Adverse Childhood Experiences with Gaby Morales

[00:00] Michelle: When I heard Gaby Morales speak about adverse childhood experiences, or ACEs, on the 911 Nonsense podcast, I knew I had to bring their message to you. 
Gaby explained that ACEs are adverse childhood experiences such as physical, emotional, and sexual abuse, as well as other forms of household dysfunction like mental illness or substance use problems, and living with a violent or incarcerated parent. ACEs are linked to chronic health problems, mental illness, substance use in adulthood, and suicide. 
Gaby's not new to nursing. They've been a nurse for eight years and are currently the clinical educator for a Level I Trauma emergency room and a DNP student. Through their work, they've encountered many healthcare professionals who were completely unaware of ACEs and how they affect the health of their patients. So Gaby has made it their mission to educate healthcare professionals about the impacts of adverse childhood trauma. They are taking what they call the "Tour de ACE" on the road and have even titled their presentation "The Greatest Unaddressed Public Health Threat That Most Healthcare Professionals Don't Know About."  And with Gaby's passion and efforts, I think very soon that will change. 
In the five-minute snippet: There are no aces in this card game. 
Well, good evening, Gaby. Welcome to the podcast.

[01:51] Gaby: Hi, Michelle. Thanks for having me. I'm excited to get to chat with you a little bit.

[01:57] Michelle: I am so excited. I heard you, I was going to say I met you, but I heard you on Sam Brawley's podcast, 911 Nonsense. Great podcast, great host. And you guys had a great episode. I was just, like, enthralled the whole time because part of me was screaming like, yes, someone is finally getting this word out and talking about this, and it is so important. And I knew that I just had to have you come on and talk to my audience of nurses to get this word out. And by the way, I'm a Hufflepuff.

[02:38] Gaby: I love that. Oh, my goodness. I love my little potatoes. Those are my favorites.

[02:43] Michelle: I love how you guys were talking about Harry Potter at the end. That was so great. Yeah. So that's just a little bit of fun, but let's get started. And you have a really packed bio, so give us some of your history.

[03:02] Gaby: Sure. So my name is Gaby Morales. My pronouns are they, and them. I have been in the healthcare system since 2008. I initially fell in love with healthcare when I was a volunteer and member of the board of directors of the Agora Crisis Center in New Mexico. They are actually the oldest student-run crisis center in the country. And as volunteers, we would take phone calls from anything, from folks having a bad day or maybe somebody's having some trouble with money or their partner all the way to us de-escalating somebody who has a gun to their head and is actively suicidal and they don't know where they are, maybe, and you're trying to find how to send them rescue. So that was my first dive into health care and both crisis land, and I knew I wanted to go into healthcare. I just wasn't quite sure where I wanted to start. So I started working at my local hospital, where I have been for the past 16 years. I initially started in the kitchen, actually, way back when, and have moved my way up to being the staff clinical educator at my trauma level one emergency department. So I worked in the kitchens for a couple of years, and I moved to our trauma Level I ED, where I spent five years as a unit secretary, basically. And that's when I learned  I wanted to become a nurse. So my journey into a nursing career began there, and I spent almost four years at a progressive care unit. It was a trauma surgery step-down. And when time came for me to spread my wings, I was like, well, do I want to go back home to the emergency department, or do I want to go to the ICU? And that's where I met my mentor, Rhonda, who is hands down the best nurse I have ever had the privilege of working with. And she said, Gaby, if you come down to our medical cardiac ICU, I will precept you. And that, to me, was a no-brainer. So I spent five years in the medical cardiac ICU. And after having been a COVID ICU nurse for just over three years, I just got burned out to the point that I was like, I can no longer be bedside. If I'm wanting to take care of my patients the way that I like to take care of them, I need to step aside. So I took a step aside from the bedside, but I took an equally challenging job, if not more challenging. Like I said, I'm a clinical educator for the trauma Level I emergency department here in the southwest. So I have been at my position for almost a year, and that has given me a platform to talk to folks about some of the subjects that I feel that are not just near and dear to my heart, but also pivotal in healthcare right now. And that's what I talked to my friend Sam Brawley about, was adverse childhood experiences, because I feel like we take care of such sick patients. But we don't really understand the correlation between chronic illness and childhood trauma. So if we don't understand that, how are we expected to turn things around?

[06:27] Michelle: Yes, absolutely. And it sounds like you went from the COVID ICU, like, out of the frying pan into the fire of the emergency department, 100%. When I heard you talk on Sam's podcast, I was like, they are an expert on. Like, they have so much information. So how did you come to be an expert? How did you learn about this?

[07:00] Gaby: It kind of starts out with, once you find something that you love, you just can't get enough of that, right?

[07:08] Michelle: Yeah.

