A Patient’s Perspective on Chronic Pain with Alexandra Wildeson

Alexandra Wildeson: [00:00:00] Takes most autoimmune patients five to seven years to get a diagnosis. And in that time period you get told, you know, is I think this might just be anxiety. This is just stress. This is just being a woman time after time. So you spend a lot of time tracking your symptoms, tracking your, what you think is happening with your body and trying to essentially prove that you're sick so that somebody hopefully will listen to you and help you figure out what's going on 

Preston: to be patient.

Welcome back to How to Be Patient. We are off to a screaming start today and we have a lovely guest, the Alex Wildon. Um, she is known for her podcast calling in Sick, where she discusses a lot of chronic illness and patient advocacy and also recently finished taping on a YouTube show from the uk Yesterday you did like eight hours of filming for that 

Alexandra Wildeson: eight hours of filming.

It was my first TV show. Wow. Appearance. Say, I'm gonna actually move to LA [00:01:00] now and pursue a whole new career again. 

Preston: You should. So how do you, your shoulders feel from, from curing the weight of the show? 

Alexandra Wildeson: You know, pretty sore today, I would say. Like definitely need to do some stretching. So much pressure to be a star.

Preston: Yeah. Okay. We, we'll get to unpack that later in the episode. How 

Margaret: didn't you have Preston? Weren't you a guest on Alex's show? Yes, he was. Yeah. What 

Preston: was that like? To a little bit, I qui to treat him. 

Alexandra Wildeson: He was an excellent guest. He did the intro for my episode. For me, I get super awkward when I try to intro a guest live, and so he did it for himself.

It was amazing. Yeah, I mean, 

Margaret: I'm the smartest 

Alexandra Wildeson: doctor you'll ever meet.

Preston: The best psychiatrist, the greatest psychiatrist.

So, um, yeah, but if you wanna see me as a guest on Alex's podcast, I, I did a while back and that [00:02:00] was actually a lot of fun. I, I got to go down to your studio, which is run by of all people. Lance Armstrong. It's so in a crazy crossover episode. It's like featuring land Lance's Armstrong's office is like in the building.

Yeah, it was, it was a lot of fun. I was like, this is like the last thing I was expecting, but it's a great place. Did you leave with a live 

Alexandra Wildeson: strong bracelet? You didn't, 

Preston: you know, this is kind of, this is awkward. Were there Livestrong bracelets that I could have gotten? 

Alexandra Wildeson: You know, they there.

Preston: Okay. Well, um, before we get into the episode. Um, we always start with an icebreaker and I love that I was, I was tempted to almost not do an icebreaker today, but I did kind of want to come up with a fun one. So the, the one that we're gonna focus on is about the idea of invisible crowns. So health is often described as an invisible crown that is only seen by those who can't wear it.

This is really born outta the idea that you don't appreciate what you have until it's gone. So I wanted to [00:03:00] expand on that for the icebreaker and say what are some invisible crowns that you've seen other people wearing recently that you don't get or you may have lost? And this could be health related or otherwise.

Alexandra Wildeson: Um, I think first one definitely is like, I'm missing my Norwegian crown. I'm pretty sure I was supposed to be the princess of Norway, but I dunno what happened to that one. Um. That joke didn't make Preston laugh. That's okay. None of my jokes make Preston laugh. No, I was thinking about a 

Preston: response to that.

That's, 

Margaret: that's the 

Preston: problem usually. Like, I was like, who's the girl princess of Norway? How do, how do we usurp her? He was like, processing. I'm like 57th 

Alexandra Wildeson: in line, so we just have to kill 

Preston: 56 people. Let's, let's make that 56.

Alexandra Wildeson: Uh, I think some invisible crowns that I have been not wearing is my transition out of like a traditional finance career. Um, being able to work and [00:04:00] have a, I think pretty standard or typical life with pursuing what you studied in school is what everybody kind of aspires to do and follow. And when you get sick at a certain point that might get taken away from you.

And that's been like the biggest transition for me in this last year is recalibrating my identity and understanding who I am without that crown. 

Preston: So real, an invisible Patagonia vest, if you will. 

Alexandra Wildeson: Exactly. Patagucci baby. Oh yeah, 

Preston: sorry. Forgive me. 

Alexandra Wildeson: You uncultured swine. 

Preston: Do you have some of those vests, like with your company branded on them?

Alexandra Wildeson: Yeah. Like from every company I've been in, we've got like some Goldman ones, some oil gas ones, some 

Preston: we, we get them for our hospital sometimes. I think it's just because the hospital deep down like wants to be like an investigate private equity bros. Well, I mean, we're 

Margaret: getting there with hospitals this way.

Yeah. No, for real. Yeah. 

Preston: The Patagonia's become the new white coat in a lot of ways. We have 

Margaret: to pay for our Patagonias for [00:05:00] my training programs so we don't even get them for free. And they're like $160. Yeah. Why are they, why are they so expensive? Dunno, that's my, no, I'm just kidding. That's my invisible ground.

That's my expensive, like why do I have to pay for that? 

Preston: Mine is honestly like being close to your friends, like proximity and having time to hang out with him. So like when I see like other people on TikTok that are just like, they're literally just like making silly videos and like going out with their friends, you know, or like hanging out in their dorm together.

Like those are the invisible crowns that like, I wish I still had. I guess like, I think I'm like really feeling the solitude that comes with like being an adult who works a job and goes home and like the way that we could hang out in college is just not, uh, something you can replicate 

Alexandra Wildeson: no now 

Preston: in your twenties.

Because even if people have time, people have other responsibilities. They have families. Like no one just like [00:06:00] shows up and shoots the shit like he did before. So I think I've been, I like didn't necessarily appreciate it was an invisible crown, right? 'cause I didn't appreciate it while I was in college where like I was around all of my friends.

Like I was on a sports team and I, you could just walk across the hallway and be close to like everyone that, that was in your network. So I think that's like been a crown I've been seeing recently, especially with like. Now that I'm an outpatient and I'm, I'm like treating a lot of college kids and grad students and people that like have these networks.

I'm like seeing that crown a lot more often. 

Alexandra Wildeson: Mm-hmm. That's an interesting crown. I have the opposite. I'm so happy to not be wearing that crown anymore. Hmm. 

Preston: Being close to or being close proximity to much of people. 

Alexandra Wildeson: It's too much pressure to socialize all the time and I'm way too tired to do that. So I like a like once every other week one time hangout it one time, socialize situation.

Margaret: I think Preston always wants me to be more vulnerable on the show. So I'm gonna gift this to you 'cause you're being vulnerable and 'cause I think it's in [00:07:00] theme with what we're talking about this episode of how doctors can kind of put walls up. Um, I'm 30. I like love a lot about my day-to-day life. Life pretty.

You just 

Preston: play the wah wa sound. Preston, 

Margaret: don't do that. What? I'm 31. Not. You're gonna get comments on that now you're gonna get comments on that. Your age choice. I'm 28, 

Preston: I 

Margaret: tell you. Age child. Jesus' child. I'm always called Preston 26, like I'm not 26. Um, but like a lot of my friends are like married and I am not.

And I think it's something that younger me would've thought was like worked out in my life at this point. And so I think that's mine is that I'm like, that part of my life is still a question mark. And I think it would feel comforting to have that part be settled. And at the same time, I like how my daily life is and I wouldn't change anything.

But it's still something that kind of is also part of, I think the adult structure that Preston was talking about of like, how do you build your days and like where is your relational energy focus and where is your community? I 

Alexandra Wildeson: think that's a [00:08:00] really good point. I think that also just like graduates over time, it turns into am I far enough in my career?

When should I be buying a house? When should I be having kids? I feel like I'm deep in that one right now. Like all my friends are having kids and I'm on a chemo protocol right now where that's a off the table, but mm-hmm. I would like it. 

Preston: So, so listeners, what we're really describing here, Margaret and I, is our Ericsson stages, and so we're, we're both deep in the intimacy versus isolation stage.

We're negoti and then actually I, I think Alex, you progressed past us and you're in mm-hmm. Uh, uh, was it like production versus stagnation or something? 

Alexandra Wildeson: Yeah. You tell me. These are all new, new to me. Okay. 

Preston: Um, gen, uh, generativity versus stagnation. I think because you, if. If I remember correctly, you've been in a, a pretty stable relationship.

Like you're, you're married for the last, you know, 10 years. Like it's not 

Alexandra Wildeson: this I was a child bride. I got married. Question mark has 

Preston: been answered for you. 

Alexandra Wildeson: I got married at 24. I've been married for a very long 

Preston: time. [00:09:00] Oh, so you were a child bride. 

Alexandra Wildeson: I was a child bride. Cooper was a child, husband. Um, he was 23.

Margaret: Aw, you guys were bibb, you guys were Preston's talking about child develop, uh, Erickson's like child development thing, which is like the theory that different children at different ages and then throughout life, adulthood, and it, it got eventually expanded that there's these phases that are much shorter in childhood and adolescence, but then as you move into like your twenties, thirties, it becomes the question of, I'll let you take this part, I'm pressing because I'm forgetting off the top of my head.

Preston: So we're, we're in, um, intimacy versus isolation. So this is around like the mid twenties to early thirties where you're really faced with the challenge. There's the whole point in the Ericsson stages is I see 'em like, as like little barriers that you have to kind of graduate to move on to the next one.

And this is like forming long lasting deep, intimate relationships, which I think like Margaret and I have both done. But the, the final one of that, the final boss is like your life partner. [00:10:00] The final boss of the Ericsson stage is like finding your life partner, like who you wanna spend your time with or, or being condemned to isolation, which I mean, or 

Margaret: having other, like being at peace with what you want.

Yeah. Sorry, that meant not, you do not 

Preston: True, true, true, true. True.

Margaret: I'm dead. He's like, or you see where Preston's at with that? 

Alexandra Wildeson: You'll get married or you're die. Shoot. Sorry. Just kidding. We're 

Preston: not. You'll get pregnant and die. Yeah. And then Margaret's, uh, or generation versus uh, stagnation is basically like it, you're now kind of starting solely on this journey of like legacy building.

So you're like, what am I gonna be productive in? Like, what are the, what are the projects that I'm gonna invest my time into? And then how old? And then the later Erickson stages are a lot more around, um, reflecting on like a [00:11:00] fulfilling life and like having a legacy that you, you can be proud of. 

Alexandra Wildeson: Does it take into consideration like non-linear movements or like backwards now?

Margaret: It does originally like not, not as much. Although Erickson was like a good clinician, so I have a hard time thinking he would've been like so concrete equal. Yeah. But no, I mean, I think that's the issue. 'cause like what if someone gets like divorced in their forties? After doing, like, do they then graduate back to, it's like right there, there is some issues with that.

Or even like, you 

Preston: have to load your, your previous saved game and 

Margaret: start. Yeah. You just lose that part of your brain growth and it's like, alright, 

Alexandra Wildeson: sorry about that. Shoot the ladders. We're gonna un un develop your prefund prefrontal cortex. 

