@Presro's Journey Towards Psychiatry

I will finally be able to, like, unite my ideal self and my real self. Like, boom, the second I get accepted to med school, like, that will happen.

Did that happen? Yeah.

Yeah, it did for like, 10 seconds. Okay.

Hi, everybody, and welcome to the podcast. My name is Stephanie. I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. And we are also joined here with a very special guest, Pregnant Preston, also at Press. Press Row. That's how you say your username, right?

It's a work in progress. I accept those interpretations.

Well, Preston, we are so excited to have you on. As I said when we were chatting before, I have been a fan for a while. I followed you since you were in medical school doing your high quality skits. I feel like they started out kind of, you know, you know, little casual skits, and then it just. The production level got higher and higher and I was. I thought they were so hilarious and so great. So thank you so much for being here. Welcome to the pod.

Oh, yeah. Thank you for having me. And I appreciate you think they're high quality. The budget never changed, just the level of effort.

Well, it seems like you also kind of got more people involved in the whole thing. And then you had like seven people in a quote unquote, or which was your.

Seemed to be your kitchen. Was what. What it looked like.

Yeah, that was the hardest part. Leaving my old apartment was that kitchen. I had so many memories in there. I wasn't even trying to recruit people. I would have a video go viral of a skit that had three people, and then five or six of my classmates would text me and they'd be like, can we be the next one? And I was like, I can think of something. We'll make it happen.

That's so fun, though. And that's fun that people wanted to be involved in it.

I saw you doing one of, like, this C section thing, and honestly, it looked a little realistic. I kind of had to look away. It's like, oh, my God, there was some, like, melon you were cutting or whatever. Anyway, it was. It was hilarious.

Yeah, that was such a. That was like my magnum opus. I remember telling people, I'm like, we're going to do a C section. They're like, that's the stupidest thing I've ever heard. I was like, oh, just see, it'll work.

Honestly, you could have gone into directing or, like, producing instead of going into medicine.

Actually wanted to. When I was. When I was like a kid, I wanted to, like, direct movies. I always like Wanted to, like, be an actor, like, tell my story, I guess. And it was never, like, safe enough because, like, who. Who can make it in Hollywood? So I always, like, went into medicine and cared a lot about stuff, but I had this, like, thing in the background. I was like, what if. What if I could do these things? And so I guess what we're seeing in front of us now is my. Me reconciling those two desires.

Yeah, I love that. And I feel like. I mean, I never went hardcore into the acting thing, but I did. I was interested in drama at one point, Mom. But I feel like that I might have been tailored away from that a little bit, which was probably.

Some people are dream squashers. Come on. That I am just not true at all.

But, yeah, we'll talk a little bit about how, like, just going way back, how you, like, chose medicine as a path. I guess you said that you. Were you always interested in it or was it something that you kind of found through college or what did that look like?

Exactly. Yeah. So I was a pretty rambunctious kid towards probably, like, early high school. Before that, I was just, like, huge nerd. Like, I think that's like, kind of my natural state. I was like a map kid. I liked dragons. Like, I'd, like, go to Barnes and Noble and, like, read about, like, Egyptians. And then I would. I remember, like, I would comb over, like, the Guinness Book of World Records and I would, like, memorize all of these, like, facts that I found so interesting. Like, I don't know why. I can tell you right now that, like, in 2005, California was the number one exporter of avocados. And, like, in Colorado had the number one, like, MLB attendance with the Rockies. For some, as we're loyal. But so, like, all these fan. These, like, stupid facts, I would just consume them. I loved kind of, like, engaging with, like, whatever truths were in the world. And then I was good at soccer, so I kind of these, like, two parts of myself, and as I went on from, like, soccer team to soccer team, we would, like, go to hang out after school and stuff. And then, like, people would be like, hey, like, do you guys want to, like, look at these, like, pictures of girls? You want to talk about, like, sports or football? And I'd be like, dude, did you see that? There's, like, a store that has, like, pretty realistic katanas and, like, incense? And they were like, preston, that's the stupidest thing I've ever heard. Like, no one wants to do that. And I was like, yeah, you're right. I just brought it up to mention how dumb it was and how I have no desire to actually look at any of that stuff. So like to, to be like accepted with all these like kids that I perceive to be cool because I have this strong urge to fit in and to belong. I really like suppressed that part of myself. And I remember like, I kind of like, I felt like some like dissonance about it. But like, I mean you're 14, you want to fit in. You know, you're willing to suppress parts of your identity or like things that you like pretty easily or willingly at least. I was. So we would like kind of do things. I would like adopt this almost like like jockey Persona. I would like try to go to parties and things like that. I remember my sophomore year of high school, I got in trouble for drinking at a park and I was like suspended from, from the season for like three or four games. And my mom was like livid with me. She thought, she thought I was like this like terrible person. And she was like, like, I don't know who you are, like who did I raise? Kind of stuff. And I was like, okay, like it was a shot of odd. Come on. But like, maybe I'm just like minimizing to, to forgive myself at 15. But like there was a lot of conflict around that. And I at the time was like whatever. Like I, this, this like soccer person, this jock, this party kid is like who I am. And like I'm going to go join a frat, I'm going to make a lot of connections and then I'm going to like succeed in business or I'm going to succeed in like, I think architecture was my idea. And then my junior year of high school, my mom was in an accident. So she was, she's really into cycling and she was doing like one of those century rides around Colorado and another cyclist hit her and sent her off the cliff in this ravine. And she had a T4 fracture and was became paraplegic after that with no use of her abs. And that was like a pretty traumatic event. I think like her and I had a lot of animus between us before that point. And then I'm this like 17 year old, 16 year old kid, not really sure what to do. I like have this part of my day that's impressing. I have this other part that I'm embracing that also like creates a lot of conflict with my mom. And now my mom is like dependent on me physically, but still like, I think very like starkly had this like, desire to, like, control or direct my life in a way she thought was good. So, like, it was. It was hard on me and my sisters. And, like, my solution to that was I was just going to never fight with her again. Which, I mean, it's a pretty, like, juvenile thing to come up with. But I just created this, like, hard and fast rule. Like, mom and I were not just. We're just, like, not gonna fight and that. That'll be, like, no confrontation was my solution. So I, like. I kind of, like, pulled away a lot more from, like, these parts of high school that, like, probably weren't good and, like, people are bad influences for me. And I learned how to, like, change her fully bags. I learned how to transfer her from, like, different spots in the house. So we had, like, install, like, a lot of, like, handicap equipment and like, a StairMaster, and then you'll get her, like, a new minivan and things like that. So I kind of, like, had this. I wasn't like, the main person. My older sister did majority of the help, but, like, I had this, like, other role in, like, supporting these things around her. So I think I kind of started to reflect a lot on, like, what it meant to be, like, stuck it, like, inside your mind would be, like, trapped in these. These, like, parts of yourself. And I think that I saw, like, how these, like, physicians had, like, saved my mom. Um, so she actually was probably going to die, but she landed in a creek where the cold water that was, like, running over her for about 45 minutes actually suppressed the swelling in her spinal cord. So it kept it from, like, totally cutting it off, even though, like, the, like, Central Legion had lacerated it. So, like, we knew it was, like, a very close call. But then I was like, it's kind of like, incredible that this person, like, these people were able to, like, take her and then also, like, give her another chance at life. I think I, like, idealized them in a way. And I think a lot of it was I wanted something. Like, I felt so powerless in this situation with my mom. I was like, what career could give me power over this? Like, what could give me, like, some sense of control that I have back so that I can, like, make a difference myself. So I think that's like, kind of where I got the idea of wanting to be a physician. And actually my older sister did the same thing. She's a. She's a crit care doctor now in Maine. And she also, like, was taking care of my mom a lot and got the idea to be a Doctor. It's funny because she wanted to be a neurosurgeon for a long time because she was interested in, like, the spinal cord stuff for that, and then realized that she has no. She has no drive to be in the or, and she likes emergency medicine. But I guess that's like, kind of how I got sparked to. To join and direct myself into medicine. And then when I went to college, a lot of it was really just like, figuring out, like, were those the right reasons? Was this worth it for me? And, like, how. How is, like, being a doctor gonna, like, fit into my identity, if that makes sense? So that's kind of where everything started, though.

