Beyond ADHD A Physician‘s Perspective Ep 2 with Dr. Nina Mara Di Nicola (Emergency Medicine Resident, Physician Health Fellow helping and supporting other physicians and their wellbeing)

Dr. Diana Mercado-Marmarosh: Hi, welcome to Beyond ADHD, a Physician's Perspective podcast. I am. Dr. Diana Mercado-Marmarosh, I'm a family medicine doc with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers who are three and four years of age. And in the past year, I have undergone radical transformation after discovering ADHD, coaching, and life coaching.

For the past decade, my typical day consisted of having 300 charts, backlog, a graveyard of unfinished projects and a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes the last year. I figured out the secret learn to stay in your lane. So now my mission is to help others develop systems that tap into their sown of genius.

So they too can reclaim their personal lives back, like I have.

So as we all know, ADHD can affect people in different ways and people deal with it in a different way. So this podcast is created for adult professionals to have a community. Where they can come and share whatever their wins are, whatever their challenges have been and how they've learned to over achieve.

And strive. Right? So when most people think of ADHD, usually their mind goes to that hyperactive kid who can't stay still in a classroom. Right. They're kind of annoying and distracting others, but they never remember the females who are sometimes calm and sometimes just daydreaming and they're trying really hard to focus, but they just can't. And guess what, both kids can become adults. And this is where the data gets lost. Sometimes people think that as adults, you out-grow this, and that's not the case. So I am going to be talking to you guys about ADHD, how it can be a gift. But you need to learn to unwrap it. So throughout this podcast, I will be bringing you the latest scientific data.

I will bring you different strategies and I will bring you amazing human beings who have, and are striving in their fields. But  before getting started, I have to give you a disclaimer. Well, me and my guests today are medical physicians. We are not your doctors. What that means is that the information that you will learn here is not meant to replace or to substitute any of the advice or information that your own physician there best or coach gives you.

In addition, any advise share here is considered our own views and opinions. They're not meant to represent. Any other employers, hospitals, or particular healthcare organizations. I know that was a handful. I hate to say that, but I had to, my lawyer's going to be so happy anyways, now that we got that out of the way this week, I am so excited to talk to you about a very special guest.

I have Dr. Nina Mara Di Nicola is a former Physical Therapist, turned Emergency Doctor. Who has completed her residency in emergency medicine at my Gill university and Montreal, her diagnosis of ADHD was given to her in her first year of residency. It triggered a journey into a world of pharmaceutical and non-pharmaceutical management to optimize her functioning and overcoming.

Her special interest reside and wellness led to complete a fellowship and physical health and wellbeing at UC Davis and her former research on resident mistreatment. She founded ADHD peer group for postgraduate medical alert. Where she facilitates months, monthly meetings to share resources and practical tips and tricks. When she isn't studying for her Canadian emergency medicine, Royal college exam, she can be found running on the lashing canale, playing the piano. Learning Cantonese doing yoga and meditating with her cat Livo fed. So I probably butchered a lot of those words, but don't worry. We're going to hear it from her first hand, please. Everybody woke up. Tell us Dr. Nina, tell us all the things.

Dr. Nina Mara Di Nicola: Oh, thank you so much. That was a very kind introduction. Thank you, Diana. So they call you Diana. So I guess the one thing, the one thing you, uh, you got wrong was my fellowship. It's physician health actually, that's important. So it's actually about, helping other physicians and supporting their wellbeing, and that was a fellowship year I did, or a six month program I did through UC Davis last year. Okay.

Dr. Diana Mercado-Marmarosh: Amazing. Thank you for clarifying that. That is a very important distinction. Okay. So two. What were the circumstances that led you to get this diagnosis? You, found that in your first year of residency, tell us all about it.

