Align Your Purpose – Dr. Kimbi Marenakos
Dr. Kimbi Marenakos
[00:00:29] Kimbi: Meaning I can see anyone from child to geriatric. And so, but functional actually is appropriate too, cuz that’s the approach integrative and functional is sort of my approach to wellbeing.
[00:00:41] Miriam: If you don’t mind just telling me a little bit about what got you interested in medicine and kind of your path to getting to where you are, and then we’ll go from there.
[00:00:52] Interest in Medicine
[00:00:52] Kimbi: Sure. I’m one of four children. And my father was a family psychologist and an author, and my mother was a nurse midwife and I was one of four who said she didn’t wanna be anything like her parents.
[00:01:05] I started college as a vocal performance major and, and was living in New York and performing musical theater and traveled to a lot of different places doing that.
[00:01:15] But somewhere a few years into that, into my twenties, I experienced my own deep depression and that was the first time that I experienced therapy and went to therapy myself. I fell so in love with the process. That I couldn’t get enough of it.
[00:01:32] I fell completely in love with the process of, of self-discovery and so I decided, well, if you’re gonna be studying this around the clock, You might as well get a degree for it.
[00:01:43] And then I started practicing, got my licensure and started practicing psychotherapy for, and I did that for about 14 years alongside primary care and family medicine doctors here in Charleston. And I had one particular doctor.
[00:01:59] Who, who reached out and just said, I keep hearing your name. Come talk to me about what you do. And I went and I spoke with him and he said, I’m, I’m a concierge medicine doc and I love a person, I love someone to refer my patients to, or someone to, to collaborate with me to create more holistic treatment plans.
[00:02:19] Behavioral Health
[00:02:19] Kimbi: For my patients. And I said, I’d love to do that. Sure. I said, I’m a mom first and then I’m a therapist and yes, I’d be happy to and we did that and it was fantastic.
[00:02:29] What did not resonate for me though, was the, the duality of it. The, he was the body and I was the mind. And I, I, on many occasions I just, I was frustrated cuz I wanted to take care of whole people.
[00:02:42] So I decided, well, you know what? I’m gonna go back to school. In my research, what I found was that the medical model of care really teaches and helps one, understand pathologies and how to treat them.
[00:02:58] Whereas the nursing model of care teaches you how to nurse people, nurse patients, take care of patients. And so that resonated. I applied, and did the accelerated program, and then went straight into the doctoral program, chose the family track because I already had 14 years of psych behind me, and I thought, this will broaden the scope of my care.
[00:03:19] And while I was there, I was recruited to teach psychiatric and mental health nursing. And then beyond that, I was recruited to teach students from all of the colleges.
[00:03:29] On campus and it was an interprofessional education series of discussions between students from all colleges. So that was a wonderful experience too. Getting all of these different perspectives from healthcare, working together, we would. We would provide a case for them, and each of these perspectives got to weigh in and help develop the treatment plan and, and decide how to, what direction to go for each patient.
[00:03:56] And we could talk about current events, we could talk about issues in healthcare and policy and practice management and, you know, hospital systems. We could talk a little bit about everything. And I loved collaborating.
[00:04:11] Clinical Rotations
[00:04:11] Kimbi: I also then, as I was teaching, Started a psychiatric and mental health clinical rotation where students could come through the clinic, rotate through the homeless shelter clinic here in town under me, providing integrative care and such a vulnerable population. We were able to provide both primary and behavioral healthcare to this to the residents there. And that was also very fulfilling. All of this was integrating all of my background in behavioral health with now my new clinical skills in family medicine. And I loved it. I really loved it, but I knew I didn’t go back to school to teach.
[00:04:57] I went back to school so I could care more for my patients. And so I finished my doctorate and left academia, jumped into urgent care so I could get the most diverse experience. And I spent five years in urgent care and the last two of them, as we all know, was a little thing called Covid 19 and a, a pandemic.
[00:05:23] So, It was truly and it’s, it’s terrible to say, but it was a really ungratifying experience of healthcare over the past two years. You go in to help people and what we ended up doing was disconnecting from the work because of the volume. There were days when I saw 130 patients by myself in an urgent setting.
[00:05:47] Oh my goodness. And at that point, you’ve got minutes with a patient and you, you know, there’s so many considerations and patients are coming in, I like to say sufficiently terrorized by the media about what’s going on. They’re, as far as behavioral health concerns, they’ve been. They’ve been disconnected from social supports.