Yeah.

100. That's a super inspiring story and amazing. I want to go back to what you're talking about, just, like, identity and how you kind of, like, shifted as a kid, being, you know, interested in different stuff than high school, kind of putting on this jock Persona. How did that. How did, like, choosing the path of medicine and like, through med school, how did that shift in a. In a way, and either positive or negative? Because I know some people, especially, like, when they decide to go on this path towards medicine and they find their identity just through medicine, and they're like, I'm a pre med now I'm a med student. Now I'm a doctor. And their whole identity goes into that. I know that that can kind of end up being something negative. So it sounds like you found kind of a positive light through finding maybe medicine as a path. But how did that kind of go into your identity and everything? And how did that shift through your training?

So I think the beginning of college, like, I went to the Air Force Academy, so I was still able to, like, code switch in this, like, jock Persona. I. I was actually, like, a track athlete there, so I was on the track team. I'm like an Air Force cadet. You know, everyone there looks just like me, so it's just like. It's just like a bunch of Prestons. And I think, like, I'm probably like, somewhere in the middle as far as, like, how tame or. Or how rambunctious I am. So I always, like, had that part of my identity. So I saw myself. I was like, I was like an athlete. I'm a competitor, you know, a wingman, a warrior, an airman. Yeah. Like, all this, all the. The dogma that was, like, ingrained into me. But then I think I was hesitant to adopt this idea of like, pre med or doctor. Like, I felt like I didn't deserve it until I got into med school. So I think it was weird. I. I subconsciously made, like, I'm smart my identity, which is not healthy in any way, because you can't control whether you're smart. You know, you can control whether you're thoughtful or whether you care about someone. And I think the healthy thing to do is to make a quality that you have volitional control over something that's core to your identity, rather than how pretty you are, how smart you are. And I think actually my identity, when I was, like, a sophomore in college, it was probably not I'm smart. It was probably, I'm smarter than other people. I'm the smartest. So, like, for me to maintain my sense of self, I had to perform better than other people, which is just. Mm. It's just like a. It's a nightmare. It's a treadmill that you just have to run endlessly at. So I would, like, pursue that a lot. And then I saw medicine as a way. So now I had this, like, altruistic reason or this desire for, like, control and, like, making reparations for my mom's accident. But also, medicine was perfect because it represented this accolade that confirmed for me, like, you are smarter than other people, Preston, because not very many people can get to med school and you can do it, you know? So I think that's. I saw that as, like, this is the thing that will give me self actualization. Like, I will finally be able to, like, unite my ideal self and my real self. Like, boom. Like, the second I get accepted to med school, like, that will happen. So that's everything.

Did that happen?

Yeah, yeah, it did for like, 10 seconds. Like, I'm like, an orientation. I'm like, wait, I actually have to, like, be in medicine now.

Literally, me right now. Me right now. I'm like, wait, I have to actually, like, go to medical school now?

Yeah. Yeah. I was like, oh. So I think what they call it is the arrival fallacy, this idea that, like, you'll be happy once you reach this point in time.

Yeah.

And, like, that was kind of jarring, I guess. And I think I discovered I really liked medicine. But it wasn't till I was, like, a third year in med school. And most of the time now I actually just feel lucky that I like medicine because I chose it for so many bad reasons. And not bad reasons, but, like, poor, shortsighted reasons.

And.