Dr. Nina Mara Di Nicola: So, I had suspected it many years ago, but I, you know how it is with ADHD, I sort of put off or did not make my way to access the diagnosis. And like it took literally. Probably 10 years between that moment where I started to really suspect it. And as a matter of fact, my father is a child psychiatrist and my father. He's the one that suggested it in me, but really in my mid twenties. And that was sort of, despite the fact that I had very typical symptoms as a child, like, you described that kind of very active child, often a boy, but. I was that very active child in the classroom. Interrupting all the time. I actually had to be put, like I got a separate desk that was sort of behind a wall, that they created in my classroom just to keep me physically separated from the group.

What happened though, with, since I was doing very well academically, they just kind of pass me through. And there was always a mention in my report card that, you know, I should, not talk so much or kind of control my behavior. But since I had A's everywhere, they just kept me going and nobody thought.

At that time to actually look into what was happening. So what happened was finally in residency. I guess I just wasn't really performing like at the expected level and not because I wasn't trying and it, something just seemed really off to me. Like, why is this so difficult? And, at that time I met with a psychiatrist and after one session together, just listening to my story of my childhood and like throughout my life, she diagnosed me with severe mixed ADHD. And, that's it. That's how I got my diagnosis.

Dr. Diana Mercado-Marmarosh: Perfect. You know, it's interesting what you just said. It, I kind of followed the same, scenario. Like I too was that kid and, who like both my parents had to come and sit in the classroom because I was disrupting everybody. And they would give me extra homework and I would do the homework. But then I was still disrupting. So like you said, I, academically I was doing fine, just like you were saying. And so they didn't think anything of it. I'm curious, whether prior to your diagnosis, like, did you perceive it, like you said, your, your dad had kind of mentioned it to you and you kind of thought maybe there was something, but did you always think there was something off or no?

Dr. Nina Mara Di Nicola: You know, I think I really didn't put all the pieces together. Even, when I received my diagnosis, it took another really another two years, two, three years, like I'm now in my starting my fifth year of residency. So I would really say it took that long. It took three, four years for me to really understand how much. What I just assumed were my own character traits and flaws. How much of that was reflected in this diagnosis.  And it's, it's amazing, like so many parts that, I just, you know, it's, you're so used to living in your brain and you just think this is, this is life. This is how it is. And you know, other people might get frustrated with me for certain things, but I never really saw them as a problem. And it really wasn't until I was medicated for the very first time that I started to pick up on these little details and I started to understand, oh, okay. I see how that could be frustrating for someone else.

I could give you an example. It was, I had, I had this recurring argument with my Partner at the time where I would, you would get home. I would reach into, well, I would look for the keys. First of all, which you know is very, it could take like a couple minutes to find my keys. I'd be looking at all my pockets. I didn't know where I put it in somewhere in my backpack. I can't find them.

Finally. I get all my stuff out of my bag. I get my keys out. I would, so we have this like key, this electric pass at the front door. Just to open the main door. So I would get it out. Finally open up the front door. Then from that front door to my actual door of my place is like maximum 25 steps. Okay.

And somehow between the front door and my door, I would lose the keys again. So I would put them back somewhere in my bag. I wouldn't be thinking about it. My head is somewhere else. I'm totally like absorbed in thoughts and conversation when we get to the front door and now I have to start the process again.

And my partner at the time was like, what is wrong with you? Why do you keep, like, why don't you just keep them out? And I was like, what are you talking about? Because in my head, So much time had passed and so much had happened in the 25 steps that it didn't even make sense to me. Why you would expect someone to do that?

Like, it seemed crazy at the time anybody would have that much. Awareness. Right? So, it was like literally the same argument every time. And the first time I actually started my medication, my stimulant medication, I came home from work. I, took my keys out of my bag. I tapped them on the door. I held them in my hand.

I walked up to my front door and I unlocked it. And then I just started laughing because all of a sudden I understood why that was like something frustrating. Right. And I could not have imagined that. So taking the medication was one thing that opened my eyes in a major way that I could not have understood before.

And then on top of that, like it took years of reading about it, listening to podcasts, reading books, and seeing what other people were describing as symptoms that I actually started putting all the pieces together.

