The Business of Pharmacy Podcast™
Jan. 2, 2023

Trauma and its Effect on Pharmacists | Helen Sairany, PharmD, MBA

Trauma and its Effect on Pharmacists | Helen Sairany, PharmD, MBA

"Trauma is not limited to veterans. It's not limited to you going overseas in the middle of nowhere and getting in your battle zone and coming back with flashbacks and nightmares. It's about things that didn't happen to you, that was supposed to happen to you." - Helen Sairany

Helen Sairany is the CEO and Executive Vice President for the Florida Pharmacy Association. She is passionate about exploring the effects of trauma, which has been especially pertinent during the pandemic. She finds that many healthcare workers are suffering from PTSD due to the pandemic. She explains that trauma is not limited to veterans and can come from a variety of sources. Helen also explains that toxic masculinity can lead to men downplaying their trauma and not seeking help. She explains that children are naturally narcissistic and that this can carry into adulthood if not properly addressed. Finally, she explains the signs of a narcissistic boss and how they can emotionally drain those around them.

In this episode, you will learn the following:
1. How is the trauma caused by the pandemic affecting healthcare professionals?
2. What are the consequences of growing up in a dysfunctional family environment?
3. What are the warning signs of narcissistic abuse in work and personal relationships?

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(Speech to Text)

Mike Koelzer, Host: [00:00:00] Helen, for those that haven't come across you before, introduce yourself and let our listeners know what we're talking about today.

Helen Sairany, PharmD, MBA: My name is, uh, Helen Seran. I am the c e o and the Executive Vice President for the Florida Pharmacy Association. Um, I do that for work, but outside of work, I love to write. I find a lot of joy in writing, and my passion is in trauma, and that is basically work related trauma, family related trauma, racial trauma.

So I find, um, a lot of joy in exploring, you know, human behavior and how trauma is related to every day, uh, today's operation or day-to-day of our life. So I do that for, uh, for the site. And on, um, a busy day, uh, you would probably find me in the office advocating on behalf of pharmacists and migrating to the state of Florida.

Mike Koelzer, Host: So, Helen, when you and I spoke a little bit before the show, I said, Helen, we don't really talk about [00:01:00] medicine here because I'm not smart enough. And I said, when we're talking trauma, you are not talking about how pharmacists help patients with trauma. You're talking about pharmacists and maybe other healthcare workers that have trauma themselves.

Helen Sairany, PharmD, MBA: Correct, correct. It's uh, unfortunately we live in a society that exploits trauma in all of us, especially coming out of the pandemic. For the last two years, we've all. Got a flavor of it. So the question that is worth asking is not about who has trauma and who doesn't. It's more about where you are on the scale of trauma.

Are you seven out of 10? Are you 10 out of 10? Are you five out of 10? And why is this question so important? It's because we're social creatures, right? And the last two years we've all lived, uh, socially distant from our loved ones and we were deprived of something that is very essential to our being as you know, social creatures.

But when you are not, you know, having access, To [00:02:00] your loved ones where you're not able to interact with your team, with your colleagues. It's very detrimental to the wellbeing of humans. And we saw a lot of tragedy. We saw, you know, our loved ones suffering, uh, when we were not able to see them. And we had to make a lot of, uh, morally challenging decisions as providers because we were so limited, uh, with the resources and tools.

So all in all, very traumatic and a lot of pharmacists, doctors, nurses included, are coming out of the pandemic with signs and symptoms of PTSD. This is, uh, research proven, and it's a moment of reckoning in the healthcare profession as a whole. So pharmacists not, are not alone. We're also having other colleagues in the health profession who are equally, uh, impacted by the pandemic and are suffering from signs and symptoms of ptsd.

Mike Koelzer, Host: I think the problem, especially with we Men, is that when it comes time to talk about trauma, we have this [00:03:00] ability to downplay what we're going through because we always compare it to, well, I didn't fight in Vietnam and I didn't have, you know, children die of this or that, and it's like, , there's plenty of trauma to go around.

Deal with yourself and don't be afraid of that because what might be traumatic for you might not be for someone else, but hey, they can get their own help. Let's focus on you right now.

Helen Sairany, PharmD, MBA: That is, that is so true. My second book is actually on the traumas we carry, and you would be surprised to learn that for every combat veteran, for every combat veteran, there are 10 American children who are growing up in traumatic environments. Now, there is a lot to be said about that because when you are in a war zone and you're finding the enemy, it makes sense that your, the source of your trauma is coming from, uh, the enemy.

But when you are in the US and the children, uh, struggling from trauma from the source that is supposed to be [00:04:00] give you love and affection. Why is this important to understand? Because there is a lot of, um, you know, lack of awareness about what trauma is supposed to be. Trauma is not limited to veterans.

It's not limited to you going overseas in the middle of nowhere and, and getting in your battle zone and coming back with, you know, uh, flashbacks and, um, you know, um, nightmares. It's. Things that didn't happen to you that were supposed to happen to you. A child who is extremely vulnerable, uh, warrants a two minute attachment from, uh, a caregiver, but a caregiver being a pharmacist who's going through a burnout and they are extremely taken emotionally, physically by the unbearable work conditions.

They come home and they take, bring that burnout to them, to their family environment, and that stress state that the mother carries from the unbearable work conditions becomes a stress state of a child. And because a child doesn't have the mature cognitive development, they translate that stress state of a [00:05:00] mother as.

You know, it's their fault. And they take it as them being abandoned. They don't have that understanding that, well, mom is having a bad day at work. That is why she's not giving me the attachment and the treatment that I need so badly. So this is important to understand because we are going through a toxic culture that exploits trauma in all of us.

And what is the significance of that on the children that are gonna grow up within their own unfinished childhood business? And they take that unfinished childhood business to the arena, and now their problem becomes their supervisor's problem. So, it's very significant because that supervisor now, regardless of what they do, they're expected to be the parent that this individual never had because of the unbelievable work condition.

