Connecting with Allie has been an absolute blessing. You may know her better as @patchesofot and the host of the Patches of OT podcast. Her content is super unique and deeply personally engrained. This engrained passion is what initially drew me to her. We discuss all things trauma and her experience she had through researching it through her doctorate.
If you don’t already, jump on and follow Allie on insta and also give her podcast a listen!
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Brock Cook 0:01
Hi, and welcome to a brand new episode. This episode, I sat down with the wonderful Allie Watkins, you may know her on Instagram as patches of OT, her Capstone for her doctorate program was around looking at essentially the the vicarious trauma caused in a forensic nursing setting in an emergency department. And so we delve into that, and what lessons may be learned for Occupational Therapists from that as well. I will preface this by saying that we do talk broadly about a variety of different traumas that we’re seeing through that emergency department. If that is something that triggers you, then please feel free to skip this one and hang out for the next episode. But it is a very valuable learning experience. And I thank Ollie a ton for coming on and having the conversation with me. So let’s roll the intro. Get a My name is Brock Cook, and welcome to occupied. In this podcast, we’re aiming to put the occupation in occupational therapy. We explore the people topics, theories and underpinnings that make this profession so incredible. If you’re new here, you can find all of our previous episodes and resources at occupied podcast.com. But for now, let’s roll the episode.
Allie Watkins 1:33
That’s a great question. I started out at my bachelor’s degree studying Science Technology and Society, which is a degree pretty much for the unknown. And I was going to be a it is very, very broad. And so my goal and undergrad was to become a pediatric oncologist, a doctor. But I went through a lot of life events that made me reconsider. One was in high school. I helped a victim drown, and it was a friend of mine. And I thought it was a sign of that I need to get into the health field. And I developed PTSD. from that situation, I didn’t know that I developed PTSD. And so I went years having these symptoms and thinking that there was something wrong with me. And I was like, How can I be a medical doctor if I am triggered by saving someone’s life. And so I started reconsidering, you know, what I’m going to do for my career. And my aunt currently at the time was working at an OT program, and she’s like, you should do occupational therapy. And he said, I have no idea what that is. I am not interested.
Brock Cook 2:56
No, not like PT,
Allie Watkins 2:57
like I was the no one knows. And she said, You know, they work with kids, they work with adults. They even can work with cancer patients. And I was so interested in that. And I was like, Huh, so I started researching it my senior year of college. And, you know, I was like, wow, this is sounds exactly what I wanted to do. You can, you know, then I was considering at the time PT versus OT, and I really liked how ot looked at the mind. And, you know, mental health part of it. And so, you know, having PTSD and depression and anxiety, and going through all that I was like, oh T is more my route. And I can probably help people more with those mental health issues than their physical bodies in general. And so I applied for ot school, I had to take one year break to take like anatomy courses that I never took at my undergrad school because it was pa and pharmacy driven where I went to school and so I had never had the opportunity to take the anatomy courses. And so that’s where my ot journey kind of begins.
Brock Cook 4:09
So what was the Why would you find it? I’ve not heard of someone so young having such an interesting cancer was their experience that sort of drove you to that?
Allie Watkins 4:27
Yes, when I was really young, I have a younger brother and we went to daycare. And our friend My brother’s best friend developed leukemia. And that was the first time we’ve heard what they call the C word which is cancer. And, you know, we would go to his house and play with him and he would get sick and then we would go to the Children’s Hospital here in Indianapolis called Riley’s and we would make treats for all the families who were in the oncology department. And so, the weekend before he passed, we went and visited him. And I went to the room next to him what was a cancer patient and his sister, the, the child’s sister asked me if you want to play a board game, and I said, Okay, why not. And she looked really sad when I entered the room. And then once we started playing, I think it was Candyland. a board game. She was so happy, it changed her whole outlook of the day, just to have three little girls all in one room in her hospital bed playing a board game. And from there, I said, I want to make kids happy when they’re going through such a toll of cancer. And so that moment on I knew that that’s kind of what I wanted to do.
Brock Cook 5:56
Allie Watkins 5:59
Brock Cook 6:02
This Yeah, thinking about it. I’m sorry. Yeah.
Allie Watkins 6:07
I said, Just thinking about it right now. I’m like, wow, I forgot about that, like story. You know, I don’t get to talk about it that often. But it’s like, oh, you know, it does, like, bring, it’s emotional. But definitely wasn’t one of the one of the most rewarding things in my life at a young age, especially to learn and develop empathy as a child.
Brock Cook 6:31
Yeah. And that’s, that’s a, that’s a pretty heavy experience for for any kid to sort of go through. That’s why I was, it’s, I’ve not heard of anyone straight out of the gate going, like, I want to work in oncology. I’m like, that spot didn’t even know what oncology meant when I was a kid. So I would assume there was some history there. But it sounds like it was a fairly pivotal moment in your development, if even if it wasn’t to do with your career, but
Allie Watkins 7:03
Oh, definitely, I would, you know, everybody asked when you’re growing up, what do you want be when you would be an IV, like pediatric oncologist and be like, what?
Brock Cook 7:13
fireman or Superman and you want a pediatric? Yeah.
Allie Watkins 7:21
And, you know, I’m, I’m very lucky that with OT, you can work with patients, it’s, it’s hard to get into, I will say, and, but you can work with people that have an oncology department, and I hope one day that I could do that.
Brock Cook 7:37
So that’s still the goal is to work in that field.
Allie Watkins 7:44
I think so, um, you know, now that I’ve been on rotations there, like I worked a lot in outpatient pedes. And so you see, I’ve worked with a couple kids that have survived cancer. And, you know, I still am very rewarded with that I feel when you are so compassionate or passionate about population, and then you get to work with them. And then your kind of cup is filled, and you’re not as burnt out. And so, I’m working with them. I’m like, okay, like this, I also had a placement in Hippotherapy, and I loved it, there was so magical to see the kids get on the horses, and with all different diagnosis, and they felt like they were included for the first time that they could do something that other people could do. That was hard and challenging. And so I think that is also something I could see myself doing.
Brock Cook 8:40
I’m sure there’s probably even areas we can bind to. I’d be surprised there wasn’t given the just how those caper theory how hypnotherapy works, etc.
