Welcome to Headroom, the podcast where we explore all things essential to mental health and well being. I'm Jim Owens, your host and licensed mental health counselor at Lansing Community College. While you're about to hear from some phenomenal people who have incredible ideas for you and your life, podcasts are no substitute for professional medical advice. So if you need help, Please call or text 988. Okay, having said that, let's get into the Headroom and begin today's conversation. Well, good morning or good afternoon or good evening to anybody who's watching this, but good morning to my guest, Dr. Ana Kelly. Thanks for coming in.

Thank you.

This is a familiar campus to you, as I learned walking over to the studio with you. You were here once before, so I want the listeners to get to know you just a little bit. So kind of who are you, where are you from and what your background is? A little bit. And then we're going to talk about mental health. And you are a healthcare provider like me. You're an instructor of healthcare providers. So we'll get into all that. But yeah, tell us a little bit about who you are.

Okay, sure. So my name is Ana Kelly and I'm an associate professor of nursing at Columbia University. My background was I was a Michigan State student.

Go green.

Yep. It was fabulous. Go white. And then I also spent some time here at LCC. I was also a supplemental instructor in physiology. After I graduated, I went to the Peace Corps in Namibia and taught there. And that's where I decided. Decided to become a nurse. I came back to the area as a second degree nursing student. That's sort of where the nursing journey began.

Okay, I didn't know that about you. So this is cool. I'm always learning things about my guests.

When they come in.

So what did you graduate with before you went to the Peace Corps?

So I did biology and I was sort of toying between medicine or teaching because I really like teaching a lot, but I just didn't have a concept of what nursing looked like. I didn't have a lot of experience in hospitals. And so it was only once I was in Namibia at the clinic where I had an opportunity to see what nurses can really do. And it just changed my whole career path.

Oh, wow. Set your heart on fire for that. I can see it.

Yes, it really did.

You spent your career as a nurse and a nursing educator?

Yeah, absolutely.

So how long were you in Namibia for?

So I was there two years teaching biology, but ended up sort of becoming an impromptu sort of health aide in a way. And that's where I really got interested in nursing.

Yeah.

Yeah, man.

I'd love to hear a little bit about that right now before we get into the rest of your academic career and stuff like that. What was the healthcare like in Namibia at the time? This would have been, I don't know, what, 2000s?

So this was 2001 to 2003.

Okay.

And it was at the time when HIV was really reaching a peak, and it was before antiretroviral therapy was available, unfortunately, we were seeing a lot of death from that. It was a difficult time. And there was actually a tremendous amount of stigma around it as well. People would not always share that they were passing from hiv. It would always be things like GI issues or tuberculosis. But unfortunately, we are seeing that underlying event. Yeah.

Oh, so their symptoms, they would say that they fell under a different diagnosis.

Yes, yes.

Not unlike in mental health.

Sure, sure.

People show up. I'm really stressed. Are you sure it's not something like a word you don't want to use, like anxiety or depression? Okay. Was that something like that?

Yeah, it might be something like that.

And we were laughing about the stigma because it's reduced. Ridiculous.

Right.

You need to be honest with, well, I'll say as a therapist yourself, but certainly with your healthcare provider about what's really going on so you can get the best treatment possible.

Yeah, that's a great point. Yeah.

Yeah. So you. But anyway, you were able to see folks there, and it's interesting how you went there to teach. What. What were you teaching?

English, science, biology.

Oh, you were teaching biology. Yeah. But they needed you in the. Or you got working as a health aide in the clinic? Somewhat.

Yeah. We just sort of connected with the clinic there. Then I saw the nurse was running the whole clinic and then every now and then. So we could help with maybe some trainings about health promotion, HIV prevention, things like that. And students sometimes, if they had health issues, we would try to help with some small things. So it didn't overburden the clinic. Yeah.

Wow. We sort of have this spectrum or this hierarchy of healthcare professionals in the States, where physicians are at the top and nurses are somewhere below there. But in the rest of the world and throughout human history, they're doing the bulk of the work, are they not? Not to knock on my physician friends.

But that's what you mean.

You know, like, we sometimes underestimate what nurses are doing. They're doing frontline, heavy lifting every day.

Yeah, I think that's fair. And it's the largest healthcare profession. Wow.

I did not know that.

Yeah.

We have more nurses than any other provider.

We do, we do.

And we probably don't have enough.

Right. And it's still the case.

That's why you're. Hopefully that's why you're teaching. The reason I went into training counselors is two things. One, I knew there was. Wasn't enough, so somebody had to teach to train more. And number two was I wanted good ones out there because I'd heard too many stories about bad ones. In fact, that's how my journey as a. My passion for counseling started. Was a friend who told me she was in therapy not getting any help.