So this is one aspect of your question. The other aspect of men, um, you know, not being so willingly to admit vulnerability is because we live in a culture that promotes toxic masculinity. So you're expected to. [00:06:00] Perform yourself in a certain way, you're expected to compare yourself to a certain, uh, way.

And that is extremely unhealthy because you're putting unrealistic expectations on yourself. And the more you are doing whatever it takes to fit in, the more you're disconnecting from yourself. And it's a matter of time for you to clash because you just get tired of being someone that is not you. So, um, there are two aspects to the question that you just presented.

Mike Koelzer, Host: And I imagine too with trauma, when you have a clear enemy, when you've got someone who's coming at you and you can say, well, it's not my fault I have an enemy. Or when, maybe your house was broken into and you have an enemy That almost seems different than 

without an enemy. I think a lot of times you maybe start blaming yourself for that trauma, and I know you see it a lot maybe with children who have been abused and stuff there's not a clear enemy, and so that's almost harder because that blame is there.

Helen Sairany, PharmD, MBA: So children by nature [00:07:00] are narcissistic. They're egocentric. Now, I don't mean the bad narcissism and the bad egocentric that we talk about, that the culture talks about. What? My boss is narcissistic. By nature children, because they don't have that cognitive part of the brain developed yet.

They personalize everything. Mom is having a bad day at work. Well, I must be bad. Mom is not paying attention. So I feel abandoned. That is the egocentrism that I talk about. They personalize everything. So now why is this important? It's, uh, They take that with them. So whatever doesn't mature, whatever doesn't get validated at a young age, it becomes part of your adult life and you take that unfinished childhood business to your relationships and to the work environment.

So a lot of the time you might hear well. This individual doesn't have emotional maturity or this individual is acting like a child that might, that might be correct. Not at a fault of their own. It's because they didn't grow up in a functional [00:08:00] environment that validated their narcissistic needs. 

So there is a lot to be said about that. That narcissistic supervisor then our sistic supervisor probably is that that adult child that was never validated for growing up in a dysfunctional family environment. And they take that unfinished business of narcissism to the work environment that makes the work environment and be able to a lot of people.

So there's a lot to be said about why understanding, you know, the trauma 1 0 1 and how that could be significant in, in our work relationships, in our adult relationships, and developing an appreciation of why things, uh, evolve, uh, the way they do,

Mike Koelzer, Host: Yeah, I imagine in a lot of different environments, but let's say work.

Helen Sairany, PharmD, MBA: Mm-hmm.

Mike Koelzer, Host: You've got people there and probably all of us, at some point you might either be looking for something from somebody or you might be seeing something in somebody that you despise and sometimes that might be [00:09:00] the same person.

Helen Sairany, PharmD, MBA: exactly, exactly. It is, it is true. It's, um, and I've, I've had gazillion experiences of those, uh, you know, conflicting attributes in, in the individual. And it helps, it helps, you know, to understand where this individual is coming from instead of that frustration, uh, because of, uh, the ego that they bring in or the narcissism that they present.

If you look at it from the trauma lens, you actually end up developing compassion of some sort for this individual, and you realize, gee, I wonder what this individual had to go through, because they're craving for that attention. They're craving to show how important they are, and that's because they never were validated as a child by the caregiver of their narcissistic need, and they bring that to their adult life.

Mike Koelzer, Host: All right. Let's talk about one of those bosses, those narcissistic bosses, and let's put it in the pharmacy setting. So give me a setup, give me an example of what we're [00:10:00] seeing with narcissism from, let's say a boss.

Helen Sairany, PharmD, MBA: So narcissism, um, it's, I like to say there are three 

Cs that never coexist, but when they do that, it shows that this individual is having some signs and symptoms of narcissism. Uh, I would say, uh, charism. Confidence, and compassion. Um, it's hard, it's hard for these three Cs to show up because if someone is really, uh, confident, uh, and, and charismatic, uh, it's hard for them to be compassionate at the same time.

But these. Narciss narcissistic individuals because they crave so much attention, they're willing to woo an, you know, an individual, especially with job interviews, they are really, really masterful in job interviews because they show that charisma. They show confidence, they show the compassion that they will have for an individual.

[00:11:00] But let me tell you one thing, it's only a matter of time for them to clash because having these three Cs are extremely difficult

  1. You know, to portray the outside world. So they might, um, you know, love bomb an individual or love bomb a staffer for a couple months. But it's only a matter of time for the true, authentic self that is deprived of love and affection from a caregiver to show up and you realize that this individual is not what you thought it was.

So a good example will be, well, how did this individual make the majority of narcissists make it to the c uh, executive level? Because they crave leadership. And why is that important? Well, they're craving for leadership means when they're in charge they're, they're, it's less likely for them to be. Any further, any further, you know, because they're in charge, right.

And there, there is just no way they can be violated. They were, there is no way they [00:12:00] can be traumatized because they have the power. So that's how they look at it. Now, is every exec narcissistic? Uh, probably not, but I would say leadership does, like they say, corrupt or corruptible. So if you have those features of narcissism, for sure leadership is gonna feed to that.

But that doesn't mean that everybody in, in the C-suite, um, is narcissistic. But if they have signs and symptoms of narcissism or you know, they come to the position with signs and symptoms of narcissism, then definitely that's gonna fit to that.

Mike Koelzer, Host: When you talk about the um, interview process,

Would that be both somebody who is trying to interview to rise up the ladder, or is it also the interviewer as a narcissist? Can they make the job sound too good and so on for the. Candidate that's trying to get a job. Is it both ways or is it typically the narcissist is moving up the ladder with their, [00:13:00] charisma and so on?

Helen Sairany, PharmD, MBA: I would say the individual who's going up the ladder, they have that deep craving for validation, you know, for them to be in charge so that it is less likely for them to be violated or trauma traumatized like they were, uh, when they were, when they were. . Yeah,

Mike Koelzer, Host: What I've heard about narcissism too is that they've got these big walls, but if those walls crumble down, those walls are hiding a lot. So it's not just like somebody who has maybe knocked down a little bit. If you knock down a narcissist, everything crumbles because that's what it's built on.

