Lilian Gonsalves, MD

Podcast Transcript

Cara King, DO:
Welcome back to Inspirations and Insights. We hope you all are having a fantastic week. We are so excited to have Dr. Lilian Gonsalves on our show today. Lilian is a Clinical Professor of Medicine at the Cleveland Clinic Lerner College of Medicine, and staff within the Department of Psychiatry and Psychology. She holds a joint appointment in the Department of Obstetrics and Gynecology, as well as at Gault Women's Health Center. She has a special interest and expertise in mood disorders, specifically in women. Lilian has served on the (Cleveland Clinic) Board of Governors and is currently the Interim Chair for the Department of Psychiatry. We hope you enjoy this truly enlightening conversation as Lilian talks about her favorite attributes for success, which she calls her three A's, her work family integration over the years, and how her practice has shifted throughout her career, but most specifically, during COVID, we hope you enjoy. We are so excited to have Dr. Lilian Gonsalves today on Inspirations and Insights. She's coming from the Department of Psychiatry here in Cleveland, Ohio. So welcome Lilian. We are so excited to have you.

Lilian Gonsalves, MD:
Thank you. It's a pleasure to be here.

Cara King, DO:
So one aspect of your career that I found so interesting is your journey that you made from Bombay here to Cleveland. And so you joined us, I think, in 1977 for your psychiatry residency. Is that right?

Lilian Gonsalves, MD:
That's correct. Yes. I grew up in Bombay. I went to med school in Bombay. And that's where I met my husband, and he grew up in South Africa. So because of apartheid, I couldn't go to South Africa. So we decided, well, let's look at the U.S. So I got this residency interview... I got the job without an interview. So I made one move in my life from hot tropical Bombay to the Blizzard of '77. I will never forget it. I said, maybe I need my head examined. So I guess that's why I stayed in psychiatry.

Lilian Gonsalves, MD:
And the rest is history. I did my training. I started in '77 and the program was on probation. It was so bad. There were six or seven residents. And to my good luck, we got a whole team of people who came from The Mayo Clinic. So there was a new chairman, a new residency director, Dr. Dale Gulledge, the Head of Consultation Liaison and my mentor. And I wanted to really interview at UH (University Hospitals). Dr. Dick Steinhilber said to me, he was a chairman. He said, give me one year. If you still feel like this at the end of next year, feel free to interview. And I did. And here I am. All my life, I've been at the Cleveland Clinic.

Cara King, DO:
Oh my goodness. That is so funny. So your program was actually on probation, like during your residency?

Lilian Gonsalves, MD:
Yes. When I joined. But I think the Mayo Clinic team turned it around and look at it now. We have eight per class. We have a total of 32 residents and we are one of the top residencies now. It's amazing. It's amazing the change.

Cara King, DO:
Thank goodness you stuck it out, right?

Lilian Gonsalves, MD:
Yeah. Some things are meant to be, right? It just happened. And my husband was also here. He's an anesthesiologist. So he started his residency. So more reason to stay on at the Cleveland Clinic.

Cara King, DO:
Absolutely. I'm also married to an anesthesiologist. It's a good pair, right? Yeah, I am. Yeah. It's always unique when you have a partner who is also in medicine, right? Making that move together. So that's fantastic that you both found your niche here and really thrived.

Lilian Gonsalves, MD:
We always say, we talk to our patients. You put them to sleep under hypnosis, but my husband always says, but I have to wake them up.

Cara King, DO:
I can only imagine the conversations at your dinner table, right? I love it. I want to move into this area and your thoughts about being successful. So you have been extremely successful from both professional perspective, as well as a personal perspective. And in a previous interview, you stated that the three qualities important for success included affability, ability and availability.

Lilian Gonsalves, MD:
Right. The three A's I call it. Yes.

Cara King, DO:
I love this. Talk to me about these three characteristics. So why do you think they're so important?

Lilian Gonsalves, MD:
So one thing is, when you're asked to do something, do it with a smile and do it willingly. Because at the Cleveland clinic and probably everywhere else, people remember that. And this place, you live and die by your reputation. So that's one. The other is to do it well. Ability, right? Because on consultation liaison which is... I spend a major part of my life here doing CL work. CL is short for Consultation Liaison. And people remember you when your patient gets better and you get more consults and it increases your credibility. And the third is availability.

