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Emergency medicine is a supra

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normal job where you are exposed to such

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a volume

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of stuff.

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There's anger. There's misery. There's tragedy.

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And even on a great day,

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your cortisol and your adrenaline

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are maxed.

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Alright, ladies and gentlemen. Welcome back to the

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podcast. We are here

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graced by the presence of doctor Rob Orman

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once again. Rob, thank you for being on

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the show.

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Thank you, my friend.

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Always a treat chat with you. Always treat

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me back on EBM. I love EBM.

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You know what EBM reminds me of?

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Tell me. A blue chip stock.

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Oh. Yeah. We just got a bunch of

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the monthly handouts.

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They're basically the world's best review articles.

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I mean, I know that's what you talk

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about in this podcast. I had not seen

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them for years.

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They are amazing.

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Blue chip stock.

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Love it. They are pretty incredible. And thank

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you to all of our authors who might

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be listening today for continuing to write them.

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They're amazing. Yeah. And They're great.

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This voluminous

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and all encompassing on a topic that's always

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relevant to emergency medicine. It's pretty amazing. Both

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the adult and the peds ones, honestly.

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Yeah. We just we just got both of

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them. Yeah. And there's some smart people that

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write those things. I mean, I get the

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pleasure of talking about it on the podcast.

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And then occasionally, we get to have the

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author on the show, and it just goes

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to show you how smart they are because

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I just sit there and You're the the

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talking head.

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I am. I'm basking in their intellectual

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fortitude.

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It's just it's amazing.

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So I asked you on the podcast today

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to talk about trauma,

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And I didn't mean the type of trauma

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that we're used to seeing in the emergency

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department, or at least that we're aware of

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seeing in the emergency department when we talk

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about things like trauma alerts and

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victims of trauma. We had a recent event

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here in Tallahassee, Florida where I live, where

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the Florida State University campus experienced an active

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shooter incident.

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And multiple people were shot, two people died,

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and the shooter was also injured, all of

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them taken to the hospital.

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And there was a lot of discussion

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around

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what it would be like to work in

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the emergency department

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and

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experience

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an active shooter incident and be there

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in order to accept these patients coming in.

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And it got me thinking about

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my couple of decades in practice and all

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of the traumatic things that I saw.

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You know, early on

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in my career, I would go home and

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share this stuff with my wife. It was

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kind of a natural decompression and discussion.

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But my wife is not a physician, doesn't

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work in the emergency department. She has

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experience in medicine and nursing, and so she

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could lend that ear.

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But after a while, she's like, I can't

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really hear this anymore. This is kinda injurious

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to my mind to hear what it is

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that you're going through and what you see.

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And so for the subsequent,

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you know, fifteen, eighteen years, I just didn't

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have a place to share it. It was

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just this stuff that, you know, we get

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expert at

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compartmentalizing,

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and it went from something I saw at

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work to something I just stuck in a

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compartment. And over

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eighteen years, I think that compartment got gigantic,

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you know, went from being the size of

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a small bag to probably the size of

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a giant house

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of stuff I just kept stuffing in there

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and putting away.

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And it got me thinking

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with this recent incident here that we had

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in town

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about

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how much trauma

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we experience

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as

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medical clinicians, especially in the emergency department, and

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what the best manner is

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to deal with that, or why should we

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even deal with that, and what comes as

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a consequence of not dealing with it. And

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I couldn't think of anyone else better to

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have that conversation with than you, doctor Orman.

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Oh, thank you. I'm thinking about your wife

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and Yeah. Hearing all this stuff that she

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heard. And I just wanna tell you what's

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popping up in my mind right now. I

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mean, you and I have I don't even

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know how many decades stacked on top of

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each other in the ED and know what

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this feel like and what this does to

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our nervous system. And going back to the

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days when you and I were retraining it,

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emergency medicine was beyond a burgeoning field. It

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was really establishing itself, and then it was

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established. And now it's this leader. It's amazing.

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And spent all of these years and decades

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and, you know, people that were real trailblazers

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creating this

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specialty,

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and how do we do this well?

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And,

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Sam, do you ever think about how amazing

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it is?

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Just the logistics and the tactics and the

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strategies and how we operationalize

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these different

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aspects of medicine in the emergency department. It

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really boggles the mind that that's where things

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are right now. I mean, it is such

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an amazing

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field

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medically,

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and it's also

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this

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supernormal

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experience

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for a human being.

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And I think about I was at the

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ENT office the other day,

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And, oh, then, you know, ENT is walking

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in. We're gonna talk about surgery and all

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this kinda that's not super normal. That's a

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job. Or and I was hanging out with

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a buddy, this man who's a radiologist.

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And I sat with him for a couple

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hours reading field. I don't know. It was

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just fun. We're we're already that way. That's

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not super normal. That's a job.

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Emergency medicine is a super

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normal job where you are exposed to such

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a volume

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of stuff.

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And there's anger. There's misery. There's tragedy.

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And even on a great day,

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you're just your cortisol and your adrenaline

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are maxed because the parallel processing that's involved

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is

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is past the horn of the bell curve.

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And that's the normal aspect of it. And

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you see these things, and and I'm going

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back to think about your wife

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that

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you are taking this super normal experience which

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has become normalized for you.

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And now she is absorbing it with no

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context.

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And you are taking all of this stuff

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that you see, and I I think of

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it as stuffing it into the seemingly bottomless

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stuff sack. You know, like, you put a

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sleeping bag in that stuff sack. Like, oh,

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wow. It's amazing how well this fits in

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here. I got to put two sleeping bags

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in here. Yeah. Your wife doesn't wanna hear

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that. That is traumatic to even think about

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and visualize that stuff.

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You're talking about the shooting at it was

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at FSU.

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Yeah. And, I mean, these shootings have become

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a regular occurrence.

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And, yeah, these are big catastrophic events.

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And, yes, those are traumatic, and those are

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kind of big t trauma. And, you know,

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some people are gonna do better with that

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than others.

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But let's just define

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trauma

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because we we know trauma. Trauma,

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injury,

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fix, better. Or injury, not fix, not better.

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Mhmm.

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But the kind of trauma we're talking about

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today

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is anything

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that

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overwhelms

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our capacity

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to cope,

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and it leaves a lasting mark

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on the nervous system.

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We think that,

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oh,

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Rama's just in the mind.

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It's just it's just how we think about

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things, but

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that's not the case.

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That's have you ever heard of this book?

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The body keeps a score. Mhmm.

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So this is written by, I don't know

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if I'm gonna say this right, Bessel van

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der Kolk. This is kind of one of

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the foundational books of trauma and trauma therapy.

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And the trauma is not just something that

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happens to you. It's something that gets stored

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in you. You know? Like, what you're talking

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about, your storage locker, that dark room in

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your house. Right. It's it's in your mind.

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Yes. It's in your nervous system. It's in

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your physiology.

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And

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I think what you were getting at, Sam,

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that over years and years and years,

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that all of these events and all of

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this stuff changes how you process

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danger,

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how you regulate

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emotion, actually, even what you perceive as a

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threat, and then how you sleep, how you

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connect to other people. So how do we

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adapt in emergency medicine? We push through. We

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push through. And what you're talking about is

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suppression,

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and we suppress.

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We know we're smart people. Listen to this

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podcast.

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When you suppress something,

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it doesn't go away. It accumulates,

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and it very subtly and silently or maybe

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not so silently

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rewires us.

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Yeah.

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Yeah. And that

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experience or those experiences are not things that,

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at least in my emergency department, that we

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had any kind of tools to handle

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protocol

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for debriefing

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or even

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post shift

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recommendations

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for what to do with. It was just,

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like, come to work, do your work, and

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then go home. And, you know, I heard

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stories about some emergency departments where they had

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debriefing protocols after major incidents or major trauma.

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Yeah. But honestly, I don't even know how

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they do it. Because in our emergency department,

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it was like, I literally would get through

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a resuscitation

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and then have to walk into

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another room and deal with the now full

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waiting room of patients who were waiting because

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we were in a giant resuscitation. And, you

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know, what am I gonna tell my next

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patient who says my knee hurts? I'm gonna

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say, well, that's great, sir. But

277
00:09:44,279 --> 00:09:46,120
I just spent the last hour trying to

278
00:09:46,120 --> 00:09:48,600
resuscitate a three year old child who was

279
00:09:48,600 --> 00:09:51,240
with their parent and is now dead. And

280
00:09:51,240 --> 00:09:53,720
I just finished my conversation with that parent,

281
00:09:53,720 --> 00:09:54,220
so

282
00:09:54,600 --> 00:09:56,759
you give me just a little bit of

283
00:09:56,759 --> 00:09:59,054
a moment so that I can set my

284
00:09:59,054 --> 00:10:01,215
brain around your knee pain and have that

285
00:10:01,215 --> 00:10:02,975
discussion. It's like that. I could not say

286
00:10:02,975 --> 00:10:04,654
that as a physician, but that's kinda what

287
00:10:04,654 --> 00:10:05,934
I was being asked to do. They're like,

288
00:10:05,934 --> 00:10:07,615
okay, great. You talk with the parent, now

289
00:10:07,615 --> 00:10:09,455
go see the knee pain. And there were

290
00:10:09,455 --> 00:10:11,475
no tools for, you know, how do you

291
00:10:11,535 --> 00:10:13,295
handle that? What do you do next? It

292
00:10:13,295 --> 00:10:15,550
was just cram it into that sack and

293
00:10:16,090 --> 00:10:18,670
shut that compartment and and get to it.

294
00:10:19,129 --> 00:10:20,490
You know what? I've gotta tell you what

295
00:10:20,490 --> 00:10:22,410
I'm picturing in my mind to say that

296
00:10:22,410 --> 00:10:24,429
is that I can picture the trauma bay,

297
00:10:24,570 --> 00:10:27,710
room one, the big trauma bay

298
00:10:28,384 --> 00:10:29,825
with all the stuff. I don't know. They're

299
00:10:29,825 --> 00:10:32,784
like 17 exam lights in there and, you

300
00:10:32,784 --> 00:10:35,184
know, a couple level one infusers, all all

301
00:10:35,184 --> 00:10:35,845
this stuff.

302
00:10:36,384 --> 00:10:38,384
And, yeah, you spend this time in there.

303
00:10:38,384 --> 00:10:40,620
And what I'm picturing is I'm walking out

304
00:10:40,779 --> 00:10:42,299
of that room, and I take a left

305
00:10:42,299 --> 00:10:43,120
hand turn

306
00:10:43,899 --> 00:10:46,059
nine times out of 10 after a long

307
00:10:46,059 --> 00:10:46,559
resuscitation.

308
00:10:47,179 --> 00:10:49,419
You'll have either the patient or their family

309
00:10:49,419 --> 00:10:52,299
member standing outside of their room super pissed

310
00:10:52,299 --> 00:10:55,204
off that they're waiting. And it's like, yeah.

311
00:10:55,264 --> 00:10:55,764
Oh,

312
00:10:56,225 --> 00:10:56,725
wait.

313
00:10:57,264 --> 00:10:59,125
There's such a time compression

314
00:10:59,504 --> 00:11:02,324
about that that, wow, I don't have room

315
00:11:02,625 --> 00:11:03,444
to breathe.

316
00:11:04,065 --> 00:11:05,204
I don't have room

317
00:11:05,504 --> 00:11:06,004
to

318
00:11:06,384 --> 00:11:08,549
even, you know, process us a little bit.

319
00:11:08,789 --> 00:11:11,029
And I said, we think we don't because,

320
00:11:11,029 --> 00:11:13,850
oh, I'm beholden to them and their impatience

321
00:11:13,909 --> 00:11:15,909
and then, you know, their patient satisfaction, all

322
00:11:15,909 --> 00:11:16,570
this stuff.

323
00:11:17,029 --> 00:11:20,389
Almost everyone in the ED can wait for

324
00:11:20,389 --> 00:11:22,649
you to do what you need to do.

325
00:11:22,789 --> 00:11:25,095
The resus bay, critical patient,

326
00:11:25,875 --> 00:11:28,434
adjusting event, that can't wait. That is immediate.

327
00:11:28,434 --> 00:11:29,254
That is critical.

328
00:11:29,715 --> 00:11:30,535
Everything else

329
00:11:31,154 --> 00:11:33,875
can wait. It is hard for us to

330
00:11:33,875 --> 00:11:35,815
wrap our heads around that because

331
00:11:36,274 --> 00:11:38,434
you just think about opening up a tracking

332
00:11:38,434 --> 00:11:38,820
board.