Allie Watkins 8:57
Oh, sure, I was going to do my capstone on service animals and cancer. There’s a big research on how kids with cancer develop a high a score due to medical trauma that they are going through in all the mental health issues that they will continue to have if they survived cancer, because if you develop cancer at a young age, you’re always going to have that fear once they’re going to come back. Yep. And so being, you know, an OT, to help kind of work through that trauma. And usually when people are impacted at such a young age with trauma, they are they like lack social skills, they lack the ability to just have those developmental milestones meet. And so I think it would be super, super interesting to have an OT who specializes in animal assisted therapy and then oncology to help with that gap.
Brock Cook 9:58
So with the Just thinking about all what you just said then about how kids who develop cancer, when they, when they, when they’re kids, obviously, when they’re younger, tend to have this sort of constant fear about when it’s coming back. Was there any sort of, I guess, similar fear but vicariously for you going through the experience you had with your brother’s friend? Did you sort of develop this, like all it could happen to me kind of, I guess fear at a young age. Oh,
Allie Watkins 10:31
oh, totally. I like I constantly I actually have found cancer on my body. And so I’m a freckly girl. And so I have to get like my moles and freckles checked. And so I actually a couple years ago, they found cancer. It was like the first level. And so I was very lucky that they were able to remove it. But every time going, like, being involved in such a heavy case, at a young age, and seeing how the family grieved and dealt with their child having cancer, I always was concerned that, you know, I was going to get cancer or, you know, I guess I was traumatized by, you know, if I would ever get it myself or my brother. But then, you know, I still have the fear of like, Okay, I need to get my moles checked. It’s been about a year, and I’ve already had, you know, one incident. So I definitely, and I have severe stomach issues. And so my family has a history of stomach cancer and IBS. And so I. So I yeah, I guess I’ve never even thought about that, I guess I am a warrior that I will, you know, one day also get cancer.
Brock Cook 11:48
Because I get so many great questions. What I do. Now, I guess, like what what we’re planning to talk about, I’m kind of, I’m always curious about if there’s any sort of, or what the roots of those kinds of ideas are. And we want to have a look at your your Capstone, which is around sort of, essentially vicarious trauma of people in in emergency departments. Obviously, we can sort of have a look and see where you’re interested in oncology sort of stems from, but I also wondered whether there was some kind of root of interest in sort of vicarious trauma. And it sounds like that possibly might be a couple of instances where that may have stemmed from,
Allie Watkins 12:41
oh, yes, I have a very high a score. And if you’re not familiar with a scores, I’m sure you are, it’s adverse childhood experiences. And so if you have a higher a score for you are more likely to develop cancer, you know, chronic illnesses as you get older, or just unable to emotionally regulate. And so, I, Alli cannot emotionally regulate that well, when I come in tact with stimuli that I think is defensive. Or that, you know, my fight or flight system goes into action, which it happens frequently, due to my high a score in the past. And so I have to constantly be working on Take a deep breath in and out before I react to a situation because sometimes I react and it’s kind of overreacting. And so I have to really work on my social awareness and emotional regulation. And, you know, that’s taken a lot of time. But that’s just how my brain was wired as a child, and you know, it was going to my flight or fight system, my central nervous system, rather than my prefrontal cortex as a child. And so I’m still working on it.
Brock Cook 13:54
Did you do is this all stuff that you’ve like, taught yourself, or did you see any other profession during your childhood or more recently to help develop those sort of regulation skills?
Allie Watkins 14:14
Oh, yeah, um, I, you know, I feel like trauma, if you have a high a score, it usually, I don’t know, I feel like trauma follows you everywhere it goes, or you’re more sensitive to the world, or maybe you have a low resilience score. And, you know, I feel like I’m building I’m constantly rebuilding my resilience, because I started off very low. And so, around college, I didn’t really have a social support system, meaning like my family, we did not have a close relationship at all. I just felt really alone in the world. And so I started listening to Renee Brown, and on her research on connection, empathy and vulnerability, and I will tell you, her work was Life Changing, I would listen and re listen to her TED Talks into her audio books, I even ran a marathon. Just listening to all her work, and I would start to practice those things. And now I’m starting to listen to her podcast and every person that she has on there, I’m like buying their books and doing all the self help situations. But when it comes to neuro, I’ve definitely felt like I taught myself with like, the neural pathways and why I am the way I am. And with my capstone, now, I, you know, wanted to learn about trauma informed care. So honestly, I could about myself and how I deal with things. And so yeah, I guess that’s kind of why I went that way. Now that I think about it,
Brock Cook 15:53
thinking it’s good. That’s what we’re all about here. Looking is great. So let’s dive into it. So what what, what is your Capstone about?
Allie Watkins 16:09
So, I originally was supposed to do a capstone on pediatric oncology, working with kids and service dogs in working on social participation, that did not happen due to COVID. Um, this participation piece kind of knocked that out. So I had to kind of dig around last minute in order to graduate on time. And so I was between racial injustice, since that is a huge problem, especially here in America. And I was going to maybe go to a police academies and talk to the police officers about implicit bias, how to work with kids or adults that have sensory issues, or that may have autism. Then I was going to do a more love on the spectrum kind of thing on that. It’s a series on Netflix, on like, bits with disability dating. That was already taken, though, and I was like, dang it, I want to be original, and then go to the place of I’m like, oh, OTS really do a lot of work in human trafficking, or that’s a new spike that’s coming up, I guess you could say trend. And so I was really interested in that. So I looked at the hospitals around me. And I saw that there was a hospital that had an organization that helped victims or patients who, with domestic violence, sexual abuse, or if they their child was going through something, and they suspect something, and so they are called forensic nurses. Now, ooh, I could do something that, you know, could help me learn more about this population, and bring something to them. So I talked to the site mentor, and she says we are burnt out with the COVID pandemic, and the rise in quarantine, domestic violence cases, because people are stuck at home. We are experiencing tremendous turnover. We’re mentally fatigue, we’re seeing somewhat reading these cases, multiple cases over and over again, we’re seeing deaths, adults and kids, and we need help. And so it’s like, well, let me try. So I am currently creating a educational series on burnout, vicarious trauma and occupational balance to help with burnout in the with the forensic nurses in the emergency room.
Brock Cook 18:44
Your interest areas, just shock me this. So out there. So while a little bit human trafficking, where did you get that interest area?