Okay.

I just thought. I mean, I was so naive. I just thought, well, if you're seeing a psychologist, it seems like you'd be getting better. That's how naive I was. So then you go from Namibia back here, say, that's it, I'm going to be a nurse, I guess. Is that what happened?

Pretty close. And then I wanted to move back to Michigan. And so then while I was waiting to get into nursing school, that's where I came to LCC. And that was a fabulous experience. I loved it here.

Yeah.

Because it was just people from all over the world. And so it felt like I was still connecting a lot with people from different cultures. And then I really love the supplemental instruction getting to do. Teaching physiology. Yeah.

Yeah. Because my wife did that. I was saying, you guys get your own classroom to study hours and preps and exams and then individual tutoring. But I'm so glad you had that experience here. I'm the same. I love the school. I've been here over 30 years. And the diversity of the student population is one of the things that I experienced right from the beginning. Grew up kind of in West Michigan. It's very Dutch Christian, lily white community. At least it was in the 90s. There wasn't much diversity over there at all. And coming to this big city of Lansing and going to the inner city Community College, I immediately met and made friends with folks from Africa, Japan, South America, other counties in Michigan that are quite different than Ottawa county where I grew up. I loved that diversity. I'm so glad you got to experience what was that. A similar experience at msu. And then as you went on to teaching, did you find that diversity in your classes over at State, or was it not something.

I think that was a struggle that there wasn't as much. It was something that they were working on. They had gotten a HRSA grant to try to help improve the diversity. But I think it continues to be a struggle, but something that they focused on. Yeah. And even at my current institution, that's something we, we really struggle with and focus on as well.

Bringing in diversity. Yeah.

Yes. But LCC sort of has always had that, right from the beginning. Yeah.

Yeah. I don't know how that started, but it's been a great thing for us ever since.

Well, I think cost helps a lot.

Oh, that's a good point. Yeah, you're right.

Yeah.

It's an open door. It's an open door.

A very open door feeling.

I always say. We're, we're a college Right on the curb level. Like you can just step right off the street into us.

Yeah.

And I love that we're not some ivory tower.

Right.

I'm not going to pick on the Ivy League schools, even though one of us at the table teaches it one. But it is, it's reachable. It's reachable immediately for people and we can take almost anybody off the street. This is great. I think people love hearing this because so many of our listeners are students and their educational paths are not linear. They're curvilinear for sure. And I think it's helpful for them to hear from folks like us who've been successful that our paths were circuitous as well. Right. We didn't have this clear, like, not since you were 8 years old. Did you know you wanted to be a nurse?

Nope.

And et cetera, et cetera. It was like there was some finding yourself along the way. And I guess the way I would describe it is your heart got opened up in a way that you probably didn't even know it could get that big. When you were in Namibia, seeing the struggle there and the people. I don't know.

Yeah. I think that's a nice way to put it. I mean, it was definitely, I would say, an eye opening experience and I felt the sense of gratitude and like a deep feeling of like wanting to connect and give back. Yeah. So nursing was like a proper fit for that. Yeah, yeah, yeah.

Let's wrap up the rest of your educational journey there, can we? For everybody so they understand where you ended up, where you're at. So then you come back to Lansing where you kind of grew up in this area and then you went to state.

Right.

Finished a nursing degree, then a second degree.

Yeah. They had a, they had just started the second degree accelerated program. I love that program. It was fast, to the points, good education.

You were an adult learner at that point, if I may say so. So you were, you were ready to just give me the schoolwork. I can get it done. I'll crank it out.

Yeah, that's exactly how it was. Yeah.

I don't need the college experience. I had that. I had it already.

Yeah.

So then what happened after that? Did you go into work or.

Yeah, I went to work. I. I've worked at a couple different hospitals. I was at the Cleveland Clinic in Cleveland and then Indiana University Hospital in Indianapolis. Yep. So I got my nurse, like bedside nursing, which was fabulous, fast paced.

What kind of work were you doing? Yeah, like what kind of units were you working?

I started with cardiac step down for those who are familiar. So like post operative cardiac conditions, that was pretty intense. And then I moved into medical icu, the micu, which I loved particularly because there we have a two to one patient ratio.

Okay.

Yeah. I really love being able to just also focus. And it was high intensity. So you get to feel, feel like you're using a lot of your science. Yeah.

Very high level intellectual discussions on the floor about what we're going to do to treat this person.

