Awakin Calls » Mukta Panda » Transcript


Mukta Panda: Resilience of Health Care Professionals: Recharging through Relationships, Reflection, and Ritual

Guest: Dr. Mukta Panda
Host: Kozo Hattori
Moderator: Dr. Cynthia Li

Welcome to Awakin Calls. Every Saturday, we host a conversation with an individual whose inner journey inspires us and whose work is transforming our world in large and small ways. Awakin Calls are an all-volunteer-run offering of ServiceSpace, a global platform founded on the simple principle that by changing ourselves, we change the world to create a more compassionate and service-oriented society. Thank you for joining us!

Kozo: Good morning. Good afternoon. Good evening. My name is Kozo. I'm really excited to be your host for our global weekly Awakin call. Welcome and thank you for joining us. The purpose of these calls is to share stories that help plant seeds for a more compassionate society while fostering our own inner transformation. We do this by holding collective conversations with guests from all walks of life who inspire us to live in a more service-oriented way. And behind each of these calls is an entire team of ServiceSpace volunteers whose invisible work allows us to hold this space. Today, our special guest speaker is Mukta Panda. Thank you for joining us for today's call. Let's start with a moment of silence to anchor ourselves into this space.


Thank you. Welcome again to our weekly Awakin call, today in conversation with Mukta Panda. As an all-volunteer offering, each Awakin call is a conversational space that is co-created by many invisible volunteer hands. In a few minutes, our moderator, Cynthia Li, will begin by engaging in initial dialogue with our speaker, Mukta Panda, and by the top of the hour, we'll roll into our circle of sharing where we invite all your reflections and questions. At any time, you can submit a comment or question via the webcast form on our live stream page. You can also email us that's ask,

Please note that if you're watching the live stream from the designated web page link, you can make the video full screen by hitting the marked button on the bottom right corner of the video box; to return to the web page to submit a question, just click the same bottom right button or hit your computer "escape" key to exit full screen mode. And just a friendly little reminder: we're operating in a virtual space with the usual constraints of technology, overloaded bandwidths, audio issues, etc. Things can and will go wrong. Please just know that if there's a technological glitch or other issue for any of the active speakers, each will quickly come back on. We ask for your understanding in advance.

Our moderator today is Cynthia Li. Cynthia is a physician and author whose incredible healing journey led her to functional medicine, acupuncture, and qi gong, but more importantly, taught her to develop and trust her intuition. Cynthia is one of those generous souls who, just about a month ago was a guest on Awakin calls and is now already volunteering to be our moderator today. She is the author of Brave New Medicine and a new free e-book on Shielding Ourselves From COVID-19. So I'm excited to listen in on this conversation with our guest Mukta Panda. Cynthia, over to you.

Cynthia: Hi. Thank you Kozo. And thank you to the Awakin community for giving me this opportunity to introduce to you Dr. Mukta Panda. She is a doctor of internal medicine, the author of numerous scientific publications, a teacher of medical students and residents for which she has received numerous awards, including the American College of Physicians award for Outstanding Educator of Residents and Fellows. She is currently the assistant dean for Well-being and Medical Education at the University of Tennessee College of Medicine at Chattanooga. Her work is primarily focused on spirituality and medicine, narrative medicine, and fatigue and burnout -- the latter two really being epidemics in their own rights before this current pandemic that we've been facing.

She also carries forward the lineages of Parker Palmer's Circles of Trust® and that of one of my mentors, Rachel Naomi Remen and the Healer's Art. Both of these programs have helped cultivate the contemplative life in relation to public service and with specific focus in medicine. So Mukta has this rare combination of both the strategic mind to navigate and manage a large medical institution, and an intuitive heart that listens to the quietest of patient stories.

So what we'll explore today goes beyond that of doctors and healthcare professionals and into the fundamental questions of the human condition: things like discrimination and belonging, fear and courage. These are the themes in her new book, Resilient Threads: Weaving Joy and Meaning Into Well-Being.

So welcome, Mukta, and we're so delighted to have you with us here today.

Mukta: Thank you. Thank you, Cynthia. Thank you to the Awakin community. It truly is a humbling experience and an honor to be invited into this space. I really appreciate this opportunity and thank you for that kind introduction,

Cynthia: Absolutely. Absolutely. One of the guiding principles in your personal and professional life is this notion of generous listening -- listening from that place of wholeness and inner stillness, to truly receive what the other or even yourself is saying and being. Nothing drops us into the space of generous listening like poetry and music. And so I wondered if you would share one of your favorite guiding poems to drop all of us into that place of deep listening.

Mukta: Thank you for that invitation. Poetry and positive messages have called me to reflect and listen to my own self and then offer that to others to create that space for others to listen to themselves and their colleagues in community. There's one particular poem that I was introduced to in 2008, which has really been very meaningful to me, especially in how I try to conduct myself. It's The Way It Is by William Stafford. I'm going to read it out loud to everybody. I hope you enjoy it as much as I do:

The Way It Is
There’s a thread you follow. It goes among
things that change. But it doesn’t change.
People wonder about what you are pursuing.
You have to explain about the thread.
But it is hard for others to see.
While you hold it you can’t get lost.
Tragedies happen; people get hurt
or die; and you suffer and get old.
Nothing you do can stop time’s unfolding.
You don’t ever let go of the thread.

Nothing you do can stop time's unfolding. You don't ever let go of the thread.

Cynthia: Thank you. That was beautiful and powerful. And, throughout this conversation, we will be exploring this notion of threads, and I'd like to begin with asking you about some of the earliest threads, the formative threads, of your childhood. Where are you from? Who are you? This is one of the questions that sort of guides you in your life, and it's one of the threads in this beautiful book that you've written. Can you share a little bit about that with us?

Mukta: Sure. Thank you. I left India when I was around 21 and whenever I would meet people after that in my journey across the globe -- Middle East, London, and now in America -- the common question they would ask was, “where are you from?” And the answer seemed quite simple. I would say, you know, "India, of course." But it was only until about the past, say, two to five years or so that I started thinking, "actually, where am I from? Where do I belong?" And that really got me thinking about this concept of what causes ... what gives us belonging and where do I come from?

And when we talk about the thread, that is so integral to where I come from because... while William Stafford talks about this thread that is constant in our life, I really think about my story of my life as a tapestry. And it is made up of all of these threads -- some are beautiful and silken, some are coarse and hard, knotted up, jagged. And you know the top picture appears beautiful, but the under surface is that journey of living. And these threads have been given to me right from my childhood. and then they've sort of been sought out by me, some intentionally and some, like I said, I just realized them through reflection/ I grew up in a very caring home.

