Good Morning !

This week we have the privilege of chatting with Dr. Holly Neville a pediatric surgeon Daphna and I have been privileged to work with here in Florida. We had such an interesting conversation about life in medicine, happiness, being a woman in medicine and so much more. We hope you enjoy this episode as much as we had fun recording it. Have a good sunday friend 😎

Short Bio: Holly Neville, MD, FAAP, FACS is the Division Chief of Pediatric Surgery at Joe Di Maggio Children’s Hospital and Associate Program Director for the Memorial Healthcare System Department of General Surgery. Holly attended Emory University (92) where she received a BS in Biology and served as Co-Captain of the varsity swim team, followed by the University of Florida College of Medicine (96). She completed her surgical residency at the University of Texas at Houston and Pediatric Surgery at the University of Texas Southwestern. She became a certified coach in wellness and well-being in 2021. Holly serves nationally on various committees, including the Educational Committee and wellness committee for APSA, and is Lead Coach and co-director of the APSA coaching program. Holly currently serves on the Board for the University of Florida College of Medicine and the Foundation for Joe Di Maggio Children’s Hospital. Outside of work, Holly is the mom to 3 children: Zack (20), Camille (17) and Chloe (13). She is an avid sport enthusiast, enjoying paddle boarding, yoga, jogging, swimming, and Otillo racing. She also is a home chef, and due to Celiac disease, specializes in gluten free and vegetarian cooking.

The transcript of today's episode can be found below 👇

Ben 0:47

Hello, everybody, welcome back to the podcast. It's Sunday, Daphna. How are you?

Daphna 0:52

I'm doing okay. It's been a hard week. I think with all that's been going on with the school shooting, obviously,

Ben 1:02

it's been very difficult to wrap our heads around what happened. It's just, it's just disturbing. And you feel very powerless. Actually. There's, there's, I almost don't want to talk about it. Because I feel like, like many people have said, enough of the good sentiments. Some things need to change. And if we keep just wishing, good health and prayers, yeah, just it's until the next one. And we become so numb, we just become so numb to these things. It's just not right. It's just not right.

Daphna 1:43

Yeah, I was thinking, you know, what do we say on this? Are we have a podcast on neonatology that focuses on evidence based medicine. But we are general pediatricians first. And, you know, we find we had to say something that we can't stay neutral on that conversation. Pediatricians need to know the data, that firearm related mortality was a leading cause of death in the one to 19 year old age group and 2020. And unlike other causes of childhood death, which are pretty stable, this type of mortality is I mean, the graphs are impressive, it's having exponential growth. And we need to advocate for interventions that have been proven to reduce deaths, and the science is there to help us prevent this kind of ongoing loss of life. So donate, advocate, vote again, those are the things that we can do,

Ben 2:36

or you know, it's, it's, it's not my job, to like to come up with a solution. The people we elect to power have to figure this out, right? It's just like when you're in the ICU, and you're the attending, and there's a problem, you try to think through the problem and come up with a solution. And at this point in time, I don't I am not a law expert. I do not know the Constitution. And there's people who went to school who are very well versed in all these intricacies and how to how to create an amendment and all these things that I have no understanding of, and I'm not exactly sure what the solution looks like, I'm not attached to any particular solution. I just want a solution.

Daphna 3:23

Yeah, yeah. When I think about our own work, and the amount of like resources and mental work we do, we pour into just like every one single patient to save one life, it just seems incomprehensible to allow this ongoing loss of life.

Ben 3:45

And people have found mechanisms, right. I mean, we were just talking about fair, definitely about this were trying to order a year was worth supply of fentanyl for one of your patients and see how many flags come up. And how many people will ask for pre op preauth. Right? All these things you're gonna have to go through. There's, this is just one of the things that came to mind when I was talking about this with with my wife the other night, like, there's right, you shouldn't be able to buy hundreds of rounds of ammunition without somebody saying, Hold on a second, like, why are you buying that many rounds of ammunition when you're only 18 years old? It's just there's mechanisms. I'm sure there's mechanisms that people can think of. There's bright minds in this country, just please, like get to work.

Daphna 4:27

Yeah. And I mean, we're just thinking about our listeners, everybody, you know, and on top of your ongoing, regular stressors, which is actually the topic of our conversation today, especially if you're a parent in medicine. This week has been a an exceptional, I think, emotional burden as well.

Ben 4:48

One more emotional rent is the fact that it's a bit like the NICU right? People leave their kids with us and they go home and they sleep at home at night. I mean, maybe they sleep they have you can let the parents keep in the NICU for

Daphna 5:00

I well, and I think a lot of times they leave the NICU and they don't sleep well, right,

Ben 5:04

fine, but like, but there's this idea that, like, I trust that my baby is safe within the confines of the NICU, and then I'll come back tomorrow, and that my baby, obviously will be here. And, and it's the same thing with school, we drop off our kids at school with the promise that like, this is a sacred space where I will I can and to have this space violated on a regular basis is is something that society needs to look at carefully because it will it will metastasize to something awful, I think. Okay. All right. So on this very gloomy note, we are actually excited to have with us today, Dr. Holly Neville. Dr. Holly Neville is a pediatric surgeon that definitely both have had the pleasure of working with in the past. She is She is a model of excellence, and this is why we brought her on the show. If you don't know who she is, she is the Division Chief of Pediatric Surgery at Joe DiMaggio Children's Hospital and Associate Program Director of the Memorial Healthcare System Department of General Surgery. Holly Nevel attended Emory University where she received a degree in biology and served as CO captain of the varsity swim team, followed by University of Florida College of Medicine. She completed her surgical residency training at the University of Texas in Houston and pediatric surgery at the University of Texas Southwestern. She became a certified coach in a wellness and well being in 2021. Dr. Neville serves nationally on various committees, including the educational committee and wellness committee for APSA and is lead coach and co director of the APSA coaching program. Holly currently serves as on the board of for the University of Florida College of Medicine, and the foundation for Joe DiMaggio Children's Hospital. Outside of work. Holly is the mom to three children, Zach, Camilla, and Chloe. She is an avid sport sports enthusiast enjoying paddleboarding yoga, jogging, swimming and auto racing. She also is a home chef, and due to celiac disease specializes in gluten free and vegetarian cooking. Dr. Neville is an inspiration. And her perspective on happiness, women in medicine is something that I have been inspired by over the years and I think we will learn tremendously from her today. So please join me in welcoming Dr. Holly Neville to the show. Dr. Neville, thank you so much for being on the show with us today.