[00:06:10] Adolescents have been dismissed from school settings. So the acuity of patients was through the roof and the volume too was over the top. And so what this did, what it ultimately did to survive that kind of volume, you do disconnect. Mm-hmm. . And that right there was. It was an autopilot that I didn’t even know had set in.
[00:06:36] But again, it’s, it’s a, it’s a survival mechanism. And so I, I then had my own experience. I had my own wake up call in the 12th hour of a shift, and the patient came through that was not there for covid testing.
[00:06:52] She was grieving the loss of her father, and she needed a, she needed a doctor, She needed someone there in a real, vulnerable human way. And at that time, that day. There was nothing left of me and it was really incredibly devastating to me because everything I had done was to be able to do this.
[00:07:20] Kimbi: This was exactly why I went back to school, remember, was to to be able to provide behavioral health in a primary setting and to treat a whole person and acknowledge the body, the mind, and the spirit in caring for someone. All in one caring approach. And so here I was in exactly the patient encounter that I was born to have and there was nothing left of me.
[00:07:44] I was so physically, emotionally, and spiritually exhausted, and I drove home that night and I just cried my whole way home and I just was so disappointed and I felt ashamed, and I knew, I mean, it was such a wake up call. It was like blinders were lifted and I just, I was devastated and I thought, how far off the rails have I gone?
[00:08:11] How far off my path have I strayed and. I had to take a step back, a real step back, and I thought, My goodness. You know, when I was teaching at the ME, I was considered the expert on burnout and compassion fatigue, and here I was even, I had blind spots, even I was vulnerable and. I thought, what must other people be going through?
Dive Right In
[00:08:36] And so I poured myself in. I knew the, you know, didactic, I was an expert on it, didactically and academically, but now it got really, really personal. And so I made it my mission just like. Just like in my twenties when I made it my mission to understand psychotherapy and I dove in head first, I did the same thing with burnout and I started really, really exploring the three dimensions of burnout, and I wanted to find the antidotes to each of those dimensions, and then I wanted to find an insulation.
[00:09:12] A way to insulate against it. And then I wanted to share it with the world and get it out there, and I was so just charged and inspired and alive with all of this, that it just created a whole new mission for me and a commitment, a, a new purpose alignment as far as making a. An affirmation and a commitment to working in alignment with my life’s purpose and knowing my values and letting my values be the guiding principles of my every action, and no longer just being a part of a system that’s broken.
[00:09:51] And so often people think the system’s broken. How can I make a difference? Well, the system is broken. But you aren’t, and the individual can make a huge impact. Change has to start at the individual level and it will ripple out. And so that’s been the journey that I’ve been on and, and where it’s brought me now, as of just a month ago, I left the machine completely and I’ve in essence hung a shingle for myself and started my private practice, and I’ve been building it and I’m overwhelmed.
Hope for Success
[00:10:24] With the response and with the, the reception I’ve had and just the outpouring of support that’s been there. So I’m learning so much and I have so much to still learn. But the support that you leap and. You hope the net is there, , but to leap and to find that the net is, is just, it’s, it’s a, it’s just a fabric of arms of people supporting you and wanting, and hoping, and willing your success just as much as you are.
[00:11:00] It’s pretty powerful.
[00:11:01] Miriam: Sure. Oh my goodness. Thank you so much for telling us that story. It’s, it’s moving to hear just your level of compassion for people and your desire to help and to heal. There, I I wanna go quite a few different directions here. I’m trying to decide which one to go with first.
[00:11:21] How did you make the decision to leave? The machine and how would you describe the machine beyond what you’ve already said?
[00:11:32] Take Your Time
[00:11:32] Kimbi: Mm-hmm. I, how did I decide to leave it? That was another very, Powerful patient encounter. And as I said, the patient has been central for me. And, and that’s been what’s driven me every step of the way is caring for human beings.
[00:11:50] And I, I sat with a young girl And this, this young girl was suicidal and she didn’t want to live another week, and I, I acknowledged what I saw. She wasn’t even the acknow, the patient that day, but I, I, I, you know, I saw her and I. I acknowledged her pain and I asked her for a chance to help her, and we started working together and got her medications changed, and then a few months later, she’s there for a follow up visit and Here’s this young girl that I had met that really didn’t wanna live another week, and then at that follow up, she sat down and shared with me her five year plan.
