A lot of capable people are very good at pushing through. We know how to keep going. We know how to get the work done. We know how to show up even when we're tired. And that can work for a really long time, until it doesn't. Because sometimes by the time we realize how depleted we are, we're already running on fumes.

Today, Dr. Kemia Sarraf and I are talking about the reservoir, what fills us, what drains us, and why so many of us miss the warning signs until we're already pretty far down the road. 

Hey, everyone, and welcome to another episode of the Better Physician Life podcast. Thank you so much for being here today. Now, today's episode is the third in my four-part series with Dr. Kemia Sarraf. 

Kemia is a board-certified internal medicine physician, the founder of Lodestar Consulting and Executive Coaching, and someone I love talking with about medicine, leadership, teams, trauma responsiveness, and what it takes for people to do hard work without losing themselves in the process.

I'm also senior faculty at Lodestar, so this series has been a really nice way to bring together some of the work I do through Better Physician Life with some of the work Kemia and the Lodestar team are doing with leaders, teams, and organizations. In the first episode of this series, we talked about why soft skills are not soft and why trust, safety, and connection are part of how good teams do hard things.

In the second episode, we talked about uncertainty. What happens when nobody knows exactly what comes next? You do not need to listen to those episodes first, but I would definitely go back and listen when you get a chance because both conversations were really good. And today, we're talking about the reservoir, and I think this one is gonna hit home for a lot of people.

Because a lot of us are good at functioning while we're depleted. We can still go to work, and take care of people, and answer the emails, lead the meeting, and still get through our days. But just because we can keep going does not mean we're okay, and frequently, the people who are the best at pushing through are the last ones to notice how low the reservoir has gotten.

So Kemia, I'm really glad to keep this conversation going. It's great to see you. 

Oh, it's great to be back here with you. Thank you. And this actually feels like a really natural progression of the conversations that we've been having. You know, one of the things that I wanna acknowledge before we even get into this concept that we talk about when it comes to the reservoir is that there's an incredible power in utilizing metaphor for teaching, for understanding, and there's always a limitation to any metaphor that we might use, right?

It's worth just acknowledging the fact that reservoirs as a metaphor is not a net neutral for everybody. For some of us, it might be a neutral. For others of us, and I probably throw myself into this category 90% of the time, a lot of the times when I look at the impact, the environmental impact of reservoir, I'm like, "Oof, can I come up with something better than this?"

So that's worth just sort of blanket statement because it allows us to acknowledge that there's some nuance to this and to also say we still utilize this as a tool for teaching because it has so many components that we can bring in, and it's easy for people to see and recognize and begin to add to for themselves.

All right. So with that, story makes learning sticky, and metaphor makes learning sticky. And so we've found that this metaphor, thinking about our capacity, right? And how able we feel day in and day out, how ready we feel day in and day out, metaphorically really helps people to begin to actually quantify things differently, which is absolutely essential.

Before we jump into the metaphor, I wanna add another one. And the reason for this is, we say this all the time, we say rest is not a reward. We've talked about this on your podcast, right? Rest is not a reward. It is a requirement. It's a requirement of the hard work that we do. It's a requirement of being human, right?

And most of us have learned to treat rest as if it is something that we have to earn first. That we are only allowed to rest if we have completed, I don't know, what is the laundry list of to-dos. And it's a dangerous thing, actually, because it's not sustainable for one thing, right? Rest is a requirement of being a human being.

In our last podcast, actually, we talked about uncertainty as being a renowned form of torture. Sleep deprivation is another. Now, rest, as we talk about it, as we're going to talk about it today, is more than just sleep, although sleep does, in fact, matter also. 

But rest is a requirement, and recently, probably because I'm married to a cardiologist, one of the things that I started talking about is preload and what happens when we have diastolic dysfunction, right? So diastole is not optional. Diastolic dysfunction is literal heart failure. Without the rest phase of the heart, there's no preload to do the things that we need to do.