[07:08] Gaby: I first heard about adverse childhood experiences a few years ago when my wife just brought home an article. My wife is a social worker. And let me tell you, Michelle, we are a lot of fun at the dinner table. I am a Level I educator, and my wife works with children who have suffered from severe traumatic experiences, like children who have seen their parents murdered in front of them or who have been passed on from the foster care system to another. We're a lot of fun at the dinner table every night. So she brought home this article, and she showed this to me, and she was like, have you heard about this? And I was like, no. And in retrospect, it makes sense that there's a correlation between the amount of traumatic experiences that somebody goes through and a connection with how that ends up altering somebody's well-being for the rest of their life and may lead to more chronic illness. But I had never heard about it in the literature. And at that time, I'd already been an ICU nurse for a couple of years, so I should have at the very least heard whether it is during rounds with my attendings or there's school for my BSN at the time. But I never had heard about this, and my mind was blown. And then I found Dr. Nadine Burke Harris's TED talk. She was California's first surgeon general, and she gave a brilliant talk on adverse childhood experiences. 15 minutes long. It's incredible. And all I could think about was two things was, I want to be like her. And two was, how did I not know about this? So the next day, I get to work, and I tell my peers all about it, and they're like, what are you talking about? What do you mean? I've never heard of such a thing. And I'm like, all right, well, my peers don't know. Well, what about my nurse practitioners who have been in the unit for ten-plus years, and many of them have been nurses for 20-plus years and nobody had heard about it. I checked with my medical directors and nobody knew. And in fact, I had an attending specifically say one day during rounds, like, no, the literature is kind of vague about the correlation between childhood trauma and chronic illness. And I was blown away and I was like, no, how do we not know about this? How are we taking care of some of the sickest patients in the country? And we don't know that there is a correlation between traumatic experiences during childhood and chronic illness. And that's where it all started for me. And I've been on what I call my Tour de ACE. I think you are maybe the 7th or eighth person that I either do a presentation for or a podcast episode with, because we need to get this word out.

[10:09] Michelle: Yeah, we do. And I would love to get you on speaking circuit and bring you to my town because it's information that needs to be widely disseminated. There's little things here and there. I actually heard about ACE scores and the whole system probably about ten years ago from a good friend of mine who was a social worker. Social workers are amazing people.

[10:37] Gaby: Right, that go save the world. Nurses who don't know anything about affecting their patients.

[10:46] Michelle: Yeah. And they know their resources. I have such appreciation for them because they know their resources and they're a wealth of information. And working in pediatrics and the NICU my entire career, it came up on the radar one day because we have, obviously, kids that have been abused and so forth. And she talked to a couple of nurses about it, but it never went any further than that. It was just like, oh, wow, that's cool. There's a way to kind of grade people to see how sick they are, I guess, for lack of a better term. But I was reading about this, and the original ACE study was done back in 1998.  And now it's 2024. So 26 years ago, we've had the opportunity to get the word out and to do more research on it, and I don't think that's been done. I think we've fallen very short of that.

[11:54] Gaby: I think that happens with a lot of the soft science aspect of health care. We are so focused on not just what's the latest and greatest drugs or interventions, we're also not great at taking care of ourselves mental health-wise. And there's a lot of taboo. Right. There's a lot of concern with things like, well, we can't really measure it. Well, how do we quantify it? Soft sciences have been set aside and I feel like, that's been part of the reason why adverse childhood experiences didn't take off is because it's part of the soft sciences. And many of us in healthcare didn't go into healthcare to appreciate and spread far and wide the soft science aspect of our practice.

[12:45] Michelle: Yeah, and I've been a nurse for 36 years. As I was practicing, I'm still a nurse. But all of the continuing education that I took over that span of over three decades and working in the pediatric realm, never have I seen an offering for continuing education about adverse childhood experiences. And that's just so sad, because that's one of the ways that healthcare professionals can learn about what's out there is through continuing education. Never saw any conferences, any speakers. I'm so glad that you are on your Tour de ACE and you're getting the message out there.

[13:34] Gaby: Absolutely.

[13:36] Michelle: So let's talk about some of the little particulars about the correlation between a high score and this predisposition to disease.