With my parents, and my two brothers, I spent the first two years of my life in India, and then the next five years in London, and then moved to Goa, which is a beautiful Portuguese town on the west of India. My parents and my grandparents were very influential in my life. Both my parents are physicians and the integrity and the way they conducted themselves -- they're both physician educators in academia -- was a major reason as to why I decided to pursue medicine. They made it sound very much like a service and I saw how much they enjoyed it and how much people and their students enjoyed having them.

My paternal grandparents were very influential in my life. My paternal grandfather was all of four-foot five or six, a short man, but somebody who was very powerful and really large statured in what he achieved and the principles he stood for. I always remember him wearing the Gandhi cap and the white dhoti because he was a barrister, but fought for India's freedom, and the way he described the wonders of what India was able to achieve through the freedom and the struggles, but the overcoming of them, I still remember. The other thing that he gave me was the power of discipline and the power of standing up for what is right. And he and I would read stories from our scriptures and the way he explained that still is very meaningful.

My paternal grandmother was a very generous lady. She was a very simple lady, never really had any asks, was very content. She was very warm and I still remember playing in her lap. And I think what I got from her was generosity and simply contentment with life the way it is.

My maternal grandmother was the matriarch. She was a lady of immense wisdom, not being schooled in the traditional sense. She really didn't need any alphabets in front of her name. She was widowed at a very young age but she showed courage in how she stood up a lot against the norms in India for widows at that point. She brought up her two children and with the help of her sons really maintained an independent life. What I got from my maternal grandmother was wisdom in living.

I think my parents and my grandparents really taught me what I call today, the how-to-live curriculum. How do you live as life goes on with its struggle? All my parents and grandparents struggled, but they never talked about it. They role modeled courage.

I think the other thing that I learned from the threads of my family was acceptance and respect for human life. We lived in a culture in India with castes and religion having a very prominent place. Our home was always filled with helpers who were treated like part of the family, which was against the norm, and it was the same irrespective of their faith. We had a lot of helpers who were from the Islamic faith. My parents were very intentional about making sure that our helpers were educated. They were treated with the same respect. They ate the same food we ate, which was again against the norm. And even my grandparents were very welcoming because in their generation that was not something that was often accepted. So I learned respect for human beings irrespective of anything, just as being humans. So the family thread is powerful in my life.

Cynthia: That's beautiful. So I mean, it sounds like in many ways your childhood was idyllic. You kind of grew up with a large, extended family, but also mentors, elders, that were deeply influential to you as a young child. I'm fascinated by this notion that you grew up in this place of castes and different religions and yet your experience was one of true diversity, living diversity, in that it's just a natural part of humanity -- celebrating it, and not even calling it diversity, but just living it -- which is incredibly powerful for me to hear. And I think it's incredibly rare.

Could you say a little bit more about the religious and spiritual influences, both in the upbringing that you had with your family, and also what kind of glossed over London... but what was that like as a young child and what were the new influences there?

Mukta: So when I was in London the first time as a child, I was very young, and my memories are more lived through photographs and stories that my parents have told me. The religious aspect in the family was something that was never forced upon us, but it was role modeled by my parents and my grandparents.

My maternal grandmother, for instance, got up... it was a ritual that she practiced every morning... got up at about 4:30-5:00, bathed herself in cold water, and then would sit in meditation and prayer for about an hour and a half in the morning and an hour and a half in the evening. I had been, I was young, you know, I was very curious and I would ask her, I said, "What are you praying for? Why do you pray for so long?" And she would say, "You know what, I'm praying for you and all the family and your aunts and your uncles. And I asked her "So don't you pray for yourself? And she says, "Yeah, I do and the only prayer I have for myself is that I never become a burden on anybody." And you know, even at that point, that generosity, that understanding that service for others was brought in. And that's what prayer meant. And she said, "I prayed for strength to be able to get through everything in life."

My grandfather practiced yoga every morning, the sacred thread yoga as we called it, and that was his prayer. And then, when he had a long stay with us for a few months after my maternal grandmother died, I got her spiritual book, which is called the Ramayana, and it's a mythology. It's a principle of living every day, the rules of human, how to live and the right, the value of morals, the value of being true to that moral compass and duty. And he and I read that book together and he would explain it to me, more in practical aspects of what does that mean, applicable today.

So that's where they showed prayer as a way of life, something that you live into, not something that you do for an hour or so and then it's compartmentalized. It's rather something that's fluid, dynamic. And then I remember I would attend midnight mass in the convent school, and my parents supported that. So I think that's where the concept was prayer, spirituality and religion was one way to live that.

Cynthia: Beautiful. So that's interesting too, that you had this rich Hindu influence and went to a Catholic school taught by nuns. Wonderful! So then, let me know if I have this right. So you've got this childhood which gave you this rich foundation. Also one of encouraging independence, thinking for yourself. But then as was the custom, you got married quite young, and you went where your husband went, which was, Saudi Arabia, if I have that correct. So you then moved to Saudi Arabia and then you end up in the States, in Yonkers, for a short stint and then in Dayton, Tennessee. I found myself Googling Dayton, Tennessee. I'd never heard of it. It was made famous by the Scopes monkey trial, between creationism and modernism. And so that, I mean, in terms of threads is a very like Rilke says...the ill matched threads of your life and trying to weave those gratefully into a cloth came to mind.

Can you fast forward through that period of great transition personally and professionally, to bring us up to date? Well, we're going to dive into today on medicine and resilience and burnout.

Mukta: Yeah, sure. So, you know, as is the custom in India, after I finished medical school, I got married and moved to Saudi Arabia because that's where my husband's job was at that point. Both my children were born there and I did work and did some collaborative work in London. I was lucky to have my parents there and a big reason why I decided to have my children in Saudi Arabia was the fact that I had the support of my parents. And I think that's another blessing that I really thought about Saudi Arabia. I never felt out of place even though I had to cover my head. And I think I was very welcoming to the culture because of the way I had been brought up. And I was so intent on being a mother. I really enjoyed being with the children and caring for them. When the Gulf War broke out, we moved to Yonkers because my husband was doing his residency there at that point.

I didn't work at that point. I took time off to be with my children. That part was a very different type of move because I suddenly was made aware of the differences. At that point I was to restrict myself where I went in Yonkers. Some places could be more dangerous. The advice I was getting was to be sure to introduce and continue the tradition and cultures with the children because you don't want them to forget that. I think subtle hints were there, and I think I came with this idealized view of what America would be. Then what I was seeing on the television of the immense poverty or things like at that point it was I think I had sort of blinded myself to some of the big soap operas that I was watching, like Falcon Crest and things. And when I come back and I'm looking at the Clarence Thomas trial going on. It was sort of a dissociation right there. And so this sort of fear of being different set in at that time.