333
00:11:40,019 --> 00:11:41,139
And he's like, oh my gosh, all these

334
00:11:41,139 --> 00:11:42,259
patients need to be seen. I need to

335
00:11:42,259 --> 00:11:43,299
do them all at once, and that kind

336
00:11:43,299 --> 00:11:45,299
of this. But you know what? You don't

337
00:11:45,299 --> 00:11:47,299
need to be everywhere at once. Those folks

338
00:11:47,299 --> 00:11:48,660
can wait for what you need to do.

339
00:11:48,660 --> 00:11:50,740
Now maybe that's finished a dictation. Maybe that

340
00:11:50,740 --> 00:11:52,200
is to go outside

341
00:11:52,580 --> 00:11:55,214
and just, you know, kinda down regulate for

342
00:11:55,214 --> 00:11:55,794
a moment.

343
00:11:56,174 --> 00:11:58,495
Maybe I don't know. But Yeah. That was

344
00:11:58,495 --> 00:12:00,495
what popped up into my head is the

345
00:12:00,495 --> 00:12:02,334
tapping of the foot. And I and I'll

346
00:12:02,334 --> 00:12:04,095
tell you this. I was in New Orleans

347
00:12:04,095 --> 00:12:05,980
One time. I was with my dad, and

348
00:12:05,980 --> 00:12:07,340
we were at the Jazz Fest, and I

349
00:12:07,340 --> 00:12:09,500
had a episode of biliary colic. I'd never

350
00:12:09,500 --> 00:12:10,799
had that before. It was

351
00:12:11,100 --> 00:12:13,279
so amazingly painful. I just

352
00:12:14,059 --> 00:12:14,720
the more

353
00:12:15,500 --> 00:12:16,960
painful than a broken bone.

354
00:12:17,420 --> 00:12:17,920
And

355
00:12:18,294 --> 00:12:20,375
the ED doc was busy. I was watching

356
00:12:20,375 --> 00:12:22,715
him as a senior resident at the time,

357
00:12:22,855 --> 00:12:24,695
and I was watching him running around the

358
00:12:24,695 --> 00:12:25,975
ED. I was like, oh my gosh. This

359
00:12:25,975 --> 00:12:29,735
guy is really, really just rocking it. And

360
00:12:29,735 --> 00:12:31,654
we had about a four hour workup, and

361
00:12:31,654 --> 00:12:33,174
he did all the things. It just takes

362
00:12:33,174 --> 00:12:34,889
time in the ED. I can remember my

363
00:12:34,889 --> 00:12:37,450
dad walking outside of the room I was

364
00:12:37,450 --> 00:12:38,970
in. It was a curtain room and, you

365
00:12:38,970 --> 00:12:40,649
know, just getting all huffy and puffy because

366
00:12:40,649 --> 00:12:41,850
he was waiting. I was like, oh my

367
00:12:41,850 --> 00:12:44,269
god. I am a part of this now?

368
00:12:44,409 --> 00:12:46,169
I was so embarrassed. Like, dad, come on

369
00:12:46,169 --> 00:12:48,269
in. And he he he couldn't resist.

370
00:12:48,735 --> 00:12:51,235
Anyway, let's get back to trauma, shall we?

371
00:12:51,695 --> 00:12:54,735
Well, the scenario is exactly that. So, you

372
00:12:54,735 --> 00:12:57,134
know, you can imagine the trauma bay. The

373
00:12:57,134 --> 00:12:59,714
patient maybe isn't in there anymore. Yeah. There's

374
00:12:59,774 --> 00:13:02,894
8,000 pieces of used medical equipment strewn all

375
00:13:02,894 --> 00:13:05,070
about the floor. There's maybe some blood on

376
00:13:05,070 --> 00:13:07,710
the floor, and I'm finally getting a moment

377
00:13:07,710 --> 00:13:09,389
to step out of the bay Yeah. After

378
00:13:09,389 --> 00:13:11,309
having been in there for an hour and

379
00:13:11,309 --> 00:13:12,909
may or may not have already spoken to

380
00:13:12,909 --> 00:13:15,490
a family member. And now it's like, okay.

381
00:13:15,710 --> 00:13:17,389
Just gotta move on. You know, go see

382
00:13:17,389 --> 00:13:18,589
the kid with the fever. Go see the

383
00:13:18,589 --> 00:13:19,924
knee pain. Go see the chest pain. Pain,

384
00:13:19,924 --> 00:13:21,524
go see the belly pain. Yeah. Go see

385
00:13:21,524 --> 00:13:24,105
whatever it is. And there were times when

386
00:13:24,404 --> 00:13:25,625
I would be in there

387
00:13:26,084 --> 00:13:26,584
resuscitating

388
00:13:27,764 --> 00:13:30,964
with a roomful of nurses, and we end

389
00:13:30,964 --> 00:13:33,464
it. And then we're all just standing there

390
00:13:33,605 --> 00:13:34,824
staring at each other

391
00:13:35,125 --> 00:13:35,625
going,

392
00:13:36,160 --> 00:13:37,620
like, now what?

393
00:13:38,240 --> 00:13:40,240
Now we just walk out of this door

394
00:13:40,240 --> 00:13:41,919
and Yeah. Go back to doing what we

395
00:13:41,919 --> 00:13:43,360
were doing before we got in here. It

396
00:13:43,360 --> 00:13:45,759
doesn't feel right. It doesn't feel like the

397
00:13:45,759 --> 00:13:48,559
next logical thing we're supposed to do. And

398
00:13:48,559 --> 00:13:51,105
yet all of us just like, okay. And

399
00:13:51,105 --> 00:13:51,764
out we

400
00:13:52,144 --> 00:13:54,945
went. And that just it never set correctly.

401
00:13:54,945 --> 00:13:56,705
It never felt like the right thing to

402
00:13:56,705 --> 00:13:57,845
do in that scenario.

403
00:13:58,225 --> 00:14:00,465
And it leaves an impact. The next day

404
00:14:00,465 --> 00:14:01,985
for the rest of the week, every time

405
00:14:01,985 --> 00:14:03,665
I walk by that room, I'm thinking about

406
00:14:03,665 --> 00:14:05,445
that case. It takes a toll.

407
00:14:06,259 --> 00:14:07,460
And what am I supposed to do with

408
00:14:07,460 --> 00:14:09,540
that? I wanna pull back a little bit.

409
00:14:09,540 --> 00:14:11,059
I do wanna talk about that. You know,

410
00:14:11,059 --> 00:14:12,259
what am I supposed to do with this?

411
00:14:12,259 --> 00:14:13,700
But I wanna put it in a certain

412
00:14:13,700 --> 00:14:14,200
context

413
00:14:15,059 --> 00:14:15,559
of

414
00:14:16,420 --> 00:14:18,360
what can happen with

415
00:14:19,095 --> 00:14:21,254
trauma. So now we're talking about the trauma

416
00:14:21,254 --> 00:14:23,274
that gets stored in us.

417
00:14:23,894 --> 00:14:24,394
And

418
00:14:24,695 --> 00:14:27,034
so what you're talking about is

419
00:14:28,054 --> 00:14:28,954
the habit

420
00:14:29,334 --> 00:14:31,095
that we all get into or all well,

421
00:14:31,095 --> 00:14:32,774
almost all of us get into. I certainly

422
00:14:32,774 --> 00:14:34,534
would include myself in exactly what you're talking

423
00:14:34,534 --> 00:14:34,799
about,

424
00:14:35,759 --> 00:14:38,659
is thinking that we can power through

425
00:14:39,200 --> 00:14:40,019
these experiences.

426
00:14:40,799 --> 00:14:42,820
Mhmm. And that locked closet

427
00:14:43,279 --> 00:14:44,659
or giant stuff sack

428
00:14:45,039 --> 00:14:47,860
will have infinite capacity, and we don't process

429
00:14:47,919 --> 00:14:49,519
these things. And that's what you're talking about.

430
00:14:49,519 --> 00:14:51,455
We we don't process

431
00:14:51,915 --> 00:14:52,815
it. And

432
00:14:53,195 --> 00:14:53,855
this is

433
00:14:54,235 --> 00:14:56,335
an important inflection point

434
00:14:56,715 --> 00:14:57,615
in these events

435
00:14:58,235 --> 00:14:58,735
because

436
00:14:59,675 --> 00:15:01,295
what we do with this,

437
00:15:01,995 --> 00:15:03,934
how we process this, our relationship

438
00:15:04,235 --> 00:15:05,134
to these events

439
00:15:05,835 --> 00:15:06,335
can

440
00:15:07,250 --> 00:15:09,509
skew things. Now this is not definite,

441
00:15:09,970 --> 00:15:12,070
but can skew things either towards

442
00:15:12,769 --> 00:15:13,269
integration

443
00:15:14,210 --> 00:15:15,509
or disintegration

444
00:15:16,929 --> 00:15:17,429
of

445
00:15:17,889 --> 00:15:18,549
the event

446
00:15:18,945 --> 00:15:20,245
of the trauma.

447
00:15:20,865 --> 00:15:23,024
So that may be a term that isn't

448
00:15:23,024 --> 00:15:25,045
familiar to the audience. So integration.

449
00:15:25,904 --> 00:15:28,545
Can we integrate these experience? And I say

450
00:15:28,545 --> 00:15:30,545
that because you and I both know that

451
00:15:30,545 --> 00:15:33,285
it can't unhappen. Once it happened, it happened,

452
00:15:33,799 --> 00:15:35,100
and it can't

453
00:15:35,959 --> 00:15:38,679
not affect us how it affects us. I

454
00:15:38,679 --> 00:15:40,360
mean, this will be hard to say and

455
00:15:40,360 --> 00:15:42,600
hard to hear, but I would imagine that

456
00:15:42,600 --> 00:15:45,000
you and I remember, I can speak for

457
00:15:45,000 --> 00:15:46,779
myself that you remember

458
00:15:47,644 --> 00:15:48,144
every

459
00:15:48,764 --> 00:15:50,764
child that you have cared for who has

460
00:15:50,764 --> 00:15:53,884
had an untoward outcome. I mean, you probably

461
00:15:53,884 --> 00:15:55,024
picture them in your head.

462
00:15:55,565 --> 00:15:56,465
It's just there.

463
00:15:57,085 --> 00:15:59,165
You remember you feel a certain way. You

464
00:15:59,165 --> 00:16:00,689
feel grief. You feel sad. Or, you know,

465
00:16:00,689 --> 00:16:02,449
you feel feel shame. You feel inadequate. Or

466
00:16:02,449 --> 00:16:04,870
you you feel something. Or you feel triumphant.

467
00:16:05,009 --> 00:16:06,289
I don't know. It's just you feel what

468
00:16:06,289 --> 00:16:08,049
you feel. Maybe this is a great recess.

469
00:16:08,049 --> 00:16:09,730
I did the best I could. Or I

470
00:16:09,730 --> 00:16:12,049
just feel sad. You're just gonna feel that

471
00:16:12,049 --> 00:16:12,549
way.

472
00:16:13,009 --> 00:16:13,509
So

473
00:16:13,889 --> 00:16:15,269
integrating these experiences,

474
00:16:16,105 --> 00:16:17,725
you can think of that as that means

475
00:16:17,945 --> 00:16:19,164
we can metabolize

476
00:16:19,465 --> 00:16:21,705
them. It doesn't mean we're okay with what

477
00:16:21,705 --> 00:16:24,605
happened, but we have found a way

478
00:16:25,465 --> 00:16:27,625
to carry it because we're gonna carry it

479
00:16:27,625 --> 00:16:28,524
one way or another

480
00:16:29,259 --> 00:16:30,639
without letting it

481
00:16:31,339 --> 00:16:34,539
fracture us. Because we cannot outrun the trauma,

482
00:16:34,539 --> 00:16:36,620
but we can integrate these events or we

483
00:16:36,620 --> 00:16:37,120
can

484
00:16:37,820 --> 00:16:40,799
not integrate these events. So integration means

485
00:16:41,259 --> 00:16:41,759
acknowledging

486
00:16:42,299 --> 00:16:43,200
what we felt,

487
00:16:44,035 --> 00:16:46,355
letting it become part of our story and

488
00:16:46,355 --> 00:16:48,615
not something that owns us

489
00:16:48,915 --> 00:16:50,455
because we have properly

490
00:16:51,075 --> 00:16:55,014
or adequately or at least metabolized it. Disintegration,

491
00:16:56,779 --> 00:16:58,559
that is when our thoughts,

492
00:16:59,179 --> 00:16:59,679
emotions,

493
00:17:00,299 --> 00:17:02,480
our sense of self starts to

494
00:17:02,939 --> 00:17:05,900
kinda break instead of working together as a

495
00:17:05,900 --> 00:17:08,880
whole. So this event that happens kinda gets

496
00:17:09,375 --> 00:17:11,134
stuck like a bug in the system rather

497
00:17:11,134 --> 00:17:12,595
than becoming part of the program.