[13:46] Gaby: Sure. So, adverse childhood experiences are divided into three categories. They are abuse, neglect, and household dysfunction. Abuse and neglect are pretty straightforward. They may be physical, emotional, or sexual. When it comes to household dysfunction, this could be situations such as an incarcerated relative. It could be a parent treated violently at the home. It could be substance misuse in the family. It could be mental illness in a parent or guardian, or even something as common as divorce in the family. And each entity will track aces in different ways. So, for example, my wife's entity tracks ACE scores on their children with a 13-question questionnaire. Most of them are only really about ten to 15 ish questions. I haven't really seen anything more encompassing. These questions, you can simply google them and just put a scores questionnaire and the 10,12, 15 whatever questions will populate. And every time you answer yes to one of these questions, it counts as a point. So it could be questions such as, did you live with someone who went to jail or prison? Did a parent or adult in your home ever hit you, beat you, physically, hurt you in any way? Do you feel like you didn't have enough to eat or had to wear dirty clothes, or had no one to protect or take care of you? Did you lose a parent through divorce, abandonment or death or any other reason? So, anytime you answer yes to one of these questions, it's a point. Now, what I've noticed with the questionnaires that I've encountered is that they are not all-encompassing. So for myself, I am a queer human, I fall under the trans umbrella, and I didn't see anything about coming out of the closet, for example, which can be very dramatic, like, people die when they come out of closets sometimes, or. I didn't see anything in here about racism. I am a person of color, so that can be very formative. And as we know, our healthcare system has some strong biases against folks of color or other marginalized folks, like trans folks or native folks, whatever. So there was really nothing on that. There was really nothing on what about if your parent was a veteran, for example? So these questions are not all-encompassing, as they are. So what tells me is that people's adverse childhood experience scores are probably a little bit lower than they really should be. But like I said, every time you say yes to any of these questions, your score for number of ACEs goes up. There is some data that I found when I was first garnering information on my presentation. The most recent data that I found from the CDC was from 2017 at the time. And if anybody has had four or more adverse childhood experiences, they are 1.7 times more likely to end up with kidney disease, 1.4 times more likely to end up with diabetes, two times more likely to end up with a stroke, 3.1 times more likely to end up with a chronic lower respiratory disease, 2.3 times more likely to end up with cancer, and 37.5 times more likely to attempt suicide. So there's a strong correlation there. But the thing is, how do we put traumatic experiences as a child together and correlate them with chronic illness in adulthood? And it all starts in part because of that constantly triggered fight or flight system. Your brain takes input from bottom up. If your brain is regulated and the input isn't overstimulating, it doesn't put you into fight or flight. It should ideally move from your brain stem up to your midbrain, up your limbic system, and all the way up to your cortex. Your brain stem and your midbrain, part of your brain are your more regulatory functions, your reptilian functions, such as heart rate, respiratory rate, temperature regulation, that kind of stuff. As your input moves up, it should ideally move up to the cortex. But it will only move up, like I said, if you are regulated. And then that's when your brain cortex, which is what makes you you, it's what helps you. Reason. Let's call them talents such as critical thinking, inhibition, emotional regulation, and empathy, all these things are processed in the cortex. But if you're triggered in fight or flight, your body shuts down your cortex. And part of the reason why it does that is because if you encounter a bear out in the street or while you're going out for a hike, your brain doesn't want you to start thinking about. All right, well, I know. I remember that bears can run at 30 miles an hour, and if I can run at 12 miles an hour, I can start doing a cosine of the tangent of, like, no. If you start processing, going into your calculus classes and your trigonometry classes, your bear has moved into eating dessert already.

[19:11] Michelle: Yeah.

[19:12] Gaby: Your brain shuts down that cortex, right? And when you're constantly shutting down that cortex in a child that is growing and making these connections and that their brain and their environment are shaping them, having a shutdown brain cortex is detrimental to their well being. But also the other detriment that happens is that their cardiovascular cardiopulmonary system, their immune system are constantly engaged, and they're designed to eventually shut down. But the problem comes when it's not a bear that you encounter in a hike that you can run away from or whatever. The problem comes when the bear is a parent that comes home every night and you don't know if they're coming home intoxicated and if you are going to be beaten or if you're going to have dinner that night. So when that constant engagement of your cardiopulmonary systems, your catecholamines surging through your system, your immune system engaged constantly, our bodies are not designed to handle that. And when your brain is in the formative stages as a child, it's almost like a topiary. Your brain starts pruning away aspects that it doesn't really use. So if your brain is constantly in fight or flight, it will feed the brain's then the midbrain, the limbic system, to keep itself afloat, and it will start repressing part of their cortex and start pruning it away. Let's call it that way. So this is why oftentimes we see folks who have gone through severe traumatic experiences utilize anything they can to cope. Oftentimes it can be substances. Oftentimes it can be what we call maladaptive types of coping mechanisms, which I don't like calling them maladaptive, because really, these folks are doing what they can with what they got. So I prefer to call them survival strategies, but these folks are doing anything that they can to keep themselves regulated. In fact, I have been fortunate enough to have never have suffered from substance misuse. But this quote really resonated with me. And there's a comedian that said this quote who he himself has suffered from substance misuse in the past. And he said, drugs and alcohol are not my problem. Reality is the problem, and drugs and alcohol are the solution. And that's really enlightening for folks that have the privilege of never had been in the throes of substance misuse, is that we don't understand why these patients are constantly seeking. Right. But this gives us an insight, is that these folks are so dysregulated, so constantly triggered, their brains have literally been developed in a different architectural manner from somebody who's more neurotypical, that they are doing anything that they can to cope. And that constant activation of, like I said, your cardiopulmonary, your flight or flight systems, all that starts changing the way that your body reacts. It starts changing your cardiovascular system, it starts changing your brain. So eventually, this amount of stress and this amount of catecholamine release in their bodies is what leads to chronic illness.