Helen Sairany, PharmD, MBA: exactly. They are Behind those walls. Behind those walls is a very fragile child,

very fragile child, deprived of their attachment and the attunement needs from the caregiver. So what they do over the years, they built these walls around them. What is this wall? This wall is All 

All ego degrees, um, you know, uh, accolades, [00:14:00] um, executive positions, all the artificial stuff that they use to make them look good.

But behind all the walls, it's a fragile child crying for affection, crying for attention, um, deprived of their, you know, narcissistic needs that, the good needs that a child needs. Um, from a caregiver, I would say.

Mike Koelzer, Host: Let's say that someone's listening to this and they're in community pharmacy or in hospital pharmacy. Let's say they're not dealing with the CEO or the C-suite. Are there narcissists that find their ways just into those levels too? 


Helen Sairany, PharmD, MBA: So narcissism can present itself in so many layers of life as a significant other, as a colleague, as a friend, as a supervisor, they drain your energy, they exhaust you because it's all about them. Um, and then when you challenge them, [00:15:00] they go through this hostility, uh, trying to prove how you are out of line.

The other thing that is good to watch out for in these individuals is they are not good and following rules. So regardless of how many boundaries you put out there, they are notorious for violating your. Um, so they're not gonna follow boundaries. They're not, uh, good in, in EF affectionate listening. Um, they are because it's all about them, because they're so deprived, right?

So everything has to be about them. And narcissists are always the takers. They're not the givers. They take us in a relationship regardless of what relationship we're talking about. And this could mentally, physically, emotionally drain the giver because the giver, um, if you are an enabler, then you're pretty much making matters worse.

But if you wake up to this pattern, it's usually too late. A lot of women actually get sucked into these relationships and it kind of gets them into a vicious cycle [00:16:00] over and over. Cuz every time they try to get themselves out of a relationship, the narcissist, because of the, the competence, the confidence, the compassion, they suck the woman back into the cycle.

And you realize in 15, 20 years, the woman, woman finally wakes up and she realizes that her life has just been consumed by this vicious cycle. And when they finally get themselves out of it, they realize they've lost so much energy, spirituality, and, and a good life that they could have had if they ended the vicious cycle.

Um, Far earlier. This applies to relationships, this applies to the work environment. Supervisors could do the same thing, just like our significant other could su suck you up into the vacuum of their, um, narcissistic abuse. So it's very, uh, scary. But I would say it's important to look for some signs and symptoms.

The three Cs are what I like to focus on and to catch up to it. 

Mike Koelzer, Host: When you say the three Cs, you say compassion that is not one they have or is that one they.[00:17:00] 

Helen Sairany, PharmD, MBA: They fake it.

Mike Koelzer, Host: Oh, they fake it. They

Helen Sairany, PharmD, MBA: Oh yes. Oh yeah. And it's only a matter of time because it is just not sustainable.

Mike Koelzer, Host: Yeah,

Helen Sairany, PharmD, MBA: I like to say it's too good to 


true, you know? It's too good to be true in an interview if it's too good to be true for a date. If it's too good to be true for a staffer, if it's too good to be true for

anything, red flags, it's important for you to, um, this is really. Too good to be true? Or is this, um, it's, again, we're all adults and we just have to kind of make some, um, wise decisions. This is this individual showing too much, too fast, too soon, and that is a sign, you know, the iconic definition of trauma. If they are showing too much, too fast, too soon. Cause a lot of victims of narcissistic abuse come out of the relationship with signs and symptoms of trauma.

So if it's too good to be true, if it's too much, too fast, too soon, that's love bombing, then that is a red flag that you should definitely be aware of and not to proceed, [00:18:00] um, with the, with the relationship.

Mike Koelzer, Host: You know, if we look at different, uh, let's say disorders or states of mental health, it seems a lot of, like, I've heard it said that everybody has x, it's when X gets out of control for you that it's a problem. So let's say we all have anxiety and we all have some depression and we all have some of this and all have some of that, when it rises up high enough, it's a problem.

As I talked about narcissism, having that wall, is narcissism the same, that it can rise up gradually? Or because there's this highest level people shoot up there and then they wanna remain up there. Do we all have some narcissism in 

Helen Sairany, PharmD, MBA: Yeah. Yeah, we do, for sure. We all do. Uh, it's about, it's about self-awareness and you talked a little bit about mental health, uh, Mike, uh, mental health, it's a construct. There is no such thing as a gene [00:19:00] for depression. There is no such thing as a gene for schizophrenia or a gene for bipolar disease.

If you really look into all constructs that are human made, you'll realize the common template of all mental health diseases is rooted back to childhood trauma. . Okay. So to me, mental health, disease, whatever it takes. Depression, bipolar, schizophrenia, adhd, I don't know what, it's an outcome. It's an outcome of a life lived with its abnormalities, with its unbearable conditions, with its traumas.

So the common root of all mental health diseases is trauma. But unfortunately, as pharmacists, as healthcare professionals, we don't get exposed to trauma training. We get exposed to signs and symptoms, the outcomes of trauma, but not enough exposure to, uh, the root cause of all the eds and mental health diseases.

Now, do we all have it? Absolutely. And that's what I started off with. It's not about who has trauma and who doesn't. Where are you on the scale? Right? And we, we [00:20:00] all have genes. We all have genes of, uh, you know, cancerous genes. We all have genes for. I don't know what, but remember, genes are not pre-determination.

 They expose you to, uh, XY disease, but they do not determine an XY disease. It's the environment. It's the environment that 

proliferates our eugene or, you know, cell exposure. Through a science called epigenetics. So epigenetics, basically, I grew up, um, to an immigrant family that survived war, that survived atrocity similar to Holocaust.

Now I was not a firsthand exposure to that, but I still have signs and symptoms of P T S D because of the epigenetics that I inherited from my family. Why is this important to understand? Because Mother Nature has developed my body in a way to better prepare me for the trauma that my mother or my father were exposed to.