498
00:17:13,134 --> 00:17:14,595
Yeah. And it can be

499
00:17:15,055 --> 00:17:17,295
because we've experienced a single event that is

500
00:17:17,295 --> 00:17:19,214
too overwhelming to fully process. It's kind of

501
00:17:19,214 --> 00:17:20,835
a, you know, like a protective mechanism.

502
00:17:21,214 --> 00:17:23,900
So the brain kinda stores it in fragments,

503
00:17:23,960 --> 00:17:25,500
and it shows up as

504
00:17:25,799 --> 00:17:27,799
you feel like you're not yourself. You can

505
00:17:27,799 --> 00:17:30,759
have emotional numbness or sudden outbursts. You can

506
00:17:30,759 --> 00:17:33,019
even have flashbacks or memory gaps.

507
00:17:33,799 --> 00:17:34,299
And

508
00:17:34,840 --> 00:17:37,180
the difference between these two

509
00:17:38,025 --> 00:17:39,725
is the difference between

510
00:17:40,424 --> 00:17:42,684
carrying the weight, because it is a weight,

511
00:17:42,904 --> 00:17:43,725
with awareness

512
00:17:44,904 --> 00:17:46,924
versus dragging it unconsciously

513
00:17:47,945 --> 00:17:49,945
until we break. Let me pause on all

514
00:17:49,945 --> 00:17:51,630
that before we move on.

515
00:17:52,109 --> 00:17:54,210
Yeah. So trying to digest

516
00:17:54,509 --> 00:17:55,250
the event

517
00:17:55,549 --> 00:17:57,170
and making it a part of

518
00:17:57,789 --> 00:18:00,109
who you are in some kind of cohesive

519
00:18:00,109 --> 00:18:02,269
way so that you can then continue to

520
00:18:02,269 --> 00:18:04,269
move on. And, you know, maybe acknowledging that,

521
00:18:04,269 --> 00:18:06,450
yeah, now I'm changed because of this,

522
00:18:06,884 --> 00:18:08,964
but this is who I am now and

523
00:18:08,964 --> 00:18:11,545
still functioning as opposed to just

524
00:18:12,404 --> 00:18:14,085
suppressing, I think, is the word you were

525
00:18:14,085 --> 00:18:16,484
using before. Yeah. Because when you think back

526
00:18:16,484 --> 00:18:17,224
on events,

527
00:18:17,525 --> 00:18:19,125
you're still gonna think back on the event.

528
00:18:19,125 --> 00:18:21,865
It's not that it's not gonna totally disappear.

529
00:18:22,500 --> 00:18:25,220
Mhmm. So let's talk about this emotional storage

530
00:18:25,220 --> 00:18:25,720
locker

531
00:18:26,660 --> 00:18:27,880
for remote with us. So

532
00:18:28,339 --> 00:18:29,940
why don't we talk about it? I think

533
00:18:29,940 --> 00:18:32,420
what you're getting at one is habit. It's

534
00:18:32,420 --> 00:18:34,119
just, hey. We just go about our business.

535
00:18:34,465 --> 00:18:34,965
Mhmm.

536
00:18:36,065 --> 00:18:38,325
And there is kind of a culture of,

537
00:18:38,945 --> 00:18:41,265
I guess, you should say, toughness or being

538
00:18:41,265 --> 00:18:42,884
strong, quote, unquote strong,

539
00:18:43,585 --> 00:18:44,085
where

540
00:18:44,945 --> 00:18:48,005
you're supposed to bounce back fast, compartmentalize,

541
00:18:48,785 --> 00:18:49,285
and

542
00:18:49,710 --> 00:18:50,450
move on.

543
00:18:50,909 --> 00:18:52,829
Yeah. You know, you deliver the news of

544
00:18:52,829 --> 00:18:53,809
death to a family,

545
00:18:54,109 --> 00:18:56,750
and then, like, hey, the patient with belly

546
00:18:56,750 --> 00:18:58,429
pain is negative CT, and they wanna go

547
00:18:58,429 --> 00:19:00,450
home, and they're really upset. Okay.

548
00:19:01,150 --> 00:19:03,214
So we don't talk about it.

549
00:19:03,674 --> 00:19:04,174
And

550
00:19:04,875 --> 00:19:07,214
what you were trying to do was

551
00:19:07,515 --> 00:19:08,494
process this

552
00:19:08,795 --> 00:19:11,035
with your wife. You're trying to process by

553
00:19:11,035 --> 00:19:14,394
talking about it. Yeah. And so going back

554
00:19:14,394 --> 00:19:16,255
to the Resus Bay,

555
00:19:16,759 --> 00:19:18,599
yeah, there's so many different ways to do

556
00:19:18,599 --> 00:19:20,599
debriefs. And and there is one thing about

557
00:19:20,599 --> 00:19:22,359
debriefs is that, you know, if you talk

558
00:19:22,359 --> 00:19:24,279
about it too much, you know, it's like,

559
00:19:24,279 --> 00:19:25,639
hey. Let's do this debrief and then have

560
00:19:25,639 --> 00:19:27,399
a systemic debrief, and then this departmental debrief

561
00:19:27,399 --> 00:19:29,159
is gonna okay. That can end up being

562
00:19:29,159 --> 00:19:29,659
unhealthy.

563
00:19:29,960 --> 00:19:32,785
But these debriefs in the moment of, let's

564
00:19:32,785 --> 00:19:35,204
just take a pause and say, what

565
00:19:35,585 --> 00:19:37,664
what's going on? How how did this go

566
00:19:37,664 --> 00:19:39,585
for you? What are you feeling? What am

567
00:19:39,585 --> 00:19:40,244
I feeling?

568
00:19:41,025 --> 00:19:42,964
And that can be done as a group.

569
00:19:43,184 --> 00:19:45,744
One way to process we'll talk about in

570
00:19:45,744 --> 00:19:47,924
the moment stuff if you wanna get that.

571
00:19:48,140 --> 00:19:50,480
But one way to process is to have

572
00:19:50,539 --> 00:19:51,039
a

573
00:19:52,220 --> 00:19:53,039
set way

574
00:19:53,580 --> 00:19:56,000
that you do in fact process.

575
00:19:56,539 --> 00:19:57,039
And

576
00:19:57,580 --> 00:19:59,180
what happens is is we get to the

577
00:19:59,180 --> 00:20:00,320
end of a shift,

578
00:20:00,860 --> 00:20:03,535
and we think, alright. I'm just gonna go

579
00:20:03,535 --> 00:20:06,095
home, and maybe I'll watch fifteen hours of

580
00:20:06,095 --> 00:20:07,234
Netflix and,

581
00:20:07,775 --> 00:20:09,855
you know, veg out on YouTube or have

582
00:20:09,855 --> 00:20:12,734
a beer or numb myself this way. Yeah.

583
00:20:12,734 --> 00:20:14,894
And that stuff in the brain is just

584
00:20:14,894 --> 00:20:17,394
kinda ping pong and ping pong and around,

585
00:20:17,569 --> 00:20:19,809
and you're just waiting for the noise to

586
00:20:19,809 --> 00:20:22,230
quiet. There's just a lot of unprocessed stuff.

587
00:20:22,690 --> 00:20:24,769
Just go away. Go away. Let me be.

588
00:20:24,769 --> 00:20:26,390
Let me become a civilian again.

589
00:20:26,849 --> 00:20:28,769
You know that it is hard to walk

590
00:20:28,769 --> 00:20:29,505
in that house

591
00:20:29,904 --> 00:20:31,444
and be a human being.

592
00:20:31,984 --> 00:20:34,305
You know? It's like, hey. Give me some

593
00:20:34,305 --> 00:20:36,325
time. I just I need to recalibrate

594
00:20:36,625 --> 00:20:38,565
my brain and my physiology.

595
00:20:39,664 --> 00:20:40,164
So

596
00:20:40,704 --> 00:20:42,065
I don't know if we've talked about this

597
00:20:42,065 --> 00:20:43,664
on your pod before. So I I made

598
00:20:43,664 --> 00:20:46,619
this free resource called the driveway debrief for

599
00:20:46,619 --> 00:20:48,480
this thing. It's on my website.

600
00:20:49,259 --> 00:20:50,779
It says roborman.com,

601
00:20:50,779 --> 00:20:51,980
r 0 b 0 r m a n

602
00:20:52,140 --> 00:20:54,059
Com. This is a driveway debrief. And this

603
00:20:54,059 --> 00:20:55,339
is not the only way to do it.

604
00:20:55,339 --> 00:20:56,380
This is just how I did it. And

605
00:20:56,380 --> 00:20:57,660
so I made a it's like a guided

606
00:20:57,660 --> 00:21:00,174
exercise, seven minute guided exercise. And before you

607
00:21:00,174 --> 00:21:00,994
go to the

608
00:21:01,375 --> 00:21:03,295
house, in the driveway or a block away,

609
00:21:03,295 --> 00:21:04,654
if there's people who are gonna be like,

610
00:21:04,654 --> 00:21:05,715
what what are you doing?

611
00:21:06,095 --> 00:21:07,075
Take some breaths.

612
00:21:07,455 --> 00:21:10,335
Take some deep breaths, and you breathe out

613
00:21:10,335 --> 00:21:12,494
for twice as long as you breathe in.

614
00:21:12,494 --> 00:21:15,430
And what this does is it activates the

615
00:21:15,430 --> 00:21:15,930
parasympathetic

616
00:21:16,230 --> 00:21:17,049
nervous system

617
00:21:17,350 --> 00:21:19,670
because you are sympathetically activated. You know, you're

618
00:21:19,670 --> 00:21:22,789
just on. You're just redlined or just below

619
00:21:22,789 --> 00:21:23,289
it.

620
00:21:23,590 --> 00:21:24,890
So take some deep breaths

621
00:21:25,350 --> 00:21:26,730
just to settle yourself,

622
00:21:27,430 --> 00:21:28,170
and then

623
00:21:28,845 --> 00:21:30,384
if you walk through

624
00:21:30,765 --> 00:21:31,424
the day,

625
00:21:32,285 --> 00:21:33,505
walk through the day,

626
00:21:34,045 --> 00:21:35,904
what happened in that day that was great?

627
00:21:36,285 --> 00:21:37,585
What were the great moments?

628
00:21:38,285 --> 00:21:39,664
What could have gone better?

629
00:21:40,045 --> 00:21:40,829
And you just

630
00:21:41,309 --> 00:21:43,309
look at it and process and take note

631
00:21:43,309 --> 00:21:44,450
of how do I feel?

632
00:21:44,750 --> 00:21:46,669
How do I feel about this stuff? Name

633
00:21:46,669 --> 00:21:48,529
the feeling. Name the emotion.

634
00:21:49,390 --> 00:21:50,529
Oh, sad, angry.

635
00:21:51,069 --> 00:21:52,769
What can I learn from this day?

636
00:21:53,149 --> 00:21:55,845
Alright. Now that's kind of a of an

637
00:21:55,845 --> 00:21:57,845
intellectual aspect of it, and a lot of

638
00:21:57,845 --> 00:22:00,565
the processing is meant to be emotional just

639
00:22:00,565 --> 00:22:02,745
to, you know, to pull apart the threads.

640
00:22:03,445 --> 00:22:04,505
And then you release

641
00:22:05,205 --> 00:22:06,339
the day at the end of the day.

642
00:22:06,339 --> 00:22:08,700
There's a visualization to do that. And some

643
00:22:08,819 --> 00:22:10,019
and I'm gonna tell you, if you listen

644
00:22:10,019 --> 00:22:11,460
to driveway debrief, some people say, oh my

645
00:22:11,460 --> 00:22:12,359
gosh. That visualization

646
00:22:12,740 --> 00:22:15,139
has changed my life. And other people, that

647
00:22:15,139 --> 00:22:17,380
visualization is the weirdest thing I've ever heard.