[22:38] Michelle: Wow. That was a very thorough explanation, and I can certainly tell that you have a deep understanding of how these things affect the body and the brain. And as you were recounting some of these examples or circumstances, I was thinking, okay, it makes sense, because if you have a high a score and you've suffered a lot of childhood trauma and so forth, and you're using these coping mechanisms, like drugs, alcohol, whatever else is out there, to just get by, I could see the correlation between being sort of unhealthy and those things like smoking and drinking and overeating and all that leading to poor health outcomes. And then I was also thinking, okay, what if you have a high a score and you have the emotional intelligence to know that this is affecting me negatively? So I'm going to mitigate some of these bad effects by not smoking, not drinking, not eating like an asshole. But because my body is still in that accelerated adrenaline state, I could still have some of the bad effects of it physiologically. Is that right?

[24:14] Gaby: Sure. Absolutely. I think that for the most part, your average human being has one, maybe two adverse childhood experiences. Adverse Childhood Experiences aren't the end all, be all. There's a lot of buffers that we have as well. Right? Like, if you grew up in a family that, sure, maybe there was substance misuse, and maybe one of your parents ended up leaving the other parent who was abusive, and your other family supported you through that, and maybe you have other buffers, such as economic privilege or whatever. There's a lot of things that can really help ameliorate some of those challenges that you've gone through. So it's usually folks who have been subjected to ten plus a scores that we end up seeing unhoused, that we end up seeing under the influence of substances constantly. So there are buffers. Like, just because you have four or more aces doesn't mean that you're doomed. There's a lot of folks that I know that have four plus aces, and they are high functioning, phenomenal nurses in our department. For example, again, it's multifactorial, but this is a large factor in the end.

[25:37] Michelle: Yeah, I was raising my hand. As you were saying, we have some high functioning nurses that have high a scores, and I would consider myself part of that group my a score. When I took the standard ten item test, I came out as a seven.

[25:57] Gaby: My goodness.

[25:58] Michelle: Yeah. And so I knew this early on in my life, and again, I was nodding my head when you were talking about buffers, because I had people in my life, like my grandmother, teachers, and even some of my siblings, like my older brothers, that even though we were all raised in the same family, and I'm sure we all have high scores, we were supportive of each other, and that was a great buffer as well. And I'm sure many of us have worked with individuals. Once we hear their stories, we're like, man, you didn't turn out so bad thinking about where they came from.

[26:47] Gaby: Absolutely. I mean, if you think about your average person with seven adverse childhood experiences under their belt, like, you wouldn't imagine somebody who's been a nurse for 36 years and has their own podcast.

[26:59] Michelle: Yeah. Thank you for that. You're sweet. And I'm a Hufflepuff, so I don't know what you have to say about that. 

[27:10] Gaby: HufflePuffers, I've always felt that either trauma softens you or hardens you. Right. And I feel like in your case, it certainly softened you to the point that you became the mushiest, most loving and supportive of all the houses, the Hufflepuffs. Everybody needs a Hufflepuff in their life.

[27:28] Michelle: You are so kind. Thank you, Gaby. Well, I want to talk about ACE scores in healthcare providers and in patients.

[27:39] Gaby: Absolutely.

[27:39] Michelle: So let's talk first about healthcare providers, because we were just talking about that. But do you think that, and has there been any research on people that get into healthcare roles, nurses, physicians, allied health professionals, do they have higher ACE scores than the general public?

[28:05] Gaby: That's a good question. I haven't really actually done a nosedive in that aspect of aces. What I can tell you is anecdotal from my experience, and I can tell you that a lot of folks in healthcare do what practice. What's called sublimation, is that you take the challenges that you've had in your life and you funnel them into a good cause. Let's put it that way. Absolutely. Us helping other folks is a way to help ourselves. So, from what I've gathered, anecdotally, I know that many folks in the healthcare environment have aces that are sufficient to basically very easily turn them into patients rather than healthcare providers. I will be transparent. When I first took the ACE scores questionnaire, I was blown away that I only scored one point. Now, again, this is why I mentioned this isn't all encompassing. So I probably would score closer to a four in some other respects if you considered some of the traumatic experiences that are trauma with a big T. Right. Like experiences that will shape your life for the rest of your time alive. So, in the end, I do feel like I meet the criteria of being somebody who suffered so many traumatic experiences that now what I'm doing is helping others in the same boat. But I can guarantee you the literature out there probably shows that healthcare workers are oftentimes folks who have four plus aces.

[29:57] Michelle: Yeah, I think you're absolutely right on that. And again, the anecdotal evidence on that, I feel, is very strong just from being in the community for so long and talking to my colleagues and just hearing their stories. And I think that's absolutely true. I'd love to see more research on that. So, thank you for that. Yeah, absolutely. So, let's talk about screening. Because as a patient myself, you go to a new doctor, and they have you fill out the 27-page report on your medical history in the waiting room. Right? Never have I ever seen a screening question that would even pertain to adverse childhood experiences.