Lilian Gonsalves, MD:
In the beginning, you may have to do that late consult, or you may have to come in early. So our daughter is a pediatrician in New York. She likes the first two A's, but she doesn't like the third one. This is a difference. This is a generational difference. She said, I'm not staying late. So, but at the Cleveland Clinic, I think that's what works. And once you establish credibility, the sky's the limit. And then you get appointed to committees, that's how I think I got elected to the board of governors. I've been Vice Chair for 17 years. And this year actually, I'm the Interim Chair. So I know have been, this is going to end. I hope they find a good Chairman soon.

Cara King, DO:
Whatever you're doing is working. And so I think you make many really fantastic points with what you just said. One thing that's really resonating with me is this idea of availability and the generational mindset difference surrounding this, right?

Lilian Gonsalves, MD:
That's right. Absolutely. And, I've seen it with the medical students too right now. I mean, I've always believed in life after work. I've always believed in that. So the students want to quit like at 4:30, 5:00. And I say to them, patients don't stop getting sick at 5:00. So sometimes you may have to stay a little later. But there are days when you're done early, go home. I'm not going to be a police woman here, right? It's very interesting.

Cara King, DO:
Oh my gosh. I know. I've had these discussions with some of my colleagues as well. I tend to sway the pendulum way on the other side where I work way too much. And I know... I understand what it feels like to work a lot because that's where I live. And we have these discussions where part of me really values that generational difference and that they know how to say no and they know how to set their limits. And they're really not embarrassed about verbalizing that. So it's just interesting the differences.

Lilian Gonsalves, MD:
True. Very true.

Cara King, DO:
The interview that I had read where you had talked about this affability ability and availability, it was about eight years ago. I'm curious, have these three characteristics changed at all for you, or has this really been your characteristics forever? Or how did your idea of what success looks like ebb and flow throughout your career?

Lilian Gonsalves, MD:
Well, I think establishing credibility, I think is a big one. And those three A's help you with that. The other is making a difference with your patients. I have a huge practice. And I think the better you are with your patients, the more referrals you get. And that's number one at the Cleveland Clinic. If you're not a funded researcher, I think you need to be willing to see patients. And you have to be good at it. Yeah. So that. And the other is to have a sense of purpose and fulfillment. Nine out of 10 days, I'm happy to come to work because I really enjoy it.

Cara King, DO:
So I want to unpack this. You're making my brain work so much in that... You are. So where my brain is going is that: I agree. You have to show up, you have to be available. You have to be really good at what you do. But you also have to protect yourself, right? You can't pour from an empty cup, right? Linda Bradley is one of my colleagues here and she says that all the time and it really resonates with me, right? So if you don't take care of yourself to some degree, then you can't take care of others. Finding this balance can be so hard. And another line that I've heard you talk about, which again, really resonated with me is that for women, our career clocks and our biological clocks tick in harmony, right?

Lilian Gonsalves, MD:
Right. Absolutely.

Cara King, DO:
Talk to me. How have you navigated this throughout your career? Because you have to say no to some things, right? To allow other things in. How have you done this?

Lilian Gonsalves, MD:
First is you need to be organized and I'm an organized person. Either you learn it. I think I saw it with my parents—my dad more than my mother—is very successful. I learned it growing up. Two, you have to learn to say no to the right things. Sometimes you have to say yes to the right things. And that comes with experience, right? Initially you might get a committee that you don't want to be on. But you show up, do a good job. And then people will remember and appoint you to another committee. So that's an example of, if you don't want to say no to this committee, sometimes you just have to say yes. I've been very fortunate. So I have a husband. We are a great team, very great team. And, I always joke with my kids. I'm a grandmother now.

Lilian Gonsalves, MD:
And I say to my kids, your dentist never saw your mother because I just couldn't go to the dental appointments. Because my husband, as you know from your husband's career that they had some flexibility. He had post-call days every week.

Cara King, DO:
Exactly right.