Allie Watkins 18:59
I know. Um, so I think it kind of all stems back from, you know, I created patches of ot because as I was learning about OT, I was learning that there’s all these different out there, populations that we could work with. And so as I was doing my capstone, I was like, oh, my goodness, Human trafficking is a big issue. Like, I have a couple friends that are police officers. And they were like, oh, my goodness, like this is a huge issue. Like one of them had to, you know, bring a patient to the hospital and she was being human trafficked. And it’s more of an issue than we think of it is and it’s not, Human trafficking is not exactly what we think of it is, you know, we think of the movie taken. I think that’s the movie called where you go
Brock Cook 19:50
all my knowledge around human trafficking come from.
Allie Watkins 19:55
Exactly, but it could be more It’s so subtle, like, someone is learning you, and then they may be paying you or giving you nice things just to make you feel well, or, you know, there’s called recruiters and they be, you know, other females or males that trying to pay you more money and you’re being human trafficked, and you don’t really know it. You can think of the Epstein cases, those females are being human trafficked, not knowing it. So it gets really deep. And when we have patients come in, you don’t want to say, Hey, we think you’re being human trafficked, because people will take that really offensively. And so we have to kind of like go around the corner and tell them that you know, what we think it might be happening to them. So I think it’s fascinating, I just think, I don’t know, like, maybe like, when I see problems in the world, I want to jump in and try to help out. And so I’m like, oh, human trafficking, what can I do to help? And what can I do to learn? And
Brock Cook 21:09
so yeah, I think one of those like, can be included. If your relationship with the concept is from, say, movies like taken, and there’s a couple other ones, but I feel like some people would be shocked to hear that that’s actually a big problem in the States. Because that, like if you if you think that it is solely and again, like I said, I’m included, thought that it was solely people being stolen from an airport and drugged and sold in an auction. You probably I couldn’t picture that sort of really happening in America, or like in the country. It’s something that yes, would happen overseas or while you’re traveling again, probably just because of the movie. Yeah.
Allie Watkins 22:00
They say so fun fact about Indianapolis. Um, fun fact is when a super
Brock Cook 22:08
Allie Watkins 22:11
Yeah. So when the Super Bowl happens here in United States, it is the biggest form of sex trafficking because everybody’s coming together and that that’s where it happens the most. And so when Indianapolis hosted the Super Bowl a couple years ago, people Airbnb was started becoming a new thing. And so that’s where you can rent out houses for really cheap, and these were turning into houses for human trafficking. And so that’s why they’ve stopped in the future, less renting out houses, and during the Superbowl because of what happened in Indianapolis, and I just like, wow, like, they had to stop something in the system because of a huge issue that wasn’t even being talked about.
Brock Cook 22:56
I’ve never even seen.
Allie Watkins 23:00
Hmm, I didn’t either until I went to my fieldwork. And they had like such a rise in cases around the Superbowl. And so I guess it’s actually very common, but that’s not fun fact that people don’t know. Yeah.
Brock Cook 23:14
Yeah, I’ve heard a lot about human trafficking. But I’ve heard sports events I carry, it was a sport event here. Well, we like a grand final of some code of football academy, which one was the there was a massive spike in domestic violence during the game. And they were saying that it’s essentially because people were locked down. And we’re drinking a lot more than, you know, normal and that kind of stuff. But yeah, I have not heard of it being like set up as a would have to be like a deliberate, like you couldn’t accidentally human traffic someone I’m assuming it would have to be like, especially Airbnb stuff and planning, it would have to be a very deliberate sort of action.
Allie Watkins 24:03
Very much. So. Yeah, it’s I think it’s increasing, too. I haven’t looked at the full stats on human trafficking here in the States. But you know, it’s becoming more of a hot topic and a movement. And so that’s great to hear about, but when the problems come up from higher authorities or people with money, how do we defeat that? Yeah, the bottom up.
Brock Cook 24:31
Yeah, I’ve seen a few people discussing it recently. And again, I’ve just gone on they’re just they care about what’s going on in what even I don’t even know what country that movie was in. But yeah, never actually considered that it was something that might be happening in the States. But I guess when you broaden the definition and highlight sort of what else that includes, now I can picture Okay, yeah, that I can see that happening.
Allie Watkins 25:02
Oh yes, or, you know, we have many cases where females are being drugged. And, you know, they’re being drugged by other females to, you know, create the human trafficking, they’re all part of a system. And so we see that a lot, and they just don’t know, you know, because they don’t remember. And then it just keeps happening. So it’s just, it’s so unfortunate it is. So I learned so much at my capstone and seeing so much I realized now why these nurses are experiencing, you know, so much trauma, and it’s heavy.
Brock Cook 25:40
Yeah. So you were looking at sort of very traumatic cases coming in through an emergency department, and the impact of that was having on the nursing staff there. What, I guess, Ben, yeah, we’ll give a trigger warning to people, but what sorts of things were they seeing come through the doors,
Allie Watkins 26:07
you can see about anything. And so I guess the most cases that they see are sexually sexual assault. And so that could be in adults and pediatrics. And we see, unfortunately, a lot of those cases, especially in pediatrics. And so that’s our number one. The second is domestic violence, it’s rising due to quarantine and people being locked down. And that is what they’re calling the silent pandemic, of the increase of domestic violence, and whether that’s partners hitting each other, or just random. And then we also see gunshot wounds, we see stabbings, we see vehicle accidents. And you know, any kind of accident that could have been done by someone else, whether that was intentional, or by accident. So what the forensic nurses do is when they get a case, so we call it a trauma code one, and they’ll ring over the emergency department, and we’ll get buzzed. And we’ll give a little case of what’s going on. And, for instance, we had a gunshot wound come in. And so we would run down there Wait for the person to be delivered in the trauma room. And then the forensic nurse would take pictures as they’re doing the medical assessment to make sure that this person is still surviving and is going to be alive. And so they like have special cameras and a ruler to kind of measure where the, you know where the wounds are at. And then we would collect? Yeah, yeah. And then we would take their clothing and take pictures of that, and measure the, you know, wound size or bloodstains, and then we would bag it up in an evidence bag and then seal it up with their initials to make sure that no one breaks the seal, we would take the bullet, and we wouldn’t call it a bullet. They would call it something medical. So we couldn’t be taken to court by it for. So once the O r got to the bullet. Yes, a foreign metallic object. And they would put it in a box and do the same thing. And then we bag that all up and give it to the legal team from there. And so the nurses can go to court and be subpoenaed. And so they have to be really careful and their documentation and say exactly what the patient says. And so it’s really interesting. We’ve had multiple cases come in and it’s just so eye opening. And, you know, we’ve seen everything that you can see with gunshot wounds, stabby eggs, people that have been stabbed, but don’t want to come in. So it’s like four day old stab and we’re like, oh, I’m really bad cases to where you see. Yeah, patients pass away. Little kid that’s the hardest is little kids passing away. Yeah, those those days are heavy. And we’ve had I’ve been, I’ve been there and seen it. And that’s really unfortunate. But yeah, so they see about anything.