[00:12:37] Whoa. Yeah. Well done. Well done. Yeah, that was really incredible. That was incredible to me. And, but the whole time I was there sitting with her, People were coming to the door, they were knocking on the door, they were looking through the window. I could hear the other rooms filling up. And someone came to knock on the door and I put my hand up and I stayed.
Hold the Space
[00:13:01] And I stayed present with her. I held the space. I did not allow anything to push me. And when we wrapped up our. I walked out, I went and saw eight more patients in eight more rooms. And then I reached out to my employer and I said I don’t wanna do, when it comes to caring for a human being, I don’t wanna do anything urgently anymore.
[00:13:28] Mm-hmm. . And he said, Well, I wanna do everything urgently. And I said, Well then that’s where our paths diverge. And I have loved my time here. Now I need to go. And I said September 1st. And, and really that moment was that moment was a little scary. Cause you know, you can over, you could plan a new business venture to death and, you know, normally you would give some notice and just say, Okay, I’m gonna do this January 1st.
[00:13:58] Well, I didn’t, I gave about two weeks notice and I said, September one, I’d like to be off the schedule. Yeah. So again, that was the. And you hope the net’s there, and then sure enough, it is if you have the faith and you’ll make the, you’ll make that leap. It’s, it’s a big leap. And it is so worth it because the machine that I leap from, Has become so impersonal and so disconnected from the patient.
[00:14:27] It is a business more than it is an endeavor of, of care or compassion. There are providers, there are wonderful doctors out there, and wonderful, very compassionate caregivers. And sadly the business of healthcare has really overwhelmed us. And I think the pandemic, what we’re seeing since the pandemic is that the highest rate of, of suicide and suicidal ideation is among healthcare providers.
[00:14:56] And that is frightening to me. And it truly, it’s a shame when you see a community that’s willing. Sacrifice their caregivers. I feel like the caregivers are the, the canaries in the coal mine. And it’s sad to me that that’s, that we would send, that’s who we would sacrifice. So it’s a machine that is impersonal and detached and stoic and very much, very much a business.
[00:15:24] And I can appreciate the need for, for a business mindset, but I don’t know any healthcare providers that that really, it, it is such a grueling, grueling and rigorous training to get there that you have to love, you have to want it beyond a business, you know? I know, I know plumbers that do better than a lot of healthcares healthcare providers.
Bigger than Business
[00:15:52] I really do. And it’s like you, you are. To healthcare, you are called to education. You are called to these service industries, and that’s something much bigger than economics. That’s bigger than business. And so it’s disappointing that we have these people called to serve and then exploited the way that the way that they are.
[00:16:17] So it’s a machine that once you see it for what it is, it’s really hard to participate. Any, any.
[00:16:23] Miriam: Yeah, that makes so much sense to me. And I, I actually deeply worry about our country, as you know, this moves forward because you are not the first person I’ve spoken to who has spoken like this. And the other day I was talking to someone who was a teacher, and I bet a good teacher actually, and he said, I, I can’t, I can’t do this anymore.
[00:16:46] Shortage of Service Providers
[00:16:46] Miriam: And. The machine is grinding up our service providers and we’re not gonna get too far down the road and there aren’t going to be any, I mean, already that’s in many, many cities. You, you have a two month wait for a veterinarian and a six month wait for a physician and a as like, I don’t even understand how, what has happened.
[00:17:11] It used to not be like that.
[00:17:13] Kimbi: Yeah. I mean, we have a, we, I have a nurse, a young nurse that I used to teach. She was one of my students that came through. She came by this weekend, last weekend. She wanted to talk. She’s really struggling. And the the nurse patient ratio. On the unit where she’s working, which is a critical care unit, is five to one.
[00:17:33] And it should not be that high when these are critically ill patients. And so it’s, it’s frightening to her and she feels she, her anxiety as you can imagine, has, has been off the charts because of the responsibility they feel for not just one critically ill patient, but five really fragile. Yeah. And it, there’s no support to be had.
[00:17:58] There’s, there’s, there are no more hands to put on deck. So it’s a very scary situation. And we do see nurses leaving the profession left and right, and that was, we were already in a critical nursing shortage before the pandemic. Right. So,
[00:18:15] Miriam: Yeah. I wonder at what point do some of these mega corporations who are taking home mega, you know, bottom lines get removed from that space and where these providers are paid, what they’re due?