Unknown Speaker 7:47

Oh, it's a pleasure. Thanks so much for having me, Daphne.

Ben 7:50

Yeah, the pleasure is ours. So for the people who may not know we all know each other. We've worked together in the past. I personally have tormented Dr. Neville as a fellow with multiple on call nights. But I guess I wanted to start off the interview by talking to you about your your motivation to pursue a career in pediatric surgery. We don't often talk to pediatric surgeons. And I think in the past, you've mentioned that this was for you a calling and so I'm wondering is that is that the case? And where did that come from?

Holly Neville 8:27

Yeah, it really is. To me, I think the most fulfilling career choice I hear so many doctors who who maybe express regret about their career choice. I've never felt that. Apparently I told my parents when I was two years old that I wanted to be a surgeon. No family is medical whatsoever. And so it was quite a surprise to them. And when I went into medical school, I did a pediatric surgery rotation and I immediately loved it. Obviously I have smaller hands I had good dexterity I grew up doing four h and sewing clubs and and you know so the curtains from my house etc. And I think it just ended up being a good skill set for me and and it's just something for me that holds a lot of value the chance to be able to give someone back a lifetime of good health. I think it's really meaningful.

Ben 9:19

I would have been frightened if my two year old said I want to be a surgeon.

Holly Neville 9:23

I think we're in fairness I think that will alarm by the whole concept.

Daphna 9:29

I think that's such an important thing that you said you know really having passion for what you do because medicine is a is a tough road if you don't like you know what you what you picked i i You know we have a lot of trainees we have some learners who listen in and you know they may be between two specialties or two sub specialties or two types of jobs. And I think a him, it's so important, like you said, to follow your, your passion, I'd love for you to speak more on that.

Holly Neville 10:06

Sure, I always tell the medical students on the service to use the clock test. If the clock passes by, and you can't believe you're walking out of the hospital, and it's whatever time it is, that's a specialty for you. Versus if you can actually hear the audible ticking of your one beam to barely pass by that is definitely not the specialty for you. I think finding something where the days just go by and when you look at, in particular women in medicine, that the women have a very high drop out from the profession of medicine, starting seven years out of training. And you think about the opposite. So many of us do, we all have a full time job outside of medicine. And if that job has more meaning and more purpose, you're gonna leave your your job in medicine, and I don't want that so many training, so many so much labor, really, we have to keep people you know, with a passion of their jobs with their passion of their careers with a passion of medicine, and you've got to make sure you go into that right specialty or you find that right group, the right hospital culture, where your your passion is fueled on a daily basis.

Daphna 11:22

Yeah, that gives us a lot of things to talk about. But I we have a lot of things on our list. But um, I love that you brought up the culture. And you know, because you lead a group happens to be a group actually of mostly female physicians. And so, you know, what was your goal for the culture for your group that you that you set out, you know, to have?

Holly Neville 11:48

Well, this group adopted me. So I, I love I love the team that I've joined here. And one of the policies kind of that we follow as a group is family first, our patients should be treated as our family and our family should 100% be treated as our family means you have a child school event that you have to go to a doctor's appointment, a sporting event, the rest of the team bends over backwards to make sure you make it to that middle of the day, a weekend, you need to swap call, whatever it is. And I think the whole team knows that their family, their family comes first. And we all know that you have priorities outside of the hospital that have to be attended to that being said, the patients have to be attended to to so we help each other out, we pitch in. And I love the cooperative nature of this team here it really the culture of Joe DiMaggio and in my group is is fantastic. We do have two male surgeons, one happens to be married to a female surgeon, so we put him still in the female surgeon club. And one is also married to a female. So now that I know that I think we have a lot of female surgery power in our group overall.

Ben 13:05

When I was in medical school, I was doing a rotation in neurosurgery. And they were the happiest group I had encountered so far in surgery. And they had a peculiar call schedule where there was like a shift from like 430 to 8:30pm. And I said, Why is that coverage there? And they said this is if you are on picking up your duties, you're picking up your your kids from school duties, and they had specifically trenched out these hours so that if you were part of that neurosurgery group and you wanted to go pick up your kids from school and spend a few hours after school, several weeks during the month, you could do that. And I was I thought this was so novel to say, hey, like family is like your mental well being is going to make you a better surgeon. And so I resonated tremendously with that idea that family family first because ultimately it makes you a better surgeon.

Holly Neville 13:53

It does. There's nothing more stressful than wondering if you're going to make it to pick up on time. That's the

Daphna 13:59

worst. The worst? Yeah. And I you know, I think happy, happy doctors are healthier doctors, they have better outcomes, their patients are happier. It's just so interesting that we've the pendulum has swung so far. And like you said, there's so many physicians who are becoming dispassionate with their work. And I wonder if if people were able to, to set a balance like your group does, if that would help us retain more people in medicine.

Holly Neville 14:36

Burnout is such a real thing. You know, particularly in light of COVID and the pandemic and the struggles of the workforce and the shortages, burnout has become really even more of an overwhelming force and you know, and I see it in my group as well. My group is not excluded from that. But when we see burnout creeping in, you know, we try to take aggressive steps. We have team building meetings. And, you know, we work on the weekend call schedule and try to give people some more time where they have time off and with their families. And there's a lot going on in the world and with our kids and our families, too. You know, teen depression is at an all time high. And so for those of us who have teams teens at home, it's a lot of concern to make sure that you're keeping an eye on on both of your jobs.