648
00:22:17,380 --> 00:22:19,619
I don't get it. So I'm just gonna

649
00:22:19,619 --> 00:22:21,595
leave it at that. And there is an

650
00:22:21,595 --> 00:22:22,815
aspect of catharsis

651
00:22:23,835 --> 00:22:26,575
to that. And there's other ways to have

652
00:22:26,954 --> 00:22:29,775
catharsis such as through nature, just, you know,

653
00:22:29,835 --> 00:22:32,015
a forest bath, go walk in the trees,

654
00:22:32,474 --> 00:22:33,694
or debriefing,

655
00:22:34,394 --> 00:22:34,894
or

656
00:22:35,549 --> 00:22:36,049
journaling

657
00:22:36,429 --> 00:22:38,750
or some way to get those thoughts out

658
00:22:38,750 --> 00:22:40,049
of your mind and

659
00:22:40,349 --> 00:22:42,269
maybe a little bit more structured. And debriefing

660
00:22:42,269 --> 00:22:43,869
doesn't have to be formal. What you're talking

661
00:22:43,869 --> 00:22:46,029
about is Yeah. You know, in the recess

662
00:22:46,029 --> 00:22:48,434
bay. It can be talking to a colleague,

663
00:22:48,515 --> 00:22:50,914
can even be just going outside looking at

664
00:22:50,914 --> 00:22:51,495
this guy

665
00:22:52,355 --> 00:22:52,855
and

666
00:22:53,475 --> 00:22:55,495
settling. Now I will say that

667
00:22:55,955 --> 00:22:58,434
when you debrief, you want to be careful

668
00:22:58,434 --> 00:23:00,375
that you don't start co ruminating

669
00:23:01,235 --> 00:23:01,735
and

670
00:23:02,275 --> 00:23:04,750
amping yourself up again, but getting it out

671
00:23:04,750 --> 00:23:07,230
there and processing it verbally or in some

672
00:23:07,230 --> 00:23:07,730
way,

673
00:23:08,269 --> 00:23:09,869
incredibly helpful. I don't even know where we

674
00:23:09,869 --> 00:23:11,569
started with that, but

675
00:23:12,109 --> 00:23:13,890
I'm gonna throw the law back to you.

676
00:23:14,029 --> 00:23:14,609
I think

677
00:23:15,150 --> 00:23:18,109
there were oftentimes I was jealous of our

678
00:23:18,109 --> 00:23:19,154
nursing colleagues

679
00:23:19,474 --> 00:23:21,015
because we would have

680
00:23:21,394 --> 00:23:23,555
some kind of event, and then we would

681
00:23:23,555 --> 00:23:26,195
all go back to our desks. And our

682
00:23:26,195 --> 00:23:28,055
nurses worked in this little

683
00:23:28,434 --> 00:23:30,755
pod section where there were, you know, five

684
00:23:30,755 --> 00:23:32,674
or six of them together at the nurse

685
00:23:32,674 --> 00:23:35,480
station. And they would stop and

686
00:23:35,859 --> 00:23:38,920
talk with their colleagues and and go through

687
00:23:38,980 --> 00:23:41,299
what they just felt and what they just

688
00:23:41,299 --> 00:23:43,140
saw. And, you know, sometimes they would take

689
00:23:43,140 --> 00:23:45,299
a moment and they'll be in there maybe

690
00:23:45,299 --> 00:23:48,420
crying or comforting each other or talking about

691
00:23:48,420 --> 00:23:49,400
what just occurred.

692
00:23:49,845 --> 00:23:52,164
And in the physician pod, which was just,

693
00:23:52,164 --> 00:23:55,285
you know, literally 15 feet away from where

694
00:23:55,285 --> 00:23:57,544
the nurses are sitting, it is me

695
00:23:57,924 --> 00:24:00,565
and maybe a PA. There's not another physician

696
00:24:00,565 --> 00:24:01,865
in there. And

697
00:24:02,164 --> 00:24:04,404
I come back and I sit down and

698
00:24:04,404 --> 00:24:05,130
I'm just

699
00:24:05,529 --> 00:24:07,450
exhausted after what I've just gone through. And

700
00:24:07,450 --> 00:24:09,369
I'm looking at the PA who is now

701
00:24:09,369 --> 00:24:10,829
looking at me like

702
00:24:11,289 --> 00:24:11,789
ragged

703
00:24:12,250 --> 00:24:14,430
deer in the headlights, you know, maybe sweaty

704
00:24:14,650 --> 00:24:15,150
going,

705
00:24:15,529 --> 00:24:18,894
okay. Are you ready? Because I've been supporting

706
00:24:18,894 --> 00:24:21,055
this department for the last hour, and I

707
00:24:21,055 --> 00:24:22,815
really need to talk to you about, like,

708
00:24:22,815 --> 00:24:24,914
15 people. And I'm going,

709
00:24:25,295 --> 00:24:27,795
okay. I just I just need thirty seconds

710
00:24:27,934 --> 00:24:29,934
to just take a deep breath. And then

711
00:24:29,934 --> 00:24:31,955
I'm all here. So, yeah, I'm all ears.

712
00:24:32,119 --> 00:24:33,880
And I'd look over and I'd go, gosh,

713
00:24:33,880 --> 00:24:35,559
you know, like, look at them. Like they're

714
00:24:35,559 --> 00:24:36,460
sitting over there

715
00:24:36,920 --> 00:24:37,420
debriefing

716
00:24:37,799 --> 00:24:41,000
talking they're, you know, collegial covering for each

717
00:24:41,000 --> 00:24:43,080
other, the nurses who have been covering for

718
00:24:43,080 --> 00:24:44,680
this one nurse. Aren't like, oh, I'm so

719
00:24:44,680 --> 00:24:46,440
glad you're here. You can take your patients

720
00:24:46,440 --> 00:24:48,964
back now. They're listening and they're talking. And

721
00:24:48,964 --> 00:24:50,964
for us on the PA and physician side,

722
00:24:50,964 --> 00:24:53,365
there's no other physician to see patients during

723
00:24:53,365 --> 00:24:55,605
this time because of our pod system. The

724
00:24:55,605 --> 00:24:56,505
pod is mine.

725
00:24:56,884 --> 00:24:58,964
And it was just, you know, okay. Are

726
00:24:58,964 --> 00:25:01,690
you done? Are you done playing trauma doctor?

727
00:25:01,690 --> 00:25:03,609
Because now it's time to play a medical

728
00:25:03,609 --> 00:25:04,109
doctor.

729
00:25:04,569 --> 00:25:07,049
It was just it was a terrible way,

730
00:25:07,049 --> 00:25:08,730
and it made me so jealous of what

731
00:25:08,730 --> 00:25:10,990
the nurses had just 15 feet away.

732
00:25:11,529 --> 00:25:13,549
The system is not set up for support.

733
00:25:14,085 --> 00:25:16,884
It's not. It is definitely not. So a

734
00:25:16,884 --> 00:25:18,565
couple things came up in what you said

735
00:25:18,565 --> 00:25:19,865
there, Sam. And

736
00:25:20,244 --> 00:25:22,484
this isn't directly related to what you're talking

737
00:25:22,484 --> 00:25:24,105
about with the nurses, but

738
00:25:24,804 --> 00:25:26,964
very tangentially, it kinda gets back to the

739
00:25:26,964 --> 00:25:27,464
processing.

740
00:25:28,085 --> 00:25:29,304
Is there is

741
00:25:29,789 --> 00:25:30,529
a difference

742
00:25:30,910 --> 00:25:31,410
between

743
00:25:32,190 --> 00:25:35,549
reflective solitude. You know, you think about, okay.

744
00:25:35,549 --> 00:25:37,070
I'm just gonna go on a walk by

745
00:25:37,070 --> 00:25:39,230
myself out in the woods for a couple

746
00:25:39,230 --> 00:25:41,309
hours and think or sit down and journal

747
00:25:41,309 --> 00:25:42,830
or even, you know, or whatever it is

748
00:25:42,830 --> 00:25:43,724
that I do that

749
00:25:44,765 --> 00:25:45,265
is

750
00:25:45,644 --> 00:25:48,865
solitude is so nourishing. This reflective solitude

751
00:25:49,404 --> 00:25:49,904
versus

752
00:25:50,525 --> 00:25:53,005
another situation where you're by yourself, which is

753
00:25:53,005 --> 00:25:53,505
isolation.

754
00:25:54,525 --> 00:25:57,039
And solitude can be healing. Right? Time to

755
00:25:57,039 --> 00:25:58,820
process and reset, but isolation,

756
00:26:00,000 --> 00:26:00,820
that's different.

757
00:26:01,359 --> 00:26:02,320
You know? It's just kinda

758
00:26:03,119 --> 00:26:03,859
I am

759
00:26:04,640 --> 00:26:05,140
alone.

760
00:26:05,759 --> 00:26:07,779
And one of the things that

761
00:26:08,335 --> 00:26:10,494
can happen in that isolation and that's not

762
00:26:10,494 --> 00:26:12,015
exactly what you're talking about with the PA

763
00:26:12,015 --> 00:26:14,095
and, you know, the sweating, and I've met

764
00:26:14,174 --> 00:26:15,154
managing this apartment.

765
00:26:15,695 --> 00:26:17,535
One of the things that happens in any

766
00:26:17,535 --> 00:26:20,174
event, anything that happens in our lives is

767
00:26:20,174 --> 00:26:20,835
we immediately

768
00:26:22,220 --> 00:26:23,920
start creating a narrative,

769
00:26:24,619 --> 00:26:27,660
creating a story that we tell ourself about

770
00:26:27,660 --> 00:26:28,559
what just happened.

771
00:26:29,099 --> 00:26:31,119
And that story can help us flourish.

772
00:26:31,820 --> 00:26:34,880
That story can weigh us down. It can

773
00:26:35,174 --> 00:26:38,154
lead to either integration or disintegration

774
00:26:38,695 --> 00:26:39,755
of the trauma

775
00:26:40,375 --> 00:26:43,095
or the event such as, oh my gosh,

776
00:26:43,095 --> 00:26:45,335
this is horrible. I'm not up to the

777
00:26:45,335 --> 00:26:45,835
task.

778
00:26:46,375 --> 00:26:48,394
That is more likely to lead to disintegrated

779
00:26:48,934 --> 00:26:50,849
trauma. Mhmm. Okay.

780
00:26:51,490 --> 00:26:52,549
I feel stress.

781
00:26:53,009 --> 00:26:54,390
I am up to this.

782
00:26:55,169 --> 00:26:56,069
No one else

783
00:26:56,690 --> 00:26:59,109
in this hospital could manage this like me.

784
00:26:59,490 --> 00:27:01,589
This is the best chance this patient has.

785
00:27:01,970 --> 00:27:04,769
Those are stories during the event. And then

786
00:27:04,769 --> 00:27:05,269
afterwards,

787
00:27:06,424 --> 00:27:07,884
the story you're telling yourself

788
00:27:08,424 --> 00:27:09,484
can go unchecked

789
00:27:09,865 --> 00:27:10,924
when you are isolated.

790
00:27:11,304 --> 00:27:12,984
I mean, there's so many things about that,

791
00:27:12,984 --> 00:27:14,585
you know, when when you're getting back and

792
00:27:14,585 --> 00:27:16,605
the PA is just sweating and

793
00:27:16,904 --> 00:27:17,884
none of the things

794
00:27:18,470 --> 00:27:20,789
that you really want to be doing are

795
00:27:20,789 --> 00:27:23,269
happening in that moment. And Mhmm. If it's

796
00:27:23,269 --> 00:27:25,830
alright, I'd like to shift gears a little

797
00:27:25,830 --> 00:27:26,330
bit,

798
00:27:27,109 --> 00:27:27,930
talk about

799
00:27:28,309 --> 00:27:30,089
some in the moment things

800
00:27:30,789 --> 00:27:31,450
to do.

801
00:27:31,945 --> 00:27:34,744
Yeah. And because when we're talking about this

802
00:27:34,744 --> 00:27:35,244
trauma

803
00:27:35,625 --> 00:27:37,244
and these major events,

804
00:27:37,705 --> 00:27:40,505
there's this idea of trauma stewardship. Actually, a

805
00:27:40,505 --> 00:27:42,904
book called trauma stewardship. And that is how

806
00:27:42,904 --> 00:27:45,305
do I take care of myself when I'm

807
00:27:45,305 --> 00:27:48,119
in a system where trauma is going to

808
00:27:48,119 --> 00:27:48,619
happen?

809
00:27:49,000 --> 00:27:50,759
And it's things like paying attention to the

810
00:27:50,759 --> 00:27:53,980
stuff that nurtures you, like sleep, like food,

811
00:27:54,279 --> 00:27:54,779
exercise,

812
00:27:55,160 --> 00:27:55,660
relationships,

813
00:27:55,960 --> 00:27:58,119
whatever it is you love to do. And

814
00:27:58,119 --> 00:27:59,480
how do I frame this? How do I

815
00:27:59,480 --> 00:28:01,400
create the narrative? How do I process all

816
00:28:01,400 --> 00:28:02,380
of that stuff?