So that, that felt nice. But you know, sometimes nursing students will say, but I want to connect with my patients, and if they're on a ventilator, I feel like I can't connect with them. But actually in that case, you connect so deeply with the family and friends at the bedside, and then sometimes you even get the benefit of seeing the patient come off the ventilator and then you get the chance to potentially talk to them. I found it quite rewarding still in that capacity. Yeah.

Well, you're right on the edge with patients at that point then. Right. I mean, if they're in icu, it's touch and go.

It very much can be. Yeah.

But I mean, I almost want to dig into like some of the vicarious trauma of our work. I will say, I mean, a little bit. And we know I have friends who are nurses and we talk about trauma bonding that happens on the floor. And in my world, it's a little bit different. Counselors, we don't really trauma bond the same way that nurses might, because we don't talk to each other during the day while we're doing our work. Really, we're seeing people quietly. It's one on one. It's not two on one. Although I may see five or six, six clients in a day. I'm not sharing that experience with people as the day is happening. And I think in nursing floors you kind of are. I mean, in icu, I don't Know how many beds might be up there? A dozen or something. You have your two, but there's what, three or four other nurses up there with you that you can. I was going to say commiserate with. That's not the right word, but communicate with. I don't know, talk to me about that a little bit about that. Like that experience of working.

Yeah. It was pretty important to have that deep connection with each other. For me, I deal with things with humor, and so it felt like any way we could sort of make the experience more fun. So we would do, like, when it was time to, like, give the hygiene care, we would do bed baths together, put on some music and, like, help each other out. And that way we could do, like, a really thorough assessment of the patient because we're both, you know, we're checking carefully, but it makes it just like a little bit lighter, a little more fun, just those type of things. I felt like the teamwork helped to.

Carry the load because. Yeah, yeah, that's important. I mean, we can talk about that later, too. And I have with previous guests, but doing difficult work, which I'm not going to put our work is more difficult than anyone else's. Every job has its own challenges, but ours interfaces life and death quite a bit more frequently. Yours even more so, especially having worked in an icu and to share that experience with other people, it's just like the more people you have involved in it, the more it divides up the stress of the experience, I think. Right. So if you have an extra person there with you, it cuts the emotional weight of it in half because you can share it with someone. I don't know if that's exact math.

Right.

But I know for me, when I have a rough session with a client, I will then go do a consultation with a colleague and say I need to process and they'll sit there with me for 10 minutes and I can just get my feelings out because I've just heard, again, one of the worst stories of what can happen to human people. I hear about it. I don't see it like you did. You would see things. I'd have to hear about it and paint the picture in my mind. I don't know if that's worth sometimes or not. So then what happens? You go ICU and you're working as a nurse, and at some point you decided to go back to school yet again. So where are we at in that process?

Right. I always knew I wanted to become well. Once I started the nursing journey, I should say I knew I wanted to become a nursing professor because I loved teaching while I was in Namibia. So I knew that was my end goal. So I just went back to my professors and I asked them, what do you recommend? What's the best path? And they said, if you know for sure you want to BE in academia, PhD is a good direction to go. So I went into the Direct Editing PhD program at Michigan State, which allowed me to sort of bypass the masters and then go directly into the PhD in like about a five year period.

That's amazing. So what would other students do? Go on through for like a nurse practitioner degree and then Ph.D. or what?

Sure. There were definitely a lot of options actually. And for those familiar again with nursing, the doctorate of nursing practice is another terminal degree that you can get. Which when I was starting in like 2006 or so, for my doctoral studies, I was. Or no, for doctoral studies, it was later on 2009. The DNP wasn't fully understood yet at that point as much in academia, but it is now. So any who would be interested in that as a way to move into academia, that path works wonderfully as well.

Interesting.

Yeah.

So you knew. So you were kind of, I mean, strategic then. I mean, Cleveland Clinic is no accident then if you knew you wanted to be an academic, was that part of that?

Well, I mean, but even then it's a prestigious place. Yeah, I wanted to be at that time. I really enjoyed the cardiac nursing.

Oh, that was it.

Yeah. That's why I went there because they were considered top in the nation for cardiac care. Yeah. So it was a good learning experience. Yeah. Less charmed by Cleveland. It's as a community, which I want to be clear, that's probably because I didn't give it enough time. But yeah, so then I. I liked Indianapolis a lot. Nice city.

Yeah, it's very pretty.

Yeah.

So you're working on your doctorate while you're nursing then? Or did you have to stop nursing to finish your schooling?

After about a year, I had to stop then and focus because with the doctoral studies it was more. It just fit better to be either a teaching assistant or research assistant. So that's where I spent my time.

Okay.

Yeah.

And so I'm guessing you loved that and you then got. So tell me what happened after that. You graduate with the Renaissance hat? The floppy hat. That's the one we always see that Everybody wants to get that floppy.