Be Kind to Yourself
[00:18:29] It’s, it’s a shame that providers have to jump out from underneath. That umbrella and what it ends up doing almost all the time, and I don’t know what your situation is, but almost all the time they say, I’m not working with insurance. I’m going to just charge a flat fee. And that flat fee unfortunately marginalizes out a certain portion of the population and that flat fee is even making, you know it.
[00:18:55] Potentially less lucrative for that healthcare provider by doing it that way, but they get to choose their own hours and they get to not fry themselves to a crisp.
[00:19:06] Kimbi: You know it’s, That’s right. And they get to decide how to treat their patient. Mm-hmm. , they don’t have a middle man saying, No, you need to go back and try this drug first , and try that drug first and then get to the one that we know will work for this patient.
[00:19:21] You know, and it’s, it’s really, it’s the middle men and there’s a really good Post the other day by Dr. Pearl on a, a, a page called Fixing Healthcare, but it’s about the middlemen and it’s, that’s what’s really, really creating, I think, a big Stick in the spokes. A monkey wrench for us cuz they, and the way I, the way that I see it may be controversial, but really
[00:19:46] really the ones who benefit in this system are the pharmaceutical companies and the insurance companies. The patient, the community is lost. The doctors, the healthcare providers are lost. Yeah. You know, those are the ones that are sacrificed. But it’s I think something has to give and I think it needs to become a priority, and at the very least, it needs to become a discussion.
[00:20:09] So thank you for what you’re doing.
[00:20:11] Learning about Burnout
[00:20:11] Miriam: Yeah. Yeah. You’re welcome. Can we talk about kind of some of the things you discovered about burnout?
[00:20:20] Kimbi: Absolutely. Burnout. The World Health Organization characterizes burnout as three different dimensions, and the first is exhaustion, and that is physical, emotional, and spiritual exhaustion.
[00:20:37] The second is Depersonalization, and that’s a disconnect from the work and the, the purpose behind the work. The calling. And then the third is a diminished sense of accomplishment or self-efficacy.
[00:20:51] And so I set out to fully, fully understand each of those dimensions and find the antidote and the antidote.
[00:21:02] To exhaustion? Nope, it’s not downward dogs or low disposition or headstands. Although I’m a big fan of restorative sleep and a, and a healthy diet and some exercise, but that’s just part of it. Exhaustion. We need to find what it, Ultimately, what you ultimately need to do is some habit tracking and identify the activities in your day to day life.
[00:21:26] That energized you versus deplete. And when we can because you’ve done it. I’ve done it. We’ve all done it. Where we find ourselves, where the time just flies. You are having so much fun. You are so engaged in what you’re doing. You are alive and there’s a tailwind, and you could do it all day. Without tiring.
[00:21:47] That’s a good indication that, that that you’re working in alignment with your purpose. So those activities, and you’ll find those activities in your day if you do some habit tracking and then incorporating more of those habits. More of those activities into your day to day life. Schedule them. So it’s intentional.
[00:22:05] Don’t let it be accidental or incidental that you did something you loved. And so that’s the antidote to exhaustion. The antidote to a diminished sense of accomplishment is reclaiming your sense of power, your personal power and your pride and your profession, all that you did to get to this place, all that training you did, all the experience you bring to the table.
[00:22:27] And it can be a little intimidating for, you know, HR departments to hear me say this, but really what I encourage people to do is, Update your cv, update your resume, look back over it, you know, fill in what you’ve left out from the past couple years and really, really look at where you’ve been, the journey and where it’s taken you and what you’ve learned.
[00:22:51] Or the other thing, the other exercise that helps is if you write a job description for your position, and it has to include everything that you bring to the. And just look it, it, it really can, You’ll be proud of yourself if you stop and look at everything that you bring to your position. You then can reclaim your sense of power and your sense of pride in what you do, because we lose that when we’re just going on autopilot and we forget how capable we are.
[00:23:19] I remember a moment in at the height of the pandemic, I remember thinking, I should have just kept pounding pavement in New York and kept singing and acting and, and it it, it caught me off guard and it really, really surprised me to even think those thoughts because I love my work. I love helping people.
Align Your Personal Purpose
[00:23:42] And so to hear myself say that it was, that was a, a. Red flag, just one, but it was a red flag. And, and the antidote to the, the third dimension is the the antidote to depersonalization is realignment with your personal purpose.