Dr. Diana Mercado-Marmarosh: Right right now. Let me tell, let me ask you this. Did you feel like prior to your medication, like you had 25 tabs open?

Dr. Nina Mara Di Nicola: Oh yeah. And

Dr. Diana Mercado-Marmarosh: And then like you take this medication all of a sudden there's like two or three. There's not like 20.

Dr. Nina Mara Di Nicola: So I remember, I was home. Like I, so I had to go through a lot of different medication adjustments to figure out. The right dose, the right medication. I had a lot of side effects, so I really went through lots and lots of, medication changes.

And at one point I was home. I think I needed to study or something. So I took, I took like an extra dose to see if that would help, like a kind of short acting dose and all of a sudden. I realized that I could hear my fridge humming and I had never heard my fridge humming in my life. And I realized that the reason I could hear my fridge is because all the noise in my head actually quieted down.

And it was like, it was such an amazing moment. I remember I went and I made a post about it on our group that we have like a private group, right. For physicians that have ADHD and. And it was like, guys, I can hear my fridge. I had no idea that my fridge made noise. So there were a couple moments like that where, you know, really when I was very optimally medicated that I noticed the thoughts would completely quiet down.

But I have to say that's rare. Like even now with medication, most of the time, there's still a lot going on, but I can. I can focus on a conversation, a task way, way, way, way better than before. So, yeah,

Dr. Diana Mercado-Marmarosh: So that's very interesting because yeah, it definitely makes a difference when you're able to hear other things outside of you, because you actually don't have your own thoughts running, 10,000 times.

And it's so interesting. I don't know if this happened to you, but when, prior to medication, like, or maybe on the days, I don't know if there's days that you don't take medication, but when you're talking to your friends, like, you're so busy trying to like, listen to what they're saying, because in your mind, you already went to 10,000 places and you're trying not to interrupt them because then you're going to forget what you, what the connection you were going to make with them.

Dr. Diana Mercado-Marmarosh: Did you notice that?

Dr. Nina Mara Di Nicola: So I do want to say I take my medication every single day. And my psychiatrist was really very, felt strongly about this. And the first thing she told me, because I asked her, I said, okay, so I take these when I go to work. And she said, Nina, your relationships don't take a vacation. Your relationships don't have a weekend, right? So you need to take these every single day. Because at that time, when I was seeing her for this, I had just gone through a major breakup. Like it was clear from my just listening to my story, that ADHD had really strongly affected my relationships and that, insight that she had to tell me, no, you take these every day. I think that was really genius of her actually, because I, really, I do that. I mean, you know, sometimes once in a blue moon, I might skip a dose. Sometimes if I'm switching over to night shifts, But almost like I'm very diligent actually about taking my medication

Dr. Diana Mercado-Marmarosh: Thank you so much for pointing that out. You know, a lot of people have this, this thinking that like what you just said, like, oh, I only take it when I'm going to take a test or I only take it when I'm at work or I only take it when whatever right. But like you just said, you have to come home, you still have to be a friend. You still have to be a daughter.

You still have to be a girlfriend or a wife or a mom. Right? And why does work only get to have the best version of Nina? Right. No, like you just said your relationships do not go on vacation just because you think you are. Right. So that's very important to point out. And why do you think people don't want to take their vacation, their medicine?

I think it has to do with they’re thinking that they're going to get addicted right. To stuff.

Dr. Nina Mara Di Nicola: It's really interesting. So I've never personally had this concern about getting addicted. I know some people have this concern, but I didn't have. In my mind, but what I've noticed is myself and pretty much everybody I know, and I do run a support group for residents with ADHD.

So I'm in contact with quite a few other people, you know, in my position that have ADHD as well as a whole network of physicians. And I think what happens is it's this tricky thing where the ADHD brain, is a little sneaky. It's like, it doesn't like to follow rules, right. That's kind of one of the big issues, right?