So, which means our mental state develops in the mother's [00:21:00] womb. If the mother is stressed out, that child is gonna have signs and symptoms of anxiety when they're born because they carry that mental state of the mother. That is all explained to the concept of epigenetics. So do we all have it? Absolutely.

But why do, why are some people more, um, You know, more, um, irrational in terms of exposing and that, because again, mental health is an outcome, an outcome of an abnormal life being left. So if their environment is more austere than our environment, then yes, they are more likely to show signs of depression, then you are gonna show it, if that makes sense.

Mike Koelzer, Host: Helen, when a baby is born, let's say you're born to your parents, mean, let's say they've had the trauma, your genes don't change, right? It's more of a hormonal washing of things like that. you don't have different genes from their trauma.

Helen Sairany, PharmD, MBA: you don't have different gene sequences. You [00:22:00] have a different gene expression.

Mike Koelzer, Host: More of it comes out and so on.

Helen Sairany, PharmD, MBA: Because epigenetic means what? It's on top of genes.

The sequence is the same.

It doesn't change, but the expression through the signs of epigenetic, if you grew up in a war, is gonna be different than if you grew up in a resort, for example. And why is that important?

Because the epigenetic prepares you to, to survive, right? That's evolution, right? So it's, uh, so why do I have, you know, genes of PTs even though I was not exposed to the osteo environment that my parents did? Because mother nature prepares me in case, in case. But again, I tend to come across a bit irrational because my body is translating those triggers as reminiscent of a war as if I am in a war.

But again, it's, it's important to be. It's important to be aware of your environment and your history because you're better able to regulate yourself and calm yourself down. It's not, it's not worth it, and it's [00:23:00] not big of a deal, 

Mike Koelzer, Host: Helen, I warned you, if you start bringing up those big words with me, you're gonna lose me. So I didn't know that. I didn't know that was on top of that. That's what I was getting at on top of the jeans.

 alright, Helen, here's the one I don't understand.

I've been told that a lot of times our mental health is kind of like a beach ball. , you blow it up enough, and one of the seams might give out, whether it's anxiety or depression. You put enough pressure on somebody. Here's the one I don't quite understand, schizophrenia. , that almost seems like more of a black and white thing.

That seems like something that wouldn't come just from anxiety and depression, how those raise up kind of gradually. I don't know enough about schizophrenia, but it seems like that's more of a light switch. how does that come from, stress and trauma

Helen Sairany, PharmD, MBA: So again, any disease, it's poor G poor genetic

Mike Koelzer, Host: Genetic. I

Helen Sairany, PharmD, MBA: part, part environment. But what did, but what did we say about genes? They [00:24:00] are a predisposition, but they're not predetermined.

Mike Koelzer, Host: gotcha.

Helen Sairany, PharmD, MBA: They dispose of all of us equally, but it's not predetermined. What Predetermines is the osteo.

The dysfunction, the dysfunctionality.

Now there is a famous study by the C d C as 

as well as Kaiser Permanente. They looked at the impact of exposure to adversity. You know, early exposure of a child growing, you know, being exposed to trauma. Now, what kind of, what kind of traumas did they look at? Did you grow up in an alcoholic environment or a mother or father using substance use?

Was a mother or a father incarcerated? Were they divorced? Did you witness your mother being physically violated in front of you? Did you, um, so unlike, you know, did you, were you sexually violated? Were you emotionally violated? Were you physically violated? Again, it was like 10, 10 extreme exposures to trauma.

Bob, doctors, Bob and, and Dr. Vince Valdi from c d c and as [00:25:00] as well as Kaiser Permanente, conducted this study on 17,000 individuals, middle class Americans, right? Um, and they realized that trauma is far more prevalent in this, in this, Country that then they realized, um, at least 70% of Americans have at least one exposure and 30% of Americans have at least four exposure.

What does that mean? It means yes to me being sexually violated. Yes. To me being, um, growing up in an addicted environment. Yes. To me being seen, my mom being violated, whatever you said yes to. 30% of Americans at least have four. Now, this is all pre pandemic. We all know tension, addiction, anxiety is on the horizon because of the last two years.

So I'm sure these numbers are far more serious. Now, why is this important? Because they also found that the higher your score, the more you said yes to these adversities [00:26:00] or the exposure to trauma, the more negative is your health outcome. So what they found was if you said, if you said yes to four to four of these traumas, You've doubled your risk of developing C O P D developing, doubled your risk to hepatitis C. You were four times more likely to develop depression,

six times more likely to take down your life with suicide, with suicide, three times more likely to develop ischemia, which is the number one killer in the United States, and 3.5 times more likely to develop, um, lung cancer.

So again, trauma does kill. Stress does kill work-related trauma or work-related stress does make us sick. So when you're asking me about schizophrenia, I would say it's part genetic, part environment, part environment. But again, yes, we can blame genetics, but genetics is only a predisposition, not a predetermination.

Your environment is [00:27:00] what predetermines, um, your, your exposure to, to those 

Mike Koelzer, Host: gotcha. You raised the point about people being stuck in relationships and so on, and the problem with narcissists is like, if I told you, Helen, don't go out with somebody who. has this kind of personality, you know, Helen, you're not gonna like somebody who's boring if I was setting you up, earlier in life with your dates, I'd say don't go out with someone boring. Don't go out with someone who makes you pay for everything. You know, don't go out with somebody who likes to speed in their car and that kind of stuff. And you'd say, yes, Mike, I understand this, but it's hard to teach somebody not to go out with a narcissist because a narcissist, they're so good at it,

they pull you in. And at some point I don't wanna say it's too [00:28:00] late, but it's hard because that's their method.

Helen Sairany, PharmD, MBA: Well, it's also what this individual takes to the relationship, so the famous book, um, is called, uh, mastery of Love by Dan Miguel. Russ. He's the author of Four Agreements. I'm sure some of your readers would probably know when you say Four Agreements, they're like, oh, yes, we know who he is. And in his book called Mastery of Love, he talks about the Magic Kitchen, right?