817
00:28:03,224 --> 00:28:03,724
Stewardship

818
00:28:04,025 --> 00:28:06,345
of the trauma that's going to occur. And

819
00:28:06,345 --> 00:28:09,325
then sometimes the trauma gets so big

820
00:28:09,625 --> 00:28:11,625
that at anything that you and I talk

821
00:28:11,625 --> 00:28:12,664
about on the show or any of the

822
00:28:12,664 --> 00:28:14,765
things that you kinda you you DIY,

823
00:28:15,944 --> 00:28:17,404
the trauma can get stuck.

824
00:28:17,899 --> 00:28:19,519
It gets stuck. It gets disintegrated.

825
00:28:20,380 --> 00:28:21,119
And then

826
00:28:21,740 --> 00:28:22,799
then you need

827
00:28:23,099 --> 00:28:25,599
some deep work. Things like EMDR

828
00:28:26,220 --> 00:28:28,480
or brain spotting or working with a therapist

829
00:28:28,539 --> 00:28:31,039
or, you know, somatic work or things that

830
00:28:31,419 --> 00:28:32,240
are specifically

831
00:28:33,304 --> 00:28:33,804
targeted

832
00:28:34,105 --> 00:28:35,644
to manage that disintegrated

833
00:28:36,105 --> 00:28:36,605
trauma.

834
00:28:37,065 --> 00:28:38,825
And because, you know, it gets wired into

835
00:28:38,825 --> 00:28:41,005
your nervous system. All of that to say,

836
00:28:41,545 --> 00:28:42,765
these tools

837
00:28:43,625 --> 00:28:45,464
are not a one size fits all. They

838
00:28:45,464 --> 00:28:46,924
are not 100%,

839
00:28:47,384 --> 00:28:48,525
but they are,

840
00:28:49,580 --> 00:28:51,680
how do I approach this

841
00:28:52,220 --> 00:28:53,039
in a way

842
00:28:53,740 --> 00:28:56,160
that is sensible and workable

843
00:28:56,460 --> 00:28:57,359
in my environment

844
00:28:57,980 --> 00:28:59,599
to increase the chance

845
00:29:00,380 --> 00:29:01,279
of integration

846
00:29:01,580 --> 00:29:02,640
versus disintegration

847
00:29:03,019 --> 00:29:05,494
of that trauma? Or not even that trauma

848
00:29:05,494 --> 00:29:07,654
of just that event. It doesn't even have

849
00:29:07,654 --> 00:29:10,294
to register as trauma, but to make it

850
00:29:10,294 --> 00:29:12,554
more likely that whatever happens

851
00:29:13,095 --> 00:29:14,075
becomes a cohesive

852
00:29:14,535 --> 00:29:16,934
part of your narrative rather than something that

853
00:29:16,934 --> 00:29:18,960
is disruptive in your life. How does that

854
00:29:18,960 --> 00:29:21,140
land before we get into some tactical

855
00:29:21,599 --> 00:29:23,519
stuff? Yeah. No. I like it, and I'm

856
00:29:23,519 --> 00:29:25,519
totally tracking with you. So, yes, we all

857
00:29:25,519 --> 00:29:27,200
know it can go wrong. And I think

858
00:29:27,200 --> 00:29:29,279
if you've been in the emergency department and,

859
00:29:29,279 --> 00:29:31,359
you know, worked more than a day, you've

860
00:29:31,359 --> 00:29:34,179
probably already felt when it has gone wrong.

861
00:29:34,265 --> 00:29:36,505
But there is a better way. And you're

862
00:29:36,505 --> 00:29:38,424
saying there are some things in the moment

863
00:29:38,424 --> 00:29:40,745
you can do as opposed to waiting until

864
00:29:40,745 --> 00:29:41,245
afterwards.

865
00:29:41,785 --> 00:29:43,625
And so tell me about what kinds of

866
00:29:43,625 --> 00:29:46,105
things might make it more likely to go

867
00:29:46,105 --> 00:29:47,460
well in the moment.

868
00:29:48,000 --> 00:29:50,559
Alright. Yes. There's so much processing that can

869
00:29:50,559 --> 00:29:53,440
happen afterwards. Just processing that ought happened before

870
00:29:53,440 --> 00:29:55,440
having said, okay. Here is how I'm going

871
00:29:55,440 --> 00:29:56,019
to be

872
00:29:56,480 --> 00:29:56,980
addressing

873
00:29:57,600 --> 00:30:00,660
the overwhelming likelihood that these events will occur.

874
00:30:01,294 --> 00:30:03,214
Let's talk about that in the moment. And

875
00:30:03,214 --> 00:30:04,914
so we have an anti burnout course

876
00:30:05,214 --> 00:30:06,115
called Unburnable.

877
00:30:06,654 --> 00:30:09,315
It's Mhmm. Primarily for emergency docs, like emergency

878
00:30:09,454 --> 00:30:10,355
critical care.

879
00:30:10,974 --> 00:30:12,515
We work on tools

880
00:30:13,480 --> 00:30:14,779
to deal with the reality

881
00:30:15,159 --> 00:30:15,659
of

882
00:30:16,440 --> 00:30:18,599
what is happening in your job as an

883
00:30:18,599 --> 00:30:19,740
acute care clinician.

884
00:30:20,200 --> 00:30:21,960
Because it's just, you know, the job is

885
00:30:21,960 --> 00:30:23,819
what it is. You think, well,

886
00:30:24,119 --> 00:30:25,899
shouldn't be that way. Quite.

887
00:30:26,200 --> 00:30:27,980
It's that way. But it is. Yeah.

888
00:30:28,375 --> 00:30:30,154
Yeah. And this is

889
00:30:31,015 --> 00:30:33,335
one of the tools that we teach, and

890
00:30:33,335 --> 00:30:34,954
we teach it for a couple of different

891
00:30:35,095 --> 00:30:36,154
situations. And

892
00:30:36,615 --> 00:30:38,315
this is evidence based,

893
00:30:38,934 --> 00:30:39,434
and

894
00:30:39,894 --> 00:30:42,634
it is useful in so many different situations.

895
00:30:43,349 --> 00:30:43,849
Whenever

896
00:30:44,390 --> 00:30:46,809
you're just kinda getting amped up and

897
00:30:47,190 --> 00:30:48,710
you feel like maybe things are getting out

898
00:30:48,710 --> 00:30:51,269
of control inside or your physiology is taking

899
00:30:51,269 --> 00:30:52,869
over or your inner critic is taking over

900
00:30:52,869 --> 00:30:53,849
or some kind of

901
00:30:54,309 --> 00:30:54,809
deleterious

902
00:30:55,190 --> 00:30:57,690
narrative is starting to push down the accelerator.

903
00:30:58,855 --> 00:30:59,994
So this is

904
00:31:00,694 --> 00:31:03,194
dropping anchor. Have we talked about dropping anchor

905
00:31:03,654 --> 00:31:05,035
No. On the show? Alright.

906
00:31:05,414 --> 00:31:07,015
And this is one of many techniques. And

907
00:31:07,015 --> 00:31:08,375
I'll tell you, Sam, I'm here all day

908
00:31:08,375 --> 00:31:09,815
for you if you wanna talk about different

909
00:31:09,815 --> 00:31:12,679
techniques. You know, there's box breathing. There is

910
00:31:12,679 --> 00:31:13,179
reframing.

911
00:31:13,559 --> 00:31:15,319
There's so many different things that you can

912
00:31:15,319 --> 00:31:17,480
do in the moment, but let's just do

913
00:31:17,480 --> 00:31:19,480
two. One of you, this one and another

914
00:31:19,480 --> 00:31:21,819
one if that's alright with you. Yeah. Okay.

915
00:31:22,359 --> 00:31:22,859
Imagine

916
00:31:23,284 --> 00:31:24,884
that you're on a boat out in the

917
00:31:24,884 --> 00:31:27,304
water, and all of a sudden,

918
00:31:27,924 --> 00:31:29,304
a storm comes up.

919
00:31:29,765 --> 00:31:31,944
Your boat is getting tossed around.

920
00:31:32,404 --> 00:31:33,704
So you have a couple choices.

921
00:31:34,484 --> 00:31:36,404
You can scream at the storm and tell

922
00:31:36,404 --> 00:31:37,384
it not to happen.

923
00:31:37,880 --> 00:31:39,960
You can ignore it and let the storm

924
00:31:39,960 --> 00:31:41,960
bat your boat around. Storm's still gonna be

925
00:31:41,960 --> 00:31:42,460
there.

926
00:31:43,160 --> 00:31:44,220
Or you can

927
00:31:44,600 --> 00:31:46,220
look for a safe harbor.

928
00:31:47,080 --> 00:31:48,619
Steer your boat towards there.

929
00:31:49,080 --> 00:31:50,059
Drop anchor

930
00:31:50,360 --> 00:31:51,660
until the storm

931
00:31:51,974 --> 00:31:54,154
calms down. Storm's still gonna rage.

932
00:31:54,855 --> 00:31:56,154
Can I drop anchor

933
00:31:56,535 --> 00:31:57,515
and settle?

934
00:31:58,134 --> 00:31:59,515
So this technique,

935
00:32:00,615 --> 00:32:03,734
it's called dropping anchor. And this was originally

936
00:32:03,734 --> 00:32:05,974
developed in acceptance commitment therapy. And it's probably

937
00:32:05,974 --> 00:32:08,029
one of the most evidence based tools

938
00:32:08,410 --> 00:32:10,490
that applies to emergency medicine. There are many

939
00:32:10,490 --> 00:32:12,090
of them, but I don't know. There's, like,

940
00:32:12,090 --> 00:32:12,830
5,000

941
00:32:13,130 --> 00:32:15,450
articles on that. I think it truly 5,000

942
00:32:15,450 --> 00:32:18,269
articles is. So how do you drop

943
00:32:18,570 --> 00:32:19,390
and settle

944
00:32:19,690 --> 00:32:20,750
in these moments?

945
00:32:21,769 --> 00:32:22,910
And it's twofold.

946
00:32:23,414 --> 00:32:25,195
It's naming and noting.

947
00:32:25,815 --> 00:32:26,555
Let me

948
00:32:27,095 --> 00:32:27,595
name

949
00:32:28,695 --> 00:32:30,555
what I am feeling right now.

950
00:32:31,015 --> 00:32:34,055
What is the somatic sensation that I have?

951
00:32:34,055 --> 00:32:35,494
What do I feel in my body? Do

952
00:32:35,494 --> 00:32:38,235
I feel heart racing, heart thrumming,

953
00:32:39,220 --> 00:32:41,640
a tightness? Is my jaw clenched?

954
00:32:42,259 --> 00:32:44,839
Let me name that physical sensation.

955
00:32:45,859 --> 00:32:46,599
Name it.

956
00:32:47,059 --> 00:32:47,559
Alright.

957
00:32:48,259 --> 00:32:49,240
Let me note

958
00:32:49,700 --> 00:32:51,159
what I am thinking.

959
00:32:51,779 --> 00:32:52,839
What is my emotion?

960
00:32:53,444 --> 00:32:55,944
And what that means is changing fact.

961
00:32:56,724 --> 00:32:57,704
This is horrible.

962
00:32:58,085 --> 00:32:59,384
I say this is horrible.

963
00:32:59,765 --> 00:33:01,384
That is a fact. Two,

964
00:33:02,005 --> 00:33:04,884
I notice I have the thought that this

965
00:33:04,884 --> 00:33:05,464
is horrible.

966
00:33:05,924 --> 00:33:08,105
It's taking a half step back

967
00:33:08,930 --> 00:33:11,349
and noticing what your mind is doing. Because,

968
00:33:11,569 --> 00:33:13,250
Sarmaid, you know, you and I know a

969
00:33:13,250 --> 00:33:14,230
thought's just a thought

970
00:33:14,609 --> 00:33:15,109
until

971
00:33:15,650 --> 00:33:18,609
that thought takes over and completely controls your

972
00:33:18,609 --> 00:33:20,069
emotive state in your physiology.

973
00:33:21,184 --> 00:33:22,724
Naming and noting

974
00:33:23,345 --> 00:33:23,845
allows

975
00:33:24,545 --> 00:33:26,164
a hair of psychological

976
00:33:27,184 --> 00:33:27,684
distance

977
00:33:28,384 --> 00:33:28,884
from

978
00:33:29,505 --> 00:33:32,065
all of this tumult that may be taking

979
00:33:32,065 --> 00:33:32,519
over.

980
00:33:33,400 --> 00:33:34,779
And along with this,

981
00:33:35,160 --> 00:33:37,400
you can just bring yourself back to what

982
00:33:37,400 --> 00:33:39,559
is happening right now. Hope. I'm in the

983
00:33:39,559 --> 00:33:40,460
Recess Bay

984
00:33:40,839 --> 00:33:41,740
doing CPR.