[30:52] Gaby: Absolutely. I mean, in the same way, when you and I went to school, neither of us saw anything about traumatic experiences during childhood in our lectures. Like, you talk about trauma and you talk about childhood, but you don't really talk about the correlation between the two of them. It isn't until now that I'm in my doctorate that I'm finally starting to talk about some of these pivotal things. Like, we're talking about anything from critical race theory and feminist theory all the way to planetary health and salutogenesis. But we are very reactionary. As healthcare providers, we do not promote solutogenesis. We are illness management system. So, really, if you're in an illness management system that focuses on the hard science aspect and the physical science aspect of wellness, why would you ever expect to see something like adverse childhood experiences in your questionnaire from your provider or in school. It is just unfortunately not the way that our healthcare system has been designed, which is quite a shame.

[32:09] Michelle: It really is. It's shameful and we need to stand up and take notice of that and change it because I feel like we should have some kind of standardized screening. Like when a new mom comes into labor and delivery, she gets the Edinburg screen, right? And after she delivers to see if she has postpartum depression, psychosis, anything like that. And we felt like that was important enough because moms were killing themselves and killing their children and everybody was like, oh, she's such a nice person, but not really understanding, like the postpartum depression, psychosis, all of that. So we start screening for that. Absolutely. And yeah, I think there needs to be, I don't know if it needs to be in the doctor's office, but if we could condense an ace test somehow, as we have patients come in and have it be part of their history.

[33:16] Gaby: Sure.

[33:19] Michelle: How do you think we would approach it as healthcare providers? Do you think that if we had a patient that we knew their ACE score was a seven, would we be more caring towards them? Would we be more empathetic? Would we be more understanding of maybe how they got into the hospital in the first place and how would it decide what type of education we provide for them? Talk to that.

[33:49] Gaby: Absolutely. I think you hit the nail in the head. And that's the thing is that that's part of the reason why I'm out and about presenting on this, is that if you understand why your patient struggles with compliance, why your patient is maybe reacting violently, why your patient is coming in regularly under the influence of A, b or c substance, sometimes as human beings, we need that understanding to give them permission to be broken. And I think that that's also part of the reason why I like to present to folks is that in the end, it doesn't really matter what you take from ACEs. Everybody will take, hopefully something. But we're all going to plant our little seed in healthcare and help every single patient from then on with an understanding that our patients react in certain ways because of their previous life experiences. So that's one of the things that I really like about other. Now I'm going to put, throw a wrench in here and that's going to be like, well, sure, tracking aces is great, but what are you going to do with that information? So I'm going to put you on the spot here Michelle and I'm going to ask you out of curiosity, do you happen to know what the most pivotal social determinant of health is?

[35:20] Michelle: I don't know. 

[35:24] Gaby: Poverty should be a vital sign. Poverty is what determines how well you live, how young you die. In fact, your zip code will determine that for you because poverty drives everything in life. Now, for example, in my community, we live in a very poor state. So what are we going to do if we screen people for ACEs? I mean, that's great that we have that information. And that's great that maybe this nurse is going to be hopefully more compassionate again for this patient who came in for the third time this week, intoxicated and is keeping a bed in the ED. Or maybe it will help them understand why this patient maybe acts violently. But in the end, part of the challenge that we're facing is that our healthcare model is a for-profit system. So we're making money out of people's illness, first of all. And secondly, the money isn't going to the healthcare system itself. It isn't going to the patients itself. It's going to the pockets of other folks who just happen to be CEOs of this company or happen to be. It's not going to our patients, basically. So I think part of the challenge that we're facing is not just screening folks, is how can we even begin to change the system to provide sufficient support for these folks, because we are already wasting so much money in screening drugs, for example, for folks who are getting food stamps, for example. And research has shown that really, these folks are really not spending that money on substances. They are spending it truly on food. And our money is just misallocated, unfortunately. But part of the challenge that we're facing is how do we garner these resources? How do we change people's lives? By giving them this questionnaire. And we are not there yet, unfortunately.

[37:44] Michelle: We have a lot of work to do on that. And I could see it exactly like you said. Okay, let's screen everybody. But what are you going to do with that information?

[37:56] Gaby: Yeah, absolutely.

[37:58] Michelle: And right now in our country, and I feel like we kind of have this attitude of, especially to people that are suffering from poverty, is like, get a job, pull yourself up by the bootstraps. These kinds of attitudes are not helpful at all. And I started volunteering with an organization in my community that work really closely with the unhoused, and they're actually building a community. It was my first time, and I said, I need to do some more research on this because I think the way that we handle some of these societal problems is, first of all, you have to have an understanding of why are people unhoused, right?

[38:54] Gaby: Absolutely.