And he says, imagine yourself being in a kitchen that is fully full of all kinds of goods, chocolate fruits, any kind of food you want in the world. It's in your magic kitchen. That's why I called it Magic Kitchen. Then a guy comes and knocks on your door with fresh pizza out of the oven, and he says, here, I'll give you a slice of pizza, or I'll give you the whole pizza, but you have to do X, Y, Z for me, right?

And what, what is your response gonna be? As a girl? You'd be like, why would I do X, Y, Z for you when I have a magic kitchen full of all this good food? No, I'm not gonna do what you want. And I can actually even give you. You know, a pizza [00:29:00] if you want. So now that's one scenario. Then there is another scenario where there is no magic kitchen and the girl is actually starving, and then the same guy knocks on the door 

with the, with the pizza.

And what happens? I'm gonna give you this fresh pizza out of the oven, and I know you're starving, but you have to do X, Y, Z for me. 

So the girls are most likely gonna run with it, right? So yes, it's about narcissists. being masterful, but also if you are a, are you a girl coming from an area of abundance? Or are you a girl coming from an area of lack?

If you are someone who doesn't j cherish the joy within, and you only find joy outside of you, then chances are you're more likely to fall for a narcissistic guy. Now, I'm not blaming the girl, but it always takes two in any relationship. So it, where are you? Are you in from the come approaching the relationship from an area of abundance?

Or are you approaching the relationship from the area of lack? If you have a lack, if you don't have a magic kitchen in your heart, then chances are you gonna [00:30:00] fall for whoever comes falls on your on your way.

Mike Koelzer, Host: It makes me think of somebody who is going for a job and the boss is a narcissist. That can be kind of tough because if you had the magic kitchen, you wouldn't be looking for the damn job. Maybe, you know, you would just be doing whatever you want to do.

So the

fact that 


Helen Sairany, PharmD, MBA: not gonna, you're not gonna settle for

Mike Koelzer, Host: you're not gonna settle, but if you really need the job, that's where maybe some of that, uh, bad narcissistic stuff can happen. Because if you don't have that, you don't have a kitchen, you're gonna starve, let's say.

Helen Sairany, PharmD, MBA: and this is important. It's, uh, having standards is also important. Um, it goes back to relationships, uh, because I am so happy within, you're gonna have higher standards, right? You're not gonna settle for whoever comes your way next. And this is important, especially with pharmacists who are going through a burnout.

 How is this related to the era of great [00:31:00] resignation? Well, a lot, a lot of pharmacists pre pandemic had to put up with abusive and unbearable work conditions. Why is that? Because of lack? Because they were afraid, well, I need to provide for my family. Gee, what is gonna, what's gonna happen if I don't have that paycheck?

And if I let go of those six digits, then a pandemic happens, Mike, and we see waves and waves of layoffs and people get by just.

Nothing, nothing happened. And the great resignation, the way I look at it is a, it's an era of, of reflection, of realignment. A lot of people now are thinking, was that really a lack or was that just me being fearful?

It's like they're now starting to reflect that what we thought is okay, it's actually not okay. What we thought was normal and healthy is actually making me sick. because your body tells you enough is enough, your body tells you no, but the more you try to silence that, no, the more you are exposing yourself to [00:32:00] chronic diseases, because what did we say about disease?

Disease is the outcome of a life lift with its experiences, with its abnormalities, with all the abnormal conditions that you've put yourself in under. So now, yes, we had to. With our low standards for work conditions, but the great great resignation is a grade of reawakening. People are now realigning their standards.

They're thinking about that what happened two years ago, pre pandemic was not acceptable, and now it's a era of great awakening, and that's why they're masses of Americans leaving their current employer because they're coming up with better standards, which is huge 

for themselves. 

Mike Koelzer, Host: It's also a time where people feel not as bad making decisions. It's like, Hey, you know, I'm not going back to that barber that bowling league, we had those, those guys weren't best for me.

I didn't want to tell 'em, but now we've had the break, it's easier. So even on that way, it's like maybe somebody who was [00:33:00] afraid of their boss, you know, now it's like, Hey, I, I'm just gonna do this. So I think it gave a good out for a lot of people. In addition to what you're saying there,

Helen Sairany, PharmD, MBA: for sure, for sure. 

Mike Koelzer, Host: I've heard the term, complex stress. 

Helen Sairany, PharmD, MBA: S. D. Mm-hmm. 

Mike Koelzer, Host: the way I understand it is 

this is even maybe a harder one for people to admit to, you can't point to maybe this bomb blowing up or this person being, you know, murdered in my family.

But it's this constant drip over 10, 15 years of abuse. And if you took maybe one huge thing and divided it by 15 years, you know, every day for 15 years, it would just look like a drip. But that's also trauma.

Helen Sairany, PharmD, MBA: Yeah. Well, um, I have complex PTsd by the way. Um, I was diagnosed, uh, when I came back from [00:34:00] overseas because I joined Doctors Without Borders. And I realized I was the one that needed help. But my way of seeking help was I was, I was pretty much giving, being, being everything for everybody, right? Until I reached rock bottom.

And then when I came back to the US I was diagnosed, which was devastating because when I was diagnosed, P T S D was looked at as a disability, right? And, and again, of course my ego was hurt, talking about ego and narcissism. Yes, we all have it, and I have all these degrees and all these accolades, and how in the world can I have this mental disability?

Um, I have a choice to make. Was I gonna let P T S D define me or was I gonna shift it and turn it to wisdom, uh, and share with the outside world? So this kind of goes back to, um, my background and my passion for trauma, uh, complex P T S D is about. So the way I like to define trauma, trauma is what happens inside of us physiologically.