We were in Yonkers for about three years. I was very fortunate actually to again have family close by. My paternal uncle, my dad's brother and his wife lived in Poughkeepsie, New York, and they never let me feel like I wasn't with family or parents. Their home has always been home away from home and I always felt welcomed. They had actually got everything ready before I even moved to Yonkers. My aunt had sort of stocked the house with everything that I would need to bring up the children and be sufficient. But then because we needed to continue our stay for visa reasons, we moved to Dayton, Tennessee.

That was another different culture, and now I was totally away from close family. But again, I think these subtle differences were in the back of my mind, but I was very content being a mother. I wasn't working then, but that's when I started feeling that I needed to blend in, that I really needed to make an effort to understand and change. For example, I had invited some people over for dinner and I wanted to make sure that I was able to make ice tea for them. And so I had practice. I bought an ice tea maker and made sure that I was wanting to fit in, not belong and be who I was.

But I felt okay. I needed to change to be able to morph myself to fit into this community now and I made a fool of myself, actually, I wrote about it. When everybody was at home, and we were in the kitchen, I was explaining all the dishes to the people there, and they were very kind and generous. We had a little shed outside our kitchen door, which was an extra space. And it had been built and it was vacant. And one of the ladies looked out of the window and just asked me and said, “what is that?” Now in India anything next to the home like that is called an outhouse. So I just went ahead and said, “Hey, that's an outhouse.” There were strange looks that day. I sensed that something I had said was wrong, and I didn't know what it was.

Only later did I realize what an outhouse is in the American culture. And I still cringe to think about that, but I think what that told me was that it gave me the thing that I needed to learn and learn the culture, learn the colloquialisms. And really, that's when I started feeling that I was a little different.

Cynthia: Yeah. One thing that stuck out for me was you said it was the first time you felt discrimination. Not necessarily different, but discriminated against and feeling the sense of, am I worthy of belonging, which is an interesting notion in and of itself.

Just to ask the question: if you're worthy of belonging means that there's this implied sense that there's an inferiority and superiority, right? What is the whole and what is not? The piece that fits. The tapestry of America as it is right now in contemporary times and also with health care. Many patients are feeling inadvertently dismissed or somehow, they're not even returning. This fits into the paradigm that we're trained in, in terms of disease and illness. So I do feel like that's one of the insidious, but also overt, forces that begins to whittle away those threads of resilience. I'd love to dive into this topic of resilience and the epidemic and also burnout. We can definitely speak about healthcare professionals and doctors specifically. But it's a symptom of a much wider human condition and so Resilient Threads, the title of your book. You read this beautiful poem from William Stafford about that. Can you go a little bit more with the title and just kind of bring us into the meat and potatoes of the themes of your book?

Mukta: Thank you, Cynthia. you know, you're absolutely right. This is the concept of resilience and the issues that really mitigate that, like the discrimination or the lack of belonging or fear. They happen at such a micro level. And I like what you said, do you know this sort of whittles away? It's almost this gnawing until you realize that there's nothing left and how can we really think about it differently? For me, the threads by which I truly weave resilience and try to thrive in my life are rituals, reflections, and relationships. And let me explain a little bit of what I mean by that. I used to think of resilience as a sort of a competency that you either have it or not. You'd go to a course and you've learned how to become resilient. I think I have come to realize that resilience is not whether you have it or not. Resilience is something that you strive for and it's a journey that you live through. It's dynamic and you have to build resilience for yourself internal and the external influences that impact it.

It starts with a reflection and awareness of who I am. Right? And that is an awareness of who I am in my whole. To be resilient, my awareness -- my mind, my body, and my spirit -- those three things need complete awareness and they need to be in balance. The awareness of those three things need to be completed to understand what we need.

From the standpoint of the body, I think I always go back to the hierarchy of Maslow's needs. You know, simple things of taking care of our body, that is the vessel which houses the mind and the spirit. So making sure we eat right, we exercise, we are in tune to what our physical body needs. And I love the way you have written about it, especially during this COVID-19 time in your special e-book. But that's really what the body needs.

And I use an acronym which I shared very freely with my students and people. It is, you know, I know when to H.A.L.T, and avoid myself getting too hungry, too angry, too lonely, or too tired. So when I get any of these four things, I'm not at my best. And so we all have those buttons and there was awareness of that.

The mind, I think it's more of an attitude. That attitude is "I am going to bring my best self, and I'm going to be gracious and kind to myself, as I bring myself forward into the world today". I like to start my day with that and end my day with that. So, an attitude. And attitudes are contagious. By reminding myself who I am going to be that day, I am also giving permission to others, as we have a board meeting in the office. And you know attitudes are contagious. Who are you bringing yourself to work? So it's just an open space, and an invitation for people to be quiet and think about it.

The spirit. Now that is, I think the spirit is, more for me, something that is your passion, your purpose. I truly believe we all have gifts, and for me, service is nothing but using our innate gifts to bring out the best in others. I think that to me is what the spirit needs.

And the spirituality is nothing but a ritual with the spirit, with that inner light. For me that one unwavering thread is that bound thread of faith and hope. And that spirit is that faith, that unconditional surrender, that there is this power, that you only have to do what you can, and then you have to unconditionally surrender the others.

So I think resilience is developed when one is reflecting on that. And their rituals help us build this reflective space for ourselves and invite others. It is the sacred space where we feel that we can unpack our emotions. You mentioned listening, if you think about rearranging the letters of, listen, you get silence.

You need to be able to listen to yourself in silence, but also create that safe space for others to be able to listen to themselves and unpack their grief, their emotion, their happiness. When we do this in community, that is a common unity that gives us these relationships.

One way to build these relationships are stories. Something that I have learned over the years is that to be resilient, stories matter. I feel I live my life in stories, and personal stories have universal impact. So if we are open and vulnerable we share our stories and invite those stories.

Because what happens is: to build this resilience -- to go and reflect inside -- is painful, right? You have to be with that discomfort of your vulnerability. But when you do that and you share that, it invites others and you feel you're not alone anymore. It brings this community together.

Cynthia: Beautiful. So can you talk in terms of the experiences in your own life? We can talk about statistics. There's the dire statistics of doctor burnout. For example, more than 50% are now admitting to some longer-term sense of burnout, just detachment from themselves, from their purpose. The suicide rate among doctors is twice that of the national average, which already isn't good to begin with.

You also had a colleague who ended his life, due to burnout and also maybe the sense of not belonging. There was a medical student also, who took her own life while you've been at the medical center. So these are... these are not just statistics, right? They're very real, personal. These are people -- people's lives. And what does that look like? Can you give us something, I guess more practical, more on a daily basis? What does building resilience or even combating burnout look like?