Brock Cook 29:16
So with the obviously the the forensic nurses a different position to have the regular, like nurses in the DEA, obviously something like a gunshot wound, there’s a fair chance that that’s gonna be something that requires forensic involvement, but how do they decipher like, obviously, some dv cases, the injuries or the wounds, especially if the person’s not, I guess, coming forth and telling staff how it happened. Some of them could look very similar to you know, when you get in other instances that aren’t dv. How do they know like when or to get involved?
Allie Watkins 30:01
Yes, that’s a great question. So since there’s such a rise in domestic violence cases, there’s so many times your nurse that’s working on a patient. And if they slip something out and say, Oh, you know, I didn’t really fall, I was pushed out a window, which has happened, and then they’re like, ringing us up on the buzzer and saying, Hey, we possibly have this going on, and can you talk to them, and if they consent, we could, you know, provide our services. And so that’s a huge part of it, too, is that, you know, they could tell their story to us or refuse to, but they also have the right to either go, like, if they want pictures to be taken, we can help them out legally, in that sense, but they don’t want to, then we step away. And usually, that’s what we also see, too, is people who are in domestic violence cases, they go through the same, like, they’re in the cycle of trauma, and they go back to, you know, their abuser. And a lot of the times we’re educating our patients, you know, hey, this is a vicious cycle that you’re in. And, you know, if you think this is bad, it can be worse. And but using a lot of trauma informed care, we’re here for you. We believe you, we are really concerned for you Do you have a safe place to go? And so, unfortunately, you just see that a lot. It’s like, you know, I can take care of myself, I can do this. And and and it’s sad, because the cycle is so real. And it happens all the time.
Brock Cook 31:46
As you like you spoke about earlier, like someone who has a higher score has experienced different kinds of trauma and that sort of stuff through our own life. How did coming into contact? Or obviously, you mean, you volunteered for that position? So you knew what, I assume you assume you knew what was involved? How did that? Did? What did what you thought beforehand would be involved? Was it the same? Or was it better or worse? How did it play out when you actually started?
Allie Watkins 33:06
So it’s definitely glamorized being a forensic nurse. And people were like, ooh, like NCIS. Or, you know, want to take photos and be super cool. But I knew what I was getting into, because I, in the back of my head, also had to think about my PTSD. And you know, I haven’t been triggered lately. But my PTSD is saving someone or when something really traumatic comes usually in the back of my head is like, how can I save them? How can I save them? Because that’s what I had to do for a child that was completely purple. And so, you know, I was mentally preparing myself, am I going to be able to be resilient? And, you know, be able to do this? Or is my PTSD gonna limit me? And my abilities to be even at this site? And so I’ve been kind of pushing myself when we have someone come in, and the emergency room and they are, they lost both legs because of a vehicle accident and you see mangled body parts, it’s I instead of being scared or having what, what usually is PTSD side effects, which is like racing, heart sweating, you feel like you’re going to pass out. I’m at the window, looking at this. Oh, where’s that body pottery go and are they going to amputate is going to be a lower or upper party? Is it good, you know, and so I am so proud of myself that it’s been such a long journey for me to overcome and get my body regulated to this environment that I’m now stable and because I was terrified, I would never be able to be in this highly intensive medical practice because of my past trauma. And so, you know, I wasn’t prepared to see you know, children being the way they’re treated. Now. I didn’t expect to see that a lot. But it’s an Every day occurrence, and it’s, that’s where it gets me because, you know, you people choose to be in a relationship, you know, whether it’s violent or you know, not in the end, I know, mentally, it’s hard to get out of those relationships, I totally get that a child is, you know, they don’t have any safety net. And so that that is hard to see very, very hard to see.
Brock Cook 35:30
The suffering I just saw a lot and experienced a lot within, like mental health practice is there were things that say at the start of my career that you’ve seen, you be like, oh, shocked, bit sort of caught off guard, and then after a while you kind of get desensitized to it is the I’m assuming there would be a similar phenomenon, probably, to a much more extreme degree within the staff that work in these these trauma centers in these emergency departments. Is that something you’ve noticed?
Allie Watkins 36:06
I think, two point, because in the research, there is a lot about how EDI nurses, or forensic nurses can develop very bad vicarious trauma from just reading a case on a piece of paper, and my site mentor, that’s all she does, if she’s not seeing patients is she’s reading these stories. And there’s a difference between seeing something a patient come in and like, kind of seeing what they’re what’s on their body, but to physically sit down and read their whole story is another has another effect, like your reading, like, their emotions and what they went through and how they survived and what they might go back to. And then the biggest part is with the emergency room is you don’t see the outcome. So this patient may go home, and then you’re now worried about them because like, oh, shoot, are they going back to that bad environment? Did they survive? If it’s a, you know, we really hope that child’s you know, services took them out that situation, but we we never find that out? And so, or did the police take action? Are they going to, you know, put the boyfriend in jail for beating the crap out of this kid? You don’t hear any of that. And so, you often see the nurses do a lot of digging, like, you know, like if they, you know, if a police officer comes in, they may say, hey, you worked on this case, this person got locked up, we just wanted to let you know that. And they’re like, yes, it’s a full circle. Experience, which is what they’re lacking. They’re not getting that full circle. confirmation that that patient is safe. They’re constantly worrying, even if it’s subconsciously, they’re worried about that. And then you stack on the you get so many patients in a day that you’re like worrying about all these people. So think that’s the hard part. I feel like they will never, the nurses will never just become immune to it. They might be immune to like doing the pelvic exams and going through the motions of that. But to know, the backstories are hard,
Brock Cook 38:12
more desensitized to the, I guess the, the clinical aspect, more than the experience of Yeah. And that’s that, yeah, cuz that feedback loop is something that I have. Again, I’ve also and I’ve said to many people, the experience of working in an acute mental health unit is you only ever see people are at their worst, and you’ll never see, you know, the other 90% of their life kind of thing. And you do get kind of caught up in that. I was gonna say drama bubble, but it’s not it’s you get sort of not desensitized, but you get kind of in this mindset that this is it. This is mental health, when you really only seeing that sort of, you know, top 5% of people at their worst and you never see anything else. And I suspect again, to a much more extreme degree that working in an EDI would be that no one ever comes into EDI to go Hey, I’m feeling Awesome. Thanks, guys. If they’re in there, generally because something’s really bad. Yes, yes, that’s 100% true. So what, how long we are, how long have you been in for?