985
00:33:42,119 --> 00:33:43,980
Here I am right now.

986
00:33:44,359 --> 00:33:47,500
Rather than going back, going forward, ruminating.

987
00:33:48,494 --> 00:33:51,615
Anchor in the moment. And this does two

988
00:33:51,615 --> 00:33:54,015
things, and I'll explain these terms. So it

989
00:33:54,015 --> 00:33:55,855
grounds you, and that's not grounding in some

990
00:33:55,855 --> 00:33:57,394
kind of woo woo way.

991
00:33:57,855 --> 00:33:59,555
It grounds you

992
00:34:00,109 --> 00:34:02,590
to help regulate the autonomic nervous system, and

993
00:34:02,590 --> 00:34:03,250
it prevents

994
00:34:03,710 --> 00:34:04,210
dissociation.

995
00:34:05,150 --> 00:34:05,650
Mhmm.

996
00:34:06,109 --> 00:34:06,769
So grounding,

997
00:34:07,710 --> 00:34:09,090
this is intentionally

998
00:34:09,869 --> 00:34:12,849
connecting to what is happening in the present.

999
00:34:12,914 --> 00:34:14,755
And what we're doing with dropping anchors, we're

1000
00:34:14,755 --> 00:34:17,175
doing that through the body, through the senses,

1001
00:34:17,715 --> 00:34:20,355
anchoring ourselves to what we're feeling. You know,

1002
00:34:20,355 --> 00:34:21,175
are we overwhelmed?

1003
00:34:21,795 --> 00:34:23,815
Are we detached? Are we emotionally flooded?

1004
00:34:24,275 --> 00:34:25,875
Let me just come back to the present.

1005
00:34:25,875 --> 00:34:27,315
These are things we'd often like to run

1006
00:34:27,315 --> 00:34:29,130
away from. I don't like that tight feeling

1007
00:34:29,130 --> 00:34:30,329
in my chest. I want it to go

1008
00:34:30,329 --> 00:34:30,829
away.

1009
00:34:31,369 --> 00:34:34,269
Notice it. Welcome it. Here it is. Now

1010
00:34:34,409 --> 00:34:36,250
there's much more work to do on this

1011
00:34:36,250 --> 00:34:37,469
to build this skill,

1012
00:34:38,250 --> 00:34:39,789
but when we drop anchor,

1013
00:34:40,089 --> 00:34:41,230
we ground ourselves.

1014
00:34:42,174 --> 00:34:44,914
We decrease the chance of dissociation.

1015
00:34:45,214 --> 00:34:46,755
And when we're talking about,

1016
00:34:47,214 --> 00:34:48,275
you know, trauma,

1017
00:34:49,214 --> 00:34:49,714
dissociation

1018
00:34:50,255 --> 00:34:53,714
is where we become mentally and emotionally detached

1019
00:34:53,775 --> 00:34:55,769
from what's happening in the present moment. Like,

1020
00:34:55,769 --> 00:34:57,690
we're watching it from the outside. We're emotionally

1021
00:34:57,690 --> 00:34:59,690
numb. We're in a fog. And that's not

1022
00:34:59,690 --> 00:35:01,610
a horrible thing. Like, this exists for a

1023
00:35:01,610 --> 00:35:04,329
reason. It is probably our brain's way of

1024
00:35:04,329 --> 00:35:06,670
protecting us when things feel too overwhelming.

1025
00:35:07,289 --> 00:35:08,909
And Yeah. In the ED,

1026
00:35:09,515 --> 00:35:12,015
Sam, you and I both know that dissociation

1027
00:35:12,954 --> 00:35:16,175
can sneak in like a thief in the

1028
00:35:16,394 --> 00:35:18,715
night. We start zoning out mid shift. We

1029
00:35:18,715 --> 00:35:20,715
feel robotic, and our brains are a little

1030
00:35:20,715 --> 00:35:21,869
foggy. So

1031
00:35:22,329 --> 00:35:22,989
one tool

1032
00:35:23,690 --> 00:35:24,909
for this is

1033
00:35:25,369 --> 00:35:25,869
dropping

1034
00:35:26,250 --> 00:35:28,730
anchor in the moment. I will pause there,

1035
00:35:28,730 --> 00:35:30,170
and then we can, you know, briefly touch

1036
00:35:30,170 --> 00:35:31,150
on another tool.

1037
00:35:31,609 --> 00:35:33,530
Yeah. I like that. I like that because

1038
00:35:33,530 --> 00:35:35,369
I think it takes me, like you said,

1039
00:35:35,369 --> 00:35:36,989
one step away from

1040
00:35:38,144 --> 00:35:41,184
this whatever this challenging scenario pulls me back,

1041
00:35:41,184 --> 00:35:41,684
maybe

1042
00:35:42,065 --> 00:35:44,785
engages that other part of my brain that

1043
00:35:44,785 --> 00:35:47,105
is, I don't know, more executive in function

1044
00:35:47,105 --> 00:35:48,704
to give it a name and to give

1045
00:35:48,704 --> 00:35:49,684
it a kinda

1046
00:35:50,065 --> 00:35:51,449
to name it and to help

1047
00:35:51,929 --> 00:35:54,250
frame it in some way that's a little

1048
00:35:54,250 --> 00:35:56,510
healthier than than where I might go otherwise.

1049
00:35:56,570 --> 00:35:57,309
I like that.

1050
00:35:57,690 --> 00:35:59,550
So some folks might be listening at thinking,

1051
00:36:00,170 --> 00:36:02,510
you know what? I'm not on board.

1052
00:36:03,050 --> 00:36:04,989
I'm on board with all that stuff.

1053
00:36:05,335 --> 00:36:09,275
Sure. So here is an even easier way.

1054
00:36:09,335 --> 00:36:10,875
And, yes, a debrief

1055
00:36:11,494 --> 00:36:11,994
is

1056
00:36:12,375 --> 00:36:12,875
great.

1057
00:36:13,335 --> 00:36:13,835
Just

1058
00:36:14,695 --> 00:36:17,035
process the emotion, what you felt,

1059
00:36:17,574 --> 00:36:18,554
dropping anchor.

1060
00:36:19,175 --> 00:36:19,675
Great.

1061
00:36:20,230 --> 00:36:21,849
I think the most

1062
00:36:22,710 --> 00:36:25,050
basic one of all of these that,

1063
00:36:26,630 --> 00:36:28,010
appeals to our

1064
00:36:28,869 --> 00:36:30,090
prehistoric brains

1065
00:36:30,710 --> 00:36:32,570
is a body oriented reset.

1066
00:36:33,190 --> 00:36:36,304
So this is a simple way. After a

1067
00:36:36,304 --> 00:36:37,844
case like you had in

1068
00:36:38,304 --> 00:36:39,605
the trauma bay,

1069
00:36:39,984 --> 00:36:41,764
you know, and everybody wants a PCU,

1070
00:36:42,224 --> 00:36:43,045
step outside

1071
00:36:43,585 --> 00:36:44,405
if you can.

1072
00:36:44,945 --> 00:36:47,429
Mhmm. Look at the horizon.

1073
00:36:48,369 --> 00:36:49,590
Shake out your arms.

1074
00:36:49,969 --> 00:36:51,409
Shake just shake it out. Shake it out.

1075
00:36:51,409 --> 00:36:52,550
Shake it out. Shake it out.

1076
00:36:53,090 --> 00:36:55,890
Let your body discharge energy because it's energy.

1077
00:36:55,890 --> 00:36:57,110
It's stored up energy.

1078
00:36:57,570 --> 00:36:58,789
Just discharge it.

1079
00:36:59,090 --> 00:36:59,590
And

1080
00:37:00,125 --> 00:37:01,724
this is not strong evidence, but there is

1081
00:37:01,724 --> 00:37:04,444
even evidence that sprinting after these events can

1082
00:37:04,444 --> 00:37:06,304
help integrate traumatic experiences.

1083
00:37:07,085 --> 00:37:07,585
And

1084
00:37:08,045 --> 00:37:08,545
these

1085
00:37:09,405 --> 00:37:09,905
oriented

1086
00:37:10,284 --> 00:37:13,484
resets are used in certain types of trauma

1087
00:37:13,484 --> 00:37:13,984
therapy

1088
00:37:14,489 --> 00:37:17,690
to prevent trauma from embedding in the nervous

1089
00:37:17,690 --> 00:37:20,110
system. That's almost like a hack. And Yeah.

1090
00:37:20,329 --> 00:37:21,230
Some trauma

1091
00:37:22,170 --> 00:37:22,670
practitioners,

1092
00:37:22,969 --> 00:37:24,030
they do recommend

1093
00:37:24,409 --> 00:37:24,909
intense

1094
00:37:25,369 --> 00:37:28,494
short burst of exercise, like sprints, boxing drills,

1095
00:37:28,494 --> 00:37:30,275
some kind of fast paced movement

1096
00:37:30,974 --> 00:37:32,594
after a critical event.

1097
00:37:33,135 --> 00:37:34,114
Discharge energy.

1098
00:37:34,655 --> 00:37:36,414
That can be hard to do. Now running

1099
00:37:36,414 --> 00:37:38,414
sprints in your clogs in the ambulance bay

1100
00:37:38,414 --> 00:37:40,335
might be hard. Yeah. Yeah. I guess you

1101
00:37:40,335 --> 00:37:42,594
could do some squats or or something.

1102
00:37:42,974 --> 00:37:46,259
And so easier way is just, you know,

1103
00:37:46,259 --> 00:37:48,420
get out, take it out, take a couple

1104
00:37:48,420 --> 00:37:50,980
deep breaths. You can stretch or just walk

1105
00:37:50,980 --> 00:37:52,119
around a little bit.

1106
00:37:52,739 --> 00:37:54,279
It's a a lower barrier

1107
00:37:55,219 --> 00:37:56,039
still effective.

1108
00:37:56,659 --> 00:37:59,144
I like it. Okay. So name it

1109
00:38:00,265 --> 00:38:03,244
and ground yourself in the moment and or

1110
00:38:04,025 --> 00:38:04,844
walk outside

1111
00:38:05,304 --> 00:38:05,804
and

1112
00:38:06,105 --> 00:38:08,364
engage in some active movement while

1113
00:38:08,905 --> 00:38:10,824
looking at a horizon or something a little

1114
00:38:10,824 --> 00:38:11,565
bit more

1115
00:38:11,945 --> 00:38:13,704
calming and a little less stressful than the

1116
00:38:13,704 --> 00:38:15,730
tracking board for a few minutes. Yeah. And

1117
00:38:15,730 --> 00:38:16,950
don't bring your phone outside.

1118
00:38:17,650 --> 00:38:19,490
Oh, yeah. So as you said that, I

1119
00:38:19,490 --> 00:38:22,289
wanna bring up one more thing that I

1120
00:38:22,289 --> 00:38:24,710
think every emergency doc

1121
00:38:25,090 --> 00:38:26,390
would benefit from,

1122
00:38:26,930 --> 00:38:29,910
and that is a post

1123
00:38:30,875 --> 00:38:31,375
incident

1124
00:38:32,234 --> 00:38:32,734
ritual.

1125
00:38:33,994 --> 00:38:36,234
I don't know what this looks like for

1126
00:38:36,234 --> 00:38:38,574
the individual because it's very individualized

1127
00:38:39,594 --> 00:38:42,094
and it can be tiny. And so the

1128
00:38:42,890 --> 00:38:45,710
technical term for this would be signal completion.

1129
00:38:46,170 --> 00:38:47,869
Because what you're talking about is

1130
00:38:48,329 --> 00:38:50,570
you walk out of the room, you are

1131
00:38:50,570 --> 00:38:53,530
not complete. You still have an open loop

1132
00:38:53,530 --> 00:38:55,450
from that resuscitation. And that's what we're talking

1133
00:38:55,450 --> 00:38:56,670
about with all this stuff.

1134
00:38:56,994 --> 00:38:59,734
Dropping anchor. Let's reset our body.

1135
00:39:00,355 --> 00:39:03,014
A post incident ritual. So, you know, example,

1136
00:39:03,315 --> 00:39:04,994
before I walk out of the trauma bay

1137
00:39:05,155 --> 00:39:06,514
I well, I think you can see this

1138
00:39:06,514 --> 00:39:07,954
on the video. Before I walk out of

1139
00:39:07,954 --> 00:39:10,214
the Trauma Bay, I touch the wall,

1140
00:39:11,074 --> 00:39:12,775
take a breath, and reset.