And then I was like, wow, I could have hated this, but I don't. So nice. The. Then, like, my identity started to, like, kind of Go back into what I. What I was used to, which is I'm. I'm smarter than other people. I'm the smartest, which is now. That's. It's. Now the competition isn't just a bunch of people in college, but it's like, everyone who's gotten into medical school. And I was at UNC Chapel Hill, which they have a lot of really good, like, really talented, like, wonderful human beings, you know, I think I just felt lucky to be there a lot of the time. So naturally, I was like, okay, let me look at all, like, the things I'm interested in in medicine. And I was like, what are the odds that I like dermatology, orthopedics, and ent? Like, gosh, if only I wasn't so attracted to these different types of anatomy. Like, why can't I just be interested in, like, pathology, you know? Come on, Preston. Like, I had absolutely no insight into, like, basically the only criteria that I cared about when it came to picking a specialty. And I would, like, rationalize it to myself. I was like, you guys just don't understand how much I like the naris. And, like, you don't understand how cool I find, like, the triangles in the neck. You know, if. But if you did, you would get it the way I do. So I would. I would rationalize myself that, like, I wanted to do ENT and part of it was because I still had this kind of part of my soul that felt the need to connect with others and see people as a human kind of. This director part I talked about earlier, wanting to tell someone's story, and so I thought, oh, like, ent, like, gives you your voice. Like, your voice is your. It's like, the vehicle with which you transmit ideas to other people. It's like, what makes you human. And I can be, like, the surgeon and fix that for someone. Like, I can be God, which is. Which is, like, so hyperbolic and, like, narcissistic to even, like, idealize about as a medical student. But it's. But it's, like, what I thought, you know? And then as I'm, like, pursuing this, I was, like, stressed. I was burnt out. I'm trying to do all these research projects. I'm shadowing in the or, and it had everything to do with, like, phonation and dissection and nothing to do with, like, the humanity that I was, like, looking forward to, I guess. You know? Like, I built up all these ideas of what it would be, and then I'm sitting in the case for, like, four hours While the guy is just, like, slowly cutting out lymph nodes in someone's neck. And I'm like, wow, I, like, don't care about this at all, you know? And I still found surgery interesting, but I just. It felt like. I felt like it lacked. It lacked that. Like, to what for what? That I was, like, looking for. I. I think I cared a lot about making someone's. Making the inside of someone's head a better place to live. And I thought that a lot of medicine did that for people. But surgery, I felt like I would see them in the or, and then I'd see them when they leave, and then I would check on them, be like, did surgery go good, surgery go bad? You know, And a lot of beforehand was just kind of, like, it was just farming for people that you wanted to see if they needed to be noir. Like, I felt like our question a lot of times was, do you need surgery or not? Not. And a lot of the specialties that I really gravitated towards were the ones that said, like, how can I help you? You know? And I think, like, all these things were, like, seeds that were planted in the back of my head, but I kind of pushed them away. It's this, like, oh, like, this isn't really reflecting humanity the way I do. Like, I thought it would. I don't care as much about the actual anatomy as I thought I did. The philosophy doesn't line up with my philosophy the way I thought, but also, like, this will make me smartest, so that trumps all. And then in my third year med school, I really had this pretty tough time. I messed up on. It was one of those silly clerkship tests. We had to write an order, and I wrote ceftriaxone instead of ampicillin. But because of the way it was scored, it was, like, one mistake. It was, like, all or nothing points. So I lost, like, 20% on this quiz, but the quiz was worth, like, 30% of my grade. So, like, missing this one thing took me from, like, honors to pass, basically, in my clerkship. So, like, I basically was, like, I worked, like, 70 hours a week for six weeks. And, like, this one question is, like, enough to take me down. And I was, like. I was, like, livid. And I remember, like, being, like, beside myself about this. And. And it was, like, so asinine to me that I cared about this, like, tiny thing so much. And I kind of, like, had to look in the mirror and realize, like, Preston, like, you're splitting hairs over every, like, superfluous measure. You have. This is how you live your life. Like, is this. Do you like this at all? It's like, no, I hate it. I hate every second of this. I wake up and everything I do feels like a chore. So, like, I think it was, like, that was the hardest part was, like, to realize I was miserable first in, like, this pursuit, and then kind of, like, sat with being miserable. And, like, I think I viewed myself as a failure for not wanting to pursue it any longer. And then after that, I said, like, well, what actually does make you happy? Like, what did you enjoy? And I think I. It wasn't until, like, I realized that, like, I hated this and I wanted you something. I enjoyed that I was like, I was always looking for the thing that I thought would make me smart. But what if I just want to do what makes me feel fulfilled? And then all of a sudden, the scope of specialties I was interested in went from dorm, derm, ent, orthopedics, to everything.

Yeah, yeah.

Who would have thought?

Don't have to be better than everyone else.

Yeah, yeah. I'm like, I just have to do something I like to do. Like, what a novel concept. So then I kind of, like, reflected on every, like, patient interaction that was meaningful to me. Every time I, like, worked with someone, the people I liked working with. And it was, like, almost always a psych case. Like, on my family medicine rotation, it was when I would spend 45 minutes, like, doing a depression intake for someone. And when I was on surgery, it was someone who had a suicide attempt. And I was talking to them about, like, what it was like, making this, like, decision to take all these pills or to, like, to hurt themselves in this way. On OB gyn, this woman had postpartum depression, and she had these, like, intrusive thoughts about harming her kid. And I remember I cared a lot more about investigating what that meant to her than I did about going through, like, her, like, bleeding risk or hemorrhage history or, like, how things were, like, going on an OB GYN standpoint. So I was like, well, even across specialties, I still, like, gravitated towards, like, what I saw is, like, what looked at someone's soul. And I felt like psychiatry did that the best. I mean, like, the psyche does actually just mean soul. It doesn't really mean. It doesn't mean mind. I think it's Greek for soul. Anyways, so then I looked back on my psych rotation, and I really liked it. I felt like I was good at it. I. I liked talking to people and it was funny. I got this feedback where the psych residents would say, like, hey, Preston, like, kind of a proclivity for this. Like, would you, like, want to go into psych? And I was like, no, I'm doing ent yeah, but thanks for the compliment. Like, you guys can shove it. Like, I'm like, I'm gonna go do what makes me smarter than you. And then I kind of. I like, tucked my tail and I went back and I reached out to the psych department and said, like, hey, I think I made a huge mistake and I. I want to do this. And they helped me kind of like revamp my whole schedule. I went and did my. My psychiatry sub eyes and that, like, reaffirmed how much I loved it. And then we ended up here. So that's kind of my. My journey to psych.