So there's this real tendency. Not because they don't want to take it, not because they don't like it's, it's like this little rebel voice in your head saying like, oh, you don't really need that today. You can skip. And I find almost everybody I know at some point, especially early on will try to skip their medication or stop their medication.

Like I stopped my medication for almost, I think, six months of my residency, because I was having a lot of tolerance issues and they were trying, like, I was trying to non-stimulant medication to see if that was sufficient. And then at one point I just realized that. What have I been doing for the past six months?

Like I haven't been studying, I haven't been doing my research project. Like this is not okay. And I sort of woke up and I would say it really took, it has taken like three, four years for me to accept that I need this every single day I take it. I wake, I wake myself up one hour before my alarm clock is supposed to wake me up.

Like the real alarm clock. I wake up, I take my medication. I can't even think about it. I'm half asleep. I take it, I go back to sleep and when I wake up, it's working and that was like the single most. I mean, there's a lot of things that, that made a huge difference, but that made a huge difference because instead of getting up, having to think, do I need it? Should I take it forgetting to take it or not? I have some time, some days I just, I didn't know if I had taken it. And then, yeah, so it was never, it's funny, like my brain off-meds sort of doesn't really think there's a problem. It's like, oh, everything's fine. I'm fine. And then sometimes it would be like someone else that was pointed out to me and I'd be like, oh, oh, am I acting different?

And they're like, yes, you just spent like 20 minutes opening one time. It was, I literally, I was supposed to, my mom was coming over and I needed to clean my place up. And for some reason, Off medication Nina decided it was time to open my piano. I have like a beautiful, upright channel, open it up and start, like, I don't know what I was doing.

I was like looking at the chords and I was like the cords inside the account. And at the time my, my partner was. Okay. Um, I think we need to, like your mom's going to be here in the hour. Like you need to clean up and, and then, and then the next question was like, have you taken your medication? And it's like, oh no, I have not taken my meds.

Like, that's why, so you know what it did. It was a lot of external input in the beginning. People noticing the difference. And it was enough that eventually I convinced myself, like I had to convince myself that this was it. I have to take it every day. I have to be disciplined about it. And I think it's funny, this concern about being addicted because.

If you're addicted to something, you don't try to convince yourself not to take it. Right. Exactly. So that really goes against the whole addiction theory. But I'm not, I'm not an addiction expert I share.

Dr. Diana Mercado-Marmarosh: Okay. But I just bring this up because I feel like part of the community always brings. Question to me, like I know when I have patients who have ADHD and they're starting on their meds, they always ask me, okay. I just give it to them when they're at school. Right. Well, you tell me, do you want them to clean the room on the weekend? Like, do you want them to be able to play in the tournament on Saturday and Sunday? I'm like, no, you'd give it to them every day. I wouldn't take away the medication for somebody who has diabetes or high blood pressure.

Why would I take away a medication on a weekend for somebody who clearly has been diagnosed as needing it? Right. So, thank you so much for pointing that out. That is so important. Because we are impulsive people. We are very creative and very spontaneous people and sometimes accidents can happen. If we are not, you know, all there so to say.

Let me ask you this, what do you think are some of the best resources that have helped you in this last three or four years that you told me that you've been discovering yourself?

Dr. Nina Mara Di Nicola: Great question. So I have a list. I had to sit there and I thought about all the, all of these little things that helped me on my, on my journey. One of the first things was, you know, I went to the library I'm, uh, I went to the bookstore. I'm I'm a reader. I'm the kind of girl that as soon as there's a problem, I want to read everything about it. So I went to, this bookstore and I just started looking at all the books on ADHD. And I came across this one called ADHD friendly ways to organize your life.

It's by Judith Kohlberg and Kathleen Nadeau. And this is a fantastic book. It goes through every chapter and it's totally. Written for people with ADHD, the way they format things, the way they like highlight things and there's boxes and it's super like fun to read. And each chapter is just a short chapter where they focus on one little issue, that's quite common with people with ADHD in terms of their organizational abilities. And it was through that book that I recognized that so many of my lifelong struggles we're actually not stubbornness, but common traits associated with ADHD. One of the, one of the big ones there is not opening my mail.