Ben 15:23

Let me ask you a more technical question, then, do you I think there's a mental jump that's being made by a lot of people. And that's not on purpose. That sometimes moral injury, burnout is because is equal to unhappiness. And I know that you've thought carefully about what should make you happy as a physician, and what is happiness? Do you think that the two are different or connected, and because I'm afraid sometimes that people who are going through burnout saying I'm just not happy at my job, which I don't think sometimes is always the case, I'm curious to hear what your thoughts are on that, for me,

Holly Neville 16:02

happiness is 100% of choice. I choose to be happy, and therefore I am. And I have to remind myself, it's a conscious actual practice of happiness. If I'm having a bad day, I may actually force myself to smile in a mirror, which by the way, will make anybody crack up, because it's so ridiculous that a 51 year old woman has to force herself to smile in a mirror. So you know, I think that you make a choice to be happy. And then we also have to look at and analyze our situations and realize we're really not as trapped as we feel. You know, so if you have a discordance in your purpose, between your purpose and your your company's purpose, or your ethics, there's ethical malalignment. That I mean, that's a problem, no one will tell you that won't that will lead to burnout very quickly. That's something that as physicians, we have to realize that we can, we can bring up, we can talk about businesses and medicine. And and I understand that, you know, they pay me a salary to come to work, but I operate on people's children. And so when a business office says, you know, why are your numbers down? Well, thank goodness, less, more ill, you know. And but I also understand from the hospital standpoint, is that they, you know, they're providing a service, they're purchasing, you know, equipment, and people and buildings, etc, in order to run a business. And so if the numbers are down, they're going to be people who are out of jobs, etc. I get it. But still, we have to come to work with ethical alignment. And if that's not there, we need to be communicated about that and try to try to fix that alignment. But yes, being happy to me is completely separate. I choose to be happy.

Ben 17:49

Yeah, I don't know if you know, this TED talk by Yeah, this this PhD called Amy Cuddy, where she talks, the talk, I think, is called Fake it till you make it. And, and I love that talk. Basically, she for the people who haven't seen this this conference, she basically says, the way you use your body will have a direct impact on your psyche and how you feel. So she talks about, like, the people who show up to job interviews, and they're like in the fetal position, they have a much higher chance of not getting the job. But if you were coming in and taking up space and feeling confident, and you're letting your body show that you're more likely to get the job from the interview, I think it's fascinating. So I don't think it's silly, that you force yourself to smile in front of the mirror, because I do think that that directly impacts how you feel. I'm also interested in what I mean, maybe you don't know this, this other but there's this guy, Mo Godard, who wrote this book that I that I read, called solve for happy. And he's a former Google engineer. And basically, his idea is that happiness is an equation where it is equal to like the perception of the events in your life minus the expectation of what should have been. And so far, we've talked about a lot of things, but I'm wondering if, as a female physician, how do expectations play a role? Because I see my wife is an as an adult cardiologist, and the expectations on female physicians are very different than on male physicians. And I'm wondering what your perception has been on that and how does that affect your potential for happiness?

Holly Neville 19:20

Wow, that is, that is a loaded question, Ben. So I would say, you know, when you reach a certain age, but I have an improper phrase for how I say this, but you you, you care less about those expectations, and you move forward with what you really believe is right for yourself and the people who you serve. So I think this really speaks to younger women physicians, and I tell some of the younger physician that I work with, you know, if you could just Get all of those cares which I use a different lens, then you would move forward better, because society has so many expectations. And the truth of the matter is, is you can run yourself into a gutter because as a woman, you're judged on how pretty you are how physically fit you are. Are you a good enough? Mother? Did you have an easy enough labor? Or did you have to have a C section? Were you able to breastfeed? And for how many months? Were you able to do that? Well, you weren't How do you drive your car? Do you drive really well? Because you probably don't? Are you a good enough? Surgeon? You're as good as the guy surgeons? How do you do on your tests? How do you do on your board exam? Are you good enough mentor? Do you spend enough time? You know, how are you as a wife? Do you spend enough time with your husband, your children? I mean, do you pick them up from school every day? Do you make it to other sweets? Do you make it to all their soccer games? I mean, the judgment, it is overwhelming.

Daphna 20:46

And then you'll seen so.

Holly Neville 20:50

And it's not from the judge ourselves like that from such an early age. And when you finally, finally take a breath and say I'm good enough. I'm real enough. I'm physically fit enough. This is me. I accept me for who I am. And I'm just going to bring it. I think that's the day that you're happy that getting to that point, psychologically, I think is a challenge. And that's how I got so into professional coaching is is there a way to get people from this, this struggle of judgment into kind of recognizing that sage? So were your judges just attacking you? How can you move into more of a sage mode and just go forward and bring it to your family, to your work and to yourself and really feel at peace?

Daphna 21:45

Yeah, I want to come back to coaching. But I also want our listeners to understand I loved your tip about taking a break and smiling and then in the mirror. But it's not just about this like toxic positivity either. Like in your Doximity article, my goal is a woman in medicine to be happy. It's really like you said a series of decisions like conscious decisions, to find the right place for yourself, accept yourself, give yourself grace, be kind to yourself. It's not just this, it's not just fake it till you make it really like you've really put a lot of effort. And it sounds like that's what you do for people who are doing coaching with you is align, you know, priorities.