Lilian Gonsalves, MD:
And those are the days he would do this. But when you're seeing patients, you cannot cancel patients. So that was very easy for me. I think you have to communicate every single day. You cannot assume. You cannot assume anything because you always make the wrong decision. So we knew exactly what our day was going to be like, what our week was going to be like. As physicians we're able to have help. So I had a nanny. And there were times when, it's a pick up food. I mean, you don't have to be the perfect person at all time. So there was a lot of give and take. Yeah.

Lilian Gonsalves, MD:
And then at work, like my colleagues would always say, how come you leave at five with a clean desk. I do. I just do what's needed because you don't have to do everything the same day. So I have two folders. One must be done today. Of course, now we have this, right? So I flagged the things that must be done today. And the other things I keep for tomorrow, or it may never be... It's not important. You don't even attend to it. So, that's my style I think that's helpful. Yeah.

Cara King, DO:
I love that advice. So what I'm hearing is that sometimes you have to say yes, because... Like you're saying the committee work because by doing that, it opens up other doors. And I'm hearing you say, be present when you're there, right? So don't just do it to click a box, but actually be invested and be present because that's actually going to speak of your future success, right? That's going to line you up for other things.

Lilian Gonsalves, MD:
You always leave an impression and hopefully you leave a good one. No matter what you do at the Cleveland Clinic. In committees, when you give a talk, when you go to the board, in your APR (Annual Professional Review).

Cara King, DO:
I just had that last week. That resonates with me right now. And then the other thing I'm hearing you say is don't be afraid to hire things out or ask for help. So like you said, you have a nanny, right? And you had other people who helped around the house and being able to outsource things that you don't have to be present for. And that's okay, right? You can't be everywhere all the time and that's okay.

Lilian Gonsalves, MD:
Absolutely. You can't be everything to everyone. Something's going to get away. And if your husband does groceries, you can't criticize him for doing it.

Cara King, DO:
Isn't that the truth. I feel like we live parallel lives in that. Our anesthesiologist husbands are very beneficial to us. I'm not going to lie. Yeah. But online shopping has helped me actually put in my wishes without me actually going. So that's actually nice, right? I see that my husband will have the online grocery list up and I'll just put in a few like dark chocolate bars and then all is good.

Lilian Gonsalves, MD:
Yeah, absolutely. See, that's good teamwork.

Cara King, DO:
Oh, that's too funny. And the fact that your daughter, you said she's a pediatrician in New York.

Lilian Gonsalves, MD:
Yes.

Cara King, DO:
So I love hearing that kids go into medicine following their moms because it means that they had a really good experience with you at home. It gives me hope. I have three young kids. And so I love hearing that she followed suit. I'm just curious. How did you integrate her in your career? Did you ever... Like how much interaction she had with your career?

Lilian Gonsalves, MD:
A lot. It's very interesting because many of our friends are doctors. The kids have said anything but medicine. And I think it's because they never saw them. I shouldn't say never, but they didn't see their parents for important events. I mean, yes, in the beginning you're going to be on call for Thanksgiving. You're going to be on call for Christmas. But that's not the rest of our lives, right? So every evening we had dinner together. So we have two children. Our son's a lawyer in D.C. We have three grandchildren. Every evening we watched the world news. And I know it's so funny. Right now the kids don't watch the world news because they said, mom, by the time you get to the news it's old. Everything is online.

Cara King, DO:
Are you not on Twitter mom? Come on.

Lilian Gonsalves, MD:
But they remember it. They remember that. And that's when we would share stories in important things that happened during our day, all of us. And with my husband and I, it was always medical. Of course, we didn't give any names of patients or anything like that. And it's interesting that our daughter, when she calls me... She's an adolescent medicine physician. So all the patients are teenagers. They're mainly eating disorders, but her calls are sweet because they're all psychiatric.

Cara King, DO:
Yes. I love it.

Lilian Gonsalves, MD:
These are all patients who want to cut... They're into cutting or they want to kill themselves. And the pandemic has made things worse. So clearly, she must have heard me talk about the important things we do with patients to keep them well, to function, to help them function at our best. So I think that was one thing. The other is we always made it a point... One of us would show up to all the important events. Whether it was... And she was in tennis. Both of them, she was a captain of her tennis team. So that goes right there lots of tournament matches that we have to go to. Then my son was in band. So being organized, I would again go to all the functions, but I just worked my schedule, such that... In those days we didn't have to go through administration, right?