Mukta: Yeah. you're absolutely right. You know, we do have an epidemic and it really... statistics is numbers; n of 1 is reality. So when I was faced with that, it wasn't a statistic anymore, and that was a big burning platform for me to put some systems in place. The issue of and the epidemic of burnout is something that is very convoluted and it's taken us a long time to really understand how serious this is.

But change is happening and change needs to happen. It has to be a culture change. And unfortunately, we have to be kind to ourselves and understand that culture change happens at the speed of trust. You take steps forward, you take steps backward, but that doesn't mean we have to stop. It takes one person to build a community and promote this culture change. What does that mean? It means inviting people to be open, to share what is it that is causing this, to acknowledge that there is a problem. I think what I realized in my institution, when we had this tragic imperative of this physician suicide, was the denial: that, "Oh, this is a statistic that happens elsewhere. We don't have this problem in our institution." So I think the important thing to do is to create awareness; to start, depending on where you are in this phase of change, to create awareness. And unfortunately, or fortunately, data speaks.

So one place for people who want to be thinking about what can they do locally is to: one, believe in themselves, share their stories with the people that they think are their kindred spirits, and understand what is the need in their institution. The other thing, then, is to see what are the triggers within that area? What is it?

The common themes that come up in burnout are at the system level and at the personal level. At the system level, the most common thing in any place is a feeling of lack of psychological safety. And what do I mean by that? We come to work and we feel we have to put on our work hat, our professional hat. And basically -- I'll take the analogy of the healthcare system -- I come to work, I'm a physician now, I'm an educator now. I'm going to be a mother when I go home. I'm going to be a friend to somebody later on. This is what I call the 'multiple hats syndrome.' Burnout occurs when we cannot connect our passion to our purpose, when we cannot give meaning to what we do and why we do. And sometimes when we cannot integrate our life, when we feel we are fragmented and we can't bring our whole self to work with our vulnerabilities, with our lack of being perfect, we feel we are stifled.

So the first step is to create that safe space for everybody. And ways to create that safe space, unfortunately, people think are difficult. Actually, it starts very simply by asking, "How are you doing today?” Like in this particular time with our pandemic asking what we are doing at our huddles every day asking people, "How are you today? Do you have everything you need to feel safe? Simple things like, "What is something that is on your mind that you would like to speak about?" And as leaders, if we start to share our own vulnerabilities, it will give us that space. So that is one way to create that sense of safety. Then, the sense of informing people that it's not a 'top down.' It is, "We are together in this. It's circular. We all have a shared goal. What can we do?" And when that happens, you can also accept inadequacies. For example, there are times when things are not going to go the way we want, but during that time, if we understand that we are in this together -- you've got my back, I've got your back -- people can move forward.

What I would suggest is that at this particular time for personal burnout, community burnout and workplace burnout -- know what you need. My threads are the rituals, relationships, and reflections. Promote that in others and really invite conversations and promote safety.

Right now in the setting of the COVID-19, safety has two meanings. One is the physical safety which people are talking about and the personal protective equipment. But there's also the psychological safety. With other people, PPE is the technologically safe environment. All the more reason we have to tell and give people time to grieve and make sure that that grief is acknowledged and supported.

Cynthia: I think that point that you just ended on is incredibly important. That we don't tend to talk about grief when we talk about burnout or detachment or numbing to ourselves and to each other. A short-term coping mechanism is to carry on because we're encouraged to detach.

Francis Weller, a grief therapist that has really been a mentor to me and whose rituals I've participated in, said that the two primary centers of Western culture are amnesia and anesthesia. We forget and we go numb and that might help us as doctors or as mothers, as parents, as partners, as friends, as public servants, to just get through the acute situation -- but over the long term, it's a real loss of our souls.

Where do you see the room, the space for grief and addressing or releasing grief in a culture that is so fast-paced that doesn't want to look at grief? We don't have space for self-care, to say anything of developing spirit as well, but everything wants to crush all those things down. Can you say a little bit more about that?

Mukta: I think if we become intentional about making space for it, it can be done in short bites for ourselves and promoting that in others. One of the examples that I may share in starting off the day with my team on rounds is just asking everybody “how are you doing today? How are things?” And then, we try to humanize each encounter that we have with every patient, and connect the patient's story when we get the story, not just about their physical complaints, but actually getting to know the human behind who we see in the hospital or the persons we meet and build relationships with.

As we build that relationship, people are more open in the hospitals, especially, like you said, in the busy-ness. Something to think about is what I call the doorknob sign. Just before we enter the patient's room, centering ourselves to remind ourselves as to who is in that room. It is not another patient, but it is a human being who has these other virtues and qualities, and then sharing it with our students.

Something that we do is intentionally making space, maybe three or four times a week, to sit down for a few minutes and it doesn't take time once you do that -- is asking intentionally -- what gave you meaning, what gives you hope, what inspired you? I have always been amazed that when we just offered that brief invitation, how much people are wanting to share and how much they are really wanting to make sure that their stories are honored. Then they realize they're not alone. That's where the grief comes out.

One touchstone that we adhere to when we are in these spaces, which are sacred and safe, is that we are going to take off our doctor hat. We are not here to fix or advise. We are just here to be in service of that person and listen with empathy. I felt the need in such therapy for myself that we actually started what I called the RR&R sessions. That was Rejoicing, Relaxing, and Rejuvenating. We would get together one day a week for an hour on a Thursday evening, and all I had was a candy bag that I would bring, but it was creating the safe space of inviting stories.

We started using the concept of a third thing to invite these stories. The third thing is nothing but just a poem or a quote or a picture. I've used the poem that I read this morning just a little bit ago, The Way It Is, as a way to invite conversation. That has now become a curriculum setting that I do with the medical students at the Hunter Museum.

You mentioned Rachel Remen’s work and that's where the narrative arises, giving room for the narrative so that these stories can be unpacked. We do that at the Hunter Museum where art really serves as a medium to invite these stories. What I find fascinating is that I just have to sit back. My students and residents bring their stories and that narrative is so powerful that people realize how it resonates. That's where the grief comes out.

We were faced with a situation recently where we were with a medical student who had never faced the loss of a patient before. Through our conversation we unpacked how to honor that and grieve through that. The whole class ended up writing a letter of support and gratitude to the family of the person they had lost. And that was powerful, what they shared. So I think there are ways we can create these open spaces, small spaces in the day-to-day work that we do.

Cynthia: What I'm really hearing is the stories being foundational -- not just for even creating places of expressing grief and feeling safe -- but really as a way that we begin to tie each of our individual threads to other people's threads. We're all kind of linked together, which is really incredible, particularly in an old-school institution like medicine. Just for listeners out there who have not been entrenched in a Western medical education, this is a really, really big shift. It gives me tremendous hope, not just for the future, but for the present.