Preston: Yeah, exactly. Um, yeah, we should, we should do an episode, um, diving more into the Erickson stages.

I, I don't know, know too much about them. Um, but yeah, they're, they're not as rigid as, uh, we apply them sometimes. That's good. So we are gonna take a quick break. Yeah, exactly. You know, you, you still have a chance, but, uh, [00:12:00] when we come back from our break, we're gonna listen to Alex's story. Talk about your journey from investment banking, which you alluded to a little bit, and then what it was like kind of transitioning from that into dealing with chronic illness and being a part-timer.

I think sometimes even full-time patient Yeah. And the challenges of communicating with doctors. Some of these like, frustrating phrases that they use. And then ultimately we'll talk about what it means to be a good patient, which I think is something that you, um, talk about frequently as, as being a challenge for you.

Margaret: Yeah. 

Preston: So more to come after the break

and we're back with Alex Eson here to talk about your story. So I. Full disclosure. I've watched both succession and industry, so that's so, you know, my whole life. Yeah. I was like, oh my God, this documentary, 

Margaret: he can actually explain your life to you if you would like. Yeah. And, 

Preston: and I have a book on my shelf that's called Options, pricing and Volatility.

And it's fat, it's huge. And I, I've [00:13:00] read like two chapters from, I'll say, have 

Alexandra Wildeson: you read it? That's a, that's a really good one to go Right. To Snooze town with. 

Preston: Yeah. And I'm like, I am now qualified to open up a Robin Hood account and blow, blow my entire life. Savings on options gambling. There's like no way that this can go tits up.

Yeah. 

Alexandra Wildeson: No, never 

Preston: Mar Margaret. At some point, I really want to introduce you to the ALS of Wall Street Bets and the entire summit around there. I, I was there during the 

Alexandra Wildeson: game. I've, I've been 

Preston: there. Oh, the GameStop? 

Alexandra Wildeson: Yeah. Um, did you make some GameStop money? 

Margaret: I did not. No one my friends did a little bit. Not a ton.

I do wanna say though, that when I visited Preston, I was in San Antonio for a wedding. I was like. He was like, here's my apartment. And he is like, yeah, look at all my books. Where I like is the background for the podcast. And I was like going through them and I was like, oh, this one's interesting. Have you read it?

He goes, no, and this happened like four times. 

Alexandra Wildeson: You just got outed so hard. Preston's. And so I'm just, I'm outing 

Margaret: outing you because we ha recently did an episode where Preston did read the entirety of a book and I got texts from friends. I was like, this is the best [00:14:00] episode you guys have ever done. So I'm challenging the literacy.

Preston: Yeah. I sh I need to have protected reading time more often. You do. I think. 

Alexandra Wildeson: Well, you know, as a doctor you have so much free time, so much free time for reading. 

Margaret: Mm-hmm. 

Preston: Mm-hmm. I do a lot of reading, but it's not, not. Like, that's a lot of chart reading. That's true. Lot of abstract reading. Yeah. W wa boring.

Margaret: God me. Put that sound Love it. That he used after I turned 30. Okay. Moving on. You, 

Preston: you criticize my bookshelf, but you didn't go over and look at my Clara vinyls. That's, that's the real problem. Performative 

Margaret: mail final boss. 

Preston: And my machine. I just put my cats to my vinyls machine. I literally have a, I have matcha mix latte.

I'm a, it's, it's all contained. I have everything I need here and, and I'm gonna be shopping at Madewell later today probably. I'm gonna, gonna pretend I didn't hear. We're gonna on to Alex. So tell me [00:15:00] about what it was like getting into investment banking. I think what I wanna start with, um, like your journey to finance, because I think this is something that I think we find interesting in medicine because we never explore any of these careers.

So, so how did you know that you're first interested in pursuing finance? I. 

Alexandra Wildeson: I didn't independently. I have always been pretty good at math. Not to toot my own, but that's really the only thing I'm good at. And when I was in college, I was thinking, I'll go into marketing or advertising. All my friends were doing that and my parents sat me down and they said, we love you.

Um, you're really good at numbers. The creative part of your brain seems to need to develop perhaps more. My sister's an artist. I was like putting two and two together that maybe they were gently telling me that wasn't a good fit for me. I think they were probably right. So took my first finance class.

Loved it. I'm hyper competitive. I played varsity soccer and lacrosse in high school. [00:16:00] Uh, and when I got into all the finance courses, I was like, okay, I don't wanna just take the finance courses. I wanna be number one in my class. So I studied super hard when I went through the investment banking internship interview process.

That's fall of your junior year, I think. Yeah. Fall of your junior year. I just went full tilt and ended up getting offers from all the banks that I applied to and ended up going with a group that had spun outta Goldman. It was a boutique oil and gas firm in Houston. Was really excited. Um, everything about that investment banking lifestyle just felt like such high stakes and exciting and it wasn't just clocking into a day at work.

It was big, big stakes, like millions of, billions of dollars that we were playing with essentially, uh, at, you know, 22 years old. So when I had my first internship, I remember my first week there, it was, I think I was up to like three or four in the morning my first week. And I think most people at that point go, this [00:17:00] is for me, or this isn't for me.

And I thought, I love this. Like, I wanna do this forever. I'm gonna be a managing director, which is like the highest you can get up at an investment bank. I'm gonna be a career investment banker. I put all my eggs into that basket and my sweet boyfriend now husband was like, okay, this is, I'm gonna be a rodeo.

Let's do this thing. It's certainly an 

Preston: option. 

Alexandra Wildeson: Just all those options and hedges, uh, that was not a part of my life. You don't really do the options and hedging game when you were working in m and a. And that's what I did. So I did, um, like mergers and acquisitions specifically in the oil and gas space.

And then even more specifically, because you can specialize much like you can in medicine was doing like minerals. So all the rates that are underneath the ground, um, started my career after my senior year of college in Houston was working. So I, I wanna 

Preston: pause for just a second. This, this kind of like hyper competitive space 

Alexandra Wildeson: Yeah.

Preston: That you went into. So it sounds [00:18:00] like you had, you've always had this competitive drive. 

Alexandra Wildeson: Oh yeah. 

Preston: Right. And then just naturally the finance, like the ladder of getting into finance, like lent itself well to that. 

Alexandra Wildeson: It did. And it was really competitive at my school too. So within the finance major, there was something called the Alternative Asset program, and that was the top 20 students in your class.

And then within that there was something called the Don Jackson Fellowship, and it was the top 10 students out of that pool. So I was a Don Jackson Alternative Asset Fellow at SMU and like helped teach 'em classes and 

Preston: was very competitive. And how many students are in this pool? 

Alexandra Wildeson: Out of all the finance, gosh, I don't know.

I wanna say like there's maybe four or 500 kids in the finance program and then boiled down to 20 and 10. Wow. 

Preston: So, so you were selected one of 10 out of I had to interview hundred 500 kids. 

Alexandra Wildeson: Yeah. So I interviewed through that. Um, it was like a two week long process, modeling, tests, stuff like that. So you do technical interviews, written interviews, uh, financial modeling.[00:19:00] 

Margaret: So clinically speaking, you were diagnosed with being a girl boss. Is what I'm getting 

Alexandra Wildeson: or a psychopath? Both. And both. And if you've learned anything. Both and both. And, 

Preston: and then you enter these interviews, which there are multiple rounds, right? Yeah. And they really like funnel. A lot of people like they, there's a huge bottleneck of like, who actually makes it through 

Alexandra Wildeson: thousands of college students apply to be selected for one out of maybe eight to 10 seats per investment bank.

And that's like a big investment bank would be able to host that many analysts. So my year, it was five at the bank that I ended up at. So it's hyper competitive. You get flown into whatever city this bank is in the first day that you're there, they take you out to dinner, they wine and dine. You basically try to get you drunk and then they get you up in the morning at six 30, 7:00 AM to start your interview process.

Can you hang with the guys? Um, so I got very sneaky at taking my wine with me to the bathroom and [00:20:00] just like dumping it out in the sink and chugging water in the bathroom and just trying to like. Play the game. 'cause I'm this tiny, very petite woman. Mm-hmm. Competing against very large men that we're all interviewing for the same roles 

Preston: and they're all like, dang, Alex is one boys Alex, 

Margaret: she's smart 

Preston: and cool.

Margaret: So fun. So already something that was requiring some disembodiment or kind of dissociation from your body? Not in a clinical way, but in a, yeah, I need to do things secretly to make this even possible for me to not be in danger, let alone openly just be like, oh, I, I can't drink that much. I don't wanna drink.

Which is, so it was already kind of present there beyond other things of having to stay up till 3:00 AM and maybe other parts of the formation, um, into that career. A hundred 

Alexandra Wildeson: percent. And during all this too, so I was born with mixed connective tissue disease or lupus, so I was on immunosuppressants. So I couldn't drink at that extent that all the boys could because, so you had already been diagnosed 

Preston: at this point?[00:21:00] 

Alexandra Wildeson: With one out of, with, with lupus, with one of the five. Okay. 

Preston: Okay. So you had, you had one infinity stone so far? 

Alexandra Wildeson: Exactly. Okay. I hadn't bossed up quite yet. Um, 

Preston: okay, 

Alexandra Wildeson: gotcha. But it was, I mean, it was, the interview process was fun. It was hyper intellectual people, so the banter was exciting. Everyone was really quick.

Like, could you get to the punchline faster? Whatever. I, I felt so alive being in that environment. Mm-hmm. And when I got back to campus, I remember just thinking like I did it. I somehow being a female who is chronically ill and doesn't look the part, like I'm have blonde hair and blue eyes and I look like a dumb blonde probably.

I did, I did what I had sought out to do. 

Margaret: Mm-hmm. 

Alexandra Wildeson: So I was very proud of myself and I spent my senior year just kind of like enjoying that. And then when I got into my first week as a full-time investment banker. Charm of it all started to melt and I realized like, oh, the internship [00:22:00] was a lot of work, but still not the pressure or like the intensity or the aggressive nature that actually exists for full-time employees.

Preston: So when, when you're now in those like three in the morning scenarios that you said and, and you said you loved it, what did you love about it? 

Alexandra Wildeson: I liked that there was so much pressure to get something done. So for, you'd get staffed on a project, it would be like, an example is a sail of a, a basin, like a, some oil wells in a basin.

Mm-hmm. And you're trying to figure out what the best valuation possible is that you could wrap these into to potentially sell it to a, a buyer once down the road and you're competing with other investment banks to get hired for the project. Mm-hmm. So you had to financially engineer things, but know that that engineering could actually be proven out if you wanted to.

And when you get hired for the job, then it's like cranking out these 300 page decks, [00:23:00] massive financial models on a really, really short timeline. Because of course all of the managing directors on the projects and whatnot would say, oh, we can get that to you tomorrow without ever checking. Is that humanly possible?

