More than survival: Coping with the aftermath of trauma

There may never come a day when we don't get chills thinking about it, or worse. On Monday, April 15, 2013--Patriot's Day in Massachusetts--an event that has inspired lifelong dreams for people around the world for more than a century became the stage for a waking nightmare.

After three of my own personal attempts to qualify for the privilege of racing the Boston Marathon, a margin of 47 seconds kept me off the historical course this year. But full of the same spirit and excitement that has thrilled me about the race as long as I can remember, I watched it on TV with my kids. I laughed out loud when my 5-year-old asked why the elite women were running in their underwear.

A few hours later, I got a calm but grave voice mail from a close friend who had been at the finish line, telling me there had been explosions, and that he was all right but that many people were not.

Over the past 48 hours, as I've thought about what sort of commentary I could possibly bring you this week, I realized I did not personally have words that could be useful to this audience. Instead, I turned to Dike Drummond, M.D., a former emergency and family practice doctor who currently coaches physicians on recovering from burnout and post-traumatic stress disorder.

FiercePracticeManagement: What is the most important thing for the average office-based doctor to address as he or she returns to work this week?

Dike Drummond: For most of us who've been trained in healthcare, had we been present, time would have slowed down, we'd have moved toward the problem everyone else was running from, and, like the first responders on site did, we would have done what needed to be done to get the people in the ambulance.

And the ambulance would have taken off. And then all the bits would have come crashing in. What just happened? All of the emotions and everything else would have happened after the job was done, because as healthcare providers, we can't let emotions get in the way of doing what needs to be done in that moment.

For me, seeing a person with their feet blown off is unusual but doesn't traumatize me. It's a clinical issue and I need to save the guy's life. He's going to be OK; he just is not going to have feet. He's going to have to learn to deal with that but it shouldn't kill him, I hope.

But for me to have witnessed something like that—that's not supposed to happen—in the hours and days and weeks after that, it's going to come crashing in on me and I'm going to want to talk about it. Ideally, I'm going to want to talk about it with somebody who was there, or somebody who could understand. And that's one of the difficult things about being a doctor is that oftentimes when you want to talk about something bad that happened, not to vent, but just have a witness to what you experienced, oftentimes it's difficult to find someone who can talk, who can understand.

FPM: How can practice leaders help solve this problem?

Drummond: The most important thing a doctor can do, since we're the de facto leaders of our care teams, is to set a context where what needs to be communicated can be. That means sitting the team down, closing the door, and saying, "I've ordered lunch, we've cleared the decks for an hour here; let's talk."

And even if that time is spent just holding hands and not saying anything, the leader is conveying the message that, "I know that you experienced that differently than people who don't work in healthcare, so let's create a space here. Let's create a context and environment and allow ourselves to speak of these things."

Most leadership programs will talk about the content of what you do in the office, that you need to lead your team and they need to take these actions and all this kind of stuff. But the even more important is creating a context where the team can do what needs to be done. And in this case it needs to be OK to talk about any feeling you might have had based on what you saw. Because if we don't talk about and clear and be OK with being able to talk about these things, the next time somebody comes in and they're hurt severely like that--that can get in the way of you doing a good job with that person.

FPM: What is the effect on the majority of people who were not present at the incident, but witnessed the horrific images and news coverage?

Drummond: Most people in healthcare have never seen blown-off feet, thank God. However, the feeling of trauma--of having witnessed something that shook you—everybody felt that. There will be people in healthcare who will see that picture of a man with no feet and they will remember something else that traumatized them.

Everybody is traumatized during their training at some point. For me, I think back to medical school and my first day in the autopsy lab--of having to dismantle a cold, dead body with essentially a butcher knife and a set of pruning shears, and that person looked exactly like my grandfather. My second case that day was a 5-year-old girl.

Those are very vivid memories for me. I remember them being difficult but they didn't traumatize me. However, if they had, that picture of that man's missing feet could have thrown me back into how I was traumatized by my first autopsy. And off to the races we go and I put on my uniform that day and I can't go to work.

So there will be people inside healthcare who have been traumatized who will see those pictures who will link them with a different trauma, and they will have difficulty going to work that day. There will also be people who will see that picture of the man with the missing feet who will remember trauma they suffered in the past, and they will come in to work and they will thank God for the opportunity to help people today. And all of those things ideally are given a forum where it's OK to talk about it.

FPM: Is this forum provided often enough in healthcare?

Drummond: No. Almost no doctor in the country would ever think about doing that. They would think about soldiering on. They'd think, "We've got patients to see. Yes, that was horrible, but we've got work to do."

But what we're talking about is processing feelings so at the end of the day, this doctor's staff says, "I'm so glad I work for Dr. So and So because we had the opportunity to talk about it. That doctor is really a special person who cares about all of us. What an amazing job I have." That's the way it can be, as opposed to, "Thank God we made it through those 22 patients and I can finally go home and grab a glass of wine. And tonight I need three because I saw that picture of the person with missing feet."

Healthcare can be more than survival.

The bottom line for me is that it's perfectly OK to have feelings in healthcare. Anybody who taught you that you shouldn't is setting you up to fall.

The question is whether you have a safe place with people who can understand what you're experiencing--not to vent or express anger, but simply having a place where we can meet. Most of the time, doctors don't realize they have the power to provide that.

- Deb (@PracticeMgt)

Editor's note: This interview has been edited for length and clarity. To learn more about or to contact Dr. Drummond, visit his website, The Happy MD.