[38:55] Michelle: There's so many reasons, and it's not just because they lost their job. There's a lot of other factors involved. I think we're going to have to learn more about the ACE and what it represents and what you do about it before we screen everybody.

[39:20] Gaby: Absolutely. In healthcare, we're all going to take the ACEs football and run with it in different directions. Right. For me, a lot of it is about bringing awareness. I want people to hear about it so that they can do with it what their heart is telling them to do. In my case, it's like talking to anybody and everybody that will hear about aces. For other folks, like, for example, my wife, she may be somebody who may eventually move into legislation someday. And I know there's folks out here who are listening to this podcast who maybe are interested in being legislative nurses who help enact policies. And this is exactly what we need to do, is we all need to take that ball and run with it in that direction that tells you for you to run with it, because we cannot change the world if we are not aware of the problems that we are facing. In fact, my presentation, the title for it, is the greatest unaddressed public health threat that most healthcare workers don't know about. And that's because, really, very few people had heard about ACEs. When I first presented my local chapter's ACN, probably about 10% had heard about aces. When I first presented to the ENA in my local chapter, probably less than 10% had heard about it. And that's been my experience. So we cannot turn things around if we don't know what the problems that are assailing us are.

[41:00] Michelle: Gaby, what's been, some of the feedback that you've received from the groups that you've spoken to?

[41:05] Gaby: You know, it's been interesting. I have noticed that. I will get a couple of questions here and there as to yourself in your cases, like, hey, what's your ACE score? Or what do you think are the ACE scores for healthcare workers? Or things like, do you think there's a correlation between childhood experiences and quality of life as well? Things like that. But oftentimes I actually get less questions and more comments from the audience. I think it's rattling for folks. They start counting their ACE scores, or they start counting that of maybe their children or folks that they know, and they start seeing the repercussions that it has in their life and in society. And then folks become almost dysregulated. And I've had a lot of people bring up questions that weren't really questions, and they were more. I could tell that they were trying to process what they just got. But I've been blown away by the type of engagement that I've gotten from it. In fact, I had the opportunity to present for the first time outside of my city. And I had a paid presentation that I traveled for and I presented to the EMS community, which if I had been asked to present this to the EMS community ten years ago when I was first involved in it, I don't think folks would have been ready for it. I think I would have gotten a lot of pushback. But I could tell that the community was thirsty for it. Like, these folks were engaged, they asked great questions. But I think in part that's because that's what we've seen post-COVID. We've seen the psychosocial aspect of our patients take a nosedive. So I am proud to say that the feedback that I've gotten has been rotundly positive in the aspect of like, folks are grateful to hear about it. And I haven't really gotten much constructive feedback other than things like, hey, this population that you presented to the ED residents that I work with, maybe keep some of the basics out and work on more of the advanced material and challenge us, that kind of stuff. So I haven't really had a lot of feedback, constructive feedback, unfortunately, because I wonder if folks are not just afraid of providing constructive feedback, but also because maybe they're more preoccupied with understanding how aces are actively affecting them.

[43:53] Michelle: Yeah, absolutely. Could see the wheels turning in your audience members of like, I wonder what my ACE score is.

[44:02] Gaby: Absolutely right. I've seen it. And that's why I make it a point to have people chime in and check-in. I try to present myself as somebody who's approachable and easygoing. And to me, the well-being of my folks is the most important thing. Especially as an educator. I have the privilege of being part of the leadership group, but I don't have really disciplinary power. So to me, it's important that folks reach out to me and come to my office and they can cry about the fact that they made a medication error, or they can cry about the fact that their partner just came out of the closet and now they don't really know how to handle things. But to me, that's really what matters, is that I want folks to feel comfortable reaching out and speaking about it. And I make my office and my social media readily available for folks if they are in a place that they are rattled by this conversation, like reach out, don't hesitate. Whether it is to myself or somebody that you trust, please do. And that's the beauty about healthcare, is that I feel like few professions take care of each other the way that healthcare workers do for each other, especially in the emergency world. But don't hesitate. Reach out. It is important that you take care of yourself because we are taking care of our community.

[45:31] Michelle: Yeah, that's a great message. And you just seem so approachable. And I have worked with clinical educators, clinical nurse specialists, and because of where they are in the whole pecking order, I guess you could say they are more approachable because they're not disciplining employees, right? Absolutely. Yeah. Their door is always open. And yeah, it's a great relationship.

[45:59] Gaby: 100%. The compassion that you provide for others, give that to yourself. You deserve it and you need it so badly. And if you're going to take care of folks and you want to be a nurse for 30-plus years like yourself, Michelle, you got to give that compassion to yourself. So I urge folks to please reach out so that you can take care of others, so you can take care of yourself the same way that you take care of others.

[46:29] Michelle: Well, this is a message that needs to be in nursing schools, medical schools. I mean, it needs to be distributed to the healthcare community. So you're doing it little by little, podcast by podcast, presentation by presentation. What's in your future?