Lilian Gonsalves, MD:
We could block our own schedule. I would start early. I would stay late. Because most of these things we knew ahead of time and I think that's important. So I think our kids saw how we managed both worlds, both work and at home. I think that's important, but if you're never around... Or we didn't complain about work because we really have nothing to complain about. We liked it. I mean, yes, of course everyday... Work is stressful. You all know that, but that's not every day. That's not every day. So maybe it was that.

Cara King, DO:
I love that, right? Like when you genuinely enjoy what you do, which obviously you do and I'm so lucky that I genuinely love what I do too. I think that just radiates off us, right?

Lilian Gonsalves, MD:
Absolutely right. Yeah.

Cara King, DO:
And I hear about this work-life balance. I don't like that word. It's one of those things that bothers me. I'm glad that you say no too, because it should be integration, right? Balance makes me-

Lilian Gonsalves, MD:
Work-life integration is a recent term, right? We used to say balance, like you're balancing all these balls in the air. Yeah. But it's not. Because whatever happens at work, we tend to bring home and whatever happens at home, we tend to bring to work. Hopefully, you're able to separate the two, but the people who are unhappy... I think in my practice also have unhappy lives at home they're the ones who struggled. Not all, most of them I think. Yeah. So you have to integrate it. Yeah.

Cara King, DO:
I came home a few nights ago and I have a five-year-old, a three-year-old and a one-year-old. And my five-year-old was doodling a hysteroscope in a uterus taking out a polyp. And that's when I knew that I had one, that my kid was doodling a polypectomy. I was like, this is amazing. Best day of my life.

Lilian Gonsalves, MD:
You would have your hands full. I remember those days. I had two children, but somehow you go through it.

Cara King, DO:
I know and you're just so right. It's just like, all we know right now. So yeah. It's fun. One thing that a lot of people have talked when we've asked people to talk about you and their interactions with you is that you have such an incredible peaceful ambiance about you. Such a peaceful personality. And you're so calming. Well, Mary (Mary Rensel) and I are joking in that we're like, we want you to be our doctor. I need more of you in my life on a daily basis.

Cara King, DO:
And we're not kidding. We are being serious about that. So, I'm just wondering, and we're talking about sometimes compartmentalizing our lives, but how that's overall impossible. What kind of things do you do or what kind of tricks or tips you have for us when you're feeling kind of frazzled, right? Like you've had a busy day, you're trying to balance a lot of things. What do you do for yourself to maintain that peacefulness or that personality with others. We're working with our patients or even our families. What kind of tips do you have at maintaining that peacefulness?

Lilian Gonsalves, MD:
I think one thing it comes with age. I think you learn not to sweat the small stuff. Everything is not important, I think. But I do yoga. I was a student of yoga in India. And when I came here, there was no yoga. And then yoga started became very faddish. And now it's much better. It's much better. So if you've done yoga and mindfulness, you kind of focus in the moment and all this extraneous stuff you like say, okay, tomorrow or later. So you have to learn to focus. I think that... And I tend to be a very focused person anyway. When I'm seeing a patient, for instance, I don't look at my phone. I don't look at emails. It's just the patient and so I can finish my note and then go to whatever else I need to do. So I think mindfulness, I do work out regularly, always have. And by the way, when I was younger with little children, I wasn't so calm. I was a screamer at times. And you can ask my kids, especially pre-menstrually I just screamed.

Cara King, DO:
You're making me feel much better about my life. Okay. Go on.

Lilian Gonsalves, MD:
I think after menopause, you are on an even keel. So that might be.

Cara King, DO:
More hot flashy, but more even keeled.

Lilian Gonsalves, MD:
So that might be another thing. But yeah, so I work out. I work out quite regularly, always have. Not when our kids were younger because there's only so much of hours in the day and you have to kind of decide what you want to do. Now you tend to be a taxi on the weekends, drop them here, drop them there, things like that. Yeah. And I also try to eat right. And, I don't eat salty foods and things like that. I tend to eat healthy. And then we travel a lot. Earlier on, we used to take long weekends whenever we could with the family. And it really helped us recharge. But we would go travel somewhere to see friends, like leave Friday evening, come back Sunday evening. Or take Monday off or something like that.