Psychologically, emotionally, all that happens [00:35:00] inside of us because of what happened to us, what happened to us in the past. Right now, there is a lot to be said about that. There is a lot of wisdom to be said about that. Why is that? What happened is gone, but what happened inside of us can be healed. so that's one definition of trauma. But when it comes to, to c PTs, d complex PTs, it changes the definition of trauma because trauma is also about what didn't happen to you, what didn't happen to you as a child, I didn't have my father around. My father was gone, you know, he was a prisoner of war, right?

So I grew up with no father figure, so it didn't happen to me. My mother was busy providing care for all her children in a patriarchal society. So she was very stressed out. But as a child, how did I translate that? How did I take that? Well, I felt like I was being abandoned. By a woman that I needed her love and affection so badly.

Again, I didn't have the cognitive functioning to explain, well, my mom is doing [00:36:00] her best, but that's not how a child looks at it. You know, I was abandoned, I was neglected. How do I take that into my relationships? Any signs of not getting the affection that I need is reminiscent of my past, that I feel like I'm being abandoned.

So that's complex. PTSD is a prolonged exposure. It's a prolonged exposure. It's a lifelong experience of hypervigilance. Of hypervigilance and how your brain, the amygdala, the body's alarm system, that's what amygdalas is. Basically, when there something gets burned in the oven, the alarm system goes off, right?

That is your, your brain tells you danger, danger, danger. So I grew up with a hyperactive amygdala, with a sloppy amygdala, which means even if something is not burning in the oven, my alarm goes off and it misinterprets things. I'm constantly scared. I'm constantly hyper alert because of the environment that I grew up in with no father and with no affection from my mother.

So it's complex. [00:37:00] PTsD is about something that the child did not get exposed to over a prolonged period of time, and how that actually is taken over to their adult life,

Mike Koelzer, Host: I had a situation for about 20 years of my life that if I explained it to somebody, this happened to me, they're like, it's a lot that happens every day. It's like, yeah, but it happened every day for 20 years, it builds on you, 

Helen Sairany, PharmD, MBA: it.

does it. 

Mike Koelzer, Host: The way I understand some of this, Helen, have you said that it's in the past?

but your body feels like it's present. And then sometimes if you get triggered, like if, if someone looks at you a little bit funny or something like that, instead of just saying, he looked at me funny. I'm not gonna judge what that was. But you get these feelings going, you get triggered, 

and instead of blaming the past that's over, you put all those feelings into this person who maybe didn't even know he looked at you funny, and now you [00:38:00] revved all this up again.

Helen Sairany, PharmD, MBA: Yeah. Which means who has all the ammunition built up? You do. 

You do. Right. And who is the, who's the trigger?

The outside is. But does the trigger warrant all this ammunition 

for you to just, it doesn't, it doesn't. Which means it falls on you to control. Now you said yes, it happened in the past, but remember what I said about the amygdala.

 The body's alarm system, the amygdala , becomes sloppy.

But it's not the job. It's not the job of the amygdala to tell you that. It happened in the past or it happened today. It's not. That's the job of the hippocampus.

Hippocampus is the body's memory part. But when there is too much trauma, too much, too fast, too soon, your body's alarm system takes over. Take over the memory because when you're about to be attacked by a bear and of force, are you gonna think about the future? No. Your number one priority is survival.

To run away from the bear, which means you're not gonna remember. Why [00:39:00] do a lot of veterans have signs and symptoms of Ps? You have a lot of flashbacks because what happened in the war haunts them every day because the AMD is sloppy. There needs to be a lot of, , metacognition to calm their brain, to calm their amygdala so they can live a happy life, a peaceful life. But the brain of a traumatic individual doesn't know. They cannot feel safe within their body because their body alarm system is so activated that it's constantly looking for cues to protect you. So while the individual was making fun, the amygdala is gonna take it outta context, and it built all this ammunition. And what do you look like to the outside world? You'll look like a neurotic. You were like, gee, so what if you just made a joke, but they don't understand your background? 

And that's why the work is important. Metacognition such as yoga, mindfulness, meditation to calm your nerves down. Um, so you don't take things outta context.

Mike Koelzer, Host: I always thought it was noble of me to deal with someone right [00:40:00] away and not, uh, not even need time to think about it cuz I know the person I am and so on. But with some C P T S D, your amygdala goes so fast that your frontal cortex needs a chance to catch up.

And so if you let something sit even for five seconds or five minutes or five days, your amygdala is still always gonna do its job. But your frontal brain gives yourself a chance to catch up and then you can say, well, , who cares if it catches up? Your amygdala did his job. It's like, who cares?

Unless it was your 12 year old daughter that said something and you attacked her like it was, you know someone from the past instead of your beautiful daughter. So you can do it if you want to, but you're gonna be an asshole to a lot of people until you have your brain catch up to you and at least have it balanced.

Helen Sairany, PharmD, MBA: Yeah, I have a friend actually who is always so [00:41:00] combative, And if I wasn't trauma informed, I would be very upset and very offended. But I know this individual, I know his background, I know his environment. So a lot of times he, when I, even when I ask him a question, he totally takes it out of context.

But not everybody's trauma is informed, not everybody. So they might look at you as an individual who is extremely rude, who is just obnoxious, who is, you know, whatever. Uh, if they don't have an appreciation for your background. This goes back to the two roads, two roads that I, I'd like to talk about the high road and the low road that I'm sure you've heard about.

So when you get triggered, when someone gets under your skin via email, let's say via email it's so gratifying to send a nasty email back, right? You send a nasty email back and a few seconds later you regret the decision. You regret the decision. Why is that? Because the way the brain is developed, the trigger, the stimulus from outside first goes to the [00:42:00] low road.

The low road goes to the amygdala because the way our brain is developed, we have the survival brain, the reptilian brain, then we have the limbic brain, and then we have the frontal cortex, right? The part of the brain that is responsible for, um, you know, cognitive function. Executive decisions, right?

But that part does not develop until we're like, what? 25, 27. So, which means we're, we're children until we're 25, 27, because we're not mature adults until the cognitive brain is fully developed. Now the little road goes through the amygdala first, and then a few seconds millisecond, not second milliseconds.