So they say, we'll get it 

Preston: to you tomorrow. And then, and then they're like, Alex, get 

Alexandra Wildeson: this. We Alex, get this fucking done while my, and so then I'd be on my computer just modeling away. My bosses would be in the game room playing Mario Kart, and I'd just be sitting there thinking, this is not exactly what I had pictured.

This would be like. 

Preston: Yeah. And I imagine there's probably some scenarios where you spend a lot of time modeling off of just someone's like word or, or almost like tangential comment and then find out that it was like totally not needed the next day. 

Alexandra Wildeson: Oh, the amount of jam jobs that were a waste, it was just 

Margaret: terrible.

And what was it like? In that first year when things were falling away, being a woman in the space. You mentioned in the interviews Yeah. But like you also men, I know a lot of the [00:24:00] higher ups are usually men. 

Alexandra Wildeson: Yeah. I had three females that worked in my entire investment bank, um, that were on the investment banking side.

And they were all either analysts or associates. So there were no senior females at all. Um, and what happened unfortunately is like I got sexually harassed pretty bad while I was there. And when I went to go report it, there was nobody safe to turn to. And, uh, ended up kind of backfiring a little bit and I think was probably part of the reason why I got so stressed in that job and ended up getting really sick and then had to quit.

Margaret: Hmm. 

Alexandra Wildeson: But when I first started two, so usually you have like 20 people on your junior team, analysts and associates. The entire associate class quit and walked out because they oil and gas didn't perform well that year. 

Preston: All 20 their 

Alexandra Wildeson: bone. Their bonuses weren't good. So they were all like, fuck this, I'll go somewhere else.

It's gonna pay me better. They all left. This was a really like premier investment bank, and they knew that this stamp on their resume could kind of [00:25:00] get them anywhere. Hmm. So they all left, which meant all of us analysts and had to figure out how the hell do we teach ourselves how to do the job? How do we actually get the work done that needs to be done, and how do we manage all of these different personalities that are really, really intense and very demanding?

It was overwhelming, to say the least. 

Preston: Yeah. So it's, it's this story of like being selected, um, almost as like the champion of a tournament is kind of how it feels to me. Yeah. When you're describing the process of getting through internship, you're, you're like, you're like the victor of Wimbledon in a lot of ways and you, and you, you try to come, come actually show up to your job to enjoy this and then realize that like the trophies aren't there anymore and it's a lot of these kind of dead end GM jobs.

Toxic personalities, people leaving sexual harassment. And then yeah. I can see how the luster of it all starts to fade away, especially if the drive is like feeling accomplished and like being the one who's selected [00:26:00] a hundred percent. I, I've been in that spot too, not necessarily for investment banking, but there was a time in college where I was pursuing like the Rhodes Scholarship and the Marshall Scholarship.

Yeah. And like Gates, Cambridge, all this stuff. And I remember like when I got selected for my Rhodes interview, I was like, oh my God. I'm like one of the chosen, you know, the peak, like, I'm gonna do it. Yeah. Like, like God has favorites and it's me, you know, I have the 

Alexandra Wildeson: selected child. 

Preston: Yeah, exactly. Like I, I'm the protege from the beginning or the, um, the prodigy really.

And yeah, it's 

Alexandra Wildeson: a nice feather in your cap. You feel good. 

Preston: It's like a drug. It is a drug always. Like, it's, it's not actually like sustainable, it's just like you're just trying to inject your veins with the, the like, heroine of feeling like accomplished and being selected out of a crowd success. 

Alexandra Wildeson: And you keep chasing it too.

So like when I was a first year working these crazy hours, that's when you also interview for your private equity job. That's two years down the road. So it's all of these interview processes are very, very early where you haven't even proven yourself out. You don't have the [00:27:00] chops yet. You really don't know what you're doing, but they're trying to see can you teach yourself on the fly?

Do you have an attitude that flows with everybody else and can you hang, like, can you stay up late and then get up early and still crank the three pillars? Also pretty healthy pillars. Um, so I went through private equity interviews, my, I call it like my freshman year of banking, my first year of banking, and ended up getting a job at KKR.

So when, 

Preston: what is KKR? 

Alexandra Wildeson: Uh, Kravis Kohlberg. This is terrible. I don't even remember what it stands for anymore, but it's like one of the largest, doesn't matter. Private equity doesn't. Yeah. Okay. One of the largest, like most prestigious private equity firms in the US Wow. Um, was gonna join their Minerals team.

But around this time too, I decided, oh, I'm not gonna take Remicade infusions anymore. I can't take off that much time from work and I can't take off the time I need to recover. So I switched to Humira instead, which is kind of like a lower grade, lower class, um, immunosuppressant. [00:28:00] And it did not, it did not work for me.

I needed to be on that higher degree and ended up getting a kidney infect, double kidney infection, bladder infection, and UTI and like didn't go to the doctor because. I didn't have time in my mind. And it had even massive, massive fla. Because 

Preston: you had financial efforts to make? Yeah, 

Alexandra Wildeson: yeah. I was making decisions for my career instead of for me on my house.

Margaret: How, how long would the Remicade, like when you were on it regularly, like what was the time commitment per month that it would end up taking to like, leave your job, go get it? How long was a treatment? Like not, it 

Alexandra Wildeson: was not that bad. It was usually like a six hour infusion on one day. So, and then I would need one or two days to rebound where I could probably just work from home.

And that's ultimately what I ended up doing. Post banking after getting sick, staying in private equity. Um. But in my head as a like bottom of the totem pole, that would be unacceptable. And we, we worked a hundred, 120 hour weeks. It wasn't like I had the weekend, I could do it on a Friday and use the weekend to recover.

Like no, I was in the office at 8:00 AM on Saturday. So mm-hmm. In my mind it didn't make [00:29:00] sense and I still wanted to like make top bonus to make it worthwhile because if you do the math for your do dollar rate, when you're a first year banker, you're like, I am getting paid less than minimum wage. I'm working like a dog.

This sucks. This only makes sense if I get paid a shit ton in my bonus. And your bonuses are like anywhere from 50% to 200% of your base salary. So like I was in my head, in order to make all of the sacrifices I was making for my health or my relationship for everything worthwhile, I had to get in that top bucket.

Margaret: Well, and I can assume I also like beyond not having the time beyond being in this environment where everyone. It, it is high stakes and it's somewhat artificial. High stakes, right? Like completely artificial. Nothing is actually that urgent, but it's always been artificial. But if you show your weakness or you show your, be like, it sounds like the kind of environment where if you show that that will be taken against you and it, and not that, like, even if there are good people around you, that that will be seen.

And we talk about this in healthcare, sometimes less so for [00:30:00] like psychiatry, but like in med school, that like the hazing and the kind of like, it's real. People have been talking on TikTok recently. Someone made like a post about like, if you wanna go into dermatology, don't show up to your sub eyes, like with acne or something.

And I know they, they've been roasted, that's why I will not name them. But like, um, they, they, they're learning their lesson. Not to say that kind of thing online, but Good. The secret cur curriculum is what people call in healthcare. And I'm sure in your environment too, there's like all of these things that make it difficult to get care and to make it sustainable and not hurt your health in the long run.

Alexandra Wildeson: Yeah, you like the culture rewards the people that make the sacrifice and don't complain and are like bragging about how late they can stay up. I re, there was one week where I stayed up for 54 hours straight and like, I felt like I was wasted, just absolutely hammered at work. Mm-hmm. And my bosses were like patting me on the back, like, good job kid.

Like look at what you can do. Blow. You should be so proud of yourself. And I was like, I'm gonna die. I'm literally gonna die. Yeah. This 

Preston: is, this is what's [00:31:00] rewarded. 

Alexandra Wildeson: Yeah. So that was a big red flag. And when I finally decided like, I'm gonna quit this job, I think I had three months more to go and like set countdown clocks on my phone and like Cooper was just encouraging me and it was the most brutal long, three months just to get through until that bonus hit my bank account.

And then, uh, I did not go back to work. I had people mail me my stuff on my desk. I literally never showed up again. 

Preston: Wow. You made a comment that you said after I got sick. I still had to make these changes. And, and sounds like from what you described, you were already sick. So is there like a, a point where you, you see the turning point of like going from someone who's like, I'm working, I have this job, I just happen to have its diagnosis too.

Like now I'm sick. Yes. When was that turning point? 

Alexandra Wildeson: So, growing up sick, my brother was also sick. He had a brain, he, he had brain cancer and epilepsy. And so it was just very normal or familiar in our household to be sick and still function. And like my [00:32:00] dad went through testicular cancer and is one of the top surgeons in the entire world for pediatric urology.

So I had all these models of, oh, like shit can happen in your life, but you just keep going. Like, that's what we do. Mm-hmm. That's what our family does. Yeah. That's who we are. It's in our genes. So having mixed connective tissue disease growing up and having my brother have brain cancer and my dad have stage three cancer and almost dying, I was like.

Mine's just not that serious. Like I'm fine. They're 

Preston: just, they're just quirks. They're like birthmarks. Really? Yeah. 

Alexandra Wildeson: It was like flare ups where I'd be in a wheelchair for a month. Like, that's not, it's fine. Don't worry about it. Like I'm seven years old and on prednisone and taking Enbrel shots, like that's fine.

That's normal. Probably needed to see a therapist at that age. Uh, that was fucked up thinking obviously. Sorry if you're not supposed to swear on the show. We haven't had a single, not 

Margaret: explicit rated episode yet. Oh, thank God. 

Alexandra Wildeson: That's the one thing I can't break out of investment banking. I have the worst sailor's mouth and like, it's shocking to people 'cause I look like a little angel [00:33:00] child and then have a horrible 

Margaret: No, you're fine.

Horrible 

Alexandra Wildeson: swearing habit. Kurt. That 

Margaret: as much as you need to. We do for sure. Thank you. Maybe sometimes we do too much, but, but just get 

Preston: it out. 

Alexandra Wildeson: Fuck, get all the rage out. Fuck, just need to do some somatic exercise and really all this anger. Okay. You know, there's, 

Preston: there's a, uh, a study that shows that when people are allowed to cuss their perceived pain scores go down.

Alexandra Wildeson: I fully agree with that. Dealing with C ps I swears swear I've known feel better. Yeah. Uh, but to answer your question, like, yeah. So I had this perception that I had something that was going on, but in my mind it was the same as somebody having like, I don't know, a broken toe that would just get better and you would forget about it.

Like when I had flares, it was episodic and would get better. 

Margaret: Mm-hmm. 

Alexandra Wildeson: When I had all these infections that happened, it kicked off. That was probably when it kicked off the vasculitis, but I just didn't know. Mm-hmm. And over that next 12 months, I got progressively worse and I'd never been sick to that [00:34:00] degree.