Allie Watkins 39:41
I am there. I’m there for 14 weeks. So pretty pretty long. And so I definitely had to consider my own mental health because even though I’ve become resilient, and with my PTSD, you know, I do. Go to a counselor and I do checkups You know, whether it’s with my husband or social support or with the forensic nurses there, they’ve even said having someone else there, because usually it’s one nurse, per like shift, and they work 24 hours. Just having someone there to kind of vent to, is nice. And so they do three twelves. So that the place I’m working at right now is constantly open 24 hours. And so usually they’re just by themselves working. And they can kind of been in kind of get out what they’re feeling in their emotions. Even be interesting, too, it’s
Brock Cook 40:34
like, I’d be interested to see what the effect is of just working solo shifts, because I think I’ve, I have done that in one role. But it was only like, there was some overlaps. I think it was like, there was a couple of hours in each shift where you are on your own, but that was it. And even then you hated those hours. Well, I can’t imagine constantly working like other people around but like you said, there’s, there’s no one that you can sort of like vent to or is in the same position as you are. Yeah, I can’t even imagine just the stress of doing that little out everything else on top of it would not be that would that would count me out anyway.
Allie Watkins 41:21
Oh, yes. And that’s like, one of the biggest complaints, you know, is with burnout. It’s like, man, we can’t even talk to anybody about these cases, or what we just witness or you know, them, they can talk to me, cuz they’re like, this is what I’m doing. And this is how I’ve been, you know, technically, it’s just them going through their emotions and talking about it out loud. And I’m like, Okay, cool. Even if they like repeat themselves, I’m like, get it all out.
Brock Cook 41:42
Yeah, but then just just having someone else there can be a massive support. And that goes for anyone, like anyone who’s looking at burnout, no matter what field they’re in, one of the big things that I’ve seen with people that are getting burned out is their lack of connection, or the lack of social support, or like professional support, or like, clinical support. Yeah, that’s that even just on paper, this is a recipe for burning people out. Let’s put them in probably the most dramatic. Let’s put them in there on their own.
Allie Watkins 42:19
Yeah, exactly. It is. So I can’t even imagine, you know them doing this. And so they did just hire someone else to kind of work image ship. This is the first time they’ve done it. And so she started last week. And so, you know, that’s going to be helpful, because she’ll be there with someone. And so that will kind of help with that loneliness piece. And so that’s new. So I’m really excited to see how that turns out. So, but usually, they have such a high turnover.
Brock Cook 42:54
I was gonna say, so they’ve had such a high turnover. Have you know, have you witnessed that in your time there already.
Allie Watkins 43:03
I have not witnessed that. I when I first started, they were they had a new nurse starting as well. And so I was watching her observe and learn. And as I was watching her observe and learn, I was told this is the third nurse in the last year. So I was like, oh, okay, so this is the issues we’re having now. And usually, it’s because the nurses just can’t handle what they’re seeing, you know, they think, Oh, I’m going to go. I’m scenes and I’m going to take pictures. No, you’re actually going to stay in the hospital. And you’re going to be taking pictures of body parts all day and seeing all this stuff. And they’re like, Oh, this is not the field I want to be in. Yeah. And then they figure out that they’re alone. And then you know they’re going through, and especially in the research shows that forensic nurses who have past trauma high scores, they are more likely to get burnout faster, because they are going to think about their past drama, when they’re dealing with a patient and so they don’t have that much resilience when it comes to this field. And so my capstone, I’ve been collecting their Ace scores and kind of seeing Okay, where it Where are you and do you feel this way, which is really interesting in itself.
Brock Cook 44:18
So are they are they screened before they go into the job?
Allie Watkins 44:24
They are not. Their site mentor is so awesome. She’s, you know, super personable. But I don’t think they are which I think that would be a great thing to add to that position. So with my capstone, I do have them do a burnout scale and I do have them do a resilience skill to see if they have high Ace with or high burnout with a low resilience, which is a recipe for burnout or, you know, vice versa. And then then we do an ACE score during the educational series. And then near the end of the educational series, we’ll do a retake of those burnout scale and the resilience score to see if they differ. But who knows?
Brock Cook 45:13
So the ice, although I’m not familiar, I mean, I know what it is, but I’m not familiar with it. It’s not something I’ve ever done or had any involvement with. So when is that? Like, obviously not in this situation? But when would that normally be administered to people like people like you’ve had your a school done, obviously, but when is it a pediatric thing? Something you do later in life? Or what? Like, when is it actually usually rolled it out?
Allie Watkins 45:40
That’s a great question. Because I don’t feel like a lot of hospitals here. Maybe in the US, don’t utilize it that much. I know when I went, and I had to seek it out. So I learned about it. And I was like, oh, what’s my score? Google? Okay, oh, here’s my a score. That’s not so good. That explains a lot of things. But when I recently went to my mental health, I got a new mental health doctor, they did an ACE score screen. And I was like, Ooh, that’s cool. I know, that is without telling me. And then when I went to my new primary doctor, year ago, they had me fill out a score. And they didn’t tell me it was an a score, but I knew the question. Okay, that’s interesting. So I feel like people are implementing more, but I think OTS, especially like pediatrics, you know, or mental health settings, they should, you know, that would be a good, it’s a free resource that you could see what the a score is. And, you know, the questions are like, have you seen parents hit each other at home? That’s like, one of the questions yes or no? Have you witnessed a loved one passed away? Yes or no. And so, those add up? And then you know, you’ll find if you’re before, which a lot of people are over four, then you’re you have a lot of trauma suppressing your Yeah, most people, most people are more?
Brock Cook 47:03
No. So is it? Is it looking at a specific timeframe? So like, if I was to fill mine out now, am I thinking about when I was under 10? Or am I What? When is the what’s the timeframe? It is zero to 18? Okay.