1141
00:39:13,260 --> 00:39:14,619
And I don't know what's in my mind

1142
00:39:14,619 --> 00:39:16,059
or in your mind at that time, but

1143
00:39:16,059 --> 00:39:18,219
that's my ritual that I'm closing the loop

1144
00:39:18,219 --> 00:39:21,019
on this, or I'm washing my hands. I

1145
00:39:21,019 --> 00:39:22,239
am intentionally

1146
00:39:22,860 --> 00:39:24,159
visualizing stress

1147
00:39:24,460 --> 00:39:25,679
going down the drain.

1148
00:39:26,214 --> 00:39:28,534
Two examples of infinity. And what this does

1149
00:39:28,534 --> 00:39:30,454
is it helps the brain close the open

1150
00:39:30,454 --> 00:39:31,355
loop of

1151
00:39:31,734 --> 00:39:33,835
what was previously an unresolved

1152
00:39:34,775 --> 00:39:35,275
stressor.

1153
00:39:35,815 --> 00:39:36,315
Yeah.

1154
00:39:36,775 --> 00:39:38,214
Yeah. I love that. No. I like that

1155
00:39:38,214 --> 00:39:40,300
very, very much. I wish that had come

1156
00:39:40,300 --> 00:39:41,839
up in my last year of residency

1157
00:39:42,539 --> 00:39:44,639
so I could have used it in practice.

1158
00:39:44,940 --> 00:39:46,859
That's some great advice. And, you know, I

1159
00:39:46,859 --> 00:39:49,339
really do think that the emergency department over

1160
00:39:49,339 --> 00:39:51,099
time has become more and more of a

1161
00:39:51,099 --> 00:39:53,579
pressure cooker. And we've talked about this before,

1162
00:39:53,579 --> 00:39:55,815
you and I, on the podcast. So

1163
00:39:56,355 --> 00:39:58,534
this kind of information and these

1164
00:39:58,914 --> 00:40:01,574
tactics, I think, become more and more necessary

1165
00:40:02,195 --> 00:40:04,114
even in just the day to day shifts.

1166
00:40:04,114 --> 00:40:05,875
I mean, so far, we've been talking about

1167
00:40:05,875 --> 00:40:06,534
the trauma

1168
00:40:06,835 --> 00:40:09,474
of patient experiences. But, honestly, some of my

1169
00:40:09,474 --> 00:40:12,380
most traumatizing moments in the emergency department had

1170
00:40:12,380 --> 00:40:14,159
to do with conflict with colleagues

1171
00:40:14,460 --> 00:40:17,420
and consultants, you know. Arguments I had over

1172
00:40:17,420 --> 00:40:19,599
the phone or desperately trying to convince

1173
00:40:20,059 --> 00:40:23,054
some specialist that the patient critically needed their

1174
00:40:23,454 --> 00:40:23,954
intervention

1175
00:40:24,255 --> 00:40:26,414
or that they needed to come in in

1176
00:40:26,414 --> 00:40:28,835
the middle of the night and having some

1177
00:40:29,135 --> 00:40:30,114
very uncomfortable

1178
00:40:30,414 --> 00:40:32,894
conversations that, you know, sometimes it was less

1179
00:40:32,894 --> 00:40:33,394
traumatizing

1180
00:40:33,775 --> 00:40:35,295
to talk to a patient than it was

1181
00:40:35,295 --> 00:40:37,349
to talk to a consultant. So it's not

1182
00:40:37,349 --> 00:40:37,849
necessarily

1183
00:40:38,470 --> 00:40:39,530
a trauma

1184
00:40:40,150 --> 00:40:43,030
in the ED sense that brings about the

1185
00:40:43,030 --> 00:40:45,590
scenario. It could be a patient encounter, a

1186
00:40:45,590 --> 00:40:47,670
call with a colleague, any one of those

1187
00:40:47,670 --> 00:40:50,085
things. And then I also like that you

1188
00:40:50,085 --> 00:40:52,425
said, you know, there's a difference between debriefing

1189
00:40:52,724 --> 00:40:55,385
and just ruminating on a specific

1190
00:40:55,844 --> 00:40:58,965
encounter because I'm expert at that. I have

1191
00:40:58,965 --> 00:41:01,545
a advanced degree, a PhD in the rumination

1192
00:41:01,844 --> 00:41:03,989
and the reliving of the moment. That's not

1193
00:41:03,989 --> 00:41:06,070
something I recommend. You know, if you can

1194
00:41:06,070 --> 00:41:08,809
avoid that degree, I highly highly recommend it.

1195
00:41:08,869 --> 00:41:10,949
But that's something that comes back to haunt

1196
00:41:10,949 --> 00:41:12,710
me. Even now, I can look back on

1197
00:41:12,710 --> 00:41:14,949
conversations I've had, you know, over a decade

1198
00:41:14,949 --> 00:41:17,835
ago and relive them in a heartbeat or,

1199
00:41:17,914 --> 00:41:20,474
you know, when I'm watching medical dramas on

1200
00:41:20,474 --> 00:41:24,335
TV or seeing dramatizations of physicians having experiences,

1201
00:41:24,554 --> 00:41:26,074
sometimes I just can't watch. I go, nope.

1202
00:41:26,074 --> 00:41:27,755
This is reminding me too much of an

1203
00:41:27,755 --> 00:41:29,214
encounter I actually had.

1204
00:41:29,514 --> 00:41:31,320
When I'm talking with docs about this stuff

1205
00:41:31,800 --> 00:41:33,160
and, you you know, you're talking about the

1206
00:41:33,160 --> 00:41:35,099
locked room for the giant stuff sack.

1207
00:41:35,480 --> 00:41:37,800
Yeah. We have been talking about these big

1208
00:41:37,800 --> 00:41:39,180
t trauma events

1209
00:41:39,960 --> 00:41:40,460
and

1210
00:41:40,760 --> 00:41:42,840
these things that just seem to have this

1211
00:41:42,840 --> 00:41:43,660
massive footprint.

1212
00:41:44,465 --> 00:41:46,144
Ninety nine percent of the time, it is

1213
00:41:46,144 --> 00:41:48,164
accumulation of those lowercase

1214
00:41:48,784 --> 00:41:51,605
t traumas, such as incivility from a colleague

1215
00:41:51,664 --> 00:41:53,905
or something with a patient. These things that

1216
00:41:53,905 --> 00:41:54,644
are small

1217
00:41:54,945 --> 00:41:56,164
yet accumulate

1218
00:41:56,545 --> 00:41:58,864
accumulate accumulate, and those are the things that

1219
00:41:58,864 --> 00:42:00,929
we stuff into that stuff stack. Oh, god.

1220
00:42:00,929 --> 00:42:01,429
Again

1221
00:42:01,889 --> 00:42:03,889
again, I had to have this argument. And

1222
00:42:03,889 --> 00:42:05,650
you feel it, you know, even just even

1223
00:42:05,650 --> 00:42:07,170
I'm saying it right now. I'm picturing. I

1224
00:42:07,170 --> 00:42:08,550
can still feel it physically.

1225
00:42:08,849 --> 00:42:09,989
And that stuff

1226
00:42:10,690 --> 00:42:11,190
needs

1227
00:42:11,644 --> 00:42:12,144
processing

1228
00:42:12,445 --> 00:42:13,264
and attention

1229
00:42:13,565 --> 00:42:16,445
because it will accumulate and is way more

1230
00:42:16,445 --> 00:42:18,304
likely to burn you out

1231
00:42:18,684 --> 00:42:19,184
than

1232
00:42:19,885 --> 00:42:22,204
the mass casualty you see once in your

1233
00:42:22,204 --> 00:42:22,704
career.

1234
00:42:23,244 --> 00:42:23,744
Yeah.

1235
00:42:24,300 --> 00:42:27,180
And so in that processing so you've got

1236
00:42:27,180 --> 00:42:28,320
the in the moment

1237
00:42:28,699 --> 00:42:28,780
event

1238
00:42:29,660 --> 00:42:31,420
you've got the in the moment activities you

1239
00:42:31,420 --> 00:42:33,920
can perform. You've got the post moment activities

1240
00:42:34,059 --> 00:42:35,680
you can perform. You've got your

1241
00:42:36,140 --> 00:42:38,239
driveway debrief that you can perform.

1242
00:42:38,699 --> 00:42:39,440
And then

1243
00:42:39,855 --> 00:42:42,014
with the failure of all of those things,

1244
00:42:42,014 --> 00:42:44,494
then you certainly have other resources. Right? I

1245
00:42:44,494 --> 00:42:46,114
mean, you can seek out

1246
00:42:46,414 --> 00:42:49,394
therapy or trauma therapy or other resources

1247
00:42:49,855 --> 00:42:52,255
outside and away from work to try and

1248
00:42:52,255 --> 00:42:53,554
deal with those things

1249
00:42:53,880 --> 00:42:55,500
in order to either prevent

1250
00:42:56,199 --> 00:42:58,380
or treat the repercussions

1251
00:42:58,920 --> 00:43:00,920
of just our routine work. Right? So you

1252
00:43:00,920 --> 00:43:02,779
can tackle it from all angles.

1253
00:43:03,159 --> 00:43:05,239
I did not do this, but I think

1254
00:43:05,239 --> 00:43:07,819
that every emergency doc would benefit

1255
00:43:08,195 --> 00:43:09,894
from having a therapist

1256
00:43:10,275 --> 00:43:12,514
who specializes in stuff like this. I'm not

1257
00:43:12,514 --> 00:43:14,855
talking about a general therapist, but a trauma

1258
00:43:14,994 --> 00:43:15,494
therapist

1259
00:43:15,875 --> 00:43:16,355
Yeah.

1260
00:43:16,835 --> 00:43:17,815
From day one

1261
00:43:18,195 --> 00:43:18,855
of residency.

1262
00:43:19,554 --> 00:43:21,954
It maybe adds up a cost, but being

1263
00:43:21,954 --> 00:43:23,494
able to work on this stuff

1264
00:43:23,940 --> 00:43:26,019
will extend your career and just help you

1265
00:43:26,019 --> 00:43:28,339
process the stuff. Just help you process all

1266
00:43:28,339 --> 00:43:30,119
of this that comes at you in this

1267
00:43:30,420 --> 00:43:30,920
supranormal

1268
00:43:31,539 --> 00:43:32,039
environment.

1269
00:43:32,980 --> 00:43:35,539
Mhmm. And I'm saying, hey. Therapy. Therapy. Therapy

1270
00:43:35,539 --> 00:43:37,375
is the answer. Okay. Well, maybe it's not

1271
00:43:37,375 --> 00:43:40,014
a therapist, but at least a system of

1272
00:43:40,014 --> 00:43:41,614
how you're gonna do this. And, you know,

1273
00:43:41,614 --> 00:43:44,574
we're talking about the difficult consultant and all

1274
00:43:44,574 --> 00:43:45,394
that. Having

1275
00:43:45,694 --> 00:43:47,074
an approach to things

1276
00:43:47,855 --> 00:43:49,614
is going to be better than not having

1277
00:43:49,614 --> 00:43:51,934
an approach. So when there are things that

1278
00:43:51,934 --> 00:43:54,409
stress you out, such as a critical neonate

1279
00:43:54,789 --> 00:43:57,349
or a mass casualty or incivility from a

1280
00:43:57,349 --> 00:43:57,849
colleague,

1281
00:43:58,469 --> 00:43:59,929
building up pathways

1282
00:44:00,309 --> 00:44:00,809
and

1283
00:44:01,349 --> 00:44:04,150
having the confidence that you know what to

1284
00:44:04,150 --> 00:44:05,210
do in these situations

1285
00:44:05,964 --> 00:44:08,224
is going to serve you from a

1286
00:44:08,605 --> 00:44:11,164
trauma standpoint that, you know, how you frame

1287
00:44:11,164 --> 00:44:12,605
it in the moment. The story put that,

1288
00:44:12,605 --> 00:44:14,364
oh, I can navigate this. You know? What

1289
00:44:14,444 --> 00:44:16,284
this joker, I can handle this versus, oh

1290
00:44:16,284 --> 00:44:17,964
my gosh, there's gonna be conflict, and I'm

1291
00:44:17,964 --> 00:44:19,405
gonna feel like an idiot. And all this

1292
00:44:19,405 --> 00:44:21,329
toxic the inmate comes in. I got this.

1293
00:44:21,329 --> 00:44:22,769
I know what to do. These are sick

1294
00:44:22,769 --> 00:44:25,829
patients, but I'm prepared versus I am unprepared.

1295
00:44:26,610 --> 00:44:28,470
Being prepared, having pathways,

1296
00:44:29,010 --> 00:44:30,309
that in and of itself

1297
00:44:31,170 --> 00:44:31,910
is protective.