I wonder if you would say a little bit more. I love the mnemonics that you have for, whether it's the three Rs or the doorknob sign -- but also the programs, which I found really remarkable and revolutionary. You have this authority within an old-school institution, and you're integrating this softer, more feminine approach to healing.
There's a program that you created called, "Bringing your Black Bag" and "Walking in the Patient's Shoes." They have these sort of ordinary, but memorable, titles. Would you just describe some of these programs that have been in existence for a while, have really continued on? I just feel like it's really changing the nature of medical training.

Mukta: Thank you. So I think one thing that I would really like to emphasize is that I used to start feeling that, gosh, if only I had this, I could do this. I always felt that I needed more to be able to achieve something. And then, finally in community -- in a non-medical community, actually -- we were talking. Suddenly I had this feeling, I need to do with what is in my hands now. Affirming that I am enough. I think that was a big revelation. So with that, I went back with the mindset, redirect and reframe, and say, okay, what can I do now? And that's when the Bringing Back the Black Bag project started. We pretty much had a rule in our office that if a patient did not come back for three visits, then we would send a letter of dismissal, as we say, a non-adherent patient. This happened to a dear, dear patient that I had developed a relationship with and I knew the background story that why this patient couldn't come was because she had had a stroke and had no availability at that particular point to keep her appointments. So that was an ‘aha’ moment. It grew out of a little bit of frustration and early dismissal of something. It also made me think how many other patients that I was guilty of doing the same thing.

So we decided to create a program where we would go into the patient's home and do house calls, which is a long tradition. So we created this proposal of Bringing Back the Black Bag. I got a grant from the Gold Foundation and a team of a nurse, myself, and sometimes another faculty member with the residents would do about six house visits a year per resident where we would go in and we would look at the patient and their surroundings. The revelation was just amazing. We got to do a full assessment of the patient as a human being in mind, body, and spirit. When they come to us, they're completely naked, physically, emotionally, spiritually. But they have a different sense of comfort when they are in their own home.

I found that the residents and students and including myself, had that connection with their stories in a very different way. A lot of my residents wrote about those relationships, which was published in the Humanities Journal. We also did some studies to show that patient adherence was better with fewer visits to the emergency room. So that's one of the things. There’s another big one that we have in the system currently. One big reason for burnout is the paradox or the pressures of volume over value. It feels like because of the busyness and the way American medicine incentivizes admissions is on volume, which is called RVU and we don't need to get into the semantics of it. But the program we have talked about is to really affirm the value for the human relationship, the time spent with a patient, counseling the patient and their family, the time spent really doing preventative health, the time spent with addressing the mental and behavioral aspects of a patient visit, and it's called bringing the "R" back in RVU -- relationship value unit. So what we are trying to do here as leaders is to normalize the culture around that it is important to build this relationship with patients to have best outcomes for what we went into healthcare for. So that's another program that we have, and it's called bringing back the R in RVU. That's the program to really address and mitigate burnout in our institution.

Cynthia: Right. And can you give us one story, one specific story? You talked about these home visits being transformative, but can you be more specific? Bring us into a virtual experience of that.

Mukta: I still remember this one patient, but I'm going to call her Ms. Connie. She's just a wonderful, wonderful teacher who was teaching in the undergraduate level and very well read. She had rheumatoid arthritis so she had some physical disabilities secondary to bad arthritis, but then ended up having two strokes which left her unable to drive. She was a patient who did not keep three visits. She and I had formed a relationship and we would talk about books that she was reading and I called her at home and I could tell from her voice that she was really depressed. Luckily for her, she had wonderful friends and a couple of friends of her mother's friends' children took wonderful care for her. When I took this very good empathetic resident for this house call visit, we realized we had to climb three big steep steps up to even get into the area of her house, and then about seven or eight steps to reach her place. The family was still in the process of making it handicap accessible. But the moment he saw that and the moment he went in, I could see his demeanor change. I could see his whole body language change. It just transformed how he took care of the patient.

When we were going back in the car, he said, " Dr. Panda, we really need to make sure that she continues to do the things that she likes." So he made arrangements to get in touch with the YMCA, arranged for a bus, the Silver Sneakers bus that would come and pick her up twice a week and take her to the after school program where she could continue to reach the students and help them with their homework, something that she really wanted to do. So besides just taking care of the physical illness, he wanted to help her improve her quality of life, give her back meaning. That to me is connecting his passion with this purpose gave him joy. So it was a total win-win situation. I'm still in touch with the resident and we still talk about Ms. Connie.

Cynthia: Wonderful. Thank you for that. I am mindful of the time. It's just about time for Kozo to come on and take some questions, if there are any from the listeners. But I want to conclude this particular portion by saying what a rich upbringing you had with the role models of your parents, and also your grandparents, and your parents having had positions as public servants. I think it's also important to say that they were in the public hospital which was a very different setting than a lot of other doctors where you grew up. Then as I understand it, your great grandfather was also a traditional Indian healer. I was just sitting here listening to you, both on the personal level, but also on the institutional level, of creating change and being a beautiful manifestation of the love, the guidance, and the wisdom that you received in those formative years. So thank you for sharing all of that with us.

Mukta: Thank you. Thank you for the opportunity.

Kozo: Yeah, thank you both. This is a beautiful and important conversation. We already have a number of comments and questions coming in, but just to remind you, if you're on the webinar, you can just type in the web form to ask a question. If you're listening on the live stream, you can send us an email at I'm going to read one quick comment because I think it sums up a lot of what people are feeling. It says, "This has been meaningful. Greatly appreciate Dr. Panda's insight and authenticity. Her stories and rituals are helpful. Thank you very much. You are an inspiration and so needed in the medical profession to humanize it more."

And I would say that both of you are both in the medical profession and both humanizing it more. I don't think it's any coincidence that you're both women because we definitely need more of the divine feminine in that space. That brings me into a question. I'm going to use my prerogative as the host and ask the first question, and I'm going to go off script here. To keep this a conversation, I think since you're both in the medical profession, I'm going to open this up to either or both of you. Obviously, you don't have to answer, but I'd also like to include you in on this question. We had a retreat that was called “Healing and Transformation” retreat where we invited doctors, patients, nurses, all different people in the medical field to this retreat. Then we were going to have these breakout sessions, so we asked people to write topics of what they wanted in the breakout session. One of the topics was burnout and resilience. Then we had people vote on which topics they wanted to have sessions on, since we could only have space for four sessions. The highest vote was resilience and burnout, that got the highest number of votes. So we formed a breakout and nobody showed up.


