Today Nearly 300 of Us Will be Killed or Injured with a Gun

My heart is heavy this week due to gun violence. Today, it is a mass shooting that happened afar. Most days it is something that happened in my own trauma center’s catchment area.

Some people ask why I only speak up about our nation’s epidemic of gun violence when there is yet another mass shooting. After all, as a trauma surgeon I am all too familiar with the daily toll of gun violence one person at a time.

Whether it is the young urban dweller who lacking hope for a good future, in the absence of socioeconomic security and educational opportunities, turns to a life in gangs armed with illegal guns and ends up in a crime fueled shootout…

Or the depressed middle-aged suburbanite who under the oppression of dark feelings related to job loss or divorce or perhaps seemingly no obvious stressor attempts to take their own life with a hand gun…

Or the believer in concealed carry who, in a state of inebriation, engages in what might have otherwise been a simple fisticuffs that instead turns out to be a deadly bar fight…

Or the curious child who, due to the momentary carelessness of an adult who would swear they are an educated legal gun owner compliant with best practices for firearms safety, pulls the trigger with a devastating outcome…

Or the bereaved, yet obviously mentally unstable, individual who acts on his grievances against his mother’s surgeon by gunning him down in the clinic

Or any of the 297 Americans killed or injured daily due to firearms, as trauma surgeons, my colleagues and I bear witness the death and destruction caused by our nation’s obsession with the right to bear arms first hand each and every day.

While it’s a thrill for a trauma surgeon to get a great case—it might be the adrenaline surge of doing an ED thoracotomy on a coding patient with a hole in the heart or the exhilaration of the exploratory laparotomy requiring 4 or 5 lacerated organs to be repaired—but as a human, each and every time I am called upon to care for someone who was shot, no matter what the circumstances, I feel sick to my stomach. My soul grieves for those who I can’t save, for those who will be left permanently disabled, and for everyone—patients, families, and caregivers alike—who will share the post-traumatic stress of having gone through the shooting and its aftermath.

This should not be happening in a civilized society.

To be sure, there are myriad other issues that contribute to gun violence in our country ranging from economic insecurity to mental illness to extremist beliefs to the ubiquitous violence we see in our LED lit world today. And, let’s not be naive; many objects can be weaponized to intentionally or unintentionally injure, maim, and kill others. As we have come to know from the fertilizer used in Oklahoma City to the ball bearings used in the Boston Marathon to the box cutters and airplanes used on 9-11, to the beer bottles, lead pipes, knives, bats, and automotive vehicles that we surgeons see as causes of trauma every day, it’s not just guns that are the problem. But it is foolish to think that these other issues contributing violence in all of its forms trump that of essentially unfettered access objects that, in any form—shotgun, handgun, semi-automatic—have a singular purpose: to injure, to maim, or to kill. The original purchaser’s intent may have been different—perhaps for target practice or for hunting animals or for self-defense borne out of paranoia of threat to personal property that is seemingly rampant in our society—but it’s just too easy, no matter how the gun was acquired and by whom, for guns to be used to cause harm whether by murder, or suicide, or terrorism, or accident.

And so, when there is a mass shooting that attracts the social media outcry of those around me—those known to me from near and far and those unknown to me who simply come across my news feed—I do speak up more vociferously than I do in my everyday life as a trauma surgeon because, in the deepest depths of my heart, I am hoping that this increased attention might galvanize WE THE PEOPLE to find it in our collective consciousness to finally take steps to re-envision what the right to bear arms means in a civilized society. No other country accepts this as an inalienable right; and, as a result they don’t see nearly as many deaths and injuries due to firearms as we do. But we hang on to this 18th century notion as a point of American pride. It’s time for 21st century Americans to figure this out because today nearly 300 more of us will be injured or killed by gun violence.

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Hey Carpool Mom, Your Vehicle is NOT a School Bus and Boys are NOT Cargo

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Hey Carpool Mom! Yeah, that’s right I am talking to you in your Yukon XL SUV.

Even though your vehicle is the size of a bus, it is not, in fact, a school bus. Therefore, stopping in the middle of a busy road to load a dozen boys into your vehicle is a really bad idea. You have no flashing stop sign jutting out on your driver’s side so there’s nothing to keep oncoming rush hour traffic from bowling into the boys who clearly have not been taught to look both ways before crossing the street. Or, perhaps your random stoppage in the middle of the road led them to believe that they too could put aside any regard for their personal safety in the rush to leave practice.