So this is really worth us sitting with, because we act as if the preload doesn't matter. And it does, and the preload occurs during rest. It's when we are restored. It is when the heart fills. It is when the reservoir, and we'll transition to that now, has the opportunity to fill back up. 

So when we talk about reservoir, there are multiple components to this metaphor that we use. And one component of it is capacity. Capacity isn't fixed. This is important, right? The size of the reservoir itself is not fixed. My reservoir empty, is bigger than my 16-year-old kid, right? Why? 'Cause I'm old. I've been around longer. I've been through more, I've experienced more. 

And all of that stress over my lifetime, which did not kill me, did in fact make me stronger. That healthy stress helps to increase our capacity. So my empty reservoir is bigger, longer, deeper, and more robust. Then the water represents how much energy we have to put forth.

Resiliency is such a loaded word right now, especially within the medical community, because so often the resiliency work that is handed to us, or the resiliency training that is handed to us, is actually just a weaponization of our resilience. It's that list of things that if you and I did more, we would have more to give.

That's not what I'm talking about here, right? The water level within the reservoir represents how much energetically I have to pour into whatever it is that I want to do or have to do. Then, of course, you have the river, and that can change quickly. I mean, that's not fixed either, obviously, right?

Sometimes it changes from the time I wake up in the morning to the time I get the kids on the bus. But it fluctuates. It fluctuates more quickly, though, than does the capacity. Also, if you just think about it, the greater my capacity, the more fluctuation I'm gonna be able to tolerate, 'cause there's just more there to begin with, more preload.

All right. So then you've got the rivers pouring in. This is where I think most of the time, resiliency, quote-unquote, big air quotes for those of you who can't see us, “resiliency training” goes wrong, right? Because there's this huge focus on those rivers flowing in, saying, "Well, are you doing? Have you done? Are you? Will you? Can you?" And a very big focus on just one river. We call it the physical river. 

Are you getting enough sleep? Are you eating nutritious foods? Are you getting exercise? Always labeled that way. As someone who's allergic to exercise, I personally resent that one, right? So, you know, how are you tending to your physical river?

But we know there's more than that. There's a spiritual river. There's a socio-emotional river. There's a mental river. There's a financial river. And every river flowing into our reservoir has multiple tributaries contributing to it. The physical river has tributaries called sleep and nutrition, nourishment may be even a better word, right?

Movement or play. Don't ask me to exercise, but I'll play all day long, right? All of those things keep these rivers robust. So we begin to look at all of this. Again, traditional approaches to this often fall off cause they don't look at the spillways. If you would only do more, Michael, then you would have more, so I could extract more.

That's how it often lands, right? So you're feeling crispy critter. You're feeling a little burned out. You're feeling a little depleted. Well, go do this resiliency training that will give you a whole list of things you gotta do. So go do something, so that you can do some other things, so that I can get more out of you.

That is the weaponization of it.

What needs our attention, what demands our attention, is what's pouring out on the back end? What are the spillways? So imagine, you know, this dam that's there, and there are these spillways that are open. That's where energetically we're pouring ourselves into, right? What are the tasks that are draining the energy from the system?

We get really explicit, we get really specific, and we get really granular about that because the granularity matters, right? Often, when we start the conversation, people are like, "Well, work is a spillway. I can't turn off work 'cause I gotta eat." "Hell yeah, you do," right? What within work?

There are many spillways within work. Do they all have to be open 100% of the time, right? 100% open 100% of the time. Let's even get more granular, right? So what are the spillways within that umbrella that we call work? Email's a big one for most people, right? There are all kinds of things.

So as we start to get more granular, we ask ourselves, "Well, does this really need to be 100% open 100% of the time? What happens if I start to turn it down?" Coming out of COVID, this was a really interesting conversation to have with people in particular, and I think now is a good time to revisit this as well, right?

Because in a genuine emergency situation, most of us have an all-hands-on-deck response, right? We fling everything open and respond to the need. This is our training. For many of us, it's our nature. And when the threat or the situation is prolonged, the emergency is prolonged, like it was with COVID. As it is now for many in the medical profession, and in government, and in law, and as it is for everyone walking the planet.