So I have a habit of opening my mail maybe once every six months. Now let me tell you Diana. Probably my most expensive, bad habits

Dr. Diana Mercado-Marmarosh: I was about to say that's a very expensive ADHD tax you're paying their girlfriend.

Dr. Nina Mara Di Nicola: The last time I did or a couple of. I think a year ago, I went through this process of opening all my mail for the past year that had accumulated and I had to pay thousands of dollars in late fees for things like my property tax. And just like so many things I hadn't paid my license. Thankfully I hadn't driven. So like, oh my gosh. These little, like, I don't actually, I don't actually know how neuro-typical people remember to do all these things because it's, to me, you know, we have this, very interesting sense of time, which is now, or not now as you, as the, you mentioned earlier,

Yes. So, but what was comforting to me, I really thought this was like a Nina problem. Like Nina doesn't, whatever it is. It's the rebel in me. I don't like to open my mail. It's just strange thing. And then when I read this book, they talked about this, about mail backlog, about how it's common for people to not open mail for like months and months and years.

And I was like, oh my gosh, This is not just me. Right. And there was such a freedom with that. And like, it made me feel better. It made me feel like I was less broken, less stupid. Like I used to think it didn't make sense. Right. Because I, was a physical therapist. I had gone through all this education, all this university, you know, then med school.

Well, before med school, I remember thinking like, I know I'm smart, but I act really stupid sometimes. Right. I lose things. I can't figure out how to like wash dishes and sort them properly. Like these little simple things. We're complicated for me and really complicated things were easy for me. And it was always like that my whole life I would get, I would score top grades on the hardest exam.

And then I would make little mistakes on the stupidest things. So that, you know,

Dr. Diana Mercado-Marmarosh: They would tell me this, like I would do similar thing. They would tell me the Diana you are booksmart. But you're not street smart. And I would always get myself in trouble. Like you just that like the complicated things. No problem. I got it. But the common sense things. Forget it.

Dr. Nina Mara Di Nicola: When I got into med school, I remember more than anything feeling like, oh good. Now people will believe me that I'm saying. Like how sad is that? It's so crazy that I felt like I had to prove something because something didn't quite make sense. I felt like I wasn't really living to my full capacity.

So that was, so that book was one of my big resources, a couple more, I'll mention the ADHD for smart ass women podcasts that Tracy Otsuka that you were on. That podcast, you know, I remember. I don't know how I found out about it, but I, I think I probably just found it on Spotify because I, I love Spotify.

I love music. I like, I have music playing almost 24 7 if it's not actually playing it's playing in my head. So, and I discovered that podcast and, you know, every episode she's interviewing people and she's talking about, knew about different concepts associated with ADHD. And I, I completely identified.

Almost everything she talked about in that podcast. And it blew my mind, like how much of who I thought was me. And like, this is my personality. Like those are ADHD traits.

It's, it's fascinating. Um, you know, and then my other resources where the people around me, I have an amazing ADHD coach. Her name is coach Maddy or Madeline Cote here in Montreal.

She really helped me reframe my challenges, uh, challenge my negative self-talk and really learn to believe in myself. Because, what we've discovered is that children with ADHD because of their ADHD gets so many negative messages, they get way more negative messages than the average child. And that has an impact on you.

And you start to talk to yourself in that way. And I see this all the time with my, um, my co-residents with ADHD is that people just start to. Doubt themselves and blame themselves and think like, oh, what's wrong with me? Why did I do this? Whereas, my coach really helped me understand like, oh, that's my ADHD.

Why did that happen? Exactly. Like getting curious, as you said, get curious, ask questions and don't. Don't judge yourself, like, Accept that that's, that's part of who you are. You're a human being. Even if you're a doctor, you're a human being right. At the end of the day, we're all humans and humans are going to make mistakes.