So ended up quitting my job in banking, went home for a little bit, moved to Austin, sight unseen, and I'm not kidding, I slept. 14, 15, 16 hours a day. Mm-hmm. I was so tired. I had a new puppy, couldn't even get myself to get out of my apartment to go walk her. So I hired somebody to come and walk her twice a day.

For me, I was at a debilitating level of fatigue, and in my brain it was, I'm recovering from investment banking. Like I just worked my ass off for the last year. Of course, I'm tired 

Preston: 120 hour weeks. Like who wouldn't feel tired? 

Alexandra Wildeson: Yeah. Who's, who's gonna catch up to you? And, you know, I wasn't having a healthy lifestyle at that point.

I was either having eight espresso shots and working until four in the morning, or I was taking four shots and going clubbing at the evening. Like the, that was the extremes that I was living in. Mm-hmm. So it was, uh, got, gosh, I guess 2018 fall, I started going to the primary care, my primary care physician and saying like, I feel, I just like feel weird and I don't think it makes sense.

I had a [00:35:00] rheumatologist here that was just super old school, like the kind of old school doctor that would say, you just have to get married and then quit your job and you'll be just fine. You don't have any autoimmune symptoms anymore. And I'd be like, okay, that doesn't seem like a great solution.

Margaret: Meanwhile we know. Yeah, 

Alexandra Wildeson: now you, now you understand why I was a child bride, was just trying to follow my doctor's orders. Be a perfect patient. You said this is the cure to lupus. 

Margaret: Like, I dunno, I dunno. What's secret cure? Secret? Secret, secret. Don't pharmaceutical 

Alexandra Wildeson: companies know? Yeah. 

Preston: Big pharma doesn't want you to know be a child, married and getting pregnant.

Those the two cures to Well, I 

Margaret: mean, being pregnant is actually protective against autoimmune stuff, which sadly, but only during that time. That's true. True. Sorry, unrelated. I'm sorry. I work in perinatal, so I'm like Whoa. Oh, I love 

Alexandra Wildeson: that. Yeah. We'll gab about that. Don't worry. Yes. Um, so I finally get. Kind of through the shuffling.

See a dermatologist, have a lump on my foot, get a biopsy and have like that heart fall outta your body phone call. Hey, you have this really [00:36:00] rare disease, uh, it's degenerative. We gotta do a lot of testing. You know, some people die within four months. And 24-year-old me who had just quit investment banking had started working in a private equity job that I thought would be less work and Austin, and ended up being the exact same amount of work because it was another Goldman spin out company was like, okay, uh, do I quit my job?

Do I go travel the world? Do I, like, what do I do with this information? And as I'm sure you can imagine with what I've shared so far about myself, I didn't do any of that and was like, I'll just work harder and it'll be great and this will be exactly what I'm supposed to do with my time. So what, what was, was the diagnosis you got at that point?

Poly arteritis. Noosa. Got it. Okay. Yeah, so mentioned vasculitis and I. Unfortunately, just like didn't have the best care team in Austin when I got this diagnosis. Besides my dermatologist, who is still one of my doctors today is like my quarterback for my health. She's the one that helps me make decisions like FaceTimes with my family, was invited to my wedding.

Like we love her. Uh, she's [00:37:00] phenomenal, but she helps kind of guide us through that first year and Cooper and I got engaged and I was going in and outta the hospital, like 10 different hospitalizations. And that first year, um, started methotrexate was on like a hundred milligrams of prednisone every day.

Nothing was working. Like we kept throwing stuff at it. And after my wedding, right before COVID lockdown, I got really, really sick. 

Preston: So I was in the 

Alexandra Wildeson: hospital and so 

Preston: your wedding didn't cure? 

Alexandra Wildeson: My wedding, didn't cure. It actually made me like a lot sicker. 

Preston: That first rheumatologist is like. 

Alexandra Wildeson: Damnit. I could 

Margaret: have sworn, 

Preston: he's like, you just didn't get married hard enough.

He's 

Margaret: like, you need to have you, have you thought of cooking more for your spouse? 

Alexandra Wildeson: Exactly. Exactly. 

Margaret: He's like, housewives in the fifties. 

Alexandra Wildeson: He's like, it was a New Year's Eve wedding that just like that, that wasn't gonna be, he's like, and it 

Preston: rained you undid at all actually. Mm-hmm. Got jinxed. Okay. Sorry.

Continue. 

Alexandra Wildeson: So basically like got, got sick but kept working during all of it. Mm-hmm. [00:38:00] And looking back, I wish that I hadn't, but also I wouldn't change things because it's gotten me to where I'm today. But basically the last five years was this story of me going on pretty aggressive chemotherapies. I've had over 10 surgeries now at this point.

Um, lost and gained all the prednisone weight, lost all my hair, grew my hair back. Uh, kind of went through the rigmarole of a pretty aggressive autoimmune disease. Ended up developing some comorbidities like, uh, complex regional pain syndrome. That has all of its own stories that are difficult. Um, had a botched spinal surgery where I was paralyzed for a little and then had to have a laminectomy and regain all of that.

But basically TLDR went through my finance career, got really, really sick, tried to fight it, and finally after the botched spinal surgery, had the come to Jesus aha moment of maybe I need to like stop fighting the flares and just flow with them and like stop trying to force myself to fit into this life that I thought [00:39:00] I was supposed to have or could have.

And maybe I'm supposed to just take a deep breath and figure something else out and that's not failing. Mm-hmm. 

Preston: So how long did you last in Austin fighting these flares? Still trying to stick with private equity or finance. 

Alexandra Wildeson: I had a eight, nine year long career in finance with all of it going on. 

Preston: You did this for nine years?

Alexandra Wildeson: Yeah. How long have you been out of it for? I stopped finance like March of this year. Oh, okay. Pretty recently. Yeah. That's so recent. Pretty recent. Uh, no. I, I stopped corporate finance like a year ago. Um, and then ended up launching a consulting firm with my sister that was like more venture capital related.

And then I've taken a step back from that too. 

Margaret: Mm. And how has it been in the last year, like stepping back from it and trying to kind of live out this different path [00:40:00] or at least a different pace of path? 

Alexandra Wildeson: If I thought redefining my identity was just like getting PAN was hard, having to step away and pivot my entire career in life was way, way, fucking harder.

So much of. How I viewed success and like a good life was tied into my performance at work. And like, I was always a four oh student. I was always in the top bonus bucket. You're a 

Preston: winner. Like you identify as a winner. I 

Alexandra Wildeson: was a winner. Yeah. And I couldn't do anything else. Like, I couldn't go out drinking. I was on cytoxin chemotherapy.

I couldn't travel. I was so sick. Like all I had that was right. Spots in my life were like my marriage. Mm-hmm. And my job because I couldn't see my family and I couldn't socialize and see my friends and that was it. So I threw myself really, really heavily into my work, for better or for worse. Um, so having to take a step back from that and it not being my chronic illness, but being the botched spinal surgery had so many frustrations because it felt like somebody else had taken it away from me.

Yes. Instead of me being able to [00:41:00] make the decision, which I prob like candidly, I probably needed to make anyway. Mm-hmm. That, that wasn't a good thing for me to continue doing. 

Preston: So ultimately your botched spinal surgery was like the cuda ta for your finance career. 

Alexandra Wildeson: Exactly. 

Preston: And maybe the spine surgeon was looking out for you.

They were like, this is someone who by slow he up. Slow down. 

Alexandra Wildeson: Yeah. He was like, this girl really seems like she just needs to get a get married. 

Margaret: He was like, you know what? She will listen if I do this, but exactly. One of the things I talked to with my, like patients with chronic pain often from like the model of acceptance and commitment therapy and then I used to work in a pain clinic in med school, um, but is like holding the duality of Yes, like the grief of what, what you're going through and what other people aren't and how do we validate that and have compassion for it and how do we build something like a life that is, feels meaningful and connected to values in a different way.

And have some control. And it sounds like, you know, [00:42:00] the surgery not being in your control and it kind of felt like someone else was taking it away. And then your work being a place where you could exert some predictability and control in your life and that you were good at it for your identity. Taking that away in the long run is probably a good thing.

But in this like intermediate run is probably really difficult. Mm-hmm. Because it's further uncertainty. 

Alexandra Wildeson: Very much so. And I always think like when these catastrophes happen in life, they never, I mean, I'm someone that likes to derive meaning out of everything for better or for worse, but nothing ever makes sense in the moment.

It sucks. It's heavy and it's hard. You have to feel it. You have to feel it all. But down the road, I think it's easy to look back and be like, well, maybe it was what had to happen in the most fucked up way possible, but. Was I gonna stop working in finance and would I have made my chronic illness worse?

Yeah, probably. 

Margaret: Mm-hmm. One of the metaphors I use for a lot of my patients with grief and when they have a life-changing illness is [00:43:00] some of what you just said, but also I use the metaphor of like, I have them do a meditation where they imagine like an asteroid comes and makes a crater and it destroys everything around it.

And they really liked that area. And what we do in the beginning of therapy is kind of just sitting and looking at the crater and noticing it and and talking about what happened. And then at some point there may be little interesting new flowers that grow along the side of the crater, and we can appreciate those flowers and at the same time say, I wish the crater wasn't here.

Yes, I wish the asteroid hadn't happened. Yes. And these are really interesting flowers that I wouldn't have loved without the crater coming. 

Alexandra Wildeson: I think that's a really good analogy, and I think that resonates. 

Margaret: Sorry, Preston, I know you, you're guiding this episode, so, but that is my favorite metaphor. Oh, no, I, 

Preston: I was just literally think I was like, yo, well, she has like a crater in her spinal lamina, like, like I do.

I'm missing 

Alexandra Wildeson: some bones. Like 

Preston: she is the crater, you know what I mean? Whoa. I'm the, the crater [00:44:00] Amy asteroid, all of them. I'm a guy and the flower, I'm the creator, the asteroid and the flower. 

Margaret: Yes. Mario and Warrior. Yes. I'm Bower and Mario. 

Alexandra Wildeson: But that is ultimately what made me pivot my career is I was sitting at home on medical leave, depressed as shit.

Being like, gosh, I just worked so hard in chemotherapy, got myself into remission and this horrible thing happened. What am I supposed, like what am I doing wrong? Why does this shit keep happening? And, uh, ended up just like started posting online and it went pretty well. And I was like. This is really rewarding and really fun and has that competitive feeling that I liked about finance, but in a really low stakes way where there's no urgency and, well, I guess there is if you place it on yourself and sometimes I have.

Preston: Mm-hmm. But being 

Alexandra Wildeson: a like chronic illness, you can 

Preston: win that social media too in a lot of ways. Yeah, I know what you mean. 

Alexandra Wildeson: Yeah. But then also like [00:45:00] having the layer of being a chronic illness creator, the things that make me feel really good aren't necessarily, and this is with a grain of salt because the metrics still make me feel so happy when I do well.