Yeah. 

When the emergency is prolonged, we start to forget what's open. It just is draining in the background. Post-COVID, especially in 2022, when we really started traveling to do these leadership trainings in person again, we would ask this question. People are like, "Oh my God, yeah. I mean, we started this thing in COVID that was at 5:00 AM every day," or, "It was 10:00 PM every day," or it was whatever, right?

Or, "I set my phone and my email up so that I was always available, and I've never thought to adjust it again." So we just forget, and these are drains. We have spillways in our personal lives. We have spillways in our community lives. I mean, all of these different things. We gotta look at them, get granular about them, and then be in choice.

You wanna leave it open? Be my guest. Just know you're doing it. Choose to do it, rather than doing it by default. Because diastolic dysfunction is heart failure, and rest is not a reward. So that's another really important component of this. Because then what we can begin to do is look at all of the things, look at this holistically.

What's flowing out? What's pouring out, right? What have I deliberately opened? What got opened for me? Who poked a hole in my dam that I didn't patch or notice, right? Sometimes these aren't things that we choicefully did in the first place, right? What can I turn down? What can I turn off, right? Then we start to look at what's the current water level here?

Now, sometimes we make a choice. Look, first of all, balance is BS. I didn't say it the whole swear word, but balance is BS, right? I hate that concept. I hate that concept because it sends us seeking something that I've never found. I have never found a perfectly balanced way of being.

There are times when the demands are really huge, and they are legitimate. And if I'm seeking balance at that time, I am not living into who I promised this world I would be, or my family I would be, or my team I would be. When the demand is high, I need to be able to show up, which makes it really, really important that I'm tending to these other things, to my water level in advance, because I want to be able to show up.

That's an integrity thing for me. Okay? So it means I gotta look at what's going on with my rivers. What haven't I taken care of? But I also have to look really critically at my spillways. Am I doing this because it is contributing something, or am I doing this because it's habit? Am I doing this because it's adding to, or am I doing this because I haven't thought about it?

Did I let so much of a hole in this and I haven't patched it up?

This is effortful, right? Which is, kind of lands in that same place as, the weaponization of resilience. It does take effort. It requires we audit what's going on. It requires that we be in choice about what we are and are not going to do. And it is absolutely essential work. And I'm gonna say one more thing about this, because every single one of us has people or have people in our lives who we call them our spotters.

They got eyes on this. They see it. They see what our water level is. They see how much is pouring out. They see that three of five rivers are bone dry, and they're telling us. They're saying it to us in any variety of different ways. They're warning us about this, and some of us are better than others of us at listening to those people and heeding that advice.

We're grinning like Cheshire cats 'cause we both stink at it.

But we don't get better if we don't know that exists as a thing that we need, if we don't value it, if we don't practice listening to those people, even if our immediate reaction is, "Oh, I'm fine," right? Or, "I just gotta get through." These may be true. Sometimes we have to, but we better have safety plans for what we're gonna do in the meantime, because boy, that water goes to zero.

Your ATP goes to zero, you're dead. I can't fix dead. I can fix anything but dead, right? And so we have to pay attention to this, not just because it's what keeps us going, but because when we're completely depleted there's nothing left for joy either. There's nothing left for connecting, and there's nothing left for all of the really beautiful, great stuff in life that we also wanna be present for.

There's nothing left for our kids. There's nothing left for our friends, our family, our community, our spouses. There's diminishingly little left for our patients or our clients or our colleagues, and that's the stuff that, that, that's where the joy lives in all of this. It's why I hope all of us went into this to begin with.

It's really, really important 

Yeah. And, this is deeply personal work to take a look at what does your reservoir look like? What do your spillways look like? And one of my favorite quotes about coaching is, "It's really hard to read the label from inside the jar."

And so when we put that work on us, like, we can critically appraise where are our spillways, what did I leave wide open and not pay attention to? And sometimes it can be really helpful to have that spotter who can help us see the things that we can't see. 