Holly Neville 22:35

Yeah, I mean, I literally when I came to the conclusion that I needed to change something, I really made a conscientious decision. I think similarly to when people want to lose weight, or when people want to get in shape, or they want to run a marathon, I started a daily practice, a daily practice of telling myself a mantra in you know, in the morning, feeding myself positivity. And you know, Ben, when you talk about fake it till you make it when I have to do public speaking or it's very similar to I swam in college, you know, when you're standing up on the swim blog, to change into a different persona. No, you take a deep breath, and now you're here, and you're gonna go, you're gonna go get it. And similar to I mean, being a surgeon, when you walk into the ER, especially, for instance, a trauma or something truly terrifying. There's a moment where you walk in where, you know, you're scared, you have to, you know, take that deep breath and step right in, I heard the most amazing interview on NPR this morning about a medic. Well, a frontline doctor in Ukraine. And she says that when she walks into the frontline does with her team, her knees are shaking every time. And then she takes a deep breath, and she gets to work and she does her job. And we think about the terrifying situations that people are in around the world. And, you know, it makes me feel small, it makes me feel humble that people, people are so strong. Have to take that moment. And they have to just jump in and and recognize that they can do it.

Ben 24:12

Yeah. And to go back to, to go back to this to this reference of this TED talk. called Fake it till you make it it really isn't about saying, Oh, you're not you're not qualified, you should fake it until you make it. It's about this imposter syndrome of saying, Who am I to be in this position, and you feel so scared and you feel inadequate? And the idea is no, just just fake the confidence that you're lacking, and you'll see how everything will come into place. So by no means was I saying that? Anybody that's not really qualified. Go ahead. And I'm sorry.

Daphna 24:44

No, no, no, I was just saying that there are so many other steps that I think we don't talk about and that's why I loved your piece about happiness and making those those conscious decisions. So, you know, I don't, I don't want people to take away and say, Oh, it's just as simple. I'll just be happier. Like, you made some big changes in your life when you felt like, you weren't as happy as you could be. And in fact, it's, most people say, Well, I had to do less and to do less and to do less. Sounds like you're doing even more than before you made that conscious decision. But you changed the way you thought about the priorities in your life. And I think that's so valuable.

Holly Neville 25:29

Yeah, I, I did more. But I did things a lot differently. Really, if it was a priority, I made sure that it was a priority. And it was treated as such, my children, my family, you know, and then and then my work and how I approached work. It was really a total my fitness. I mean, I went back to exercising I had read at the time, a really interesting article about how so many children don't actually know their their moms, right? Like, their mom's just their mom, and they don't see the human behind them. funny because my son at the time was like, a tween a preteen. And he said something about wanting to learn Russian, I was like, Oh, I took Russian in college. It turned out that the kids didn't know I played the piano, which I had taken lessons from a concert pianist, like through part of college. They didn't know that. I mean, I lost all the Russian skills, so I don't speak it anymore. You know, they didn't know they actually didn't know me.

Ben 26:34

Yeah, it resonates so much, because I keep saying this story. But when I was in college, struggling over an organic chemistry problem, my mom came to my side and solved it. She's She's a pharmacist, obviously. And I said, How do you know this? And she's like, I'm a pharmacist, like organic chemistry is what we do. And same thing happened. We were watching a movie, somebody spoke in German, and she translated was like, you speak German. She's like, Yes, I took German for years. And it's exactly what you said she was, she's my mom. But I never saw all these facets, until very late in my life,

Holly Neville 27:07

really opening up to the people around you, and you and letting them in a little bit, you know, or a lot bit letting people know you for you. And and I think that's so important that people really understanding you and getting you and, you know, making a decision whether they like you or not.

Ben 27:26

And you mentioned something that Dr. Jimmy Turner, who's an adult anesthesiologist, who also does coaching spoke to us on the podcast. And he says this phrase, which I think is is very true, and it resonates with what you were just saying that if you don't set your own priorities, someone will set them for you. And it's only up to you to decide, are you are you ready to do it? Or are you going to let the hospital job something set your priorities? And I think I think it's something that I tried to remind myself every day.

Holly Neville 27:51

Yeah, yeah, that's that's real wisdom there. That's true.

Daphna 27:55

Well, I think that's the perfect segue, then for you to tell us more about your coaching journey, you know, how did you on top of all the things that you do? How did you decide to get into coaching? And I mean, you're mentoring a lot of people. So how does that work?

Holly Neville 28:11

So coaching kind of hit me. You know, out of the blue, I came across an email from the Association of women's surgeon saying, Hey, your coach, and I thought, This sounds fun. I went to the meeting that year, and did this little coaching symposium with this incredible woman named Dr. Carrie Pelham Mara, who's up at Mass General. And in this coaching symposium, you kind of learn basic techniques about coaching. And really the concept that coaching is much like the stagecoach that it's named after right, this is a private space that really is is not a real space, but more inside your head, where you can think about what your priorities are, and what your strengths are. And then leverage those strengths to get to be where you want to be not mentoring, not where your mentor tells you you should be, not where society tells you where you should be, but where you actually want to be. And then using strategies that have worked for you in the past, or that you could envision working for you now, in order to get there. And so the coach is really just a guide, the coach doesn't need to know anything about you. They don't need to understand what your job is, what your work is. They just need to learn what your priorities are, what your strengths are, through you, explaining them to them, what's worked for you in the past and then guide you through finding your own solutions. So there's no suggestions or solutions. There's just there's some brainstorming sessions to think about solutions. And then coaching is used for it's used for weight loss. It's used for executives, it's used for everybody. I mean, really, truly anybody could benefit from coaching. And so after that AWS study that I participated in, I thought This would be amazing to bring it to the pediatric surgeons and I worked with another pediatric surgeon to bring this program to the Pediatric Surgery fellows across the nation using the American Pediatric Surgery Association. And so we're, we're getting ready to start our third year now in May of coaching fellows, or residents in pediatric surgery. And this year, we're going to start to offer to early career pediatric surgeons like yours one through three. And also here at Memorial Regional Hospital, we've worked with our residents here as well, I think it's a really cool thing with I think if people can learn these strategies early in their careers, they really can start to set their own priorities. And Ben, like you said, if they're setting their own priorities, that's a lot different than starting out your career with someone else setting them for you. Mentoring, I think is so valuable peer support is so valuable. But coaching is different. Because it's self driven, it's learning how to do it, yourself. And it gives you a lot more space to think about what you really want out of your out of your day out of your month out of your year out of your life.