So then we noted that a number of the physicians, a number of the medical practitioners said, I know that is really important but I don't feel comfortable going there. I feel like it is showing weakness. I feel like I don't want to be seen there. So I am asking both of you: if a doctor or trainee is lucky enough to be in your group, then you make it an integral part of what you do. But for all the other medical practitioners, around the world and the United States who aren't able to be in your group and feel the need for that, but then don't make space for that. How do we get them to become more resilient?

Mukta: Thank you Kozo. I think what you highlighted is not unique to the group of people that you had. I think that is something from one personal experience and what we have heard is that there is burnout with the term burnout also. I think that is something that either you are in denial or you are really fed up of hearing it, that you don't want to deal with it.

I think we have to change the language, right and, I think we have to first normalize the culture that we are not heroes, we are humans. We are not perfect. We have to accept and promote that in others, that it's okay to say that you messed up and that's where leadership becomes so important. Then there are other imperatives that are consequences, so why not put the emphasis and reframe it towards self-care and colleague care and something that we are promoting here is we all in the healthcare profession, take the Hippocratic oath right, and that is timeless. But it was written at a time which is very different from today. Our healthcare system is one people have said it is more of a commodity, consumerism. Self-care needs to be invited into it. We have to promote it intentionally. So we actually are gifted by an oath to self-care and well-being where we are calling for a partnership. Partnership with the leaders of our healthcare institution and here, and I am going to make a plea for us that we are the system. We are each leaders, we are leaders of ourselves. So we can start with ourselves. Change happens with self, and even if it is between one or two people that we can help, right? And if we give permission to ourselves to care for ourselves and offer that to others, then change will happen slowly. So I think that would be where I would bring it today, that creating that space and open invitation is what we do every day.

Cynthia: Beautiful and I just have a couple of comments, I would not go to a breakout session on resilience or burnout either (laughs). I think that resilience … As you know, I have practiced integrative medicine, so a lot of it is about wellness and all that -- but resilience and wellness have gotten either diluted or gotten just a bad rap. It isn't like, “oh God, okay, I know I need to eat better and I know I need to exercise and I know I need to sleep more.” We don't have the cultural milieu to first of all have the space for it, and nobody wants to do more. They were burned out, so they wanted to chill out. So the phrase that I really like, so first off, burnout is really the shadow, right? It's sort of like, well, you got to do the inner work. You got to look at the shame and the guilt and the grief and nobody is going to do that. But really there's the epidemic of burnout as a detachment from ourselves, right?

Detachment from ourselves as connected to others, to the environment, to our greater purpose, to our soul. And so really, the word I just prefer is authenticity. How do we live as our authentic selves? And it reframes the whole thing. People are like, “Oh God, I am really out of touch with myself.” Well, hello, that's like the number one quality of burnout, right? You are not living from that deep place.

So, it is about reframing it, but it is ultimately just how do you connect to yourself? How do you connect to your highest self, your best self? Be yourself as physically healthy, so it can be a healthy container for the soul to do what it needs to do. I mean I am right in there with everybody else, I am burned out on burnout.

Kozo: I love that, how do you reconnect with yourself because I was thinking, the HALT -- the hungry, angry, lonely, tired. Well, from what I know, I haven't experienced this, but I have heard a lot about it, that in medical school, if you are hungry, you don't eat right or in residency if you are tired, you don't sleep. I had a friend who was training to become a cancer surgeon and she was talking about doing these surgeries that take like 16 hours, right? And I said, “what if you have to go to the bathroom?” And she said, “you don't have to go to the bathroom.” And I am like, “what do you mean you don't have to go?” She's like, “you don't go, you don't have to go.” So there is this disconnect with who I am, what my body is doing, baked into the process of medical school, residency, and even being a physician-practitioner. A lot of the people who are treating COVID-19 right now are going beyond the bounds of what their body can handle.

So I love coming back to authenticity, “what's going on?” And Mukta, it's a beautiful invitation you have of just asking people, “how are you doing?” That can bring them back to authenticity, right? Wonderful conversation.

So I am going to get to some of the questions. Cynthia, if you have any comments or if you want to share, please feel free. So Darpan asks, “are there some practices which you can share or any learning one can indulge in to expand one’s sense of resilience?” I think specific practices or training.

Mukta: To me, I can share personally, I think, going into those hard places and really making time to not deny, but unpack, when I feel that I am not at my best self, and allowing myself to be in that space. So something that I think about myself is that I always used to ask the question, why me? I would feel like, okay, I have been telling the same thing ten times, and somebody else comes and does that, and they get in, you know. Why, why, what is it about me? Instead of thinking of it that way, reframing it as, why not me?

So I was hurt physically with my back and I was really in deep depression and really down and reframing that to “why not me?” When you start doing that, it's a very humbling experience and it makes you then suddenly be grateful for all the blessings that you already have. You are intentional about the positive. Your mind then turns to the positive. Then the same thing we often don't ask that question, why me when things are going right, right? But being intentional about asking when things get right when you are, say, successful in whatever you want to do and you are happy, why me?

And that is humility in a different way. That is, again, you have to feel that happiness with humility and embrace it. But for me at that time, it is a way to remind myself to be grateful, but pay it forward. I found that these intentional ways of taking time to sit with that discomfort of being in a place where I don't feel my best or I feel like I am angry or upset or to use the word, not tense my shoulders. shoulders feel tense, to find that. And the other things to have a happy place. We all need a happy place that we can go to. Whether that's a picture, a scripture, a song, something that can reframe and redirect our mind.

And sometimes it's okay if that happy place is a punching bag. It's okay to go ahead and think of getting that frustration out. My children have been very, very instrumental in my life, both my daughter and son, and now they are spouses. Two things I got from my children. From my daughter, it was "happy thoughts." She gave that to our family when she was all of about 10 or 12 years old in a casual conversation, which just transformed how we thought and how the atmosphere was in that tense situation. That's become a mantra of mine and my family. So turning to the positive and from my son, he is a deep listener and it was, "Now, let's talk about this. Let's think through this." And I'm always reminded of those two things: "Let's pause. Let's take a deep pause and unpack it, and then we can find some meaning in it."

Kozo: Beautiful. I love that because it's so simple, right? "Why me? Why not me?" And then when you do succeed, "Why me?" Then the other thing about it – a lot of cancer patients, they make that similar shift right? From "Why me? Why did I get this cancer?" to "Why not me?" and "What is this guiding and showing me?" So it's beautiful that it's happening on both sides of the stethoscope, that the doctors are asking those questions and patients are.

Cynthia: Mukta, do you have a particular ritual that you start the day with, a meditation or an embodied practice or is there anything that you do? Or even, throughout the day, if you're in between patients or you're feeling stressed out, what is your go-to ritual or rituals?