Allie Watkins 47:25
Yeah, anything that happened? Like around before under your 18? And so I think that usually set at the top too. So it’s really easy to fill out. I hope you point out after just googling,
Brock Cook 47:40
for one, I don’t think there’s gonna be too much in it. But I’ll, I’m curious. I’ll definitely feel one out. I am curious about the age of 18. Though, that seems rather arbitrary.
Allie Watkins 47:55
I don’t know. I think it’s because like your teenager? I don’t know. Yeah, I don’t know why 18. Cuz I would have thought that the person who study?
Brock Cook 48:03
Yeah, I would have thought sort of early 20s given that our sort of values and that sort of stuff are continuing to be shaped up until that point, and any kind of trauma is gonna have a big impact on, you know, how you see the world, how you shape your lens up until sort of that, I mean, it’s still gonna have an impact afterwards, but it’s gonna have a bigger impact, because you’re still forming those values. That value system up until that point, it doesn’t sort of go ad. Yep. And there’s not like in the States, I don’t think there’s any sort of big thing that does happen after 18. Like, I’m thinking like, legally. So like, in Australia, the drinking age is 18. Like, that’s probably the biggest thing that happens at ID. Other than that, other than that, like, there’s nothing else that really happens, I’m still an immature brat at 19. Like, that didn’t change overnight.
Allie Watkins 49:05
That’s true. That’s a great question. I don’t know why the cutoff is 18. But now I’m gonna have to look it up when I’m down here.
Brock Cook 49:13
I just wonder whether you like if you ran it, even though it’s standardized to 18. A lot of the time, those kinds of things are just because this is who we had access to. But I wonder whether like if I ran it with someone who was or like if I ran it on myself thinking about up until sort of, for me, it’s probably later because I’m immature. But so 24 ish, 23 ish. Whether or not like the results would be invalidated. I mean, obviously, they wouldn’t be as standardized as if I just filled it out based on my first 18 years. But yeah, it’s interesting. Yes. Very interesting. Because Yeah, I’m not I’m not I’m not fully up on the trauma thing. Obviously. I know. I’ve been about sort of trauma informed care and would hardly not even remotely say that I’m an expert in it. I’ve worked with a lot of people who’ve experienced trauma and that kind of thing. But sort of the very few things that I do know that trauma is one of the only things that will change your value system after us sort of concreted in. And to me, I’m like, that’s, that’s a pretty big thing, you can literally come out of something with a completely different perspective on life, which previously wasn’t even possible. Which is why I just find that at the age of eight, that’s why I sort of went 18 why it like, it’s not like we just all of a sudden become super resilient after 18 or anything.
Allie Watkins 50:49
So true, and a lot of the hard things come in our 20s, whether that’s, you know, grandparents passing way or odd relationship or domestic violence within our own relationships. Yeah.
Brock Cook 50:59
Moving especially, especially people that are like people are living at home later. You know, previously, it might have been that, you know, at 18 was when people finished high school and moved out of home. Like that might have been a big transition period. But people aren’t doing that so much nowadays, they’re living at home until sort of after university, so I might be living in home at all 2530 some cases. So I think I wonder whether, I mean, again, I’m basing this off not knowing anything about this assessment, but just those sort of those like very concrete stipulations always flag for me in my head. I’m like, I wonder why that is. Because some cases, in some of them, I have found what I have learned that, you know, are this is done that this to this age, because this is what we found. I’m like, Oh, that’s interesting. Whereas Yeah, this I’m like, I wonder why it’s 18 and not. Why not? 16? Like, why? Interesting. Yeah, that’s good. That’s good. I thought about that. My God goes to 18. How long does it take to do?
Allie Watkins 52:09
It literally takes like, probably two minutes. You should take it.
Brock Cook 52:13
Alright, let’s do it. Now then. To find it, did I score anything? Nice. I was trying to Wow, nothing. I’m like, that’s great. I was a flop. I didn’t get anything. That’s amazing. This thing whether it explained why the ad because it actually doesn’t say, I don’t even know what this website is aces too high. Sounds like a blog post thing. But it’s got all the questions in here. But it doesn’t actually say like, refer to I prior to your 18th birthday. There it is. Yeah, I scored zero. Which I guess I probably should be happy about.
Allie Watkins 53:03
Wow, that’s amazing. Yes, you should. It’s amazing. I like taking it again. Right now. There’s 10 questions or two questions for you?
Brock Cook 53:14
Yes. Okay, good. That’s it. Researchers came with the ACE score to explain person’s risk of chronic disease. Think of it as cholesterol score for children childhoods toxic stress. It’s a very layman’s way of explaining it. I like that. Hmm. With an Acer score of four or more things start to get serious the likelihood of chronic pulmonary lung disease increases 390% hepatitis 240% depression 460% attempted suicide 12 120%. Okay, so just a slight increase, then. Fire. Wow. That’s a big increase. So you finding some of you finding the nurses that you work with any d? Are they scoring high? Oh, yeah. They’re scoring. Yeah, all of them have a very high score. What do you reckon the average would be? If you had to, like guess obviously not looking at the data right now, but if you had to guess what would you say the average would be? Let me see. Huh. I would probably say like a seven. Well, okay. That’s very hard. I only say that because my my score is a seven. Like, dang.
Allie Watkins 54:49
It’s very common. It’s so unfortunate.
Brock Cook 54:54
I wonder if this is the resilience questionnaire you’re using. I just found it similar questions, but it’s like a Likert scale instead. Like, definitely, probably not not sure. Probably not true. Definitely not true. There’s 14 questions. Yeah. Yep. Interesting.
Allie Watkins 55:24
I’m sorry, if you have a high a score and a high millions, then you are going to have a better outcome.
Brock Cook 55:31
What if I have no a score? Which is makes it a high resilience? I probably don’t have a new rising. I’ll probably get nervous.