That was like the most insightful.

So introspective.

I mean, that was. Nobody has talked about choosing their specialty in. In that way. I mean, wow. I really feel like you should. You should give lectures to students about.

Choosing your specialty 100 too, because, like, the amount of introspection that you've done, like so many people still haven't done, I mean, not to just like on surgeons, but so many of them didn't do that and always wanted to just be better than everybody else and always wanted to just be the smartest in the room and do the most competitive specialty. And like, I mean, I'm even seeing that now when I'm walking through the doors. I'm. I've been asking people what specialty they want to go into one of orientation. And everyone's just like, wants to be the most competitive one. And because we're used to being the smartest people in the class, you know, we have been. We. We've gotten to this point, but now it's like, I don't know, you just see so much of that ego and just what you were talking about, just noticing that your whole ego was built up in this wanting to be smart. And like all of your value was placed in and your self worth sounded like it was placed on being smarter than everybody else. And I. That is such a common thing in medicine and the types of people who go into medicine. And I think it's so important for people to like, hear that story and maybe do some introspection on themselves and see like, why they want to do this and like how they can maybe shift on that.

Yeah, it took. So I realized these like, bad parts of myself, but it took me to like going to Therapy to realize where any of them actually came from. Because ultimately, like, your need to measure your self worth outside of yourself means that you don't think it comes from here. So I remember when I went to my therapist, I said, hey, I know my problem. Because I'd come to this point with you guys. I was like, I've tied my self worth to my academics. I'm aware of that. We just have to untangle those two things, and then I'll be cool as a cucumber. And she was like, why is your self worth tied to anything? You weren't supposed to say that.

And you're like, I got it figured out. I can come in here, and you just need to tell me exactly what to do. And then there we go.

I'm done.

Yeah. So then she goes. She goes like, the Dalai Lama says that, like, just because you exist, you're enough. And I was like, that's stupid. And I was like, well, actually, that kind of makes sense. So. So about, like, four weeks of that, I was able to unpack that. I was like, wait, my worst fear is that I'm worthless. And I'm always trying to find evidence in my life to reassure me that I'm not worthless. And the genre I found for my worth happened to be my intelligence. But it could have been my beauty, or it could have been my athleticism or my, like, I don't know, like, my social value, my humor, my sexual value. Those are all things that, like, people find as their, like, medium which wish they prove their worth. For some people, it's all of them, or. Or how rich I am, I guess. But I realized, like, wait, if I just, like, think I'm enough, then maybe I could do things I like to.

Do.

Instead of just being, like, running from this distressing feeling, which I think is. It was like, this weird switch where I think through college, through a lot of medical school, and even just, like, the early part of residency, I was running from this fear of failure. And now I can, like, run towards something that I like. It's so much nicer.

Mom, have you ever heard, like, somebody in your generation be, like, this introspective about talking about choosing their special anything?

No, no, no. It's just. It is so. I mean. I mean, you, like. I can see it in other people. I mean, I did see people, especially, who chose surgical subspecialties, not because they loved surgery, but because they just wanted to say that they were a surgeon, you know, and that was. Or they wanted to say they were. Whatever it was they, they felt that that brought them prestige, importance, whatever it was. And, and I've seen a lot of people be completely miserable in, in choosing, well, even choosing medicine. Right. People who really were never cut out to be a doctor don't enjoy being a doctor. And, but they chose it because they wanted to say they were a doctor or their family wanted to say that they were a doctor. And those are such terrible reasons for doing that. But no, I've never heard anybody go through and just talk about, I mean, just doing the work, getting to that place. It's really, it's, it's, it's really lovely to, to hear all of that. I mean, you, you've set yourself up for success in your professional life.

Well, thank you. I, it's, it's easy for me to condense this in 15 minutes to share you guys, but, like, this was extremely painful. Like, like this was years of like, like agony and anguish and like, probably the. Something like the hardest, like, Frank staring at myself in the mirror that I've done. So it's, it's like, funny to laugh about it now, but it's, I'm, like, I'm honored that you can, like, I feel almost like, thank myself and like, all those years, like, dealing with this stuff and say, like, yeah, it is impressive, I guess.

Well, it is, and it's impressive. And I love for our listeners to, to hear that. I think that, that. I think that hopefully somebody listening to this is going to hear that. And, you know, obviously that's. They're not just going to get from point A to point B in A in the time, in the length of this podcast, but, you know, hopefully that encourages people to do the work, to go to therapy and really figure out those things that, you know, so that they can find what is meaningful to them. So it's really, it's really helpful.

Do you feel like there was a stigma about going into psychiatry, like, being at unc? I know that a lot of the big schools in Texas, because I go to McGovern here in Texas. A lot of these big schools, a lot of people go subspecialized, so specialized. So psychiatry, family med, it's definitely more of a stigma. Do you feel like that was the case and kind of why you wanted to go more to those top three specialties?

Mm, yeah. So there were like 160 of us in the class, I think, with. By the time people, like, rolled out for their PhDs and other, like, extraneous career paths. And I think like 40 or 50 of us wanted to do some version of surgery or subspecialty.

Yeah.