If you only hold off before you press, press the button, the signal will continue its way to the cortex. Cortex is here, amygdala is here. Reptilian brain is here. Bottom up. Bottom up. Right now, the amygdala's gonna do its job. It's gonna say danger, danger, danger. And you're gonna be like, [00:43:00] oh, this nasty person is sending me this nasty message.

How dare they? I'm gonna fight back. And then you send the message through the low road, because the low road went through the amygdala. Then a few seconds later, the cortex gets the message. and the cortex tells them, Hey, that was not worth such a, so much tension. So I tell people, this is important because it's okay.

You're angry. Write the email, but don't send it. Write it, because that's gratifying,

It's gratifying. Sleep on it and come back the day after, or come back a couple hours later and you're. Holy crap. I was gonna send this. I, I can't imagine how many times I've done this and I've laughed on myself

and I've, I've caught my, and I've caught myself in shock because amygdala is blinding. The emotional hijack is blinding.

Mike Koelzer, Host: There's a book, it was a Dale Carnegie book, either about anxiety or about how to win friends. I think [00:44:00] was the anxious one, but it talked about Abe Lincoln doing this, you know, the same method. And I remember about 15 years ago we had a cottage and I had to buy all of the mattresses for our family all at one time.

And the mattress guy likes it. Screwed me over somehow, but it's hard to define a screwing over of like $29. That's all it was. But for some reason, it was triggered and I wrote this nasty letter to him and it was just terrible. And I said, I think I still have it in my file cabinet. I knew it was stupid to send it, but I spelled it all out and got it outta you and gave yourself a chance to catch up.

Helen Sairany, PharmD, MBA: Yeah. And a lot of time, especially with this individual that I know has a lot of trauma, I, I don't argue at the moment. And I think when things, and again, I'm not a saint, I'm sure I have my moments where I'm like, gee, I could have done better. We're all human after all, right? But there are times where when the individual is regular, Never push [00:45:00] back when, when amygdala's in a hijack, right?

But when things are calm, and you'd be like, I think this is what you meant. Right? And you would be surprised how many relationships, how many marriages would be saved if or if we only knew the tactics of how to handle any communication and not let the amygdala hijack, um, our brain. And even if it does hijack, is there a way you can work around it?

And that's not easy. That's not because I, because I've fallen for the trap so many times myself. So,

Mike Koelzer, Host: Growing up in different situations, kind of the modeling to me was, don't say anything until the amygdala hits and then something blows up. You're either really, uh, happy or you blow up.

 And I remember one time this person said, there was a better way to treat your employee. It's like, what do you mean I had a right to do this and that? She said, well, you could. Told them, and I'm like, really?

You mean I don't have to be quiet or blow up? There's actually a, a middle where I can just talk to people.[00:46:00] 

Helen Sairany, PharmD, MBA: Yeah, no, I know, I know. It's important to find some tools and resources to regulate. I know my outlet is to find a trustworthy friend, a trustworthy friend to talk to when things bother me. I don't, I try and I try not to internalize it. Um, because that's also part of regulating yourself.

Meditation is important. Running outside is important. Nature is important. But also, you know, I find a lot of value in that deep human connection and how I can, how I can use that to regulate my body and have this individual kinda hear me out a lot of time. All you have to do, just listen. Just listen.

Mike Koelzer, Host: Sometimes I knew it was good to talk to people, but I found myself complaining to them when I probably should have gone more directly to the person. But that's kind of how it was modeled for me. It's tricky stuff.

Helen Sairany, PharmD, MBA: human relationship is not easy.

 It really helps individuals to self-reflect. One of the [00:47:00] tools that I utilize when I give talks and training, I use the saboteurs. Now you might ask me, what is that?

Saboteurs are basically, um, attributes in us. The sabotages are relationships. They're called saboteurs. Now, the significance of saboteurs is it all goes back to the unfinished childhood baggage that we all have, right? Why is this important? Because if you are not validated, you're gonna crave for validation.

you're gonna be a perfectionist. You're gonna be a controller. Why a lot of narcissists crave to be an exec because that's their way of controlling the situation. So they don't get abused anymore. Right. Or they don't get violated anymore. So these saboteurs, I actually give the assessment. I actually just gave this talk to the 50 state execs.

Um, they're 40, 49 other execs, plus myself, plus they're President Alex. And they all took the assessment and you would be shocked. Majority of the room were controllers. Majority of the room were [00:48:00] controllers. We're talking nine out of 10, 9.6 out of 10, 9.9 out of 10 

I wish you could see the shock on their faces. But perfectionism is good. Being an overachiever is good. But too much of perfectionism, too much of an overachievement. Too much of a controller can be sabotaging to you, to your loved one as well as your working relationships. Now, they were all execs. Did I tell them you are the problem?

No, but it was about self-reflection. If you are a 90.9 0.9% controller, it means you need to do something about that because you're intimidating, you're scaring the crap out of your staff. You know, you're scaring your staff, you're intimidating your people. If you're like 90.9% perfectionist, which means your staff is gonna say, regardless of what I do, This individual's not gonna be happy because there's too much of a perfectionist.

 I usually use this assessment and then I talk about the root cause of the saboteur in them, and I relate it back to their early childhood. So there's a [00:49:00] lot of reflection, trauma, reflection, dysfunctionality, reflection, and it's just, it's, it's a very emotional talk that I give because it makes all these people super powerful, um, super impactful to kind of reflect and there's so much vulnerability that you see for the very first time for them to kind of, you know, 

demonstrate and reflect.


to you it's, it's fascinating.

Mike Koelzer, Host: It's really interesting answering those tests, maybe they're looking for a certain one. Mental deficiency, for lack of a better word, but they're looking either for O c D, uh, you know, narcissism, depression, or anxiety. So you answer these things, and my family tends a little bit towards O C D, as a way to combat anxiety or whatever.

And it's interesting answering this stuff because it'll ask questions like, you know, I'm the best person in the world and I'm this, and you go down these things. It's like, who in the hell would answer yes to that? And then you go down something else, it's like, who in [00:50:00] the hell would answer yes to those questions?