But when I get like the DM from someone's husband that says, like, my wife has completely changed her outlook on living with a chronic illness, and like, we're going on dates again, that feels really, really good. And I'm like, I would rather chase that all day than this career that I thought I wanted to have in finance.

Preston: Yeah, absolutely. So thank you for going through your. Inspiring and beautiful story with us. When we come back from this break, we're gonna talk a little bit more about what it's been like for you engaging with all of these doctors, and then we're gonna do a quick segment where we, we're gonna bring in classic doctor phrases into the workshop, and Margaret and I are gonna try to make them better or just nix them all together.[00:46:00] 

So I, I shouldn't call them vacations, but I I've noticed that you, um, since, since I've known you for the last like two months, you'll go on these trips to like different places. I think you went to UPenn or UChicago, UPenn. Um, tell me like, what are these like for you to have almost like an army of doctors across the country?

Alexandra Wildeson: Uh, I love it because I'm famous, obviously. Um, I, I feel really growing up in a medical family, I feel really grateful that even though I have this. Very rare, terrible disease, I can still give back to the medical community and like help mm-hmm. Move that needle for the next patient that gets this, that doesn't fit the criteria.

Most people with PAN are like 80-year-old white men, and I'm not that, that I know of. So being able be not yet still time, 

Preston: anything is possible. 

Alexandra Wildeson: It's 2025 baby. Um, yeah. Being able to like be in [00:47:00] clinical studies and participate in research has been really meaningful to me because it feels like there's purpose behind the struggle.

I think. Um, I'm a big fan. So that's who these trips are. 

Preston: They're to participate in large national clinical trials. 

Alexandra Wildeson: Exactly, yes. Yes. So like Cleveland Clinic, NIH, uh, UPenn, UT Austin, UT Southwestern, those are like the areas that I go to that I get looked at, poked and prodded and asked a bunch of questions and feels good to be able to give back like that.

Margaret: Mm-hmm. 

Preston: And, and like among this, having like a whole team here in Austin too, and the amount of emergency department visits that I'm sure you, you'd rather not try to like tabulate. Um, you, you've, uh, post about this a lot and, and something we talked about, um, behind the scenes was this kind of the frustrating communication or, or sometimes like vague runaround that you get when you're working with [00:48:00] doctors and trying to plead about your pain.

So I asked you before this episode to kind of, I think noodle was the term you used on like some of the phrases that you think are either unhelpful, frustrating, or, or you're like, what does that mean when you get them from a doctor? And I think this is like a fun chance for us to do this because. It's not often that I get to be a doctor who talks to a patient who isn't my patient.

You know, like this is kind of like, it's really just like the 

Alexandra Wildeson: you're welcome for my friendship. The 

Preston: council of the minds here. Yeah. So, so let's, let's, let's take a chance at, look at some of these phrases, which I, I feel like I'm afraid I may have used at some point, and Margaret and I are gonna try to, to reconstruct them, or, I like that.

I'm excited 

Alexandra Wildeson: because I, I think they're very well intentioned to just arm wave at the front. I think nobody comes at a patient with the intention to like piss them off or make them feel sad or unseen. Mm-hmm. Um, but there is medical jargon that will naturally make somebody feel that [00:49:00] way. I think like the most comical one is like when you get a scan and it just says like, unremarkable, un unremarkable.

I thought I was really remarkable.

Preston: So, um, just looking at this list that you gave me, the, the first one that comes up is your labs look normal. Tell me more about why that's frustrating or, or doesn't. So it takes resonate with you. 

Alexandra Wildeson: It takes most autoimmune patients five to seven years to get a diagnosis, and in that time period you get told, you know, is I think this might just be anxiety.

This is just stress. This is just being a woman time after time. So you spend a lot of time tracking your symptoms, tracking your, what you think is happening with your body and trying to essentially prove that you're sick so that somebody hopefully will listen to you and help you figure out what's going on.

So it's kind of an ongoing joke in the chronic illness space that you get labs back or di or [00:50:00] procedures back and they just say. Normal or nothing. And a healthy person would be like, oh, pH like, thank God I'm okay. A chronically ill person's like, great, now we're back to square one. Mm-hmm. I have no idea what's going on.

My body's feeling terrible, but presenting medically normal, none of this makes sense. How am I ever gonna find a provider that's gonna believe me and take care of me? 

Preston: Mm-hmm. So, so there's an undercurrent or, or an implied statement, which is there's no, there's no reason for you to be in discomfort like this.

Alexandra Wildeson: And I, and I do think, like unfortunately a lot, a lot of times when tests come back normal or labs come back normal, some physicians do say, you know, come back if you get worse. There's nothing I can do. Which is I think, mm-hmm. Very brave to say, but also really frustrating. Yeah. 

Margaret: Yeah. I can see how, obviously it would be frustrating and confusing to say like, I have noticed a difference in my body, you know, in this concrete time period, in this way.

Especially when it's given, I, I mean, I can see that [00:51:00] sentiment being given contextually in a way that does not suck as much. Yeah. And I can see it being given as sucking a lot. So I think the, like one way you could say it is, I could say the sentence, your labs look normal. However, the labs that we have are the things that we know how to look for Many people, like you say, go a long time without having signals that we can measure.

And so I know that this is still happening. I want us to approach it this way and I want you to see me again in a couple months and I'm gonna keep talk to, you know, I'm gonna read on this and talk to one of my colleagues who works in this to see if there's any other further testing we should do.

Mm-hmm. Love that. The way would be, these look normal. You seem kind of anxious. I'm gonna refer you to psychiatry. Yes. Mm-hmm. Yeah, 

Alexandra Wildeson: that is, and I have had, yeah. Way too many providers say that to me where I'm like. I'm already seeing a psychologist. I know. I've got stuff going on up here too. Thank you.

Mm-hmm. 

Preston: I think the, the whole, like your labs is [00:52:00] such like a generic, vague thing to say. Like, my first thought is like, well, what, which labs? Because there's almost always like another lab that can be drawn or like, at what point are we calling it with like, we've done the labs, you know what I mean?

Because I think in most scenarios it's like they've done A-C-M-P-A, cbc, you know, c maybe they've looked at like one or two generic antibodies like an a NA or something like that. And, and that hasn't revealed anything, but it doesn't mean that there aren't more labs to be drawn. And also like, doesn't mean that we haven't, like, haven't exhausted all of our, like, diagnostic capability.

That's rarely the case. So I'm, I'm 

Margaret: gonna clinically disagree with you though on this right now. 

Preston: Sure. What do you mean? 

Margaret: I mean, I think one, as psychiatrists, we very rarely use labs. So I, I just, I was. Alex, you don't know this, but my dad is a retired primary care doctor who worked in like systems level management.

So like, I think yes, that it's like there could be further expertise that someone [00:53:00] needs. And I also don't wanna engender more distrust and like if someone sees a rheumatologist and they're like, these are the labs you need and these labs are normal. I, I don't know, I think there's already this myth out in the world right now that's like, you should be getting all these labs that are not evidence-based labs.

And so that's why I'm pushing against you, Preston. 

Alexandra Wildeson: I agree. But I, I also think there are labs that just, I do think like some of rheumatology is antiquated to be, to be candid. Yeah, I could see that. Yeah. Part of that is when we look at labs, it is against that whole pool of people that have gotten that lab.

Mm-hmm. And I do think as we progress in medicine, it's gonna become more individualized. Yeah. So if you're looking at your labs over time and you are seeing variations mm-hmm. Even if it's quote unquote in the normal range, unremarkable, that should be a conversation. Totally. I will say like unfortunately, those are the things that get missed and that's why a patient often will then get way sicker and that's when they get diagnosed instead of, Hey, I've [00:54:00] been looking at your trends over time and I noticed like, you know what, you're still in the safe zone, but your inflammation markers have been going up and up and up every single time we tested.

We should have a conversation about this. 

Margaret: Yeah, I definitely think there's the question of like, if you have someone who's not doing standard of care medicine, yes. And I don't disagree with you that there are people who are not doing standard of care. They're not following the 2025 guidelines. Um, and there are tests that can like, not in your specific conditions or anything, but there are the, one of the things I'm thinking about is there's been a lot of stuff around like getting cortisol levels tested and one of the things we know is that they're not replicatable, but people are being told to do them and then they come to us and they're like, they told me this, but it's not.

Indicative over the, like, long term of finding in a population an illness and an illness we can treat, which you, you're nodding and you know, agree, but I just say that to say still online health, 

Alexandra Wildeson: health flus that have zero training at all. [00:55:00] Um, not to shit talk. Anybody with the medical medium does that a lot, 

Margaret: but if you're, if you're not being heard by like, right, if the rapport is bad regardless of the labs, then this is gonna make any of this not like, not great.

But I think from the medical side, one of the things I worry about is thinking about splitting in healthcare and that like our people who do a, I have know people who do simplified labs that are so intelligent and can, if they had the time, would tell every one of their patients like, here's why we're doing this in this way and here's like actually the percentage based on this study that dah, dah, dah, dah.

Yeah. Um, I'm not saying that that's the majority, but I feel like that's also one of the issues right now with healthcare is like. How many bad actors are there and I can't know. Right. I can only know what I do and what some people do. Um, yeah. Well, and 

Alexandra Wildeson: I also think like for people like y'all who are clearly passionate about what you're doing, you are working in your field beyond [00:56:00] what is asked of you in your career, this podcast, talking about things online.

I think that unfortunately, like from the patient experience, there are more, maybe, maybe I was just naive when I was younger, but my experiences with providers has astronomically gone downhill when I was younger and would have a flare up, it was, I could go to the emergency room and get, somebody would say something positive and it wouldn't be like, you're faking it.

Right. I go to the emergency room now and it's not my normal emergency room where there's a protocol in my file. 

Margaret: Mm-hmm. 

Alexandra Wildeson: It's, you look fine. You are faking it. And I don't think that's lazy medicine. I just think that's like a really overrun. System. System. And it's a lot of patients that have a pressure of urgency to figure out what's going on with them for things that are not urgent.

Margaret: Hmm. Yeah. I mean, you also mentioned that your dad is this like doctor and is really, really great. I once had a friend tell me who was a nurse, [00:57:00] that she was like, Maggie, I love working with your dad. 'cause she had a period of time when she was studying that she didn't, she goes, and he's not the standard average.

And maybe you've experienced that as well coming Yes. Growing up and also moving from child based medical care and pediatrics to Yes. Adult care, which is a very different world. 

Alexandra Wildeson: A hundred percent. I mean, growing, growing up with a parent that's in medicine, it's, you get protected to some degree. You see the best doctors without having to go through the rigmarole of trying out different specialists and seeing who's good and who's not.

Like your, your dad knew, oh, those two over there suck. Not.

Preston: Yeah. So I, I guess what I was saying with the labs thing was that. You can say your cell lines look normal and your electrolytes look normal, but they don't explain your symptoms. 

Margaret: Yeah. 