And then another 40 were doing internal medicine, and then a bunch of stragglers and all the other, like, specialty things. And UNC is, like, famously, like, family medicine, primary care type specialty. But even then, like, a surprising amount of us were still all doing, like, surgery and surgical subspecialties. So it was almost like everyone on the surface would, like, praise you for going into primary care, but it was almost like, good for you for, like, doing the thing that I couldn't. Like, good for you for serving and, like, admitting that you're not as good as I am was, like, kind of how it would, like, come across, you know, like the. What do they say? Like, so needed, I couldn't do it, but so needed. I'm glad you're doing it. Okay. I would always joke because, like, people would say, oh, gosh. My favorite was when someone would say something like, I just couldn't see myself doing anything other than cardiothoracic surgery. And I'd be like, do you want to unpack that? Like, you're. You're, like, incapable of seeing yourself as anything. Anything other than a cardiothoracic surgeon. Like, that is like, you're. I'm like, you're a second year in medical school, you know, so. But they would. But they would just, like. They would just, like, make this grandiose statement as if it was, like, irrefutable, you know? And now, because I've declared myself incapable of envisioning myself as anything else, I was like. I was like, what if you use. Instead of, like, you can't see, you're choosing not to see, you know, because this seems like a pretty active choice now all of a sudden, the whole statement gets kind of deconstructed. But anyways, I felt a little bit of stigma. I think a lot of it was internalized, though, because, like, there were some of those people that had that. That would harbor that prestige, but also I would be very sensitive to it because I had a lot of it myself. And there were. Because the other part of UNC were these really incredible people that just wanted to do primary care. And I was so inspired by them. Like, there. There are, like, people that I met there on even, like, our first day of orientation. They were like, yeah, I. I got, like, a full ride to UPenn for medical school, but I just, like, really like the way UNC forms family medicine, and I want to, like, do this program. And I was like, holy crap. Like, you, like, just genuinely, like, want to do Good in the world. I was like, okay, like, yeah, please, this is the one. Like, yeah, right. So there were a lot of people like that. And I think I wouldn't see those qualities as well because I didn't see them myself. But as I was transitioning to psychiatry and these people, like, these are really genuinely altruistic, high achieving people were supporting me. I was like, oh, I got to see this other part of medicine that was really endearing and I loved. There's actually this one person, my friend Rachel. She was kind of similar to me in that she was actually going for plastic surgery really early on. And before I switched from ent, she had switched to psychiatry. And she was someone who I saw as like, really talented, had a lot of same self worth issues I did and had a really like, strong sense of direction. And so I was just kind of inspired by her. And I like reached out to her and she like told me about how much introspection she did. And I think I borrowed some of her introspection to say, like, hey, like, I resonate a lot of with this. And so in a way, like some of the people at UNC were even like the reason why I got into psychiatry because they were trailblazing it too.

Yeah.

So like there, there are a lot of great people that come out of that place.

Yeah. That's awesome. How do you feel like the. Your shift in kind of identity and finding yourself work or finding yourself worth and doing this work has helped you outside of medicine. I know you talked about how this led you to psychiatry and not trying to, you know, actually finding the specialty that you want to go to. How do you feel like that has shifted outside of medicine and how has that then shifted going into residency and through intern year?

Yeah, so I can, I can tolerate any kind of environment where I'm being judged so much better now. And who would have thought that social media is an environment where you get judged? So I think learning to like accept myself and not associate myself worth with these external factors has really helped me stabilize in the context of all this fame that I've like had to deal with. And I guess I say had to deal with, like it's a burden, but I also sought it out because it, like getting that much praise on like a funny video or something is extremely destabilizing because you're like, I'm amazing. Like I'm all these things. And then that praise can immediately turn into ire and criticism, like vitriol from the crowd. Oh, great. Like I was amazing, you know, Worthless. And I'm worthless again. So. So. And it became. It becomes, like, so much to have. Like. Like, I think a couple months ago, I had like 45, 000 comments in a month. And it was just like. It's just like, unlike an unfathomable amount of interaction that I couldn't, like, comb through all this stuff. And for. For, like, the beginning of, like, when I was first in social media and going viral, I would. I would, like, compulsively, like, every, like, minute I was like, I have to check the comments. I have to check my response. I have to check. And it felt like a prison. It was awful. Like, I was either compelled to check my phone to, like, relieve the anxiety of someone saying something negative about me, or I was impelled to do it because I was like, maybe I'll get a good feeling. I'll get some praise. So it was like. It's like my phone had turned into a Skinner box for both bad and good reasons. And it was. It was just like. It was awful. And I felt like I was living in my phone and I was like, checking real life, like, during a lot of these times when I was like, first taking off. Because if you have a viral video and I don't know how to describe this to someone is just like, it's. It's intoxicating. It's like, completely.

You see that video and you're like, you want to keep tracking. You're like, oh, did this one blow up? And that. Like, I don't. I don't know. I mean, I'm not a psychiatrist, but I feel like it's a dopamine burst with. I check my phone and I. It's a million views. I'm like, what? Like, whoa. Like, I'm so great, you know? Like, yeah.

And then. And for me, like, I was always trying to picture, like, how many people in a stadium would have, like, perceived me. So, like, these skits I had, I was like, okay, 50,000 people. How big of a stadium is that? 500,000 people. How big of a stadium is that? And then at some point, my brain just, like, broke and it became a number. I, like, couldn't, like, comprehend it anymore. And I think that is also gets, like, pretty damaging because you can't. Not damaging, but it's dangerous. Cause you can't really, like, put a pulse on how large your reaches and that you're like, a part of this tribe of, like, several million people. I think, like, every part of my evolution, like, made me designed to be a part of Like a hunter gatherer band of like 50 people. Like maintain like 100 total relationships between like whoever lives like across the creek and like the ravine or something. So now. But now I can post a video and have access to like quite literally 100 million people overnight. Yeah, it's like a lot. So the fact that I could say, like, hey, wait, my self worth is getting tied up in this too. Let me validate like what I want to do. And I care about myself. Agnostic to what the crowd thinks. That was super helpful. And then like, now that I can like acknowledge that I don't get as much of a dopamine hit from a viral video because I'm like, this doesn't change my value. The video did well, but I did something I want. But also it tempers any like, negative feelings I have about like, criticism I get. And a big thing actually that I've done is I've shifted my goals into things I have more control over. So I used to make my goals, like to hit a certain number of views, hit a certain number of followers. These like, benchmarks that I thought would make me happy, which are also treadmills. And I. Then I've. My goal recently has just been to make content that I'm proud of. And I know it's like super vague, but like, if I finish a video and I watch it back and I'm like, I like that I care so much less about how it performs and I no longer like, check the trajectory or anything like that. So that I think all the groundwork for this hopefully healthy relationship I have with my social media was so. Started in medical school when I was like, trying to figure out what specialty I wanted. So I guess to answer your question, like, how does this bleed over into my. My other rest of my life? This was this whole other section where I was getting measured, but based on like, my comedy and my like, social appearance. And I was able to kind of do the same work because it was really the same formula.