Allie Watkins 55:42
Writing well, till your 18th birthday, that is Yeah, trauma Have you had after,
Brock Cook 55:48
then, my life took over. No, I myself to have had a look, compared to a lot of people that I’ve met and spoken to you through work and out of work I, I consider my life to have been fairly easy by comparison. So I’m definitely privileged in that way. What’s amazing. So the nurses that you were that you’re working with, are scoring very high. Are you seeing like, are you looking at the like, because this sounds like it was sort of aimed at chronic disease, are you aligning that with any experiences they’ve had of chronic disease, or mainly just looking at burnout? Or is burnout classes are
Allie Watkins 56:32
mostly just looking at birth? That’s right. And that is, that’s what I already say, like, these nurses do have a lot of health problems. Um, you know, they, but they’re very proactive, which I think I find that fascinating, these nurses that I’m talking to, they are seeking out not just like, Western medicine, they’re also looking at like functional medicine doctors, they are seeing counselors that are like specialized in trauma. But this is all that they have to pay for out of pocket, you know, just in order to function and thrive at work. But they also have high high score. So they got to talk about, you know, those traumas that they’re, you know, suppressing. When you look at burnout, we often suppress, and when we continue to suppress, we get stuck in the burnout cycle. And it’s not until the action plan, whether that’s exercising, which is the biggest thing that you can do, or move your body, if you don’t like to exercise. Breathing, is working on your central nervous system to get it back in and track. You know, then, you know, you see chronic illness happen. In fact, our you know, one of my, the forensic nurses that I work with, she has extreme hormone imbalance. And when you look at people who have a lot of trauma, or experienced a lot of trauma, what’s happening is when you’re going to flight or fight response, you’re developing a lot of cortisol, which is your stress hormone. And that’s pumping through your body continuously until you resolve that trauma. So if you’re suppressing it, it’s continuing to go and it goes to your adrenal glands, which is your thyroid. So you often see a lot of females especially have thyroid issues. And so right now she’s talking to her doctor right now to figure out how to balance those hormones out. But you can cause a lot of function to like your kidneys in your liver, if you are always going through cortisol. And then if you’re always stressed out, your body’s also trying to pump, you know, adrenaline that you’re going through. So you’re just so wired up in your body’s not being able to function. Yes, constantly. So I often see that like, people are like, yeah, my hormones are so out of whack. Just like wow, your cortisol levels I better super high. They’re like, Yeah, actually just saw my functional medicine doctor, and they are.
Brock Cook 58:59
Yeah, cuz I think that’s something that really interesting. A lot of people don’t really think about when it comes to burn out. And that sort of stuff and, and trauma in general to like, especially a sort of long term trauma, not sort of acute trauma. Is that that one of the bigger issues and the reason that some interventions like mindfulness meditation stuff work is that your body is constantly on. Like there’s no downtime, there’s no recovery time. And that’s why you also get these feelings of fatigue and brain fog is because your body’s been just on and I feel like that’s, that’s one of the things that people don’t like, they start trying to treat the individual sort of symptoms, like I’m tired, so I’ll sleep more. Like Yeah, okay, that’s gonna help a little bit but it’s not sort of helping the root cause. So it needs to be not just that you need to actually do something that’s going to, you know, stop you from being over Teague. So you need to address that always on aspect, which is hormonal based. But I think that’s a that’s a way and correct me if I’m wrong, I’m assuming this is probably where you were sort of looking with your, your Capstone, but that’s a place that I think OTS can really have a big impact.
Allie Watkins 1:00:25
Oh, 100%. And that’s what I’m learning a lot with this Capstone is that these nurses, of course, they’d have medical issues, because they’re suppressing all their trauma. So what I’m going in is I’m going in and saying, Okay, look at all this trauma that you’re suppressing, and look how it’s affecting your body. That’s the first series, and it shows how your body can be affected by trauma. Using the body keep score, book, I can’t remember the author, it’s like van bezel, and then the second educational series about burnout in how your body keeps score and how you get stuck in the burnout cycle. And the health effects that happen with that. And then the last part, which I think OTS can have a huge impact in impact in is occupational balance, and what we’re need to do versus what we want to do and making sure that we are fully balanced in order to, you know, be the best practitioners we can be or best forensic nurses we can be. And I think we as OTS often even forget about our own occupational balance, and I know for sure I have and so learning through this, it’s like, Okay, I need to make for myself, I need eight hours of sleep in order to function as a human being, I move my body even though I don’t want to move my body and not for appearance reasons, I need to do it for my own mental health. I need to know, I’ve been taking a lot of deep breaths lately. I’m overwhelmed around, I don’t know what to say something. And that has helped out so much deep breathing has helped me out personally. What else I’ve been doing. I know, I guess just like, if I’m super overwhelmed, I go for a walk. If you have stomach issues, if you are triggered by stress, or a stressful situation, you often get I don’t know if you ever had this, like when you’re like heart drops, and maybe your stomach feels upset and you you just feel
Brock Cook 1:02:23
a bit of a noise. No. Have you ever experienced that? Yeah.
Allie Watkins 1:02:27
Yes. And I learned that’s part of our vagus nerve, and it’s called the dorsal vagus nerve. And it goes down to our stomach and affects like all of our organs, donor. And so I like if you like are super traumatized, or just have, everything stresses you out, that’s constantly being flared. And so I’m like, man, I got to figure that out. So I need to start deep breathing, like, every day, at a certain time to just come my SNS system.
Brock Cook 1:03:00
Yeah. And there’s certain techniques that I’ve heard, I’m not sort of fully ofay with the techniques, but there are certain techniques that I’ve heard, that, you know, are able to tap into, or I think one I saw the other day or heard on a podcast actually was like, it was something to do with diaphragmatic breathing, and how that may even be tapping into that that particular nerve is able to help suppress those sorts of feelings and that sort of thing. I could be I could be wrong, but I’ve heard of techniques, specific breathing techniques to essentially help different things. Yeah.