Way to role model Carpool Mom! Your friendly local trauma surgeon suggests that you consider pulling over at a safe location, with your signal on, and have the boys look both ways and use the cross walk before piling into your SUV. Unless of course, you are trying to cut down on the volume of boys you must drive around by encouraging brain injury, internal bleeding, long bone fractures and the like because, well, that is a strategy I suppose for the exasperated Carpool Mom.

How many seats does that behemoth have anyway? Does it come equipped with seat belts as most modern American vehicles do? Because by my count, even with that extra row of seats in your giant SUV, there were 2 too many boys in the passenger area of your car. So I guess it’s no surprise that not a single one of them made any effort to put on a seat belt after piling into your vehicle. I suppose that goes hand in hand with the street crossing technique you and your, ummm, safety consciousness have inspired in these boys. Oh, and I bet you are thinking I should not frown upon the two who piled into the cargo area for not putting on seat belts because, well, there are no seat belts for the cargo area.

So again, your friendly local trauma surgeon would like to gently remind you that seatbelts save lives. Oh, and it’s the law in our state to have those boys in restraints. Also, there’s a reason it’s a cargo area and not a passenger area: boys are NOT cargo. If your ginormous vehicle is still too small to handle the entire team, why don’t you consider asking another parent to help with the carpool? Surely there is someone else willing to share the Carpool Mom of the Year Title.

Because clearly your nonchalant wave back at me as you pulled away indicated that you relish that title. However, it seems to me that you are undeserving of the title since you are seemingly oblivious to the risk you have exposed these boys to with your carpooling technique. You were lucky that oncoming traffic stopped and let the boys barrel across the street just feet from a crosswalk without bothering to look both ways. And, if you stop short during the remainder of your journey, two boys will be flying out of the lift gate window. If you cut a turn too sharply through the center of town, bodies will be careening into each other and the metal cage you have tossed them in without proper restraints. Or, if you get rear-ended, at least one of them will strike his head on the back of your seat and you might be trading in your damaged SUV for a wheelchair van.

As your friendly local trauma surgeon who has held in her hands the brain matter of boys struck by automobiles while haphazardly crossing the street and has had to deliver the sad news that a boy will never walk again due to lack of being restrained in a vehicle that crashed, I hope that you, Carpool Mom, are prepared to live with your grief and the grief of the other parents, when your “I’m indestructible” attitude gets a harsh reality check.

Here's the SUV in question. Vehicle details have been anonymized to protect the guilty.

Here’s the SUV in question. Vehicle details have been anonymized to protect the guilty.

Each year, 1,600 motor vehicle passengers under age 15 die while nearly 130,000 more are injured in car crashes in the United States; and, nearly 300 more die while another 10,000 are injured when they are struck by vehicles. More than half of the children killed in car crashes are unrestrained. Proper restraint use reduces motor vehicle related morbidity and mortality by more than 50%. Furthermore, jaywalking and lack of attention to oncoming traffic are the culprit in well over 50% of adolescent pedestrian vs. auto deaths. Today, Carpool Mom, you encouraged those boys in your care–entrusted to you by their parents–to jaywalk and they most certainly did not look both ways before getting into your over-filled vehicle that you then put into motion without having the boys properly restrained.

So next time you are in charge of carpool, ask yourself, “how would the other parents feel if I had a party and served alcohol to their sons?” Because today you might as well have gotten those boys shit faced drunk with the example you set for them and the risk you exposed them to. I was not on call to accept incoming injured patients this afternoon, but I sure hope everyone got home safely.

Hypocrites in our own house: Maternity leave and American Healthcare

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Netflix listens to doctors.  Google, Facebook, and Apple listens to doctors.  The United States Navy and Marine Corps listen.

The above “companies” have updated their maternity leave policies – lengthening them all past 12 weeks… and all paid.

But yet, healthcare doesn’t listen to doctors.  And let me tell you how.

I am pregnant.  Which is a blessing in of itself.  In fact, this is my 4th pregnancy, but I only have one child living.  So really, this is an absolute blessing that I have had a healthy pregnancy so far.  I should be over the moon excited.  Yet, there has been a black cloud over my heart since I first saw the “yes” on the pregnancy test.