1298
00:44:32,690 --> 00:44:34,474
Yeah. Yeah. That's a great point. You know,

1299
00:44:34,474 --> 00:44:37,114
I never ever in my career thought that

1300
00:44:37,114 --> 00:44:37,855
having a

1301
00:44:38,155 --> 00:44:38,655
pathway

1302
00:44:39,035 --> 00:44:42,255
for how to deal with a resistant consultant

1303
00:44:42,715 --> 00:44:45,535
would have been something I needed. But absolutely,

1304
00:44:45,594 --> 00:44:47,980
that would have made so much of my

1305
00:44:47,980 --> 00:44:49,119
practice easier

1306
00:44:49,500 --> 00:44:51,579
to have that, you know, the little button

1307
00:44:51,579 --> 00:44:54,059
you push go. Oh, this person's being difficult.

1308
00:44:54,059 --> 00:44:55,819
I'll just push this button, and I'm gonna

1309
00:44:55,819 --> 00:44:57,920
walk down this road of questions.

1310
00:44:58,474 --> 00:45:00,235
I see you don't want to come in

1311
00:45:00,235 --> 00:45:01,614
in the middle of the night.

1312
00:45:01,994 --> 00:45:04,635
Let's talk about why I'm calling. And then,

1313
00:45:04,635 --> 00:45:06,635
you know, answer yes, answer no, answer no.

1314
00:45:06,635 --> 00:45:07,135
Okay.

1315
00:45:07,594 --> 00:45:10,315
Yes. I can see why you have understood

1316
00:45:10,315 --> 00:45:12,255
it to be that case. However,

1317
00:45:12,699 --> 00:45:14,539
let me go back to the patient that

1318
00:45:14,539 --> 00:45:16,059
I am talking about. You know, it would

1319
00:45:16,059 --> 00:45:18,380
have been so much easier to be like,

1320
00:45:18,380 --> 00:45:20,140
I need a call center script for how

1321
00:45:20,140 --> 00:45:22,059
to deal with this consultant in the middle

1322
00:45:22,059 --> 00:45:23,579
of the night. Would have made my life

1323
00:45:23,579 --> 00:45:26,785
so much easier. Okay. To that point, and

1324
00:45:26,844 --> 00:45:28,364
it's gonna sound like a shameless plug, but

1325
00:45:28,364 --> 00:45:29,644
I have to put in the context of

1326
00:45:29,644 --> 00:45:30,785
story. Every

1327
00:45:31,085 --> 00:45:34,445
cohort of Unburnable, this happens. What you're talking

1328
00:45:34,445 --> 00:45:37,664
about, we have basically a month on

1329
00:45:38,045 --> 00:45:40,785
navigating difficult consultant and communications,

1330
00:45:41,639 --> 00:45:43,420
and it's about this stuff.

1331
00:45:43,799 --> 00:45:45,960
And what happens is a lot of docs

1332
00:45:46,359 --> 00:45:47,960
this is the thing that brings misery to

1333
00:45:47,960 --> 00:45:51,260
their career. And then they've learned these tools,

1334
00:45:52,119 --> 00:45:53,819
and they can't

1335
00:45:54,494 --> 00:45:54,994
wait

1336
00:45:55,694 --> 00:45:56,514
that doc

1337
00:45:56,974 --> 00:45:58,514
to start giving a bunch of crap.

1338
00:45:59,054 --> 00:46:00,194
And they're waiting

1339
00:46:00,494 --> 00:46:01,474
like a panther

1340
00:46:01,855 --> 00:46:02,674
in the night

1341
00:46:02,974 --> 00:46:04,815
to pounce and not pounce in a bad

1342
00:46:04,815 --> 00:46:06,335
way to say, oh, I'm gonna shove it

1343
00:46:06,335 --> 00:46:08,039
right back in your face, but, oh my

1344
00:46:08,039 --> 00:46:10,360
gosh. I can see what a joke this

1345
00:46:10,360 --> 00:46:12,599
is, what a joker you are with these

1346
00:46:12,599 --> 00:46:14,219
things. And, you know, this is

1347
00:46:14,519 --> 00:46:17,160
compassionately towards the other person, but I'm so

1348
00:46:17,160 --> 00:46:19,660
excited to be able to deploy these tools.

1349
00:46:20,085 --> 00:46:22,965
And you think about that, Sarmad, and just

1350
00:46:22,965 --> 00:46:25,144
apply that to anything that you do in

1351
00:46:25,284 --> 00:46:26,505
medicine that,

1352
00:46:27,045 --> 00:46:30,505
oh, I'm so excited to deploy this tool

1353
00:46:30,885 --> 00:46:31,864
of communication,

1354
00:46:32,244 --> 00:46:34,660
of I know how to get vascular access

1355
00:46:34,660 --> 00:46:35,880
on this critical patient.

1356
00:46:36,180 --> 00:46:37,559
I'm excited versus

1357
00:46:37,860 --> 00:46:39,000
I freaking

1358
00:46:39,619 --> 00:46:41,719
read this is about to happen.

1359
00:46:42,500 --> 00:46:45,000
Woah. How different are those careers?

1360
00:46:45,785 --> 00:46:47,164
Yeah. Yeah. That's incredible.

1361
00:46:47,625 --> 00:46:50,265
That is incredible. Alright. Tell me the name

1362
00:46:50,265 --> 00:46:52,505
of the course and where someone can go

1363
00:46:52,505 --> 00:46:54,825
to learn more. Okay. So when you find

1364
00:46:54,825 --> 00:46:56,585
all my stuff at RobOrman.com,

1365
00:46:56,585 --> 00:46:58,364
that's one on one coaching. That's the unburnable

1366
00:46:58,425 --> 00:47:00,985
course. Unburnableunburnablecourse.com,

1367
00:47:00,985 --> 00:47:02,239
or or you can just go on my

1368
00:47:02,239 --> 00:47:04,719
website. There's lots of different places to find

1369
00:47:04,719 --> 00:47:06,400
it. And we've got a podcast and lots

1370
00:47:06,400 --> 00:47:09,280
of free resources specifically for emergency docs to

1371
00:47:09,280 --> 00:47:11,280
address pain points that come up in clinical

1372
00:47:11,280 --> 00:47:11,780
practice.

1373
00:47:12,400 --> 00:47:12,900
Absolutely.

1374
00:47:13,295 --> 00:47:15,454
And those links will be in the show

1375
00:47:15,454 --> 00:47:17,535
notes. There is so much more we could

1376
00:47:17,535 --> 00:47:19,875
say on this topic. But if you're listening

1377
00:47:19,934 --> 00:47:22,255
and you work in the emergency department, I

1378
00:47:22,255 --> 00:47:24,735
just want you to know that much like

1379
00:47:24,735 --> 00:47:27,695
your continuing medical education fills in your knowledge

1380
00:47:27,695 --> 00:47:30,699
gaps for treating patients, you need something

1381
00:47:31,000 --> 00:47:31,980
in this

1382
00:47:32,440 --> 00:47:32,940
area

1383
00:47:33,239 --> 00:47:35,799
to complete your practice and your knowledge so

1384
00:47:35,799 --> 00:47:38,440
that it will encourage your career to be

1385
00:47:38,440 --> 00:47:41,019
as long and as fulfilling and as joyful

1386
00:47:41,319 --> 00:47:44,394
as it potentially can be and prevent that

1387
00:47:44,394 --> 00:47:45,454
burnout. Or

1388
00:47:45,835 --> 00:47:47,594
as I tried to explain this to my

1389
00:47:47,594 --> 00:47:50,394
teenage daughter, what it's like to invite someone

1390
00:47:50,394 --> 00:47:52,875
into your massive mansion of a home and

1391
00:47:52,875 --> 00:47:55,275
say, hey, welcome. Come inside. And then the

1392
00:47:55,275 --> 00:47:57,579
person walks into a room that looks like

1393
00:47:57,579 --> 00:47:59,900
a small bathroom with some white walls and

1394
00:47:59,900 --> 00:48:01,819
a window. And they go, where where is

1395
00:48:01,819 --> 00:48:02,859
the rest of the house? I mean, this

1396
00:48:02,859 --> 00:48:04,780
place is a mansion. Why am I standing

1397
00:48:04,780 --> 00:48:06,139
in this teeny little room? And I go,

1398
00:48:06,139 --> 00:48:07,739
oh, this is where I live. And they'll

1399
00:48:07,739 --> 00:48:09,179
say, well, what's behind that door? And I

1400
00:48:09,179 --> 00:48:09,839
go, oh,

1401
00:48:10,219 --> 00:48:12,719
yeah. I've been cramming stuff in there

1402
00:48:13,094 --> 00:48:15,414
for decades. There's no space left in the

1403
00:48:15,414 --> 00:48:17,335
rest of the house. So I live here

1404
00:48:17,335 --> 00:48:18,394
in this little room.

1405
00:48:18,695 --> 00:48:20,234
So if you wanna enjoy

1406
00:48:20,614 --> 00:48:23,175
your house and your home and all of

1407
00:48:23,175 --> 00:48:25,514
the spaces that you are supposed to have

1408
00:48:25,610 --> 00:48:27,369
for the long, long life that I hope

1409
00:48:27,369 --> 00:48:28,969
you live, then you need to have these

1410
00:48:28,969 --> 00:48:29,469
skills.

1411
00:48:29,849 --> 00:48:31,769
And I'm happy today that there's a place

1412
00:48:31,769 --> 00:48:33,369
you can go to get them, and there's

1413
00:48:33,369 --> 00:48:36,489
always other resources out there. So devote a

1414
00:48:36,489 --> 00:48:37,949
little to talk to some colleagues.

1415
00:48:38,324 --> 00:48:40,484
Go to roborman.com

1416
00:48:40,484 --> 00:48:42,244
and take a look at the resources. But

1417
00:48:42,244 --> 00:48:44,085
do yourself a favor and partake in those

1418
00:48:44,085 --> 00:48:45,464
things as soon as possible.

1419
00:48:46,164 --> 00:48:48,164
I love that metaphor, Sam. You told me

1420
00:48:48,164 --> 00:48:50,724
that before we were recording, and just picturing

1421
00:48:50,724 --> 00:48:52,980
you standing with your arms at your side

1422
00:48:52,980 --> 00:48:54,820
with no room to move around. That's right.

1423
00:48:54,820 --> 00:48:56,900
It's fine. That's what it's like. Welcome to

1424
00:48:56,900 --> 00:48:59,780
my mansion. Welcome to my mansion, my castle.

1425
00:48:59,780 --> 00:49:01,780
Wait. Why are we in this room? This

1426
00:49:01,780 --> 00:49:04,180
tiny little place. I'm sorry. The rest of

1427
00:49:04,180 --> 00:49:06,204
it is just jam packed to stuff I've

1428
00:49:06,204 --> 00:49:07,664
been cramming in there for years.

1429
00:49:08,764 --> 00:49:11,005
Oh, my goodness. Well, doctor Rob Orman, thank

1430
00:49:11,005 --> 00:49:12,864
you so much for being on the podcast.

1431
00:49:13,005 --> 00:49:16,364
Once again, the contributions are so enlightening and

1432
00:49:16,364 --> 00:49:19,329
so important and so career transforming. If you're

1433
00:49:19,329 --> 00:49:21,829
listening, again, I can't recommend it highly enough.

1434
00:49:21,889 --> 00:49:23,650
Go check it out, robwormon.com.

1435
00:49:23,650 --> 00:49:25,250
Rob, thank you so much for being on

1436
00:49:25,250 --> 00:49:27,269
the show. Always a treat, my friend.

1437
00:49:28,609 --> 00:49:30,609
Well, ladies and gentlemen, that's the end of

1438
00:49:30,609 --> 00:49:33,085
today's episode. Thank you for joining us. Don't

1439
00:49:33,085 --> 00:49:35,744
forget about ebmedicine.net,

1440
00:49:35,804 --> 00:49:38,304
your one stop shop for all of your

1441
00:49:38,444 --> 00:49:41,884
emergency medicine and urgent care medicine needs. This

1442
00:49:41,884 --> 00:49:43,744
month, we've got a free antibiotic

1443
00:49:44,045 --> 00:49:45,960
guide for you when you subscribe,

1444
00:49:46,420 --> 00:49:49,380
and we are releasing the new and improved

1445
00:49:49,380 --> 00:49:51,780
version of the laceration course, and you can

1446
00:49:51,780 --> 00:49:53,880
find out more about all of those things,

1447
00:49:54,011 --> 00:49:57,131
as always, on the website ebmedicine.net.

1448
00:49:57,131 --> 00:49:59,231
Until next time, be safe everyone.