Preston: Yeah. That that was like the alternative phrase that I would, I would offer. And I think that's a way of saying like, you shouldn't have any reason to have this pain or discomfort.[00:58:00] 

So 

Alexandra Wildeson: I think, I think that's perfect. Like as long as you just don't disqualify the patient's symptoms and they walk away even with unremarkable labs feeling still seen and heard. 

Preston: Yeah. I think it helps to just specify which labs, even without going into the necessary jargon, but like we looked at the number of red blood cells you have, those are within the normal range, but that doesn't mean there's not other places we could look.

So the next one is you'll just have to learn to live with it. And that's, I feel bad because it's so bad. That's some well in, in a, a nicer way. That's been a lot of like what news that I've delivered to people and in a lot of ways is kinda like a fundamental tenet of acceptance and commitment therapy.

Yeah. Yeah. It's so, yeah. What are like some of the situations where you've been told that that's a 

Alexandra Wildeson: lot of, a lot of it's like pain related, I would say, of there's not really anything else we're we can do. You know, we've tried all these different procedures or medications and it doesn't seem like any of them are [00:59:00] working for you.

So I think you're just gonna have to like, learn how to cope with it. And they're not wrong. Like there's not much you can do with CRPS. Uh, I do have to cope with it, but it makes me feel very isolated or alone in that battle versus like, Hey, when this flares up, I'm still on your side and we'll still talk and try to figure out something to make you more comfortable versus like, sorry, you're fucked.

Preston: Yeah. Like, what are you gonna do about it? You are gonna have to learn to, to live with it. I think my proposed. Changing change to that is that like, we're gonna have to figure out a way to live with this. And so even just replacing you with we is acknowledging like, I, I like it's not on you alone to figure out how to cope.

I'll help you figure out ways to cope and we'll kind of even planning this together with also the knowledge that this crater isn't gonna go away. 

Alexandra Wildeson: Yeah. Yeah. I think it's like the, it's the, we centered, it's the team, it's the, you're not alone. It goes a really long way, especially for new like freshmen, [01:00:00] chronic illness patients that mm-hmm.

Don't know who to trust, what to trust. Don't really know the different personalities that are out there in the medical space. Having someone know, having someone give them an indication that they can still go there when shit hits the fan. That means the world. 

Margaret: I mean, I think similar to what we were talking about earlier, but like holding the both end and then also holding.

Although the uncertainty of medicine is like a, like in terms of like, we don't know everything yet is a frustrating thing in chronic illness, I think can also be a space utilized for hope of like, 

Alexandra Wildeson: yes, 

Margaret: I'm gonna keep reading. Like I am on your team and my job is to kind of be looking at all the kind of the upcoming research articles and bring things to you.

And I think they could help. So we may not have, we'll, we'll be in this together, like Preston said, and we don't know what 10 years from now or five years or a year from now is gonna look like. 

Alexandra Wildeson: Mm-hmm. That was the best piece of advice that my dad gave to me during my chronic illness journey was there's someone in med school right [01:01:00] now that will develop a medication that will change your life in 10 years.

And that gave me a lot of hope. Like just knowing that what's here right now is not what is here forever. Like maybe chronic illnesses aren't chronic forever, we dunno. Mm-hmm. 

Margaret: Mm-hmm. 

Alexandra Wildeson: Maybe that's naive also. I don't know. No, I mean, I mean, I 

Preston: don't. 

Margaret: I think when I learned, I feel find the neurobiology of pain actually something that can be incredibly hopeful in a lot of cases in that like there are things that we do that impact, you know, for over broad term the nervous system.

Yeah. But like with central pain, sensitization and then different things that can actually really help and that having an organized approach can be really effective for a lot of chronic pain things. Does it make it go down to zero? No, but we know that we're plastic and I think it can be one of the jobs of the provider in settings of chronic pain or chronic symptom, whatever, whichever it is, is to hold that time, that frustrating timeline, but of real improvement for the patient [01:02:00] when they're in the middle of pain and kind of executive dysfunction because your kind of, your brain's on fire at that point.

You don't have Yes. The cognitive capacity when you're in an acute flare to hold that 

Alexandra Wildeson: you don't, you really don't. And I, I think you're also saying something else that I really liked you. And that's how there's other things that are available to help with pain, like pain reprocessing therapy. I think a lot of new patients get hopeful that there's just a silver bullet, just one pill that they can take and the burden's not on them to make all these changes to their life that already feel so overwhelmed by their condition.

But a good provider I think will help you reposition that as like, yes, you have to do more and make these changes, but there is a goal and a reason why and you will feel most likely better from doing those things. It's getting comforts. Really important reframe 

Preston: because people want that silver bullet like you talked about, and it makes them very vulnerable to snake [01:03:00] oils that promise to be that one thing.

Yeah, big time. So the next one, um, I think this is a low hanging fruit. Precious started with this one is you're young and healthy, otherwise. 

Margaret: I think that one's perfect. And, and then tell 'em to get married. 

Alexandra Wildeson: Say, yeah. 

Preston: Yeah, yeah. So 

Alexandra Wildeson: I love when my providers tell me I'm otherwise healthy and I'm like, cool.

What? What? What's, otherwise 

Margaret: you're 

Alexandra Wildeson: like, your life got cancer. I guess so, yeah. Your life fell off, 

Margaret: but otherwise the other three limbs are good to go. 

Preston: Yeah. Yeah. 

Margaret: I guess so. 

Alexandra Wildeson: That's our standard. 

Preston: That's classic silver lining. You don't do it to someone that you're trying to empathize with. It's essentially like just an invalidating statement to be like it's worst.

Look on the bright side. Yeah. Yeah. 

Alexandra Wildeson: At least you have a husband and you're not like dating right now. I'm like, 

Preston: period. So like outside of your lupus, outside of your parid dose, outside your complex regional [01:04:00] pain syndrome, you're otherwise though 

Alexandra Wildeson: the end endometriosis, like outside of those things, 

Preston: endometriosis is so evil.

Margaret: There was a evil the other day that was like a woman had been hospitalized because it had somehow migrated to like into her like leg. And had like co Did you see that video? I was like, terrible. This is so evil. Why is this illness afflict us? 

Alexandra Wildeson: It's so under researched. It's so sad. Like it can go every anywhere in your body.

Yeah. Truly. Yeah. 

Margaret: It is evil. 

Alexandra Wildeson: It's, 

Preston: wow. Well, okay, that would, that was all I had for the unhelpful ones that, that I could pull away quickly. And then the next one, this will be rapid fire section. We're so good at this. This is explaining medical jargon. So the first one you had was differential diagnosis on there.

When, when do you, when were you when you first heard the word differential diagnosis? 

Margaret: It was my dad. You're fine. My dad was like, he's like, differential diagnosis. You're annoying. My dad was like, [01:05:00] 

Alexandra Wildeson: okay. So, uh, just ask them what the differential diagnosis is. If they say you're fine. Okay, dad, they're like really looking at me funny when I'm asking that and I, I don't know what it means.

Preston: Mm-hmm. So, so for anyone who's listening, who, who's a patient doesn't, hasn't heard this phrase before. Differential diagnosis is just everything. It could be everything. I reckon it could be possibly 

Margaret: open up that brain and a good differential includes a like, here are the things from your history and physical and labs that make me think it's this and here's some of the things that make me think it may not.

And each one has that in the list. Um 

Alexandra Wildeson: mm-hmm. And it's not a great question to ask every provider, I would say, but when you have a provider that keeps going like, you're fine, you're fine, you're fine. Mm-hmm. But you have like great example post COVID I developed. Uh, dysautonomia. Mm-hmm. Had a, had a heart rate that would skyrocket to like 200 beats per minute, randomly.

And then standard bradycardia where my heart, it was like 37 beats per minute. Oh wow. I was so tired all the time down. Bad [01:06:00] Armstrong is jealous. Was down bad. I know. It's like an athlete over here. The EP cardiologist was like, you're just like a young, healthy female, you're fine. And at this point I like already had PA yet already had all this stuff and I like, they're like, have you read my chart?

I'm really not. There's really something going on. What's the differential that all of this could be differential? Tell me Appropriate setting. Not an appropriate setting in the ER when you're having a flare up. Like they're not gonna know, they don't know your history. Mm-hmm. They have someone who's bleeding from a gunshot wound to deal with.

Preston: Yeah. I think I, and Margaret, I'll let you kind of answer this too. If a patient asks me, what's your differential diagnosis? Like point blank like that, and I don't have rapport. This patient, I think I can like. On edge. It, it feels like they're trying to challenge your thoughts in Oh, yes. At least that's how it could come across.

Like, like, like are have you even considered, you know, X, Y, and Z? Because I think what one thing that makes providers get [01:07:00] defensive is when there's, there's always the, the sister in the room who's under like second year of PA school and she's like, I'm gonna make sure all the doctors are doing everything right.

Or I wanna post that clip. So 

Margaret: Preston gets canceled on, I love it about midlevel. Get the brother 

Preston: in, in nursing school or something. And they're like, they're like, the creatinine's low. Like, what are you gonna do about that? And you're like, I'm, I'm here for the suicide ideation low. Like yeah, let's,

Alexandra Wildeson: that's, uh, outta my scope. Yeah. 

Preston: I'm like, uh, and so maybe I need to like just check, like check myself when someone asks that they're probably just trying to like, use medical jargon to communicate with me. Um, I think they're trying get to the 

Alexandra Wildeson: same level. Yeah. Upset with. 

Preston: Yeah, exactly. And, and it's strange.

I think that if, if the patient just said, what are all the things that you think this could be? Or like, what are all the things you're considering? I feel like a lot of providers would take that, um, more graciously than like, what's your differential outside of this? Just like the amount of times we get pimped [01:08:00] in our like, instruction situation is not word 

Alexandra Wildeson: my guy.

So tell me, how often are you getting pimped Preston? 

Preston: Yeah. Well it, it's, it's when people ask us like intense questions Yeah. In the clinical setting. Oh, that's a different, possibly like called pimping. Yeah. But like what's your differentials, like something that kinda like triggers your fight or flight when you're in these scenarios?

Alexandra Wildeson: Kind of from like when you're like in training? Yeah. 

Preston: Yeah, exactly. Like, um, like an attending. That scene from Whiplash when he is like going up to the drummer and he keeps slapping him in the face and he's like, faster and beats and different, it's like, what's your differential? Yeah. What are they gonna be?

What? Tell me what's your can't misdiagnosis? You know, patient's coding, 

Alexandra Wildeson: tell me. 

Preston: Yeah, exactly. So when you get asked those questions, you're like, oh God. And, and then you go into the see the patient, the patient's like, what's your differential? And you're like, nah, you too. 

Alexandra Wildeson: That makes a lot of sense. A lot.

And honestly, I think if patients had that understanding or perspective, they'd be like, oh God, I don't want to make my doctor feel that way. Mm-hmm. And I think they do it because they think if I sound smart enough, they won't write me off as like [01:09:00] just having anxiety. Absolutely. 