And that's how we got. So I would say those are my, my best resources and my psychiatrist. I don't know if I can name, drop her, but her name is Dr. Valerie... She's been fantastic. She's walked me through like so many medication changes. She's gone so far as to treat my migraines, which no doctor has ever treated in my life.

I've had migraine headaches since I was seven years old. And it took a psychiatrist to say, Hey, maybe we should treat these migraines so you can tolerate your stimulants. So that's been amazing. Now I have migraine treatment and she always advocated for the non-pharmacological management in the form of sleep diet and exercise, which is not easy to implement as a resident.

Let me tell you that. But the more I pay attention to those things. The better. My life is 100%

 Amazing! Let me ask you this because some people don't don't understand what the difference is between like a physician and like a coach. Could you differentiate those for me a little bit?

Dr. Nina Mara Di Nicola: Sure. Well, obviously a physician is somebody who has medical training. Um, if you're talking specifically about, well, I guess the physicians that would be involved with ADHD are physicians. So family interests and, well, my psychiatrist really. So I've had. Lots of, meetings with my psychiatrist. So first of all, they diagnose, right? So we're the ones who are actually giving you this diagnosis after evaluating you and applying, uh, the clinical criteria.

And I would say my psychiatrist directs my care, especially with the medications. So she's finding everything, responding to whatever changes, that need to be done. But ultimately, and I think early, very early on, we identified that I would need more, like I would need more coaching, something more, behavioral, and she doesn't provide that.

So at that point, I used, I think initially I was doing more therapy, like psychology, work with, with, actually I was lucky and my therapist actually had ADHD and told me, like, I was very open about it and actually had training in ADHD. So that was, that was quite, interesting. But even then therapy is going to be more like reflecting and maybe going back to previous issues in your life and trying to kind of cognitively work through problems and feelings where coaching is much more strategic and like, okay, let's, let's implement strategies now. Let's, analyze what needs to be done now. And sort of, she would really help me like look at the big picture, figure out what I needed to take care of and then, and then try different strategies. And it was just in the beginning with my coach, it was a lot of trial and error and, and a lot of it was this reframing.

So. My therapist did that with me to that work of like, okay. I would say, oh, I had a really bad day. And I remember my therapist saying, what does that mean to you? And I was like, you know, it's just really distracted. And I did a whole bunch of stuff, but I just feel like unsettled. Like I had done laundry and done some cleaning and done some studying and like, I did all kinds of stuff, but I didn't feel good about it.

Just my, like I felt chaotic. And I remember her saying to me, Nina, a bad day is when you don't get out of bed. And I was like, oh, okay. Like the, I feel like we put the bar so high for ourselves. We put ourselves like, oh, you didn't like run a marathon today and right at the five hours, that's a useless day.

Right. So there's that reframe. So does that help kind of separate

Dr. Diana Mercado-Marmarosh: So I wanna thank you so much for pointing it out. What I want to point out here for our listerners, is that there's not one right way of helping ourselves when we have ADHD, right? Like I am not like pro or against medicine. I am not pro or against exercise, I am not pro or against coaching. Of course, I'm going to be biased and tell you to do all the things, especially to do coaching because I'm a coach too, because I have now seen how it has transformed me. But what I want to say here is, they can all beautifully work together and compliment each other because they all have a part that helps to unlock our brain and gets us to the next place of where we want to be.

Not because we have to, not because that's, what's going to make us like, feel like we're finally on broken, but because. We people with ADHD are like the dreamers and the shakers and the ones that don't just think, oh, well that's the way it's always been. Let's just leave it that way. We're the ones who are like, well, that shit ain't working.

How do we change that? Right. And when we start asking those questions that other people sometimes don't ask, we think outside the box and we need to have the ability to. Take into action without judging ourselves. Like you just said, like as kids, because we weren't maybe doing, or even asking, we come up, those, we weren't fulfilling our potential or where we thought we could.