Yeah, no, I mean, that's a really good. I mean, especially for me to hear, honestly. Oh, when you started doing content, did you kind of. Were you like, yes, this is something I want to do. I want to like, fully, like, make content. Or are you kind of just making it for fun? And it kind of blew up. Like, how did that start exactly?

Yeah, I think it just started because I thought it would be fun. I wasn't, I didn't have any idea where it would go. I don't know. I hate using the analogy of a Drug. But it feels like I was just kind of, like, checking out the alley, and then I accidentally injected heroin, and.

I was like, holy crap, this is really good.

You know, like, you're just, like, messing around online, and then a video goes viral and you're like, what a feeling. I want to capture that again. And then I think I was, like, chasing that feeling for a while. And then I realized that there were, like, good reasons, like, self expression, like, creativity, connection that I get out of social media. And I could almost, like. It was almost like the. That initial hive going viral was, like, what brought me into the space, but then what made me stay where, like, all the, like, the good things that I found about it. So I use, like. I used to use it as, like, a way to, like, pad my. My ego. But then, I don't know, you get, like, a DM from someone, they say, like, hey, I've been depressed for a really long time, and I've been like, watching your videos, and, like, your last one, like, really helped me have, like, the courage to go, like, talk to my doctor about starting ssri. I just wanted to, like, say thanks. That's, like, big deal. I mean, like, I. I like when I get those dms, I screenshot them and I keep them, like, in an album in my phone. And it's kind of just like something I'll go back to, to remind myself of, like, the. The real impact you can have on someone. I don't know, make a million people laugh, like, whatever. But I feel like I've, like, done my job as a physician if, like, I can, like, help with the stigma just a little bit, that someone's, like, willing to, like, change their life. There was a video that, like, someone was, like, afraid of the stigma. They were like, I don't want to feel weak if I start a certain antidepressant. And I made, like, a video reply to them, and they messaged me, like, three months later, and they're like, hey, like, the meds, like, kicked in. I've been doing a lot better. Thank you.

That's awesome.

So. So it's just, like, stuff like that. It just replaces, like, any of the other, like, superficial BS that. That you have out there. And I think, like, that's kind of the reason why I'm sticking around. So I still like the comedy stuff, but all this other stuff is way more meaningful to me now. And I kind of. I try to see it as, like, an extension of, like, my desire to just, like, do good.

A hundred percent.

Yeah, Stephanie and I Were talking on our last podcast that, you know, for Gen Z, the majority of them get their medical advice from TikTok and social media. And so I was like, wow, as a doctor, here I am, you know, trying to make a difference with this or that. But you can have a lot bigger impact with social media than you can even with the patients that you see in your office. And so I think it's really. It's. It's fantastic that you're doing that. And, you know, some of that is just getting people to get into the office, but to see somebody. But that's really. That's really helpful.

Okay. Like an ambassador for, like, all the other great physicians out there.

Yeah, yeah, well, okay. And along those lines of, like, doing good for our listeners. I. So I went back and watched a lot of your videos, and I watched the whole story about what happened with the Bose headphones, which I just thought was such an incredible story for so many reasons. Would you mind sharing that story with our listeners of what happened?

Oh, yeah, sure. So there's actually some backstory to this that I didn't share online initially.

Inside scoop.