Margaret: Yeah. Just making 

Alexandra Wildeson: it up. 

Margaret: I think also like, you know, we, we glibly mentioned like private equity in healthcare and healthcare systems and overload.

Um, I think one of the things that can be hard for clinicians is a couple. Things related to this. One is like if there are 50 people in the emergency department and or even if you're a primary care doctor and you have 15 minutes to see each of your patients, because that's the way that you can bill for Medicare, if Medicare still exists, whatever.

Um, and they can be the best person ever in those 15 minutes. And I've seen a lot of patients have understanding of the system and have grace for people that not everything can get done. But I've also seen a lot of patients who do not, uh, those 

Alexandra Wildeson: patients make me mad. 

Margaret: Yeah. Candidly. And like you there, the similar to us being like, and there are doctors that make us mad.

There are providers that make us mad. Yeah. The second thing is, um, the kind of like true [01:10:00] tension between I'M and my body. So I know my health best and I went to medical school, so I know your health best, which I think is a true, it's ego play. It's ego play, but it's also like, you know, your body best in terms of describing like what is the quality of your pain?

Like how often does it happen? How long has this been happening? How is it disrupting you? Reading, like listening to a podcast about like how a kidney works is not the same as being a nephrologist. No. So I think that also it becomes a tension. Yes. Right now in particular with the amount of misinformation and kind of like questioning of health authority that is systemic and great.

Alexandra Wildeson: I agree. And I think, you know, to take it one step further too, I think it's very magnified in women's health. Yes. Probably because women's health is disgustingly under research, underfunded, overlooked all the time. Yes. So you have these patients that are getting dismissed time and time again, and then are just angry as shit.

Um, but they, I mean, you gotta give grace where grace is due [01:11:00] and you don't know everything. And just because a doctor might not know everything also does not mean that all doctors are bad. It just meant that that doctor didn't have what's going on in your body and their scope of deep understanding. Yeah.

Margaret: Yeah. Now I think that the parts where there are gaps and now under funding in healthcare and historic problems and harms that were done are, I like wrote a substack on this recently are then I used to like sell products like different supplements or different like cortisol balancing. Yes. Blah, blah, blah.

I'm sure you've gotten so much stupid autoimmune shit on your TikTok, 

Alexandra Wildeson: but it pissed you off more than me. It makes me, I like if I'm on prednisone and it's two in the morning and I'm having insomnia, I will comment on those videos and it as you should, not me, it's Victoria, my prednisone alter ego's a bitch that comes out, that keyboard warrior.

Don't talk about all doctors like that. My dad's really good. 

Margaret: It's like, but you could not have any, have you considered that if you took their [01:12:00] cortisol adrenal supplement milkshake once every day for a hundred a month? I'd be cured. You'd be cured. I mean, us doctor, we don't want you to know that. Sorry.

I'm sorry, Preston. I'll stop off. I've been gate. 

Preston: Ah, the secret's out. Part it here, here, why, why you have to do this. So, so the, the next one on our list is, um, a MA. What is it and why it's bad. 

Alexandra Wildeson: Can I tell you a funny story about ama? 

Preston: Yeah. F yeah. My first question was, have you ever left a MA 

Alexandra Wildeson: one time Ooh, 

Preston: diva.

Oh, spicy. 

Alexandra Wildeson: One time. And anyone who's 

Preston: listening it stands for against medical advice. 

Alexandra Wildeson: It's not good and you don't wanna do it, and it's bad to have in your chart, and insurance companies really don't like it. So I wouldn't suggest, uh, but I did, I did go at AMA once I was in, I had been admitted into the hospital.

Um, it was [01:13:00] a team that was rounding on me that I'd had before. Mm-hmm. That had a doctor that told me that the only thing wrong with me was a length discrepancy. I asked to have a different team round on me and they said no. And I was like, I'm not putting myself through the finance or emotional burden of having this jerk off tell me that I have a leg length discrepancy.

And him not helping me with his flare up. Mm-hmm. So I just packed up my shit and I left. And not super proud of that moment, but also a little bit proud of that moment we both told you that. We've been like, 

Margaret: well, you're gonna just have to deal. So all of us we're doing confessions today. 

Alexandra Wildeson: Big confessions.

My a MA funny story for you is one time I put an a MA box on my Instagram being a asked me anything and my uncle and my aunt are also in medicine and they called my parents frantically saying, what is Alexandra doing? Why is she not listening to her doctors? 

Margaret: This is my ama a MA, I'm actively live streaming leaving the hospital.

[01:14:00] Uh, and you can ask me anything about it, 

Preston: a ask me anything while IAMA. It's ama squared. 

Margaret: I'll 

Preston: do, so my, my co-ed soccer team is actually called A-M-A-F-C because I think it's funny, it's made up of all doctors. 

Alexandra Wildeson: You have to get creative. 

Preston: Yeah. 

Alexandra Wildeson: What do you think about when patients go a MA, 

Preston: you know, um, there are some times where this is, this is, uh, I guess a confession.

Like I've thought the patient's safe to discharge, but like the attending for whatever reason, wants to, wants to keep them. And there's like maybe some concern about liability or they want, like, make sure that this like extra test comes back. Yeah. And as I'm like, handing the paperwork to sign in my head I'm like, go off what you got?

Like, there have been times and then there's other times where I'm just like. Bro, this is not, this is not how you wanna [01:15:00] go. Trust me. Like 

Alexandra Wildeson: a lot of backfires if you do that one. 

Preston: Yeah. So I, I think I, I guess, um, to be open about it, like there, there's a lot of, I think, like mixed emotions when a patient leaves a MA because there's a huge part of you.

Yeah. There's a huge part of you, like, wants the best for them and, and you know that they're going against care that's going to be sometimes lifesaving or, or really like life improving. And then also like when a patient leaves a MA, that's like a lot less work for you. So it's like you simultaneous, you simultaneously feel like sorrow, sympathy and relief.

You know? I, I don't know Margaret, if you've ever felt, is this bad? Like if I have not, 

Margaret: I'm dead. That you just said it's less work for you. I mean, no. Well, this gets to the burnout part of this, like, which is like, I don't think all of these like systemic parts, it's like people, by the way, the. The specialties that people are very publicly comfortable hating on, often have a higher predominance in, in modern medicine of women, and often [01:16:00] have more emotional labor involved in their work and want to in our under underpaid relative to other specialties.

Now, there are a lot of people who work in the hospital sense, who should have dignity and work in fair pay that do not have the same salaries. Doctors, I won't say that's not true. And people are like, why are my pri, why can't I get a primary care doctor? Why can't I get a good, like a thoughtful rheumatologist or DR or like, so pediatrician or psychiatrist who actually listens and it's like they're underpaid.

Um, if they're wanting to stay in research and do systemic stuff and wanna stay academic, they're double underpaid because you make like half mm-hmm. In academic and they're less patient 

Preston: facing 

Margaret: and they're less patient facing. Um, so. I guess I just, I think that I did this like ethics fellowship my second year in residency and like one of the conversations we had was how much can you dehumanize someone in the process of making them into a physician and expect them to have empathy?

'cause we know that empathy goes down from middle of med school, like basically when you start clinical stuff, but predominantly in residency. [01:17:00] And do you have to take an empathy class at the end? No. No. We take like an That's information I found. Yeah. Um, I mean we have like patient, like I think we talk about empathy and stuff throughout med school, but No, um, the, the point of this being is they're bad actors in healthcare, like in everything.

But if you have a systemic level thing that is increasing suicide rates is making people not go into these patient facing and emotional labor heavy specialties. Then I do think, not on an individual level, but on like, like community level. If you didn't vote for this type of healthcare to matter. Then let's not be super duper not again, not an individual level.

This is my rant. I'm sorry. Mm-hmm. But like, then don't be surprised that like no one wants to go into it. Like if you, it's like you have to be in med school. It's like people who are going to primary care and psychiatry impedes are treated like, they're like saints and heroes. That's great that people wanna be do that out of the goodness of their heart.

But if you make it only that we're not [01:18:00] gonna have enough people doing it. And you're also not gonna be making it a sustainable career to have good care all the time for these complex problems that we're talking about. Um, I totally agree with you. Yeah. That's my a MA rant. It feels unrelated, but it's like what Preston said of like, well, it's less work for me.

It's like, yeah. 

Preston: Yeah. It's, it's, it's, it's just like a, a, a fact, you know? You have so much work you have to get through in the day and you're staying late, and then that's, that's one less person to round on and you like, feel bad that you feel relieved by it. Yep. You know, 

Alexandra Wildeson: I don't think you should feel bad about that though.

That's not your, that's not your guilt or burden to carry. Yeah. 

Margaret: But that is the thing in healthcare, I feel like, especially in some parts of healthcare, it's like that is so part of your training is that like mm-hmm. My friends who are in pediatrics are like, the, like culture of pediatrics training is, you should feel so lucky that you have the privilege of taking care of children.

And so if you're tired, if you're experiencing what you experienced right. In your job in finance mm-hmm. [01:19:00] While you're making much money, making very much less money, um, it is frowned upon to not kind of show an outward face of like, what a great thing that I get to do. I get to serve the kids. I mean, yeah.

Yeah. And it, so yeah, that makes sense. That makes sense. So I think there's a lot, like in terms of, I don't want, and I frankly have been treated very well by my like, training so far. Like I feel very, we did a burnout episode and I'm not very burnt out. But I grew up around a primary care doctor and two siblings who are also in medicine and Yeah.

You have a different bar. Yeah. It's like, how, how do we create this care that patients want? Mm-hmm. And, and who actually gets who, what patients are prioritized in our current system. 

Preston: Well, I think it's a good segue into to kind of the final part, which is what does it mean to be a good patient? This is something that Alex, um, talks a lot about, struggling with, and I, I think this has been kind of the theme of our [01:20:00] episode in a lot of ways is how do I win at whatever I do, whether it's finance or private equity or content creation, and now we have the, the ultimate victory is like, how do I win at being a patient?

So, so Alex, I, I'm curious, how would you define a good patient as someone who's like chronically in that role? I guess 

Alexandra Wildeson: so I have like two different thought modes on it. One is very unique to me. Mm-hmm. Growing up in medicine, having a dad who was. Very good at his job. Mm-hmm. I think I got like idolized doctors.

Mm-hmm. And I, like every doctor had that like fatherly, uh, role, trans role to me. Yeah. Transparent. So I'd be like, please love me. Tell me I'm doing a good job. Yeah. You're like my dad, dad. Number five. Yeah. Yeah. So I'll talk about that with my therapist later. Um, no, but it, I think it was, I wanted to show that I was doing all the things that I was working really hard at my health.

I was, you know, taking the steps that I could to control what I could to make [01:21:00] myself feel better so that they knew I was always striving to get healthier. I never wanted to be the patient that complained about pain and I didn't, didn't ever wanna be the patient that was sitting on their ass and had the doctors saying like, if she just did this, I think she would feel better.