Yeah. I look charming in my hat.

The doctoral hat. Yeah. So then what happens after that? You walk out with your doctorate and then you say, what Happens, Yeah.

So I did my PhD research in South Africa because I wanted to return to that region of the world. And we focused on HIV and tuberculosis care, trying to look a little bit more at patient advocacy. And so when I finished, that topic led me to do a postdoctoral fellowship at Columbia with a professor there, Dr. Larson, who focuses on infectious disease. So that was a good opportunity to sort of continue that. That work.

Okay. And that led into then an assistant professorship at Columbia, is that right?

Correct. That's how it came to be. I did enjoy the research, but I always knew I loved teaching the most. You know the story. And so I talked to my advisor about that and she said, well, there's an opportunity of professors going on maternity leave if you want to teach that class. It was the pathophysiology course, and it ended up going really well.

And you loved pathophysiology? I did love it.

Going deep. Deep. Yeah. Into the science. And so then we. I was able to then switch over to. Then they hired me on as an assistant professor.

Okay.

Yeah.

Very cool.

Yeah, it was a great journey.

So a bunch of big cities you've lived in?

Yeah.

Really? You know, Cleveland, Indianapolis, New York City. I don't know what the cities were like where you were at in Namibia or South Africa, but I was in.

A rural place most of the time. Yeah.

But so what was the state of mental health care in South Africa? Not just the country, but southern Africa. Do you have a sense of that when you were there? Was that even on anybody's radar?

Yeah. It's funny you mentioned that because that was like one of the main findings on the dissertation work because we were looking at side effects of drug resistant tuberculosis treatment. So it was known that one of the drugs in particular caused a major side effect of even as far as psychosis.

Oh, wow.

Yeah. And so we sort of just tracked with interviews to see what patients would indicate they were feeling. So we used words like anxiety and depression as best as they were understood in the local language. And. And then we compare them to what was written in their medical chart.

Okay.

For what was documented and of all the symptoms, it was the anxiety and depression that was almost never documented in the medical chart. But the patients had indicated that they were feeling that at a high level, whereas all the other physical symptoms were documented.

Interesting.

Yeah.

Scratching my head now.

Yeah, I knew you'd enjoy that.

So we don't want to write that down.

Yeah.

So do you suspect patients were actually reporting that up before, earlier in their care, and it just never got written down, like people just kind of pushed past it.

Well, and so this is where we tried to be careful how we wrote it up. Because at the same time, you don't want to sort of criminalize the providers who only have a few minutes with the patients. And so they're dealing with something that the patient brings forward and they're maybe not so quick to say something about depression or anxiety and you know, they may not even ask it. And that was, I think, the point we were trying to make. What if we asked, what would they say?

Yeah, I love that you said like, come on, we gotta start asking these questions, which now they do. You and I are about the same age and I remember going to get my annual physicals and they never did a mental health screening with me. Now they hand me a little, they ask or they hand me a little 10 question phq, something, something now, you know, just check, you know. But that wasn't even on the radar in our profession. We might say as healthcare providers as much. I don't know if that was your experience or how you were trained, even as nurses or nursing back. You know, we could talk about it 20 years ago now at least. Right. Was that mental health screening even part of a general check in or checkup?

No, you're right, that's more recent.

Yeah. And stuff was still going on back then. We just weren't asking the questions. And so whether or not people were writing it down in the chart, part of that is because it wasn't part of the process. It wasn't expected of them necessarily to do that. And mental health is still a very new science. I struggle to even use the word science on it, honestly. It's pretty abstract and everyone's experience is quite different, but we have terms that we can try to use to, I don't want to say pathologize, but to put the experience into pathological terms so that we can talk about treating it and so on. I'm not going to go into the long history of psychology here, but just briefly, we've tried to, as a profession over the last hundred years, hitch ourselves up a little bit more to the medical model so that we can be a little bit better understood and that we understand exactly what it is we're working on with individual patients. We don't even necessarily use the word patient in my profession too often. We often use the word client still, even though it's health care. I have a health care license, but we still say client as if it's a business transaction.

You know, it's the same in nursing. We even had to switch all of our questions, like our exam questions, to client to client. Yeah.

Is it now client? Yes. So it's not patient anymore?

No, it's client for training.

Okay. For training, yeah. I'm curious because I love the origin of that word patient means. It's from the Latin for suffering, means one who suffers.

Well, okay.