Mukta: Thank you. I like to start my day first by thinking of three good things, even before I get out of bed. I remember to smile. I've always found that helps. And then thinking of three good things and reading something positive. I love quotes. I always turn to quotes, and I pick a quote at random from whatever my mood is at that time, and I reflect on that quote and I try to find meaning for me in that. So that's time with myself in the morning. A few years ago when I was suffering from ‘empty nest’, I actually started sending those quotes to my children with a little bit of a prompt, not expecting any response. Of course, they sent it along to different people, and one of them was my father who was a very wise man and he was in his late seventies at that time. I was working that day. Towards the end of the day I looked at it and he had responded. It was a very deep, philosophical response. I was in tears when I read it, and then I realized he had hit "Reply All." So I decided when I go home (he was in India) that I'm going to tell him, "Okay, you don't need to hit 'Reply All.' Just send it to me." But I got such good feedback that day, that by the time I got home I said, "You know, he's 79 years old. If he wants to hit 'Reply All' he can hit 'Reply All.'" That started a virtual conversation between my dad and me, which actually was the first book we wrote. I read that quite a bit every morning now. So I have my quote that I had sent and his response and I think about that.

Kozo: Beautiful. We have...I think it's a question. It says, "Best empathetic way to help someone dealing with deep grief? How and what to say?"

Mukta: Maybe I can respond to this with a story that happened not too long ago. I was called into service. We were shifted in how we took care of patients, and oftentimes the patients that we took care of, we did have a relationship with. So this was a patient that I didn't know very well and was gravely ill and passed. By the time I got to go and meet the daughter, the critical-care physicians and other consultants had gone by and shared the news. I went in not really knowing what to say. The daughter was there sobbing, and I had known from some background that the decision to make her mother, that there was nothing that could be done, had been a very difficult one until that point. So not knowing what to do, I just sat down. And I just sat and we sat there for a long time. And I have also learned that I don't hide my emotions and when I feel emotions in others, I spontaneously have that emotion. So there were tears in my eyes and the tears were running down and we just sat there. And after a while, she just lifted her face and she said, "Thank you. I needed a good cry. I don't want to answer any more questions. I just don't want to talk. I just wanted to cry."

So a lesson for me was that sometimes not saying anything is enough. Her body language, the way she was, she seemed in her space and it seems sacred that I didn't want to interrupt. So that is a personal experience and a big lesson that sometimes silence speaks volumes and just physically being there. The other phrase that I have used sometimes is, "I am sorry, and I'm here to be with you in whatever way you want." Just keeping quiet and asking them. For people that I know, just listening, because the grief is of different types and people unpack their grief in different ways. Just offering and letting them know that you are there for them. And then, when you know somebody very well, sometimes just making sure that they have what they need for their health, also to sustain them. Sometimes that may be sending food or flowers. But offering what they need as a way to connect with them. Then giving them that space to come to you when they are ready.

Kozo: Beautiful. Cynthia and I are associated with Commonweal and, at Commonweal they have healing circles. One of the core principles is "Never underestimate the power of silence." It's beautiful especially in those times of grieving.

Cynthia: Right. And Mukta, I just wanted to comment too, your remarks on whether it's just the importance of human touch, right? Whether it's a hand or even just a touch. We're there holding them in space. The grief, we've approached it as a problem that has to be solved, but it's really this human experience that just needs a witness. What you said is so beautiful. I think it's incredibly hard for doctors too. We feel like we have to figure out everything and solve everything and to just not jump in, but just to be there with your presence and listening is really beautiful.

Kozo: Yes, that brings up a question, Mukta. So in the bio it said you focus on the power of touch in healing. Obviously with COVID-19, touch has not only gone out of use, but touch was very rarely in the medical profession. It's not only gone out of the medical profession but it's gone out of contemporary society. I had this dream last night (my family is from Hawaii) and I saw my friend from Hawaii and I was like, "Hey bro! Yeah" And we were hugging, locked hands and hugging, and all of a sudden we went, "Oh shoot! Oh, sorry! Oh, social distancing!" I think we can all agree that touch is a very important part of healing and being a human being and how do you see that shifting when it is being eradicated from all aspects of our being?

Mukta: Absolutely. Yes, it is a different way of being. I think that's why it's even more intentional that we connect. I think human touch is a form of connection that is very sacred. It starts as a baby, as a child, and we grow up with it and the skin-to-skin contact. Then there are cultures that you don't touch. I didn't grow up in a culture where we hugged. "Namaste" is the way we greet in India. But still, the connection is there. I think for me, what I have learned from this, both in putting my professional hat on and personal hat on, is that we have to be even more intentional about connecting. Here is where technology really needs to be used to our advantage. I used to send a buddy check. We had a little group and one way that we are talking about mitigating burnout and promoting a sense of community around a common unity is that I started a buddy check. On Friday, to a group of people, we would say, "Sending you happy thoughts. Here for you. Have a great weekend." Now I'm more intentional to send it even more times a day. And virtual hugs. I'm grateful for all these emojis that are out there! And the other thing is when we are with our masks on, how do we communicate with patients? I've got my shield on, the mask on. One way I've found is just being open to them and saying, "Look, I'm sorry if you can't hear me very well through all of this. I'm sorry, but I am here for you." I started using a lot more gestures-- I always talked with my hands. My children always made fun of me for that. But, I think, I started doing that even more. I think we have to be even more intentional about connecting to people and using different ways and trying to understand what is their connection language.

Kozo: Yeah. I mean, this connection we have now through zoom, that's our daily connection. So, we have a question, and I'm not sure exactly what this means, but if it doesn't resonate, we can go to something else. Vidi Desai asked, "What are some of the processes you have used in these spaces?"

Mukta: I think I lost you, Kozo, towards the end. It said, "What are the processes you've used in these spaces?" Was there anything else after that?

Kozo: No. No. The question stops there and that's why I'm not sure exactly what he's referring to.

Mukta: If I understand what they're asking is, "these spaces..." I can give you the example of when we created the RR in our sessions or the sessions that we have at the Hunter Museum now with the students. The process we've raised is there are certain touchstones that we invite people to know that they are here for-- just the physical act of being in a different place from the busyness of work is helpful. I let them know that this time is a gift to themselves to be how they want to be, to reconnect maybe with what they wrote in their personal statements to come to medical school. There is no evaluation on this, so that takes off the burden of the students, and it is not a share-or-die moment. They need to be able to get out of it what they want. I am going to simply facilitate a conversation. We start with, for example, you can start with a quote, with a prompt. For example, for the thread, we do this with the students that are just going to graduate. I shared this with them and then just ask them to lift up a few words that meant something to them, or a line in the poem, and why did it speak to them. Then I think about giving them a prompt. "Think about the thread that resonates for you. What makes the thread important and how are you going to sustain that thread as you leave medical school and start residency?" It's from one milestone to the other. Then they self-reflect for about five or six minutes. Then we group them into triads or four, all depending on how many students are there. Before that, we prepare them with the rules of listening, empathetic listening. So we tell them, "You're going to shift. You are there in service of the person. You're not there to offer advice or fix, just listen to hear." And then we talk about, "How is that different?" And then we unpack in a big group. For this particular class, I asked them to write a letter to themselves, and I've been doing this for a long time. "So write a letter to yourself about this thread." And I'm going to mail it to them after two months when they've started their residency. That's something that I always get feedback about -- that letter means a whole lot to them. So I don't know if this is one example of a process.