Yeah, yeah, the inside scoop. So on my inpatient psych rotation in February, we had like, a pretty, like, a traumatic sentinel event. Basically, I was, like, going to find a patient who had schizophrenia in the morning to, like, interview them. It's my first time meeting the patient, and they. They weren't in the room, and so I was like, oh, maybe they're in the day room. And the nurse was like, no, they're definitely in the room as we go back and check. And then we, like, go. Go look in the bathroom. And he was, like. He was, like, on the ground, face down in the bathroom, and he had strangled himself with the bed sheet. And we, like, had to, like, turn him over and start doing his code blue. And the patient had expired, and it was, like. It was pretty traumatic for me. I, like, I've seen dead patients in the hospital before, but there's something, like, different about it being on the psych floor because you have this expectation that they're healthy. You know, it's different when it's in the ICU and everyone's been kind of, like, mentally preparing for this person's body to give out. And it was, like, hard for me, like, thinking about this person. So they had this delusion, this psychotic delusion that aliens were coming to the Earth and the only way that they could save the earth was to kill themselves. Like, they had to sacrifice themselves. So, like, when they were, like, Asking them the night before and everything about like, do you have any suicide ideations? Nothing. Nothing they would deny at all. Because they were like, this is what I have to do. Like, I, like I know my task. Like, this is what I have to do, like to save the world. And like, it's really hard with us as psychiatrists to assess risk because the person who really wants to kill themselves and the person who doesn't want to kill themselves at all are going to have the same answer, which is, no, I'm not having any suicidal ideations. And like they're going to fall on like either end of that spectrum. That's kind of how it was for this patient. So like I was just, I was like pretty distraught. I was intellectualizing. I, I like was like deep diving. I was like, is there something about like the type of delusion that like makes someone more prone to suicide that this could happen? Because a lot of people, like they have a delusion or paranoia that the FBI is following them and it's so distressing for them that they don't want to be alive anymore and they just kind of want that suffering to go away. But this was, this was like active. He was like, in order to save the world, I must die. Like the delusion was pushing him towards it. It wasn't. He was just trying to get away from the delusion. So I was like trying to read about that. If there's anything different there. And then, I don't know, it was just, it was just kind of like, like a dark time, I think. And then I go on TikTok and Bose is. Has this like video that's like that awkward moment when you can't tell if someone's crazy on the street or if they're listening to headphones. And then they like in this video there's this guy who's walking and he's like pretending to like respond to internal stimuli and talk and the other person's like afraid of him. And I was just like, come on, man. I just, I normally let a lot of that stuff go, but I was just so mad and like this, I was like viscerally mad. And I tried to like temper a lot of that. But like I flashback to these times when like I diagnosed someone with schizophrenia on the ward and like some of the ones like really strike me. And this has happened a couple times. They'll like, you tell them like, hey, these, like you've had these hallucinations, the medication helps it go away. You have a condition called schizophrenia and they sit with that. And they say, so does this mean I'm officially crazy now? And then I, like, you kind of, like, sit with them for a second. And what I always say is, like, no one's crazy. This is just something that you're. You're dealing with. And, like, the men's will help with it, because I don't want anyone to think that they're crazy. And, like, I have these, like, conversations. I'm, like, trying to, like, help this person in, like, probably the darkest time of their life. Like, there's so much stigma against, like, a psychotic illness like that. And then for me to think that they're going to go out of my of, like, the hospital after this conversation, me and check their phone and see Bo's posting that. I was just, like. I just got, like, angry. So I guess I made a post saying, like, that's not cool. And I kind of told some of these anecdotes I just shared with you, and I tried to, like, frame it really positively. I was like, I'm not trying to cancel Bose. I just want you guys to do better. And then a lot of people just started commenting on the Bose page. They were like, how dare you, as a company, like, make fun of, like, psychotic people and all this other stuff? And then they eventually took it down and they apologized, and they reached out to me and said, hey, we want to make reparations. How can we do this? They were like, do you have any nonprofits that you'd like us to donate to? And I said, I don't really know if there's any that I trust. Can we just give, like, stuff directly to the psych patients? And they're like, do you know any psych wards we could give to? I said, no, I know one. The one I work at. I know the one I went to med school at. So I reached out to my audience and I said, like, here's the situation. Like, Bose wants to donate. We're going to give it directly to psych wards. Can you guys, like, DM me? Like, any places you think or comment them, and I'll look them up. And we got, like, 150 places that they, like this list they made. And people were, like, commenting, like, what they needed in the psych ward. So, like, some of the ones that really stuck out to me were, we have, like, 20 patients on the unit, and our only source of music are these, like, Walkman headphones, and you have to, like, bend the wire perfectly for, like, the audio to come through. And you only let, like, one person use them at a time. And I was like. I was like, top of the list, you know? So, like, there's a lot of, like, these stories like that. And then I compiled this list of about 15 psych wards, and I gave it to Bose. And they then reached out to those places and sent them their Quiet comfort headphones. They sent them their speakers. They sent them all these really nice Bose products. And it felt really cool to see that this thing started out being angry and annoyed. Checking this company turned into actual headphones. Arriving at someone's psych ward and at the very least, made them feel, like, a little bit less forgotten, I think. So in the fallout of all that, actually, I was like, I feel like this is a good idea for a nonprofit. Like, there's a lot of, like, it's a good mechanism for doing all this stuff. And ironically enough, not ironically, but coincidentally, I, like, teamed up with a medical student at my school, and that's actually something we constructed. So we started a corporation. It's. It's now, like, a 501C3. And we are, like, in the process of, like, collecting donations, and we're trying to, like, kind of revamp psych wards outside of just music, but there's, like, a lot of, like, books, a lot of games, like, clothes, things like that that can really just, like, make the experience better. One place that we're targeting is, like, like, discharge. So, for example, in San antonio, there's about 32 to 3,500 homeless. And at any given point, like, 20 to 40% of homeless are unhoused. People have either bipolar disorder, schizoaffective, or schizophrenia, which is way higher than I thought. I think you always think about how many people with these, like, psychotic illnesses are unhoused. But if you look at the unhoused population, it's, like, about, like, a third. So of those, they have, like, a 5% chance of being admitted to the hospital. So kind of like breaking down those numbers, somewhere between, like, 300 of these. Of these, like. Like 100 to 300 of these patients will, like, cycle through, like, our wards. And that translates to every three days, we discharge someone who's, like, probably unhoused and doesn't have access to clothes or shelter. And a lot of times try to send them to shelter, but a lot of times they don't have anything. Like, they'll be in, like, the purple psych ward pajamas. And we're like, do you have clothes? Like, no. I'm like, can you call someone? No, I don't have Family. I don't have anyone. Like, I was. This was. All my stuff was cut off by police when I was drug into the ed. I don't have anything. And then we have a bin of like, of like an XXL T shirt and a pair of like, Polly Pocket jeans. And we're like, you can try to put that on if you want. So one place that we're trying to work is just to, like, replenish these bins of clothes so when people discharge, they can, like, have some normal things. And it's funny because a lot of these programs that some of them exist, like Goodwill will donate clothes and things, but what we can never find for some reason are shoes, socks and underwear because, like, you have to pretty much get them new. You're not going to get these, like, used from these stores. So that's like, one place we're targeting to is we're trying to reach out to like, Fruit of the Loom and these and like, Bombas and these different, like, underwear and sock companies just to be like, hey, we have an idea for like, where we can put your irregulars. And so, like, that's kind of like some of the places that we're trying to make a difference. There's other, other areas, but just give you, like, insight into how it started out as just like being mad at Bose and now, like, hopefully we're going to do some, like, real good in the world with it.

That's amazing. And I think that's so, like, it's just such an inspiring story, just talking, going back to, like, social media actually doing good and also just, I don't know, saying how you feel and that leading to like, all this good happening. So that's amazing. Congratulations on all of that. That's awesome.

