when I'm here, obviously. But even going to New York City is like the smells, the sights to explore. I think I feel like when I'm at like 10% charge, it charges me and then I get back into the ICU. So that hallway, that vision that I had three years in of working and when I woke up, I take complete ownership of my fatigue and my whatever, if you want to call it burnout or fatigue because there is this entire narrative that it makes it look like we are victims and we are responsible. And I understand why I'm not minimizing these external factors that the system needs to change. And the system may not change if people like me say, well, I'm going to go and charge my battery, but I think it needs to be mutual. On one hand, we need to constantly have that self preservation. We're human. They're not stamping out robots at the end of medical school. They're stamping out humans with unbelievable talent, ability to empathize and the ability to recognize what to do and what not to do when we are in front faced with the patient situation. Right, but I think as the system, we do need to stress the system to change. But on the alternative side, I think that boundaries, but boundaries with intention, right?

Yes.

It's one thing to say like, I don't work after 06:00. P.m., that's great, but do you have a work environment? Did you sign up for this? Is that what you signed up for? In my case, I'm not when I signed up, it was an assistant professor for pulmonary critical care. And in fact, in the beginning we didn't have night coverage and we did that and we used to go all in and now I don't advocate for that. There is no way that you can do day shifts and then go in at nighttime and do it and then come back the next day and then do it again at night. So now we have moonlighting. So I think academics and clinician educator tracks and staying balanced is as much about the departments and administration, but it is also about us because we all get vacations, right? Yeah, we all do get those weekends off. So if we don't choose to charge ourselves the best way we know how, that's going to be a path. I don't see us succeeding in the long run.

Yes. And when you mentioned that you are going on vacation and you tell your students that, hey, we need to get this paperwork in because I'm going to be gone radio silence. Okay. So they know the boundary. Now you're on vacation. Do you understand or how do you implement the boundary if someone does happen to send an email or a text and try to reach out from this other lane, the medical lane, how do you honor those boundaries when you're over here in the travel lane?

I have. A set of ringers for my main mentor, for my main boss and my three children.

Okay?

And I don't have the text messages. You know how they go ting, ting, ting. Like, I don't if it's an emergency, they'll call me. And if it's really an emergency, it better be from those five people.

I love it. So you set up the protocol.

That's it. If it was truly an emergency to the point it reached my boss or my main mentor, then they would call me, right? They wouldn't be texting me. So I actually like, for instance, when I round, I see a lot of physicians with their apple. They're like, ignore this. I am barely with the patient in the clinic for those 1520 minutes, and I leave the phone outside, right? I tell them, I'm like, unless it's from those five people. I'm sorry. My kids are with my husband, so I trust and he knows my schedule, and he has the same different ringer, too. So I've basically realized that I cannot prioritize everyone the same way. It cannot happen because you're not charging your battery. So I have a priority ringer system.

That is beautiful, and it's a protocol, because what you've done is you have learned through all of your years what works and what doesn't work. And I think we kind of needed, and I don't know if I'm overstepping my thoughts here, but I think we kind of needed something like COVID to come in and shake it up and for us to realize, oh, wait a minute, our protocol isn't working. We can't sustain this. And if we want to move forward with, you said some of the best humans in medicine and not robots in medicine, then we have to have protocols. And what's beautiful is that you've learned that through your experience, and now you're teaching it. So your students are learning it, and I imagine they'll have their own experiences. Some are going to stay in medicine, and some are going to say, no, thank you. Right? But as you give them these tools, the chances of them staying in their lifelong dream are going to rise.

Yes, absolutely. And the most important thing we can show anyone that is watching us is when we are intentional, right. With what we are doing, what we are teaching, I think that that intention is going to grow a seed in them, a desire that they too, can reach that skill set. Right. It could be simple. Like, what are the five causes of hypoxemia, right? Be deliberate and be intentional. That these are the five causes and these are the main diseases that you would see in it. But regardless of what if you forgot everything I said, just remember, VQ is the number one cause of hypoxemia in the hospital patient. And you, regardless of what field you go into, you will see that, and they know that that passion is coming out, is it not? Just like this PowerPoint slide with five causes that they already know VQ and that I'm not distracted when I say that, right? And that I am showing up for them in that moment. In that moment. But I think when people get it, that when they have good teachers and they see it, their desire to be a teacher also becomes true. Just like all the teachers that I've had. So I cannot imagine, like, I don't know how long I will last in life, but one thing I'm absolutely certain about is as long as I last, I shall be in the classroom or at the bedside teaching. I have no desire to this financial independence. Retire early. I have every desire to be financially independent. But retirement, I don't know what I would do. Just go back to the classroom and teach for free.

They will never get rid of you. They're like, wait, you retired?