So with those two things in mind, I like grit through. Pain probably more often than I should, which catches up to me and I get in trouble. That's when CRPS flares up. Mm-hmm. And second is, I think I'll probably stay quieter about reporting different symptoms or whatnot, because I wanna just take a more scientific approach and give it enough time until I figure out like, oh, is this medicine working for me or not?

And then we can have a conversation on it. Like, I know you're stressed and overburdened and worked and like I, I saw my dad go through that. So like, I have this very weird interaction mm-hmm. With medicine. I think when I think of other patients trying to be a good patient, I think it's to prove that they're sick enough to deserve the care that they so desperately want.

[01:22:00] Because with chronic illness, you get told so many times that you're not sick enough or your labs are normal or you should just get married or whatever, you know? However funny thing we wanna say. Yeah. It's the same sentiment of. If I don't perform sick in a certain way, I don't get the care that I so desperately want and deserve candidly.

Um, so those are the two different strains. I just have a fucked up brain. Um, and take it one step further because competitive, 

Margaret: I guess I should say with my patients who I work with, which psychiatric illness is often, um, chronic. Yeah. I feel like so much of it regardless is like relational in that like whenever I'm, I switch like training timelines or whatever and I have to like leave my patients.

There's so much that I think happens that impacts good prescribing in psychiatry, but also in anyone that has chronic pain or chronic symptom management. It's not, this is psychiatry and it's all in your head, but it's like how well we know each other is such a crucial part of feeling safe, I think for [01:23:00] patients.

Alexandra Wildeson: Yeah. I mean you already feel so unsafe in your body. I think that's probably why my bot spinal surgery. Was so impactful to me. It's 'cause like I already feel unsafe in my body. I have trusted and idolized providers for my entire life and I had somebody go above and beyond what their scope and training was and hurt me.

Margaret: Yeah. 

Alexandra Wildeson: And that made me further unsafe in my body and further scared. 

Margaret: And the other part of the relational thing. And then Preston, I'm curious what your reflection is on this is. In that relationship, my patients and I, I feel like come to know what we need to work on for them. And so for you, it sounds like there's some perfectionism and some like wanting yourself to over function.

Right? And so a hundred percent you might be the type of patient that I say, I know I ask you every month like, oh, do you need refills on this PR as needed medication for the pain? And you say, no, I'm good. I only used it once. But when we talked about your pain, you were like, oh yeah, it was this, whatever.

And I, I might know you as like you're someone who under reports and [01:24:00] kind of bears more than even from a, like, not even philosophical, just from like a physiology perspective. Like yes. Oh, well we should treat that more so to you. I may encourage you. Be like, I know you're only gonna wanna take it once in the next month.

I want, I'm gonna encourage you. A challenge for me is to take it three times so when the 

Alexandra Wildeson: second and third days, whatever, this is a very real thing that I've dealt with. Yep. Going on pain medication was something I really struggled with because I didn't want, I had such a perception of like, that meant failing.

Yes. I was falling victim to my pain and I was then not in control anymore. And bless my sweet husband's heart who has a zero background in medicine, but boy, maybe he should have gone in that direction, sat down with me and would be like, Alex, a seven out of 10 pain would make most people like, let's put this out of the chronic illness perspective.

Mm-hmm. Let's make you see past like your own built up ideas of what pain should or should not look like [01:25:00] or how it should or should not be treated. Let's just talk about like being comfortable and being happy and like, can you do that? Take pain medication and will that still allow you to feel in control, happy, proud of yourself as a patient.

It took a lot of work, 

Margaret: but, and there, there are other people who like, maybe they've been house bound for a long time, that there's a lot of work we have to do around like pain avoidance and behavioral activation. That doesn't mean we still don't need compassion there and to do that at the right pace.

And it doesn't mean, you know, people go through different phases I feel like in how they relate to symptoms and other things that are going on straight. Again, that is this, like you need clinicians and I think more important, almost more importantly, multidisciplinary teams across expertise that are sustainable enough jobs that people stay in the same clinic and have enough time to see you and can know you and work with you on that.

Like that is when change happens with these things and that is, so much of that is out of a patient's control. 

Alexandra Wildeson: [01:26:00] I, so, uh, my podcast episode last week was like, when to feel comfortable and confident saying no in your medical journey. And one of them was with a provider. If they are not collaborating with your entire team, you have to have that like relationship trust, at least on that side in order to get good care systemically throughout your medical journey.

Preston: So I was reflecting on like, if I ever view patients as good or bad, and I, I think I usually just internalize if like, the treatment isn't working well. 

Margaret: So 

Preston: like I see them as like so complicated that I'm like, I just don't think I'm good enough to help this person. Like that's, I think ma you resonate with that.

Like, so I wonder if like, the way we see it, or at least as like psychiatrists is like, there aren't necessarily good or bad patients or, but there are bad relationships, you know? Yeah. And, and we'll kind of say like, you know, the therapeutic alliance with this patient is shot. And sometimes that does happen based off of, you know, a myriad of circumstances.

But then sometimes someone can come in and, and [01:27:00] reconstruct that good relationship with them for whatever reason, because we're dealing constantly with the complexes of like human interaction and trust. Mm-hmm. And sometimes it could be as simple as like, they're like, you know, from the same state or something, and then that's like a way into the door.

And now we can have like a good relationship and then they can get better. But like, I've, like, when I'm going through like, like my clinical clinic panel, I don't think I've ever like, thought to them even with like, challenging patients or not challenging, that's actually how I view them. Mm-hmm. Like this, this patient is challenging in the sense that like, it's going to be a challenge for me to like, give them care that's gonna like help improve them.

And, but I, I've never like come around to say like, oh damn bad patient. Like f for the day. You know, like, you don't gold per star on the way out. Like, I like this just. I'm just like, man, like what could I do better to like get through to them or to help them or to make a difference for them? 

Margaret: I think from a dynamic perspective, um, I think, I feel that, so [01:28:00] this is ahead for you, Preston.

Like I less feel that like I'm doing something wrong. But something that my supervisor and I will talk about sometimes is like, there are some patients, there are situations that can be challenging sort of regardless, but also the recognition that not every therapist or psychiatrist or primary care doctor has all the right ingredients for every single patient.

Yes. And so sometimes the question is, does this connect enough? Is part of what we're struggling with rightness of fit, um, which we talk about that ad nauseum for psychiatry, but I think is, is true and is what Preston's getting at of like, I don't think good, bad as much as having kind of some comfort and like I'm a good therapist and PS and no single person has.

Everything that someone might need to be supported in their health. And so maybe, yes, we think about collaborative care, we think about referring out like elsewhere or like there's a clinician I know who would be a great fit for this case, who [01:29:00] this is their population of interest. There's a natural kind of connection and investment at the start.

Alexandra Wildeson: I think that's like hitting the nail on the head. It's a relationship and also like a knowing where your limits are and a patient also needing to understand and respect those limits, not just in like knowledge basis or anything like that, but if a provider is way overworked and you have a super complicated medical case that they have read one page in a textbook 25 years ago, probably like not gonna be a great relationship basis emotionally.

And then also like knowledge basis, not gonna be, 

Preston: it'd probably be more like five wonky cards these days, but yeah. 

Alexandra Wildeson: You 

Margaret: can get the AI doctors on. Yeah. 

Preston: Yes. Well, um, that's all the time we have for today. Thank you so much for coming onto the show, Alex. Um, this is kind of the part with our guests where we wanna give you a chance to shout out any of your current projects [01:30:00] that you're working on or your different social media handles.

Um, so what do, what do you wanna plug? What do the floor's yours like? 

Alexandra Wildeson: Well, first off, thanks for having me on. This was a treat, like being able to talk to doctors as a patient and growing up as I did. Like, this is such a big treat and honor to me. So thank you so much for letting me share my story and have these conversations.

I think it, like, I think patients will hear this and feel like they learn something and maybe walk away with a little bit more compassion for themselves and their providers. So thank you for giving me that opportunity. Um. Uh, my platform is my name Alexandra Wildon. My podcast is called Calling in Sick Podcast.

Super creative podcast. Why is Harvey patient? Mm-hmm. We're just on the same wavelength. Yeah. Mm-hmm. Uh, I'm working on an app right now called Calling In. It'll be a community educational platform for patients to go and find people that have a similar like impact of their disease to their [01:31:00] life so that you can find different resources, friendships, stuff like that.

Um, and like we talked about the top of the show, I just wasn't a TV show, so stay tuned on my socials. If you wanna watch it comes out in a month and it'll be on YouTube. What's the show 

Preston: called? 

Alexandra Wildeson: I'm still under NDA, so I can't tell you what. It's such exciting. 

Preston: Oh, whoa. 

Margaret: Big business. 

Preston: Okay, well, um, you should feel like you won by being 

Margaret: able to say that I'm still under an NDA.

Like That's awesome. 

Alexandra Wildeson: Sorry. Um, under NDAI get it. 

Preston: Thank y'all so much for listening. Um, yeah, I've, I've been leaning into my southern, 

Margaret: he's in his catalog harder. 

Preston: I'm saying wrecking a lot more. Yeah. How is the show? We, we always want to hear what you think. Uh, this is our first time having a patient on, but we, we like getting to explore these patient stories with y'all.

If you want, y'all, 

Alexandra Wildeson: y'all, if you wanna come chat with us 

Preston: at our Human Content Podcast family, you can find us on IG and TikTok at Human Content Pods, or you can contact us directly at How to be patient pod.com. [01:32:00] You can always see more from me. It's Preston and Margaret. She's like the co-host. At our respective socials.

So I'm on it's pre row. Margaret's at Badar every day on Instagram. TikTok and Substack. Behind the paywall. Shut up paywall. 

Margaret: Preston won't pay the paywall. 

Preston: Yeah, I know. I actually don't know what's on her blog. It's 

Margaret: just a refuse to pay press and dis page.

Preston: It could be you just posted all the clips. Could never find out. Yeah, if you want to see more of this podcast, full videos are always available on my YouTube. Um, posted each week on Mondays. Thanks again for listening. We're your host, Preston Roche and Margaret Duncan. Our executive producers are Preston Roche, Margaret Duncan, will Flannery, Kristin Flannery, Aaron Corny, Rob Goldman, and Brooke.

Our editor and engineer is Jason Portizo. Our music is Bio Mayor Bens v. To learn more about our program, disclaimer and ethics policy submission verification and licensing terms and our HIPAA release terms. Go to how do be patient pod.com or reach out to us at How Do Be patient@humancontent.com with any questions or concerns.

How to be patient [01:33:00] is a human content production. 

Margaret: Bye y'all.

Preston: Thank you for watching. If you wanna see more of us or if you wanna see, this is lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac Point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They, they probably exist for real.

But in the meantime, I'm just gonna pet lilac and then I'm gonna go dance in the [01:34:00] background.