Well, think about it. If you have patience for someone, it's like a similar word, but anyway. Client. Yeah, but anyway, the medical model that we've tried to come along with and the mental health professionals use a diagnostic book published by the American Psychiatric association. So it's published by medical doctors, MDs and DOs, and we use that. But anyway, it's just a long way around of me saying it's hard to put, like, we don't have a lab test for depression. We don't have a blood test. We don't have a cuff we can put around your shoulder or your arm to test a lot of this stuff. Right. It's really hard for us to figure out where someone is at biologically. In fact, psychiatry and psychology is the only profession that I'm aware of that doesn't look at the organ they treat.

That's fascinating. That makes a lot of sense.

It's hard to look at the brain. It's actually expensive. We can look at it. But even if we were to look in there, we can't yet quite see these neural circuits mean this and these neural circuits mean that or this. Neurochemistry means this or that. I mean, we do know enough about some of the physiology of the brain to know what low dopamine or serotonin levels might look like. We certainly know with. I don't know if you're familiar with SPECT scans, that single photon emitted computerized tomography or fmris and things. I mean, we can look in the brain now and kind of see what's going on a little bit better than before. But we still don't have a data set where we could compare your brain and my brain to a normal brain, whatever that might be, and see how left or right we are of a mentally healthy brain, let's say which. We can kind of do that with a heart, can't we, with a cardiac? Like, we can take a look at blockages and visceral fat and stuff. I mean, I'm not going to speak out of my discipline here, but you can tell, right? I mean, you can tell what a healthy heart looks like versus an unhealthy heart. It's Hard to do that with a brain.

Right. And you just think about these quick clinic visits. We only have a few minutes maybe with a patient, and then you think about the cost. And that's prohibitive.

Yeah, absolutely.

Yeah.

Well, that's a big part of this, too, in your field, right, to try to get costs down so that we can do more. Is that right? Is it like, where can we. No, no. You hesitated. There's not a movement for that. Healthcare is expensive.

Healthcare is expensive. I'd like to think, you know, there's definitely a lot of people working on that, but at the same time, I just. It's been a struggle. I mean, you know, there's a lot of players involved. You know, the institutions, insurance companies, everybody's involved in the process. So it's. It's very complicated to get the cost down. Yeah, yeah.

Again, going back to the history of my field, I mean, it's like rich people got to go to therapy in the 20s and the 30s and the 40s. I mean, that's who went to therapy. And then healthcare plans and so, so on. It's more accessible now, but it's still not. It's not.

It's not where it should be.

It's not where it should be. Not everybody can get access to mental health care, for sure. Can't get access to physical health care either.

Yeah, that's right.

A lot in our country anyway. So hopefully that you're working on that. You got any grad students working on that? So maybe, yeah, we're going a little dark here. Like, this is not the, you know, our healthcare. But we're being honest, right? Our professions are not yet where they need to be. Medicine isn't where it needs to be. Healthcare is not where it needs to be. You're in the fight, you're educating.

There you go.

Yeah, you're training. So tell us where you're at now. We'll wrap up part one and we'll come back for part two and in a few minutes. But what are you doing as a nurse educator? What are you seeing? What's your mission there?

Yeah, so I think I'm in my eighth year now teaching, so I was teaching medical, surgical, nursing. I've moved more into pharmacology and leadership now. So those are a couple of the courses I'm. I'm teaching. And so, yeah, it has been very interesting watching progression of student learners. That's something you and I have dialogued about as well. Some of the challenges of helping to connect with students, and I think a conversation that all of us have in academia is about issues of grit and resilience and how do we help to foster that with our students as well. So that has been something we've been.

Thinking a lot about preparing them not just academically, but the development of their character or something. Not even character per se. That more speaks to their morals, but. How would you put it?

But something connected to that. I would agree with you. It's hard to quite put a word or name on it, but there is something deeper that I think we want to be able to connect with with our students, especially whenever they're patient facing. And how do we pull that out and not focus so much on grades, but still keep an excellent standard of education? That's it. Yeah. Let's just solve that problem quickly here.

You're right. You and I, because we have. We literally have commiserated over classroom experiences, both being educators and the hard part, like, I just assume they're all going to do the work with integrity on time. I don't even want to talk about the academic side of their path.

That's a deep conversation.

I just want to get to the. Like, you need to prepare yourself for what is coming.

Yeah. There you go. Yeah.

All right, so let's talk about more like how we've done that for ourselves in part two. Does that sound good?

Okay, sounds great.

Thanks. Thank you for tuning in to today's episode of Headroom. Remember, if you need mental health assistance, you can always call or text 988. And if you're a current LCC student, free mental health counseling is available to you at the college. You can learn more at LCC.edu/Counseling. I want to thank our producers here at LCC Connect and encourage you to explore other amazing podcasts at LCCconnect.com thanks again for listening. Take care and we'll see you next time in the Headroom.