You're like, no, but we have those old school professors at my medical school. We have professors that are in their seventy s and eighty s. And I have been at national conferences where there's a guy that's 91 that is still funded by the NIH. Who are we? We are in our 40s. We are at the prime of our life. If anything, we should be wanting to conquer science, conquer the classrooms. So to go back, I'm at that cusp of deciding. But I know for a fact that because my oldest is going off to college in the next two years, I believe in seasons. I think you can have seasons in your academic shelf life. These two to three years, I am going all in with mentoring because I'm doing that for my son anyway, right? I've always mentored, but I'm going to perfect that engine. I want to know what is it that is holding kids back and really give them a cape. I love it. Yes, go forth. I got you. But not when I'm on vacations.

And you nailed it right there. Go forth, I've got you. But not when I'm taking care of myself, not when I'm recharging. And that is such a mental shift. And you talk about those doctors who are at the bedside until they're 91. It's because they have a mental identity of who they are as a doctor. And I think you nailed it. I was going to say one last message for our listeners, and that's what it is, right? Like, I've got you, but not when I'm on vacation. And that is something that you've developed to create your own emotional independence so that you can sustain yourself should you want to be at the bedside when you're 91.

Absolutely. And I think we owe it to the not anyone else, not even to the field of medicine. We owe it to our eight year old little girl that is inside of us, right? To be happy, to be fulfilling, to show grace, to show kindness. That. I got you. I got you. You need a vacation. Let's go take a vacation. And for that you don't need anyone else, right? For that you don't need anyone else. So anyway, I am on my I think I stopped counting, but Dad's list was like he had that like 1000 places to see before you Die book, and he had it folded. I've been just going through the book and knocking a few things out and I'm going to give that book to my kids.

I love it. And look at the ripple effect of your parents, your father, the medicine field, the education field, and that support. And then he had this desire to travel and how you've been able to take both of those things and work them into your life now. Well, a couple of things. You have family, you have medicine and you have travel. Now what's going to be the ripple effect of that for your children? And it will be so amazing to watch it unfold for them with this rich heritage from their grandfather to you and their father. Right. You mentioned your husband's a physician as well.

And my husband's father is also a retired physician and he's been to like 66 countries and he believes in terms of the value of a dollar and what to do with it. He's been such an amazing mentor in that you need to spend where it matters. Right. And he is like my mother in law and father in law. Their health, like how they prioritize, what they eat, how they take care of themselves and how they interact with their grandkids and what they are teaching, it's been really nice. And I think that's what we need. We need like micro villages to surround young people and to surround us. Micro villages of different mentors, like people that lift us up. It only takes one person to say, I saw this post the other day where a pediatrician was examining, I think, an eight or ten year old girl, and the mother and the pediatrician, the girls goes to the pediatrician, I want to become a pediatrician one day so that I can take care of my children like you. And the mother goes, no you don't. She's probably never home. And those kind of comments like that's the micro village, I don't think you can tell the society, like you can't say that. I think what you can tell the society is, look at this amazing pediatrician. She is a mother, she's doing all this community service. I want to celebrate. Even those women that say they want to work two to three days, for instance, right?

Yes.

Maybe we can't do it all, like people say at the same time, you can do it in different seasons. I can imagine pediatricians that are like, can you imagine with the average lifespan going up to 88, 90, all of these women and men that will exit medicine and the stories that they carry within them, I hope will cause ripple effects in their communities because they're going to take their knowledge, their wisdom. Right. I'll still be in the hospital because.

That's where you want to be.

And you'll be I have my village. I built it out for myself. I joke. This is a side thing, but it's like when you went to high school, there were some times when your high school was fun, when you were surrounded with your friends and you had great teachers. I think we need to create those villages wherever we are.

Yes, it's very intentional living, and that's what you're doing is intentionally creating your village and your expectations for yourself and your experiences for yourself. You're not just saying, oh, someday I'll go on vacation, someday I'll travel. It's a very intentional way of living, and I think you have to manage your thought process within that, and that is the way that you're able to do what you want that intentional piece to it. And so, Dr. Akkanti, thank you so very much for joining, just for sharing this side of the medicine world and experience and your family and how you make it work, because I know that there are people out there that are burned out, and I 100% honor that. But your voice for saying, hey, here's what I've learned from that burnout, and here's what I've been able to do to make it work.

Thank you so much, Lacey, for having me keep up the great work. And I hope that we all like I think these podcasts are also micro villages, right? Yes, because we are verbalizing things. For instance, ten years ago, we wouldn't talk about it. We're verbalizing and we're trying to learn across it's like we are trying to learn across from the spectrum. So I look forward to learning from you, and thank you again for having me.