Now, you and I were both grinning probably because when you were talking about spotters, we were both probably thinking about our spouses, who, at least for me personally, my wife is the one who is, very quick to point out helping me to notice the areas where I am spinning and maybe need to slow down, and what are the spillways and how do I turn them off.

And we're grinning because, also our spouses are sometimes the people that we listen to last, even though their opinions are probably the most vitally important to our growth.

And it doesn't always sound like we think it's gonna sound, right? Sometimes it sounds "Honey, are you coming to bed?" Sometimes, these sound like different things. I see sometimes for my kids it has sounded like, "Are you ever gonna come tuck me in?"

Or, "How come you don't snuggle me so long when you tuck me in?" Right? We can learn to listen for those things. It's not a guilt trip. It lands like a guilt trip. Trust me, like, I get it. I get it. 

It used to land in my nervous system as, "You are failing. This is another thing you're failing at. You're failing at mommy-ing. You're failing at wife-ing, you're failing at verbing." Right? Like, another area you're failing. They're data points. They're signals in the noise. Listen to those, right? And adjust. 

Again, our tendency to run to either/or, going back to our last discussion, our tendency to, if I can't do it all then I won't do it, is not the right approach to this.

Turn it down. Experiment with turning it down by 5% or 10%. See what happens. It might not help. Then you can always reopen, and then you experiment with something else. But we are not infinite resources. We are renewable resources if we do the things we're supposed to do, but we are not infinite, and we treat ourselves as if we are.

And sometimes we treat each other as if we are as well.

I think in leadership this becomes particularly insidious because we think that in leadership we have a single view of the people that we're leading. If you can imagine, we're all standing at the base of the dam looking up at it and just seeing the water pour out, and from that position, it looks infinite.

But we don't have a sense with any one person, unless there's high trust and there's high safety and they are sharing with us, and we are paying attention, and we are monitoring, right? We don't have any sense of what's happening to the water up top. They may be at 1% left, but it's still pouring out, and so we're asking for more.

At that point, I am actively harming my team. I am not benign. I am actively harming that person. And so beginning to think about this for others, 'cause we're always better at thinking about it for others than we are for ourselves, becomes really important, as does actually listening to and starting to notice when our spotters are giving us signals, because they do have an eye on both.

They have an eye on the water level. They have an eye on what's pouring out, and they have an eye on those rivers way up in the distance. Rest is not a reward. 

This has been such an important conversation. If the listeners are interested in learning more about this and about Lodestar, can you tell them a little bit more about where to find you?

Yeah. Depends on how much they wanna learn, 'cause I'll teach all day long, this is a core component of every course we teach, whether you're coming in because you wanna do a coach training course, because you want trauma mitigation, trauma disruption skills through one of our TMMC, or you're looking for advanced leadership development through BRAVE, or through All of Us.

This, as part of the learning and the skills, and it's not just theoretical, right? We actually take everyone through this practice and develop these practices together, is a part of our core teaching. Because without it if the reservoir goes to zero, that's the end. It's end game.

So reach out to us. Find me. I'm not hard to find: lodestarpc.com and set up some time to learn more about one of our programs, or just register for one of our programs. 

Yeah, and I will link this in the show notes as well because, as you were just laying out, this work is not work for one sphere of your life.

I have used this work in every single aspect of my life: in clinic, in interpersonal and professional relationships, at home with my kids, on the highway, right? Like, these are such important skills, and I have learned so much, and so appreciate you so much.

And so next time, you and I are gonna be bringing all of these ideas together. We're gonna talk about how this work actually becomes real inside teams, and leadership groups, and organizations. You know, if this episode made you think about your team, your leadership group, or your organization, definitely reach out to Lodestar and check out the work that they're doing.

It's so incredible. And if you're enjoying these conversations with Kemia, send me a note. Let me know. Again, we are having so much fun with this series, and we'd love to know if you'd like to hear more. Thank you, Dr. Kemia Sarraf, for being here. Thank you so much to the listeners, and we'll see you next time on the Better Physician Life podcast.