Ben 31:07

Yeah, and I think and I think the medical system is so pervasive from that standpoint, that you always have to be 150% all the time, right? Medical school to get in it's impossible residency just as hard. And then you find yourself reaching the end of the line where you're about to become an attending, and you've never been anything other than full on. And eventually, you spent three years into your full time first full time job, and you're like, I can't do this anymore. And you're just out of breath out of steam. So yeah, I mean, I think I think this is important. Now, my question to you is, what are the things that I guess maybe the most important thing, you try to stress to trainees to help them be more introspective and take better care of their mental well being and their balance in general.

Holly Neville 31:56

So really having them recognize what their priorities are, I mean, there are two exercises that are my favorite one is the wheel of life where you kind of put your priorities on a little wheel, like a spoke like a bicycle wheel. And then you rate yourself where you are versus where you want to be. And so, you know, maybe you're a resident, so your financial wheel is like super horrible. But you're, you know, your professional wheel, you feel like you're doing well. So that's higher, and your family is kind of not doing that great. So you end up with this very misshapen wheel. And it really allows you on pen and paper to see kind of where am I at compared to where I wish I was, and what can I change one small step today to make a difference towards improving those things. I think this is so important for trainees because I don't know what the actual term is, I call it the summit phenomena. But we think we're going to reach the summit, and we're going to eautiful suns rise and everything's going to be better, right? So for pediatric surgery, residents in particular, you know, the trainings 8 million years, and by the time you finish, you're gonna be an attending and oh my gosh, you know, you're gonna hear the angels sing, all of a sudden, your life is gonna be better, you're gonna have a pig, you're gonna see your family. We all know like, that's not the reality. It's another day of work, right? Is there or is your purpose, not there? Because if it's not there, that summit, you're you're not going to be satisfied with your arrival to the summit. So I think making sure people have a realistic Summit, what is your Summit, because if you're summits finishing residency and finishing training and getting this job, but then you don't think you're going to be working, you're going to be sorely disappointed. The second exercise I love is that the gas tank exercise and this this I live and die by Well, I live by because I have to die. And that's basically that everyday you start the day with like however much gas in your tank, and then everything around you is going to start sucking gas out of your tank. How do you keep your tank from running dry? So literally, if I'm going into have a hard conversation with a family, a child that's just been diagnosed with cancer, and I know the family is devastated and I know that they are going to need an emotional pole. Well, while I'm walking over to talk to them, I literally will think about the most positive things in my life. I will conscientiously make a decision to fill my tank. So when I walk in that room, I can just give for days the big difference of how I can be patient, how I can give time and how I don't feel like I'm losing myself to somebody else's situation. And the same I mean, I have teenagers, God knows I need to come home with a phone. Fortunately for me, I have a decent commute so you know I use that commute to kind of recenter from my day's work, finish up, tie up any loose ends and be ready to come home and be a mom with a refilled tank.

Daphna 34:58

That's awesome. What any analogy. You know, my, my daughter is young, and she loves this book, How to fill a bucket. And so we spend a lot of time talking about things that fill her bucket and things that don't fill her bucket. And, you know, it's a good reminder that as parents, we have to do that for selves. But I love how you bring that to your daily practice, when you feel like I don't have anything left to give, but you found a way to like, give part of yourself back to yourself before, you know emptying your tank. That's really cool.

Holly Neville 35:35

I think that trainees can really benefit from simple skills like that, like how do people how can people just overall, make it through a day without kind of hitting the bottom and this, it's hard work.

Daphna 35:47

One thing we've really learned through doing the podcast and connecting with people on social media is that it's nice to talk about these things for people to feel like other people in their situation are doing the same thing. So I'll disclose that when the pandemic started, I really felt like I needed help. We, Ben and I, in our professional lives, things were changing. And in my home, white things were chaotic. And so I did enlist the help of a coach who has been instrumental. And in fact, Ben probably doesn't know this. But I mean, she's probably the reason my work with her is the reason that I said yes, when he said, let's do this podcast thing. And I said, Yeah, I think I could move that to higher, you know, to something that would, would bring me a lot of joy and, and passion. And so I mean, it changed my life trajectory, really, I think working with a coach. So all of that is to say I'm giving people permission from from someone in our own field to reach out and do that. How do you think is the best way for people if they're curious and learning more about being coached? To engage with with that?

Holly Neville 37:04

Yeah, there's so many opportunities. When I took the job at Memorial, the executive team provided me with a code. So when you're taking a new job, you can always negotiate that into your contract. Most large corporations have coaches that they can provide you with. Outside of that coaching can be expensive. But there are a lot of different resources where you can search for a coach online or word of mouth to physicians. For our female physicians, you know, we have the physicians, Mom group or other physician groups and social media that can help link up coach. And then there's so many, maybe more academic institutions than otherwise, but that have coaching programs like the ones we've started at Memorial, I mean, carried Palomar through Mass General has spread coaching research programs that have now rolled into full fledged coaching programs across the nation. So many times your institution may have a coaching program that you're just not even aware of that, you know, free to take part in and do the lessons. And one of the great things about participating in these studies, or the resident coaching programs, is you get trained as a mini coach. And so a lot of the skill sets and the lectures and you know, and obviously that's it's free. So so many institutions, I think around the country are now delving into these residency coaching programs that can provide free coaching to some extent for an attending if not get them linked into the system and help them find their own coach.

Ben 38:33

I wanted to go back to what you were talking a minute ago about being a mother and I think for many female physicians, there's always this this concern and this preoccupation with being not present enough for their children. And I think it's a perception because sometimes it's not true but there's this this almost endemic guilt of like oh, whatever time I do spend with my kids, it's still not enough and and sometimes we interview physicians and other professionals and the audience may not know whether how their schedule what their schedule looks like and for the audience, you work a ton and and you've made significant efforts to make sure you were present for your children. I'm wondering exactly how do you manage such a busy and demanding schedule because again, you are a pediatric surgeon, it is stressful it is demanding physically mentally, how do you balance the two so that when you are at home you are not only energized present, but you've also managed to make to create enough time for you to spend with your your kids and your family?