But then you go down something where you kind of are like, let's say it's an O C D column. You're like, of course I put this in order, and of course I do this, it's like those people in those four columns are nuts. But when you go down the column that is, Defining you.

You're like, why Wouldn't you be that way? But unfortunately, you're as far to the outside as somebody else would if they weren't part of that.

Helen Sairany, PharmD, MBA: Exactly. Yeah. It's fascinating. 

Mike Koelzer, Host: We're Talking about hypervigilance. You can congratulate yourself for being hyper. , you can say, my amygdala is doing great. I'm picking up all these issues. I'm still alive. I haven't died. The Panther hasn't come and eaten me.

I'm keeping my eyes out. You can do that. But at what expense? At heart disease, at not being able to be present in a conversation. There's a lot of ways to congratulate yourself, but a lot suffers.

Helen Sairany, PharmD, MBA: Exactly. For sure, for sure. Yes, I totally agree.

Mike Koelzer, Host: Helen. When I [00:51:00] went on, Amazon, you've got one already on there. But I know you're working on some other things.

Helen Sairany, PharmD, MBA: So, yeah, so my first book, trading Grenades for Candy, it's my memoir. It talks about my childhood, it talks about my family, it talks about immigration to the us. It talks about discrimination. It's everything. Helen, finding herself in the wilderness, coming to this country. Um, you know, um, as a young child and, uh, you know, being spotted by the US Marine who deployed to my country, finding this child with a grenade in her hand, and then waving back the candy at me in an exchange for the, for the grenade.

And then coming to the US and finding myself and. , you know, trying to give back to this country that has done so many good things to me because it's a land of immigrants and I feel like I owe America so much. But then the story has a lot of trauma, has a lot of, uh, trauma that, uh, I portray in my life story, but unfortunately we didn't get to it in book number one.

So book number [00:52:00] two, it talks about what it is to live with P T S D every day. And then, and, and I take advantage of my story. I talk about trauma before my own voice, from my own experiences, and I also provide some tools and resources to kind of regulate yourself as a significant other, as a loved one, as a supervisor, as a, as a colleague.

Uh, so I'm hoping that the second book will be huge for the pharmacy community, for the medical community especially, or for an average citizen to see how my story opening up about my vulnerability, uh, to help people, um, you know, take advantage of some of the things that I talk about and also some of the tools that I share so they can have a better quality of life moving forward.

Mike Koelzer, Host: I had a guest on, Few months ago, and he was talking about how his new bride and he were driving and someone t-boned him. And she died. And I said, it's hard for me to even talk about anything at this point because things are so small compared to that.

And he said, [00:53:00] Mike, you might think so, but there's some finality and peace and forgiveness in what I did. He said, you know, some people going through divorce or doing this, they're having it a lot tougher. He said, don't compare. I imagine though, Helen, when people come up to you to talk about trauma, they're like, I brought this up earlier.

 they're like, Helen, I shouldn't talk to you. I've never been in a war torn area with a grenade and things like that. What do you tell people to do? How do you say it's okay? You don't have to compare.

Helen Sairany, PharmD, MBA: So I like, I like to, uh, look up to Victor Frankl, the Jewish Jewish Holocaust survivor. Um, I just adore them, man. And he talks about the wisdom of suffering. Um, he went through a Holocaust. His wife was pregnant. She died, uh, in Auschwitz. He lost his parents in Auschwitz. And he talks about how if there is any meaning alive, there is also meaning and suffering.

Um, and that's what I like to talk about. When I told you I was diagnosed with complex [00:54:00] PTs, I was devastated. I had a choice to make. I could just let them. Disability, define who I was or turn the, you know, the, the suffering or , the label to wisdom. So I choose the latter, um, because there's a lot of wisdom, uh, to be said, um, about suffering.

Survivors of trauma have a lot of wisdom to share with the world. Um, I like to travel around the world and I would say I would definitely pick a trauma survivor to accompany me in exploring the world because it is wisdom.

There is wisdom and uh, and that's how I would like to look at suffering a life for sure.

Mike Koelzer, Host: We all have suffered some trauma and I think the person may have felt the trauma and have dealt with that, they're a path ahead of almost everybody else, because everybody else is gonna feel it somehow.

It's like your time is coming. So people that 

I have already had a lot to share.

Helen Sairany, PharmD, MBA: For sure, for sure. Yes. We live in a society that exploits [00:55:00] trauma in all of us.

Mike Koelzer, Host: Like advertising and stuff? 

Helen Sairany, PharmD, MBA: It's everywhere. In our school system, in our healthcare system and TV and everything. What we think it's normal. What we think is healthy is neither healthy nor normal. What we think is healthy is making us sick.

Mike Koelzer, Host: And it's selling you things to soothe that instead of getting to the base of stuff,

Helen Sairany, PharmD, MBA: It's the lack They capitalize on the

Mike Koelzer, Host: capitalize on your lack. Absolutely.

 Well, Helen, thanks for meeting. Thanks for bringing up these important issues, which sometimes we either maybe hide a little bit or sometimes they're just not on the front burner, 

Helen Sairany, PharmD, MBA: my pleasure. And I'm, I'm glad, I'm glad that my voice helps individuals to figure out what is going on in their life. Uh, it goes back to the point, I was making an article that, uh, pharmacists are coming out with signs and symptoms of P T S D and Mike, that article went viral.

pharmacists said that you gave us a voice. We had all the signs and symptoms, but we didn't know [00:56:00] what it was, and you helped us. Um, Identify what it was. So a lot of times, a lot of times just, you know, identifying an emotion, identifying as, as suffering for what it is, it really helps. So, and I'm glad to be a source to my colleagues in the profession and if anybody needs to reach out to me, they can find me on social media and I am more than happy to be, , an informational 

source, uh, to trauma if, if I could be of any help.

Mike Koelzer, Host: All right, Helen. Very good. Thank you again and we will keep in touch.