We learned to use the inner critic or the judge voids in us to motivate us, to keep growing, to keep up, to keep up. Come on one more thing. You got to look at the big picture. You're going to become a doctor. You can do this two more hours. Oh, you have an eight for five. It's okay. You got this. Like, like it pushes you, but not from a place of like, oh my God.

Look how amazing Nina’s doing it. Look at everything she just got done today. No, your brain's like, what the fuck girl? You haven't done all 20 things. And like everybody around us, it's like doing two things. Right. But we need to do 20 things. Right? So the coach allows you to see what thoughts we think are helpful, but really are not.

And to see how much you are actually doing, how much of a bad-ass you are like, oh my God, look at everything we shared. You have established a way for residents to feel supported, right. For the wellbeing of not just yourself, but those other people around you who have ADHD. You don't really even talk about like, because of stigma or whatever.

Right. And you are allowing people to really voice and grow right. And empower them. I have to make, I'm going to just ask you a couple of more questions cause I want to value your time, but I'm pretty sure that the listeners are like having a ball, listening to everything you're saying. Tell me, what is the key to living successfully with ADHD?

Dr. Nina Mara Di Nicola: So I think the key third, two keys. Okay. And we've touched on them, but to bring it all together, number one is learning about your brain working with it and not against it. Don't try to fit into what society expects. One of the resources I didn't mention earlier, but I love is the How to ADHD YouTube channel. This is hosted by Jessica McCabe. She's a young woman who has ADHD. And she actually gave a Ted talk that blew my mind. You guys have to watch this Ted talk and she talks about how he took her up into her twenties to like mid twenties, late, late twenties until she got her diagnosis and then started to really use, be able to use all this untapped ability. She had, she had actually been labeled as gifted as a child and was writing like high school grade exams in grade school. But because of her executive dysfunction, it wasn't coming together and she wasn't able to kind of make something of herself. And in this talk, she says, if you judge a fish by its ability to climb a tree, it will live its whole life believing. It is stupid. And, and she says you're not a failed version of normal. And I find that that's just so key to recognize that. For fish, we need to swim. And if everyone else is climbing a tree, like that's cool, but we're going to be over here, fishing, swimming. So that's really important. And then the number two thing is building community.

Having other people with ADHD. To turn to when you experienced the unique challenges that come with this diagnosis, it really is a lifelong journey of finding strategies to manage symptoms. And it really helps to be surrounded by others who are on that same path. Something my coach always tells me or used to tell me a lot in the beginning, but now I got it, was you have ADHD, your brain seeks variety and novelty. So don't expect the systems we put in place today to work forever because in a couple of weeks, your brain's going to get pretty bored of your systems. And that's when you have to, which he says is re-sparklize it, make it sparkle again, shake it up a little bit, make it pretty right.

And I think approaching it as this lifelong journey. Is the most important part, because if not, you're going to get really frustrated. If in three months your perfect system didn't work anymore. Be like, expect it, expect that you're going to have to keep working on this. And that's kind of all the fun. So just keep going.

Dr. Diana Mercado-Marmarosh: So what are your goals for next year? Tell us.

Dr. Nina Mara Di Nicola: I have so many goals. Diana. I am like. Yes, this is very ADHD, but I will tell you so many goals. So number one, I need to finish this residency I'm in and I want to finish it really strong. That means ACEing my Royal college exam, which is in eight months. And I also want to do some moonlighting so that I get to experience being an independent practicing physician before I have to go out there in the world completely on my own.

So, those are like my major career goals right now. I'm also learning Cantonese. So that's been, you know, that's a journey. I definitely want to get better on that. I had originally told myself six months, I had six months to become conversational in Cantonese. I'm not quite there yet. I'm now, like about seven months in, but you know, it's amazing.

I do it a little bit every day and I've picked up. Quite a lot. And then my major, if I go beyond the next year, but kind of moving forward into the future, I would say my major goal is finding a career path that will allow me to integrate my passion for physician health and wellbeing with my emergency medicine training.