[00:24:00] And that to me is the most powerful one. And I, that’s why I saved it for last there, because it’s the disconnect from the work that I think poses the biggest threat to all of us and the depersonalization and that sadly, when I was exploring the models of care and the programs of academic study, What I’ve found was an article called The Devil is in the Third Year, and it’s all about the dramatic, dramatic dip in or decline in empathy in third year med students and in the third years when they start rounding on patients and putting hands on people and really being a part of the care team.
[00:24:46] For that to be, when we see the empathy disappear, that’s frightening to me. And I, I, again, I did a lot of research on shift work disorder and that compassion fatigue and healthcare provider moral distress. But what I learned and what I continued to hear is that it’s built into the training. It is in that third year, you see the decline.
Reach Your Full Potential
[00:25:09] But it’s also part of the training. It’s not just a response to the training, It’s part of the training is to keep a, a a wall between you and your patient, remain somewhat stoic. You know, maintain a boundary, a, a distance from your. Patients, and I understand the survival mechanism there. I understand the motivation is to, you know, you’re going to deliver some difficult diagnoses and prognoses, so you know you have to survive that.
[00:25:40] You have to get through some really difficult, difficult encounters, but to disconnect from the patient to depersonalize an endeavor that. Innately, in essence, it is as personal as it gets. This is someone’s health, it’s their life. That is problematic to me and depersonalization. As I said is, is the biggest threat, and then what would be the antidote?
[00:26:08] The realignment with your personal purpose and what I see as our purpose is what we are uniquely gifted with, what we can do uniquely in this life. That is our responsibility is to actualize and to reach our full potential. I think every one of us will, will be and is accountable for how we used our gifts, how we used those very, very, whether whatever it might be, and if it’s, if it’s being present and, and patient and compassionate and hold the space for a young girl who is, is finding a five year plan.
Your True Design
[00:26:46] Then I’m accountable for how I use that. Did I squander it? Did I depersonalize and cut myself off from the work? Or did I allow myself to feel the full breadth and depth of that encounter with another human being? So that aligning with your purpose, I think is really, it’s something that drives my every single day now.
[00:27:09] Miriam: Yeah, that is a space that jumps into the mystical, almost the mystical, magical, where you get to live out who you are designed to be. And I think sometimes people are struggling to find out that who are they designed to be? But I also think many people have forgotten that space because they’ve gotten pulled into the grind or
[00:27:33] just chewed up by the machine and you know, I can tell you, having reconnected with that space has brought you so much life. It’s, it’s interesting to listen to the cadence of your voice and the tone and to hear how much life there is in this new space you found? Mm-hmm. .
[00:27:53] So let, let me transition and ask one more question before we have to end.
[00:27:57] On your website you have a little blurb or it’s like a thing that goes across your picture that says, “Be well.” And I thought that’s such a nice Thought, command, exertion. And I have a feeling it underpins your entire philosophy about how you do medicine. Now, can you talk a little bit about be Well,
[00:28:20] Be Well
[00:28:20] Kimbi: I would love to because that.
[00:28:23] That became a part of my branding so organically. It’s, it’s what I say. And actually my medical scribe that’s been with me for a few years in different, different clinics, she’s, she’s wonderful. And if I tell her she’s. She stuck with me cuz I’ll, I’ll keep her wherever I’d go. And she’s she’s just amazing.
[00:28:43] But she’s, you know, she was one who pointed out that I say be well. Every time I leave a room, every time I leave a patient encounter, she hears me leave the room and say, Be well. And so it, and it wasn’t really on a conscious level, but that was my, my wish, my wish, my command, my hope, my everything for the patient until we meet again, be well.
[00:29:07] And so it, it just. We arrived at that little tagline on the logo so organically it just, it, it was there. It was like, let’s just use it. So yeah. It’s you. It’s you, it’s me. Oh, so nice.
[00:29:23] Miriam: Can we thank you for this time? Can you just tell our listeners how they can reach you if that is something you would like them to?
[00:29:31] Kimbi: Oh, please, of course. Whether you’re thinking of whether you’re chewing on the idea of jumping from the machine or a patient who might wanna consult on something, I would love nothing more. Connection is, is where I thrive. And they can reach email@example.com and that’s D R K I m I dot. Very good.
[00:29:54] Miriam: Thank you so much for your time, and I’ll say to you and to our audience, be well.
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