[46:53] Gaby: You know, at this point, Michelle, I'm just kind of trying to make it day by day. I am working full time and I am in my DNP full time and it is just day by day, know. But I would love to someday have enough time and energy to take my presentation nationwide. I don't quite know what I'm going to do with my degree yet. I know that the DNP will open doors if I want to be practicing bedside or if I want to be teaching academically. So I am getting myself through the program so that I can have as many doors open to myself and as many opportunities. But at this, like, I am doing everything that I can so that I can remain in healthcare. Because nobody knows better than you, Michelle. And maybe many of our folks who are listening right now is that healthcare took a big nosedive in the past few years. I tell people healthcare was an unrestrained driver speeding down the freeway and was intoxicated, hit a wall, flew through the windshield and faceplanted and dragged their face down for like 30ft on the asphalt healthcare took a big nosedive in the past few years, and if we are expecting to be nurses for 20, 30, 40 plus years, we got to take care of ourselves. So that's kind of what I'm trying to do right now, is taking care of myself. And I am telling everybody to take care of themselves so that I also can give myself permission to take care of myself. But who knows? This is the first time in my career that I don't know exactly what I'm going to do, and I'm perfectly fine with it. I am just trying to stay present as much as I can and trying to stay afloat as much as I can.

[48:46] Michelle: I love it, Gaby. That's great. Well, as we come to the end, I have a couple more questions for you. So this one might put you on the spot a little bit. You don't have to answer right now. You can email me later. But is there someone that you would recommend as a guest on this podcast?

[49:07] Gaby: That's a good question. Trying to think about it. I know there's some speakers that you seek every once in a while.

[49:23] Michelle: Right now, I'm looking for, and I haven't put out the APB yet, but I really want to talk to a nurse ethicist.

[49:30] Gaby: Ooh. I don't know somebody in that department personally, but I think that's a brilliant idea. I think that's a very important and nebulous subject. I will try to think and see what I can scour for you, but if there's somebody that I can just put off from the top of my head, I would love to see. I really enjoyed how you had a lot of multidisciplinary aspects and folks coming into your podcast. Like, I've seen social workers come into your podcast episodes. So one of my favorite things about healthcare is our multidisciplinary approach, and there's a lot of entities out there that are part of what makes us successful in healthcare. So, I mean, it could be somebody like a housekeeper for 20 years in their hospital. What can they share with us about what they see, about what they're proud of, about what they're worried about? It would be wonderful to see somebody like anybody that is, any folks that help us be successful in healthcare. I think that would be brilliant to bring in.

[50:51] Michelle: That's a great idea. Yes. All those allied health professionals that we work with and depend on.

[50:59] Gaby: Absolutely.

[51:00] Michelle: Our friends with and colleagues. I think that's a great idea. Thank you so much for that. Well, where can we find you?

[51:08] Gaby: I am not on social media very much because I'm pretty busy. But if anybody wants to hit me up, they can shoot me a message on Instagram. I know you'll have my link to my Instagram account on your website. So by all means, shoot me a message. Just so I know that you're not a rando trying to sell me cologne from somewhere in Indonesia or, you know, these folks can reach out to me, by all means. That community, to me, is invaluable. I want people to feel supported. I want people to feel free to ask questions, to reach out for me, to speak for them or for a podcast episode. I don't really care. But I want people to feel supported and like they're not alone. Because if we're going to make it for 36 years as nurses, we got to lean on each other.

[52:01] Michelle: Yes, we do. That is so true. Well, yes, I will put that link in there and encourage my listeners to reach out. And I think one day I'm going to see you on the national speaking circuit, and I'm going to say we need to bring Gaby to our town.

[52:22] Gaby: I would love that sometime.

[52:23] Michelle: That would be so wonderful.

[52:25] Gaby: What an honor.

[52:27] Michelle: Well, it's been an honor to talk to you today. I really appreciate you taking the time at the end of your day to do this, to bring this message. It's so valuable, and you have just communicated it in such a compassionate way, and you've broken it down so we could understand all the nitty gritty about ACE scores. And I really appreciate it. Gaby, thank you so much.

[52:56] Gaby: Absolutely. No, thank you.  We got to get this word out, Michelle. If we're going to change our community, we're going to do it one conversation at a time, right.

[53:05] Michelle: Right. Get it on blast.

[53:09] Gaby: That's right.

[53:10] Michelle: Well, you know, at the end, Gaby, we do the five-minute snippet. So are you ready for that?

[53:17] Gaby: Ready.

[53:18] Michelle: Five minutes of fun. Going to start the timer.

[53:21] Gaby: Wait, we haven't been having fun yet. What do you mean?

[53:23] Michelle: Oh, yes, we've been having lots of fun. More fun.

[53:28] Gaby: More fun without the trauma. Perfect.

[53:31] Michelle: There you go. Thank you.

[53:32] Gaby: Okay.

[53:38] Michelle: Favorite pizza toppings?