Holly Neville 39:38

Well, I'm I'm definitely only human so I would say I'm successful at the most that I can be, but not 100% No, but my children are my priority. And and therefore you know, I always do my best to treat them as such. You know, my kids are engaged in sports and extracurricular activities. Use and so that actually gives me more time to get home before they get home. They strongly believe in eating dinner at the dinner table. My kids, they really prefer movie night which Friday nights we usually have movie, they get to sit in front of the TV, but they try to talk me into movie night like every night. You know, I actually I love to cook. And so I come home and I cook dinner, usually while they're finishing up so in practice and then we eat together as a family and I think eating together as a family. It's it's really important. It certainly is for me and and so in that regard, I spend the evenings with them. I do take call when the kids were younger. That was back in the day when we used to go back into the hospital for every appendectomy. Now now, appendectomies are urgencies not emergencies. And I actually would come home, have dinner with the family put the kids to bed. And then I would go back in and do my appendectomies after. I really support taking kids to school in the morning. You know, when I worked at University of Miami, every other week, I would take the kids to school every morning, we live within walking distance to where they went to elementary school. And that was my schedule. Now obviously, the kids are bigger once in college, once in high school and drives herself. And then my youngest child is in middle school and I try to drive her to school at least twice a week. The rest of the driving I'm not able to do because she finishes school like two in the afternoon what mom or dad's very challenged. You know, and I think that this, this really, it's not just a mom problem, the parent problem, I rely on a lot on the fact that I read an article a few years back that said that children of working women are more balanced, more successful, more confident. And so I try to give myself a lot of reassurance that my kids are turning out, okay, and that the time that I do spend with them is high quality time. And and that they recognize that I'm there when they need me. And I really do believe that I am, there was a point, son didn't know I was a surgeon.

Ben 42:16

Yeah, having two working parents, I remember that for for us growing up at home, there was never a question whether it work was something we should be doing. Like, like we saw our parents work day in and day out. So there was never a day where we said, hey, like, I don't want to work today. Like this was the tone of the household. And I think it allowed us, my siblings and HB to be successful. Sorry, definitely, we're gonna say something because then they want to move on. So I

Daphna 42:40

wanted to say of note, we're not asking this question, because you're a female physician, we actually ask everybody, how do they manage their work life balance, because especially in our households, you know, the dad, you know, Does, does a good share of the parenting load. So we feel strongly and in fact, in the NICU, we really recognize how much a second parent can can help carry, you know, the the load so, so didn't we just want to be clear that, you know, I hate it when we only asked female physicians one thing, but we actually asked that, I

Ben 43:17

wonder, I wonder, I wonder something definitely about the fact that like, for me, I can be very objective about the amount of time I spend with my daughter, and I just spend a tremendous amount of time with my daughter. But even when I'm working, I'm like, you know, like, I'm very objective about like, Hey, I've spent we've had meaningful interactions this week. And, but I feel like for my wife, even when she does spend a significant amount of time with my daughter, it's never enough. And there's always that guilt somehow. And I talked to her about it. I say, I say you're doing fine. Like why are you feeling bad about this? And, and I'm wondering if this is a maternal thing, where there's never a point where it's enough, it feels like you're right. And so I'm curious, if do you feel Do you feel that

Holly Neville 43:57

there's so much peer pressure back? Sure. And in the in the social networks at school? There, there really is. Gosh, I'm just gonna say there's a little bit of working mom shaming. Yeah, absolutely. I have been asked like, oh, gosh, I'm sorry. You have to work. I have to. I worked so hard to work. Yeah. Afterwards, yes, I do have to work. Like, you know, we do need food on the table. But But that, gosh, I didn't just pick a job like that. I really, like I said, this, I feel is my passion. And you know, and the, the involvement in the school, the school associations and you know, I was the the, what was it called the newsletter writer for years, because it was really the only job I could take. And I felt guilty that I wasn't, you know, going to the all the meetings at 9am. And then the peer pressure is worse than high school and middle school rolled. Absolutely. And then

Daphna 44:56

the Mean Girls never stopped being mean girls do that.

Holly Neville 45:00

On social events, which in Miami, it's tropical chic. I don't know what they,

Daphna 45:04

I don't. But can I wear my scrubs? Right?

Holly Neville 45:09

I'm just a human. And yeah, the judgment. This is this is well, you know what we were talking about earlier, the judgment of how you mom, from the other moms, and from yourself it is, gosh, it's a tough crowd. So if you have kids who are in the elementary and middle school, it gets better in high school, you get the peer pressure lessons. But middle and elementary school, tough crowd, it's hard to win, it's hard to feel like you're winning.

Ben 45:41

I mean, my wife and I have completely stopped, like to these parents meeting 10am On a Thursday, it's like, who who can do that, like 10am on a Thursday, nobody's working.

Daphna 45:53

But I think you gave us a good tip for that early in the in our talking together. And you said like, you just have to tell yourself that, like what I do is enough, in my family situation, and not, you know, I don't know what's going on in those other families, I can't speak to what's going on with them. And I think for our listeners, many of which you just finished this grueling cramming for our board exam, you know, my daughter's a little, a little, she's school aged and, and I thought, Gosh, this week, this month, really, I've really been, you know, not pulling my weight as a mom and, and the other day, she said to me, mommy, your tests all done? I said, Yeah, it's all done. And she said, Well, I'm really proud of you, you've been working really hard. And I saw how much, you know, you've been studying. And that just, you know, blew my mind that, you know, it was not a bad thing for her to see that I was working really hard to do something that was important for for all of us. And so I think it's good, you know, for us to relieve ourselves of that guilt. And that there is there is there are some benefits to having, you know, a parent that works really hard.