Thank you. I mean, it's still a long way to go, but it's. This is the stuff that makes you feel like, okay, social media is worth it.

Yeah.

There's a lot of cool things that you've done with this tool.

And I love what you said about, like, making a video that you're really proud of. I've been. I mean, I've been like, dabbling in social media. You know, I grew up with this, so this is like what I've. I've done for so long. But I. That feeling of making something that you're really proud of, like, that feeling and then seeing people respond to it or making a difference in somebody else's life. I love what you said about screenshotting those DMS and stuff, that is truly what makes it all worth it. So, like, that's really inspiring to hear.

Thank you. That's flattering.

Just wrapping up a little bit here. We don't want to take too much of your time. If you just kind of want to touch on just a little bit. I did want to talk about your intern year just a tad bit. If you want to kind of touch on just like, how that was and transitioning into your second year of residency. And then we'll kind of. We'll wrap up on everything else.

Yeah, of course. So intern year was really hard.

Yeah.

And I think my girlfriend at the time, she was like, starting OB GYN for her intern year, and I think that eclipsed a lot of my experiences because I felt like I didn't deserve to, like, suffer as much because she's working like 90, 100 hour weeks and I'm working like 60 or 70 hour weeks as a psychiatrist, unless I was like, on internal medicine or something. I think that, like, the toughest part for me was, like, the volume of emotional toll that I had before. Earlier, when I was a med student, I had like, my one patient who, like, had a lot of emotional trauma, but I could just give them everything. And now as an intern, I have nine, and I have to, like, skirt through all of them, you know, and you're like, talking like, wow, like, worst day of your life. Get in line. You know, I've got like six more of you to go. And I think, like, I definitely had a lot of. I lacked a lot of self compassion about, like, how callous I thought I was becoming, just because I was so overwhelmed by, like, all the stuff I had to do. I think the first part of the year I definitely was in survival mode. So I would. I don't know, I'm still like, trying to forgive myself about this, but I would. I would, like, kind of, like, learn all the right things to say. You know, like someone's saying something to you and you're just kind of numb and you just think, like, you just say, like, that's really normal that you're going through that. Like, I think you're doing a great job, though. And I'm. And like, in my head I'm like, I believe nothing that I said. Like, I didn't hear you said, to be honest, but I know, like, if I, like, align these words in the right way, you'll feel good. And so I think I had a lot of distance where, like, people felt better by how I was treating them and, like, I was helping them out. But Like, I didn't believe necessarily all the things I was saying, and I felt like I was going through the motions. And I talked to my girlfriend about it. She. She had, like, the same thing. I think she delivered, like, 120 babies her first year. She said that she was, like, telling a lot of people about, like, an intrauterine fetal demise. And she, like, had her speech down, and, you know, she tells someone about, like, the worst moment of their life, and then is like, all right, time to get it. Go get a muffin. Because I've got to do, like, six more ultrasounds after this. And, like, it doesn't stop for me, you know? So it took me a while to. Then I think around, like, January to say, like, okay, like, there's, like, a balance here, and I don't just, like, have to survive all the time. And I can. I think I was, like, measuring myself as a good doctor because, like, I always had. I, like, had to feel empathy. I had to care. I had to, like, feel everything. And, like, that was my proxy for being a good doctor. But I was like, really? Like, what? I can control with my actions. If I do right by this person. I can't control my emotions, but I can do what I know is, like, good for them. I can do what's, like, a diligent workup. I can, like, really listen to their problems. And if someone. If someone feels heard by me, I don't think it matters too much, like, what's going on in my day. And I think that was, like, pretty helpful. And I'm still like, that's kind of, like my, like, where I'm at right now, actually. Yeah. As I've, like, really started to proceduralize a lot of, like, human interaction, I kind of like. We're learning a lot about therapy, and I break down things. It's like, okay, this is like a complex reflection. This is a simple reflection. This is a, like, a classic affirmation, a validation. I can, like. I see my brain, like, pick them out of conversations. I'm like, oh, Sometimes it feels like a game. Like, okay, you can, like, play validation here. They'll appreciate that. Or, like, okay, here's a good spot for, like, an affirmation. And I. I. Sometimes I feel like I was like, suck the humanity out of it, because I'm, like, turning it into this procedure so I can acknowledge that it's both. Like, the way in which we interact, like, is sometimes somewhat procedurally. Literally. Like, it's grammar, it's syntax, it's diction, and also it's the way that you make other humans feel seen. Like you can do things for selfish and selfless reasons. You're not either a selfish person or a selfless person. So that's kind of like. That's Preston's, like, current PGY1 to PGY2 transition with, like, I guess, my relationship with myself.

Okay, well, thank you so much for sharing that. I ask everybody this at kind of the end, when we're wrapping up as I'm starting this journey. This was day one of orientation. So really, at the beginning, like, what advice do you have for me as I kind of start this whole. This whole long process?

I'm going to talk to you like how I talk to myself. And I would just say, Preston, like, take a deep breath. Stuff that you think matters doesn't. You need to find what gives you meaning first and then see where that ends up being in medicine. So I think that's what I would say.

Well, thank you so much. This was amazing. This was awesome. We really appreciate you taking time out of being a busy resident to be here and chat with us. And I know our audience is going to appreciate this whole conversation so much.

Oh, thank you.

I mean, really. It was just so. Just really incredible talking to you. It's. It's. It's fun. I want to keep talking to you.

I know. I feel like I could.

Y' all make me feel so good. So if you want to follow me, I'm@.pre on TikTok or it's Prez Row on Instagram and YouTube. If you want to ask me any questions, you can just email me at askpres. Romail and inquirepropagations.org is the best way to get in contact with the nonprofit. The website is coming soon, but not right now because I'm procrastinating on it.

Okay, love that. And you know where to find us at generationsmd on TikTok and generations md on Instagram. And we will talk to you next week. Bye, guys.

Bye.