I really want to keep working with physicians with ADHD. I'd love to develop like a screening tool that we could apply to residents to help them identify who would need further testing. Because I think so many, like I've seen so many residents who get picked up in residency and sometimes it's because things aren't going well.

And by that point, you know, they've already, some might have some negative, stereotypes about them or perceptions about them. So if we could pick these people up earlier, maybe medical school or when they get into residency, I think we could really help them. Also, I have this longer term goal of just working towards changing the culture of medicine.

And that's what you're trying to do with your podcast. Right. I think, medicine is trying to fit us into little boxes and is not really celebrating the diversity within the community. You know, rather than having us have to apply for special accommodations. Like in my residency program, you can go to. Specific, you know, office for students with disabilities and apply for special accommodations.

And let me tell you, Diana, some of the accommodations, some of the residents I work with have been given, okay, you have the right to take notes during a patient interview. You have the right to look at your notes when you are reviewing a case, those sound to me like pretty normal things that people would.

needing as he can be with a diverse set of strengths, not everybody has a perfect memory. And the fact that we have to ask for accommodations and go through a process to be given the right to take notes when someone is giving us their detailed, complex medical history that we have to get right, because we're using that information to treat them. That actually blows my mind.

Dr. Diana Mercado-Marmarosh: Yeah. I mean, when you go to the restaurant, when a waiter comes and tells you what you want to order, right? Do you look at them like they're stupid because they can't keep straight. Whether you want jalapenos or cheese on your burger, like come on, right?

Dr. Nina Mara Di Nicola: I used to be a waitress. So I'm nodding over here so hard because. The first thing they taught me was, Hey, you take a piece of paper, you draw a grid, there is your table, and you have to write the meal that each person at that table ordered, I worked in a buffet and they would have like 12, 20 people tables.

And if I didn't write it down, then nobody's going to get their salad and their soup. Okay. Exactly. Well, that's normal and it's normalized. So why to normalize this in medicine, normalize the fact that. We are human beings and we forget things and that's okay. And it doesn't make you a bad doctor and it doesn't make you anything. It's just makes you human. Right?

Dr. Diana Mercado-Marmarosh: Dr. Nina, it's been such a pleasure to talk to you. I know you are going to be changing medicine. I know your fireball. I can hear it. So I know our listeners are would be dying to get in touch with you to put you on their YouTube channels, to put you on their next movie, to put you on their books so that we can change ADHD physician's world.

Okay. How can they get in contact with you?

Dr. Nina Mara Di Nicola: So you can, I'm pretty old school. I have an email address and I have a Facebook account and that's pretty much it for me. So you won't find me on any other, I honestly, I don't, I couldn't handle having any more social media accounts. So, basically you can find me on Facebook at Nina di Nicola, and my email address is nina.dinicola@gmail.com. I could spell it out. It's Nina, N I N A and Di NiCola is D I N I C O L A.

Dr. Diana Mercado-Marmarosh: And I will put that information on the bottom of the podcast so people can reach out to you. And I would definitely list out all the resources that you said, because those sound amazing.

So there you have it, guys. You heard a rockstar. She is here. She is making noise. She is changing medicine and. I want to thank you for joining us for the overachieving ADHD Physician podcast. It was such a pleasure to talk about everything that Dr. Nina had to share with us today. As you see, sometimes the symptoms are there, and even when we do get diagnosed, it takes us a little bit of time for us, become curious with our brain and use all the resources around us. And even when we get it just right, our brain knows it likes to spice it up. So re sprinkle it like she, like she said, and keep on doing the best that you can have a good. Thank you.

Dr. Diana Mercado-Marmarosh: Someone who understands that time is our most valuable asset. Please click the subscribe button and join my Facebook group beyond ADHD, A Physician's Perspective so that you never missed an opportunity to create time, at will. Do share this podcast with your friends. So theytoo can learn to live life and stay in their own lane