Holly Neville 47:09

And when your child recognizes that, that's like, take it record it

Daphna 47:14

that's better than any trophy, right?

Holly Neville 47:19

Believe in societal contribution. Right. I think that schools work is everybody pitches in? Obviously, the way society works, vaccines, everything else, no, everybody has to do their part for society to work well. So I understand the importance of those organizations. And I think for parents, who are struggling with how to make this work, you know, finding a chore, whether it's writing the loot newsletter, I mean, you can do it too, in the morning, they don't. They don't know that. They don't they don't care when you do it. They don't need to know when you do it. But you know, there's always a contribution, right? You know, when you're when your child has the bring things to school lunch, and just always sign up for the silverware plates and napkins. That's right. That's right. Yeah, that's right, jump on that as fast as you can. And then you're really sending your best possible dish. And maybe you're not going maybe you are going but make sure every once in a while you show them that you're actually in a live a live human, you know, and I think do your part and always contribute. And you know, the WhatsApp chats are obviously they're the, they're the saving grace for working parents and also the bane of your existence, you have to sign up. But it allows you to voice and keep involved. And there always are tricks for you know how to really be part of something when you can't show up at 9am. And finding that so it works for you. That certainly does diminish some of the mom guilt and some of the judgment when people see in those organizations that you're pulling your weight, and you're doing a full time job and everything else I think they recognize that are putting in the effort.

Ben 49:05

Yeah, I wanted to before we're gonna get to the end of the show, I really wanted to ask you this question, because you are an exceptional leader. And I've learned from your demeanor from the way you talk to colleagues to parents tremendously since fellowship. But since we're talking about expectations, and I was talking to my wife about this as well, there's, there's really a nasty perception, right that like, if you, if you're opinionated, and you give orders and you're a male, then you're you're a great leader, right? You're a leader, a leader of men, but if if you're, if you're a woman, somehow you come across as like, Oh, she's very bossy, and and there's these dichotomies. And, and I'm wondering what is the way for people who are experiencing that, to navigate it in a way that allows them to continue to succeed and I know we touched a little bit on that before, but I am wondering how you managed to be so successful at growing well as a leader, and earning the respect and the admiration of both your peers and pediatric surgery. But I think also, I can speak for the neonatologist, who really, really respect you and value your opinion. So I'm wondering, how do we go through these motions?

Holly Neville 50:20

I don't know if I have an answer for you on that, then I think that you know, women, especially women, surgeons, gosh, I mean, when I was training, the women's surgeons had such a bad name, you know, really, they were past they were considered to be passive aggressive and ended with cat lady. People were really mean about the women surgeons, and I always took the approach. And I still try to, to the best of my ability this day is to treat people like I want to be treated. And that's, that's families, I may not understand the parents situation, maybe we take care of children that are, are really critically ill. And maybe I would be making different choices than the parents are making. I may even disagree with them completely. But it's not my child, it's their child. And so really just respecting everyone that you come in touch with. And if people are horrible to you, I have no idea what's going on in their life, there may be something really impacting them. And so I try to give people grace for what their interactions may be with me and I, I just tried to live like, like, to the best of my ability, and be the most respectful I can and treat people how I really want to be treated. And so far, so good. It's worked for me, I really even in surgery residency training in Texas. He was treated well, I mean, I had nicknames, but the guys had nicknames too, and theirs were horrible. And my nickname for all of residency was sugar, which, you know, you really cannot be too upset about sugar. argued, maybe it's a little sexist, or what have you. But honestly, if I told you the nicknames of the men, which I cannot on, you would say you take sugar too. You know, and I don't know, I just think that you have to, to come into each day, recognizing that a lot of people are going through a lot of things that we have no idea. And people act well, and people act badly and just to try to hold it together and act like you would like people to act towards yourself.

Ben 52:33

That's a very stoic perspective from you. I really like I mean, you're echoing a lot of the teachings of Stoic philosophers. So I could not agree with you more.

Daphna 52:42

When it comes to attitude, actually, that I think brings us to the next thing we wanted to talk about. We don't always feel like pediatric surgeons want to be in the NICU. We've never felt that way with you, actually. And I wonder, what is it about the NICU that some people just don't just don't want to be there? You know, they come they do a great job, and they work with the families and they take care of the babies. But why do some pay? Why do some surgeons like it? And some surgeons? Not like?

Holly Neville 53:17

I don't know, I actually this is a whole news flash to me. I think everyone goes into pediatric surgery for the for the neonate. The neonatal aspect of Pediatrics is what's what's so unique. What's so interesting. The babies with congenital anomalies, each one's slightly different than the next. It's always such a challenge. It really is. It's invigorating, you know, you really have when you're operating on a newborn one, you're under a huge amount of pressure. Or it's like, perfect, perfect, perfect, but two, you never know exactly what you're going to find which. And again, it's that chance to give someone a healthy lifetime. You know, it's not not an appendix or fixing our hernia. So I'm surprised. I think that, for me, has always been the best and brightest area of collaboration. You have teams coming together who are both incredibly invested in the same like sub kilogram baby. You have the smallest amount of matter with the most amount of investment and the nurses do, you don't find nurses more invested than then in the NICU? So for me, the collaboration when you walk into a NICU is incredible. And you know, Ben, you talk about harassing me at night, but Ben only called me when when a surgeon was needed and you know, and the NICU doctors, they really become very in tune with their patients and and when somebody calls you in the middle of the night, you know, it's going to be for a valid reason. That that's I think the amazing thing about the collaboration between pediatric surgeons and NICU doctors is they're there to kind of totally different schools of thought invest Did all their energy into this just tiny little beam? And that's it's the most fun part of my job. Okay, cool.