Lilian Gonsalves, MD:
I think we did a lot of that. And then of course, after the kids left, all of a sudden I felt, I now have just one job. My husband doesn't get it. It's that cognitive load, right? You know. Planning, who's going where, who's going to have what for dinner or things like that. I mean, you're constantly thinking about it. Even though my husband helped me. I was the one who maintained the tone at home. Yeah. When they left, it was very freeing. Of course I missed our young one, especially when he left for two weeks or three weeks. And then we started. You don't have to be home at a certain time and don't have to have meals on the table be picked up. It was great. It does make it much easier. You'll see after the children leave.

Cara King, DO:
I'll talk to you in 18 years.

Lilian Gonsalves, MD:
Yeah, it is.

Cara King, DO:
Right. It's so liberating. Like right now, literally you're like you said, my head space is around like meals, right? Like as soon as you feed them lunch, you're like what's for dinner. It's like this constant always just trying to keep them alive.

Lilian Gonsalves, MD:
Absolutely. It's not easy when the kids are young. And I was tired. I remember being tired. And I think looking back, I would have liked to work part-time, but there was no part-time job at the Cleveland Clinic. So I waited. I waited 10 months and then the chairman called me. He said, Oh, we have a job for you. We created a job for you. So I came back. I was unemployed for nine months. Yeah. And then, we worked it out. There were these... Especially after the second child. Yeah. There was some tiring days, but it all worked out.

Cara King, DO:
It brings me back how this like the ebbs and flows of life, right? Like the push and pull and being able to stay flexible and rolling with what's needed at home versus work. And so having that mentality is really important. And you can tell you've been extremely flexible over the years.

Lilian Gonsalves, MD:
You have to be. Yeah.

Cara King, DO:
Yeah. In your career, you've had so many incredible moments. You've mentioned a lot of them being on the Board of Governors and Interim Chair. What has been the proudest moment in your career? Can you narrow that down?

Lilian Gonsalves, MD:
I think when I got elected to the Board of Governors and I'll tell you why. Because this is 20 years ago. You didn't get appointed, you got elected by your peers. So that says a lot. I was the first Psychiatrist to be on the board. There was a joke. The board needs a psychiatrist. That was not the case at all. And yeah, it was very competitive. It was very competitive. They counted your votes and things like that. But so that was great. And then being on the board, these were long days, 7:00 AM to 6:00 PM.

Lilian Gonsalves, MD:
But at the end of the five years, I really felt that I got more than I gave. So it was wonderful. It was wonderful to see how this big organization works and then doing the APRs. You get to know people. You know who the stars are. And most people, I think 95% are fine. And then, occasionally you have the difficult people, every department has that. So I think that though, that was a good time and I had to wait. I know I couldn't do it when my kids were young because I couldn't come to 7 am meetings. And also, my husband starts at 6:30, so you have to kind of balance it. And I said, fine. My career would be a little slower, no big deal. Yeah.

Cara King, DO:
When you were on the board, how many other women were on the board with you? Do you remember?

Lilian Gonsalves, MD:
I was the only one. For four of the five years and look at it now. So for one year, Sue Rehm (Susan Rehm, MD) was with me. Yeah. That was it. I was a lone ranger. I even have the picture here. I'm the only one.

Cara King, DO:
Proof. Photographic proof. I mean, you have led the way for us though. Like the world that you lived in during your career, early career and mid-career, is so different than what I'm experiencing. I just have so much gratitude to you for paving the way. So thank you.

Lilian Gonsalves, MD:
Well thank you. Yeah. It was very different. And I was one of 10 women residents when I started in '77 and then when I got pregnant, the end of my residency, people looked at me like I'd fallen from Mars. It was so... And in those days how we hid up pregnancies with the clothing and not the clothing that our young daughters wear today, right? Yeah. It was so different. And hardly any women. I would hardly see any women around on rounds, but look at it now. 50% of the medical school is... Graduating students are women and when I make rounds, it's wonderful. It's wonderful to see women everywhere. Yeah. And even the board, I think a third of the board now includes women. Yeah. It's very big changes. Big changes.