Kozo: Yeah. I think it's beautiful. It's a beautiful example. So, first I'm going to apologize to all the people who are sending in questions. We're not going to get to them all, but I'd like to go to this question from Dr. O'Neil. "How would superior relationships help avoid and get cured from COVID-19?" And I think I'd like to bring Cynthia in on this as well because Cynthia just released a document about shielding yourself from COVID-19. So, "How would superior relationships help avoid and get cured from COVID-19?"

Mukta: She may need to be unmuted, I think.

Kozo: Oh, it's for the both of you, Mukta.

Cynthia: I didn't quite understand the question. "Superior relationships..." Is that what it says?

Kozo: Yeah. Maybe...

Cynthia: Like, strong relationships?

Kozo: Yeah, like powerful or predominant relationships. I'm not sure. He capitalized them both, so I thought it was a reference to something you guys would be familiar with that I didn't know. But yeah, it could be just like, maybe having better relationships, I mean, "superior" as, as opposed to inferior?

Cynthia: Or maybe divine relationships, since they capitalized?

Kozo: Yeah.

Mukta: So “how can these relationships be healed,” you said?

Kozo: Help avoid getting COVID-19 and help get cured from COVID-19. So both.

Mukta: Okay. superior relationships. I'm going to use the term "superior" as in maybe leaders? I don't know, because "avoid getting COVID-19" I didn't understand. "Getting healed from COVID-19"? I'm sorry. I'm having a problem understanding the question too. So how do superior relationships avoid getting COVID-19 and getting healed from COVID-19?"

Kozo: Avoid getting COVID-19 and then healing from COVID-19. If you get COVID-19, to be healed from it. How are relationships important in either of those, either protecting yourself or healing yourself?

Mukta: I think one, I think we'd look from getting COVID-19, I think there are so many uncertainties, and a big part of the idea we are feeling the grief that we are feeling is this anticipatory grief of uncertainty. You know, "What now? What later?" I think being open and transparent about that in a relationship will help us understand the ground rules of that relationship, which would mean that we would have to maintain social distance even in close relationships, especially if you have had a high risk of exposure. For example, I had my parents living with me who are elderly. So when I was on clinical duty, I would make sure that I did not bring anything that I wore or used in the hospital into the home; showered completely head-to-toe before I met with them, and then, social distance. I mean, we didn't sit at the same table and eat and I brought a mask in the house. But I think we still maintained that because there was that understanding.

So I think that is one. Being very aware that there are some things physically that we need to do to prevent exposure. Regarding the spiritual aspect of a relationship, I think that is for self and others. Go ahead and definitely have that communication, but also try to prepare yourself for your internal strength and invite that in others, whatever that is. So for me personally, that was the whole thing that I need to make sure that my body is physically fit and mentally and spiritually fit the best that I can do. And then I always go back to this one thread of unconditional surrender, that this is all I have power for me to do. The other thing I always talk about, whenever we go through this sort of grief, our heart is broken. When we live, our heart gets broken. And I know Parker (Palmer) talks about how you can allow your heart to break. You can either pack it so much and not unpack anything that it just shatters. Or you can allow yourself to sit with that and let it break open. And when you let it break open, you invite all the discomfort, but you also invite everything else and it just expands in this beautiful way. And in the relationships that you have, invite that heartbreaking open together.

Kozo: Cynthia, did you want to share on that?

Cynthia: I was just noting the time, but just a couple of quick comments. In medicine, we tend to look at risks much more in terms of health outcomes. What we know is isolation -- the opposite of strong relationships, whether we're talking about a divine connection or laterally in community -- is now really seen as big a risk factor against health and resilience as smoking. So it's a really serious health risk. And I look at, in terms of holistically understanding the body, the immune system is both preventive of the COVID-19 or any other infection as well as therapeutic. It's our immune system that's fighting off infections that we get. So we know that stress from isolation and lack of community really dampens that immune response, weakens this inner shield that we have. So absolutely. It's not just an extra. It's truly paramount and fundamental to immune strength.

Kozo: Beautiful. Both of you reminded me of Thich Nhat Hanh when he was asked about burnout, he said, "Have a community. Have a sangha. Have others who you can share your experience with." And I think that's been a powerful theme of today's talk. Mukta, we're going to go a little over. I apologize for that. Just to let you know, there are still four questions in the queue that we haven't gotten to. So it's spurring a lot of inquisitiveness. It's been a beautiful talk. The last question we always ask our guests, Mukta, is "How can we as ServiceSpace, the global, volunteer community, serve you, help you in your work?"

Mukta: Thank you. I think I'm going to piggyback on what Cynthia said. I think creating spaces for this community to have conversations, to build this community where we don't feel we are alone. Creating an awareness of normalizing the human condition of not being perfect, of being human and allowing the human to integrate as authentic human beings, as their whole self. So engaging in such community dialogue and bringing the opportunity to bring our whole authentic selves in whatever we do, not the roles we play but who we are. We are not what we do. We are who we are, and allowing us to celebrate that. So giving us these platforms and building such communities.

Kozo: Beautiful. Beautiful. Cynthia, did you have any final comments before I close the circle and end with a moment of silence?

Cynthia: No, but I would actually like to read a quote from Parker Palmer, what he said about Mukta, if I may. It's very short.

Kozo: Yes.

Cynthia: I think it just sort of sums things up: "I'm grateful to Mukta Panda," Palmer says, "for having the courage to share how she keeps her heart open despite heartbreak and is teaching her medical students to do the same. Internal medicine may be Mukta's clinical specialty, but she is a healer of the inner life as well." So thank you.

Kozo: Wow. Beautiful words from Parker Palmer. Thank you both. I think this has been such a beautiful, symbiotic conversation between two very heart-centered healthcare professionals. So we've gotten comments saying that this has been a wonderful conversation already coming through. So thank you both. I think what really sticks out to me, Mukta, is just asking that question, "How are you doing?" And making an intention to continue to ask that. Don't just make it a formality. So, that's a practice I'm going to walk out with today. So thank you both. We're going to end with a moment of silence and, I'll ring us out in a bit.


Kozo: Thank you.

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