Ben 55:10

What is the worst call that a surgeon can get from the NICU? What is the one that

Holly Neville 55:16

from the NICU? You know, the ones that I really, I really don't like is, is, um, fallacies with ruptured sacks. Oh, god, it's so hard to deal with, you know, and it takes more than just creativity, it's kind of Yeah. Um, and none of us like the, you know, the baby who's getting ready to go home, and then comes down with a terrible case of fulminant, necrotizing, enterocolitis. You know, those, those really, you know, just bring you to your knees.

Ben 55:57

I feel like a lot of the Pediatric Surgery literature sometimes is is away from the neonatologist eyes because they get published in surgical journals. And some of it makes its way to the neonatal publications. But I am wondering, What, in your opinion, is the next big thing for pediatric surgery, especially in the NICU? Is there is there one area that that as a as a specialty, you think, is really the next big thing that that pediatric surgery is going to tackle? And what kind of changes are coming down the pipeline?

Holly Neville 56:33

Wow, well, don't you wish that necrotizing enterocolitis will come to an end. I wish I would tell you that was the next big thing people are gonna tackle. I really think that health interventions are starting to become more innovative and ramp up and we're probably going to start to see more more therapies kind of slowly developing over time, I don't think there's going to be a boom repair. You know, we're already doing minimally invasive therapies, and, and all of that. I think one of the, the most common things we see are the babies with imperforate anus, for instance, and the anal rectal anomalies. And I think those babies have have gotten the short sticks, so to speak for a long time, I think that they get repaired or they get sent home. And then there's kind of this drop off and care unless they're at, you know, kind of very specific centers. And so it's not really a NICU thing, but it's a continuation of their care. I really think that starting to be widely recognized as we're not giving the patients the lifestyle they need, that they need, followed on a regular basis and implement more aggressive therapies for giving them real functionality. Long term. So I would say not in the NICU, but coming out of the NICU really being aggressive with a colorectal care that so many of these babies born with with colorectal anomalies need?

Ben 58:06

Definitely, you have the last question. Yeah,

Daphna 58:08

no. My last question, again, really focuses on on collaboration. And you know, what is the best way? If we're going to call you in the middle of the night? You know, what are the things you really what are the pieces you really want of like, the perfect konsult

Holly Neville 58:24

Having worked with residents for so long? I love a console to start with a, you need to come in, or you don't need to come in, I think it's just clean with a long meandering conversation. I mean, I start falling back asleep. And I don't

Daphna 58:42

worry about getting dressed, I guess during Yeah, hard to focus.

Holly Neville 58:45

And so really, you know, that middle of the night console, I think, a very clean like, hey, Holly, I have a problem. And I need you to come in. And then really whatever you say, after that, probably I'm not going to pay that much attention to because I'm popping in my scrubs and running out the door. Or the hey, you know, I need to I need to run something by you can you get up and get to a computer. Another good way to approach things and then I know that it needs to be a very collaborative, like they don't need my body, but they need my eyes to look at X rays and to give them like, basically they need a sounding board. And so, you know, setting it up for a sounding board console. I also I think that's a good strategy. And then the Hey, I just wanted to make sure you're new to see this baby first thing in the morning. We got a baby who has X, Y or Z overnight. So I always think that if you start those expectations as very clean line expectations, it makes the console just go so much better and aids in the collaboration is you know in the middle of the night your brain is looking for how can I get back to sleep and if you open a window, even a little crack, the surgeon is going to try to take it and And I see mistakes that are made because Because somehow the surgeon managed to get back to sleep. And they shouldn't have rightly should have come in. And I think just making that very clear. I mean, you guys know, you know, there's a problem. And you're don't want to make the surgeon come in, but I feel like maybe they need to come in.

Daphna 1:00:22

Yeah, I think a lot of people take the approaches by build a really good story, they'll just say that those have been when, when we should just tell you what we know is the end result, right?

Holly Neville 1:00:35

Called call for a reason, right? Yeah, yeah. And so and surgeons are on call, and they have to stay close to the hospital and all those things. Because they may have to come in for an emergency. So I really for me, it's so much easier on my brain. Because I know when when someone calls me about something that doesn't sound quite right. And I say, Well, do you need me to come in? They're like, Nah, but yet, the rest of the night or the next few hours until I finally been, I can't sleep anyway, because I know I'm doing the wrong thing, too. I just think it's easier when we all agree, you're gonna come in. And honestly, I think that people need to lose the shame in the game, right? This comes in and they get there and they're like, this is totally fine. Okay, who cares? That's why they need to take call, everybody just needs to get over it. And sometimes people are going to drive in for no good reason. But it was for a good reason. You thought the patient needed to be seen. So everything is to recognize that and I think that teams get along a lot better when there's very clean communication. And so just need to come, I need you to get up and look at this. Or, hey, just see this in the morning. That's how I love a console. That's great. Awesome. I

Daphna 1:01:51

think it really this. I love the framework, I think it speaks to what a compassionate person you are. More than anything

Unknown Speaker 1:02:00

for sleep, or the other.

Ben 1:02:05

This was tremendous. I'm going to play that last soundbite to my medical students who were talking about, like how to call a consult. So

Daphna 1:02:11

that's the right thing about do it. How do I call me attending? How do I call any consults, I think that's valuable.

Holly Neville 1:02:18

Total residents calling me in the middle of the night, just just started out with get out of bed and start or I don't need you to come in, but it just makes the rest of the conversation otherwise you're trying to figure out, you know, really, the rest of its focused on me trying to figure out can I go back to sleep, please? Um, so which isn't the right thing for the patient? Right? So it's much clearer if the first line is just how am I going to get there as fast as I can just makes it easier.

Ben 1:02:51

Holly, thank you. Thank you so much for being on the show with us today for sharing so much knowledge and advice. I think people will benefit tremendously. I'm probably going to give this episode early release to my wife, because so many of the things we've talked about. But yeah, no, thank you. This was this was tremendous.

Holly Neville 1:03:10

I know Ben and Daphna. Thanks so much for inviting me. It was really fun talking with you guys today. Thank you.

Ben 1:03:24

Thank you