[53:41] Gaby: Green chili. Hands down.

[53:44] Michelle: Yes, I like it. Okay. Would you rather discover a new species or a new planet?

[53:51] Gaby: A new planet, because that means new species in there. Right?

[53:55] Michelle: Hey, I love it. A twofer. Okay. Favorite adult beverage?

[54:04] Gaby: I will drink craft beer any day, but gin takes my heart. Oh, goodness.

[54:10] Michelle: Gin. Okay. A few years ago, my daughter and I went online and got this collection of gins. It was like, all these gin samples. It was very interesting.

[54:22] Gaby: That sounds amazing.

[54:24] Michelle: Yeah. And then we made all these cocktails from them, so that was fun.

[54:29] Gaby: I'll have to look out for that. Christmas present to myself in March.

[54:30] Michelle: Exactly, yes. Would you rather go without running water or electricity for a month?

[54:41] Gaby: Oh, electricity, hands down. Running water is like, what you need for keeping yourself clean, we have candles and have to live with them. Could you imagine, Michelle, me living without a phone? Oh, I would be so happy. Nobody can email me. Nobody can be like, this needs to be rolled out right now. Education wise. No. That sounds so nice. Running water, powers out.

[55:10] Michelle: Okay, favorite dessert?

[55:13] Gaby: I am a fat kid at heart, but I love chocolate chip cookies. For sure, they have to be plant-based. I'm plant-based, but chocolate chip cookies is where it's at. And if you put a little bit of sea salt on it, you got me.

[55:30] Michelle: Favorite hidden gem in your city that only a few people know about.

[55:35] Gaby: Ooh, that's a good one.

[55:37] Michelle: And remind me what city you're in again.

[55:40] Gaby: I'm in New Mexico.

[55:41] Michelle: Okay.

[55:43] Gaby: Goodness. That not very many people know about. Well, there's a lovely little place that I like to go visit, hot springs throughout the southwest, and so I'm trying to make it a point to go to as many hot springs as I can, whether they are standalone or they are kind of a little more developed. But we have a lot of beautiful hot springs here in the southwest. So anything from Hemis Hot Springs all the way to the Strawberry something hot springs in Colorado, I'm all over that. That's my jam.

[56:24] Michelle: It sounds lovely. Would you rather marry a psychopath or a sociopath?

[56:31] Gaby: I mean, they're the same thing.

[56:36] Michelle: I was like, aren't they kind of the same?

[56:38] Gaby: Yeah, they sure know. I have been known to put up with a lot more than I really should have Michelle in my past relationship. So I can guarantee you I will date either one of those, so long as they're like, it takes me a couple of years to realize that I'm in a toxic relationship. Thank God I finally found my wife, who is not a sociopath, not a psychopath, but she's beautiful, and that's done enough to hold my attention. But unfortunately, I probably have dated one or two of those if they were attractive enough.

[57:16] Michelle: I think back, and I'm like, God, hasn't there always been one person in our past that was, like, a little bit unhinged? Right?

[57:28] Gaby: Yes.

[57:29] Michelle: Okay. Favorite board game.

[57:32] Gaby: Favorite board game, you said?

[57:34] Michelle: Yeah.

[57:36] Gaby: I love Cards Against Humanity. That's definitely what I love to do with my friends. I always seem like, damn funnier than I really am. And it kind of keeps me humble because I don't always win. But it's still my favorite game because I love to laugh whether I'm funny or not.

[57:55] Michelle: I haven't done that one yet. It's been on my radar, though.

[57:59] Gaby: Oh, well, just be prepared and open-minded for it. And don't ask your children to explain things to you. Just google it yourself.

[58:06] Michelle: Okay. Oh, gosh.

[58:07] Gaby: Okay.

[58:09] Michelle: All right. Would you rather have a poem or a song written about you?

[58:16] Gaby: Oh, song for sure. Like, music moves the heart and the mind and the brain like nothing else. So a song? Absolutely. Even if it's a bad song, even if I did something awful to somebody, that's fine. I don't care. I will belt it out. Write a song about it.

[58:33] Michelle: I love it. All right. Anybody out there wants to write a song about Gaby, bring it on.

[58:39] Gaby: Bring it.

[58:40] Michelle: Love it. Gaby. It's been so much fun. Thank you so much for indulging me at the end. I love to see the off-duty side, and you have certainly provided that, and you have certainly provided our audience with so much information and so much value, and I just appreciate it. Again, of course.

[59:01] Gaby: Thank you for giving me this platform to spread such an important message around. And thank you for doing what you're doing. You took that ball and you ran with it, Michelle. You are disseminating all that important information that many of us have never really heard about. This is the way that healthcare should be. It should be proactive. We should be talking about true issues rather than being reactive. So thank you for this. I appreciate you.

[59:29] Michelle: Well, I appreciate that. Thanks so much and have a great rest of your evening.

[59:35] Gaby: Thank you. Likewise.