Allie Watkins 1:03:41
Yeah, I learned through my capstone because we teach about, you know, the breathing and with our patients. But when we actually do that, when we breathe in, we are activating all of our muscle. And then, so we activate our SNS system or sympathetic, sympathetic nervous system. And then when we take a deep breath out, we activate our PNS system, our peripheral nervous system, which will regulate and then that’s the PNS kind of calms our body after a stressor release. So we’re activating or, you know, response to stress, and then deactivating it so we’re learning how to change our heart rate variable was what I’ve learned, which I thought was super interesting, like knowing the science behind it, in order to kind of teach the patient or the nurses like, this is why this is I feel like my brains always thinking that way. Like, why am I doing deep breathing, because deep breathing sounds like a waste of time to me. And then when I learned about it, I was like, oh, wow, because this system works this and that system works that and so, you know, if I have a patient that’s curious, I can kind of explain that to them, which the nurses are
Brock Cook 1:04:51
not just hyperventilating and getting a head spin. That’s right. So you said at the start You’re I think you said you’re putting together like a training thing for the nurses. So what they’re doing what are you actually gonna teach them what’s what’s what’s involved in your, your training course thing for them
Allie Watkins 1:05:16
my training, my boot camp works out as a. The first one is about how trauma, trauma works out in our body. And so they like did an educational so I want them to learn what it is. And then they do a therapeutic activity. So like the first one, I believe they identified, we’re in her body feels tight, we’re in their body feels foggy by like coloring. So using that self awareness and mindfulness of where our body actually hurts, they also had to write a word that describes their journey. And then they pinned it up on the wall to kind of build community so people know what their word is. And you know, maybe their journey was a lot harder than others. We did another activity, but I’m, I can’t remember what that activity was. And then the second series is all about education on burnout. And then I made like a visual reference representation of a burnout cycle. And their activity was a creating a burnout scale from one to 10, one being your absolute worst. And like, for example, the worst time of my life, when I was super burnt out, I went to the ER, not knowing that I was actually suffering from a panic attack, or an anxiety attack, I thought I was having a stroke, and my anxiety is just so bad. My anxiety is just so bad that, you know, I will lose my vision, or I’ll lose sensation in my hands. And I didn’t know that was even a thing. Yeah, it was super scary. I had to like crawl into the emergency room. So for knowing that that’s my lowest of my low that I you know, could go or thinking thoughts. That’s number one were 10 is like, I’m feeling really happy. And you know, super duper. So that’s been, you know, that was helpful for me in creating awareness for them. And then the last one is about occupational balance. And so I taught them what occupational balances. And then I made a kind of timeline of their day to kind of fill out, are we resting? Are we doing what we need to do? Are we doing what we want to do? So they’re like kind of scheduling. And then the last part of the project is creating a video for them. So I’m going to make them, not make them but I’m going to have them. They’re going to get a list of questions about COVID and the silent pandemic and their thoughts. And this is a therapeutic like reflection piece. And so they’re going to write down what they think or what they’ve experienced. And then I’m going to video, record them with their consent, then I’m going to edit the video and they’re going to, for my dissemination plan is that they’re going to all watch it together and kind of learn and kind of build resilience and be like, wow, we can do hard things. We got through this insane year of Yeah, crazy cases of domestic violence, the pandemic And so yeah, that’s
Brock Cook 1:08:23
awesome. And these, I’m assuming these are resources that will sort of exclusively before that particular department, they’re not something that you’re going to release to everyone else.
Allie Watkins 1:08:38
I don’t know, I was thinking about that. Um, I think it’d be helpful for a lot of people, but I have a lot of imposter syndrome. It took me a while to get it out my skilled nursing facility guide that I just recently put out, but I was like, Man, this would be really good for people of all professions going through this, you know, to create awareness and stuff, I would definitely have to revamp it and make it look a little bit better and in terms and use maybe a different program to write out what I have, but I think it would be useful for people, but who knows. Yeah, I
Brock Cook 1:09:16
think it’d be awesome. Be a great resource. Especially for especially for like students going into placement where they haven’t, especially if they are having lower aces scores that probably haven’t sort of seen a lot of the stuff that they may come across on placement. Like I know if I’d seen some of the stuff that I’ve seen since on placement. I probably wouldn’t be in it like that factors. But again, that was again, yeah, there’s there’s times where I was sheltered, I don’t know. But since then, fine, like I can I’ve worked I’ve got have the skill set to work through it. And I understand like, I think understanding behavior is a big part of some of the stuff that I’ve seen. So if you can understand why it’s happening and realize that, you know, sometimes it’s not a logical OR conscious decision that that tends to help in processing it. Oh, yes, I totally agree. But yeah, I think that kind of resource, you could almost tailor to different populations. And it’d be it’d be super valuable. Just Well, thank you.
Allie Watkins 1:10:39
He will thank you. You’ll have to get a 5% royalty on it.
Brock Cook 1:10:43
No, I’m good. I’m okay. It’s all yours.
Allie Watkins 1:10:48
Okay, wow. Thank you.
Brock Cook 1:10:51
Gift of my random ideas.
Allie Watkins 1:10:52
Thank you so much.
Brock Cook 1:10:57
That’s awesome. So yeah, I’ve, I’ve learned a ton. That’s really, really interesting. So how are you hoping to? So when you’re finished and you start working? Is this a field that you’re now interested in? This sort of burnout and I guess, almost change, team culture kind of thing? Or are you still looking at the the oncology side of thing, specifically,
Allie Watkins 1:11:28
I think if I were to get in the oncology field, I would definitely whatever I’m learning right now, or whatever I the material that I’ll have, at the end, I hope to bring to whatever job that I’m in and help my future colleagues. Because let’s be honest, we all go through burnout. And especially if we ever go through pandemic again, which I hope we never do. And I think this would be super useful to help to our co workers into, you know, family members who are going through caregiver burnout. Goodness, gracious, they go through a lot. And so I think this information would be helpful, and I hope to, you know, give it to anybody who needs it, and also practice it myself. Because I’d be, you know, a hypocrite if I didn’t. So, I’ve learned a lot through the process. And I changed my habits, and definitely created more occupational balance in my life, that’s for sure.
Brock Cook 1:12:24
So if people are looking for you on social media, where can they track you down? Where can they find you? And find out when you’re going to release all these amazing resources.
Allie Watkins 1:12:38
That’s right, you can find me at patches of OT, on Instagram. And I also have a page for my service dog and training. If you’d like to see her in action. It’s called this’ll in training on Instagram as well. And that’s the so like the weed.
Brock Cook 1:12:56
Very cute. So nothing like a we
Allie Watkins 1:13:00
see, so. No, I know. She is not like anything like, Louis but yes, she’s very cute.
Brock Cook 1:13:08
Awesome. I’m glad other people think she’s cute. Um, I was half expecting you to bring her along today. Okay, that’s fine. I know. She’s actually sleeping. Outside somewhere. Yeah, nice. Yeah, she’s probably tearing up our car. So probably just so yeah, thanks so much for coming on today. It’s been it’s been really good to chat in general and tap into your your experience. It’s been really fun.
Allie Watkins 1:13:40
Thank you so much, Brock for having me. I’m so honored to be on here. I like listen to your podcast all the time. And, you know, see you doing your great work. So I’m like, wow, you wouldn’t have me. That’s amazing.
Brock Cook 1:13:57
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Transcribed by https://otter.ai