Cara King, DO:
Yes. Tracy Hull was my Board of Governors (reviewer) for my APR. So yes, she is amazing. She's a force. I'm trying to get her on this podcast too. For sure. My goodness. And you bring up this idea of pregnancy. This is a common theme that I've heard from a lot of women docs who've been here for years and years. Dr. Linda Bradley, who we interviewed a couple of weeks ago, also spoke about how she had to hide her pregnancy and how she was just became resentful about that, right? Like her male colleagues could celebrate this really important time in their lives. And she felt like she couldn't be open about it. And I just can't imagine the mentality behind that. Internally many people are grateful or excited they're pregnant, but not being able to outwardly express that, I just can't imagine what that must have felt like.

Lilian Gonsalves, MD:
It's hard to hide it after a while, right? Everyone knows it. They look at you and they know your pregnant.

Cara King, DO:
Exactly. Especially when you're not very big to begin with, right? There's not a lot of space for it to go. For our last question, we really want to dive into what COVID has done to your patient population and how your patients have kind of shifted throughout the years. So Mary and I are curious, how has your patient populations needs shifted maybe from the beginning of your career to now? Or what kind of shifts have you seen because of COVID?

Lilian Gonsalves, MD:
Perfect question because women's mental health is 90% of my practice. And I have to thank Gita Gidwani for this. The famous Gita Gidwani, right? So in the mid-eighties, she called me and she said, Lilian, I need your help. My patients are driving me nuts. I said, Oh really? What are they doing? Everyone has PMS. And I know what to do with it. So I started a clinic with her every Wednesday morning, right through. And I developed this big practice. So initially it was a PMS clinic. Then it became the pelvic pain clinic. And now it's pregnancy, postpartum, menopause. So that's my whole practice. The big change has been that women are more willing to acknowledge that they have anxiety and depression, they come to treatment. In the past, they wanted to come directly to my office, the Cleveland Clinic doctors that I saw. Now they wait in the waiting room.

Lilian Gonsalves, MD:
So the stigma it's still there, but it's much less. I love my practice because patients grow older with you. So many of these women now have children while going to college and they call me and they send me pictures and it's heartwarming. And to see that their kids... They really raise good kids despite the postpartum depression and whatever, because there are good medicines. There are good medicines. So I think during COVID our numbers went up, there was more anxiety, there was more depression, more drinking, more suicide attempts. But in my outpatient practice and I think it's because most of my patients, the average age is 54. So they're not young. So they've coped with it quite well. But I think it's taught us how much you really need to live a good life, right? You need family, you need a decent job.

Lilian Gonsalves, MD:
And it was a year of losses. Like for us, for some of us, it was structure, not seeing family. For me, it was not being with the grandchildren. We couldn't see them as much. But for others it was huge. It was loss of income. We had someone whose wife died from COVID in our department. Someone whose father died. So those are huge losses. And it makes you realize you can't take anything for granted here and life happens. But I think people will probably come out stronger I hope. This year, there's a little more optimism with the vaccination. I can feel it. I can see it. Yeah. But patients, I think just in general at the Cleveland Clinic are older and sicker. When I look back, I feel I hardly worked because our patients were so easy. Not anymore.

Cara King, DO:
Oh gosh. It's so true. And you're right. I feel like during COVID, it's really stripped us down to really feel what's really important, right?

Lilian Gonsalves, MD:
Absolutely.

Cara King, DO:
There's been so many things that maybe I have in the past stressed that they're important, but like when it comes down to it, it's our health, our family, our loved ones, right? Those connections that we have with our colleagues, like that's really what's important.

Lilian Gonsalves, MD:
Absolutely. Yeah.

Cara King, DO:
And you see we come out stronger. With your help Lilian we'll come out stronger. Again we need you in our lives on a daily basis. So I think on that note, that's all we have time for today, but thank you so much for your time. And we look forward to maybe having you back sometime soon.

Lilian Gonsalves, MD:
Oh you're welcome. So my pleasure. You are very good at this.

Cara King, DO:
You're so kind. Thank you.

Lilian Gonsalves, MD:
Okay. Thank you.