Currently, I am the sole income for our family while my husband is in law school.  And yet, my job does not provide fully paid maternity leave.  The thoughts and stress of how we are going to balance our financial needs with my family’s emotional need for me to spend that precious, once in a lifetime time at home with our new son has left me downright drained.

I am currently in “discussions” with my large academic health physicians group as to how much paid leave I will actually receive for maternity leave.  And let me tell you, their initial response was significantly less than 12 weeks.  I think for me, the most disheartening part of these “discussions” with my employers is that they keep asking themselves, “Well, what have we done in the past?” instead of, “What should we be doing?”  Despite the fact that I will need a repeat cesarean section.  Despite the fact that due to short staffing over the past 3 years, I have given up 8 weeks of vacation and worked extended hours for years – including in-house calls up to 62 hours in a row.  Yep, folks, you read that correctly.  I have literally come in to this hospital on a Friday, and not left until a Monday morning.  And I have done it, because that is what the job required, what my hospital needed.  Trauma surgeons are a national shortage, and my profession often calls for dedication above and beyond the imaginable.

I always felt like that dedication was well placed – for my patients, for my hospital, for my community.  And that this dedication was shared by healthcare in general.  However, I feel that maternity leave is an issue that highlights my belief that for many institutions and practices, healthcare has lost its focus.  Healthcare should be about caring for people – our patients and each other.  Healthcare should be setting the standard for how other companies handle maternity leave – yet we are amongst the worst hypocrites.

After all, we are the ones recommending that women exclusively breast feed for a year – yet practice administrators dictate whether or not physicians can build 15 minute pumping breaks into their schedules.  We recommend women not return to work for 8 weeks after a cesarean section, yet we don’t pay them.  Several studies have shown that women who return to work before 12 weeks have children with more behavioral problems in early childhood, yet, if she doesn’t come back by 12 weeks, we take away her job.  We know that depression is directly linked to a lack of time off after the delivery of a baby, yet we continue to point to the letter of the law and say that what we offer is enough.  I wish these examples and studies weren’t real, but they are.

The dollars and cents seem to matter more for those that employ physicians than the health of their physicians.  The disparity of how maternity leave is handled amongst physicians here in the United States is downright shocking.  Some institutions automatically grant 12 weeks paid, but these unfortunately are in the minority. Most pregnant physicians are in a similar situation to me, and are left to fight, scramble, and scrap together time off after delivery and even time to pump when we do return to work.

And the kicker of it is, the physicians are usually the worst hit by these policies.  If I were a nurse, or an hourly employee, I would be able to roll over or accrue my vacation days. Other employees could even donate paid time off to me.  I would be mandated lunch and work breaks so I could pump.  I would never be left wondering how I could safely store breast milk for up to three calendar days. But yet none of these options are typically available to physicians.

I wish this were one of my usually snarky, humorous, Gomerblog worthy posts, but it isn’t. Unfortunately, I am writing today from a place of hurt, a place of feeling abandoned by my own profession – the people that are supposed to care about my health the most, seem to care about it the least.

I hope and pray, for the future of healthcare here in America, that these policies will change – to the benefit of the physicians, and the patients for whom we care.  After all, if we can’t take care of ourselves, how are we supposed to care for others?

Organized Surgery Begins to Battle Burnout

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General Surgeon Lifestyles -- Linking to Burnout: Medscape Survey by Carol Peckham March 28, 2013

General Surgeon Lifestyles — Linking to Burnout: Medscape Survey
by Carol Peckham
March 28, 2013

US surgeons are burned out and the numbers are staggering. Whether experiencing emotional exhaustion, depersonalization, or a low sense of personal achievement, 4 in 10 US surgeons exhibit signs and symptoms of burnout. Among neurosurgeons that number jumps to nearly 60%. Burned out surgeons are more likely to report substance abuse, clinical depression, and suicidal ideation. They are more prone to medical errors.

Interestingly, academic practice, trauma sub-specialty, increased nights of call, longer hours worked, younger age, female gender, and small children at home were all risk factors for burnout. For those of you who are new to this blog, I am a female academic trauma surgeon who routinely works long hours and takes in-house call while my small children are at home.

To be clear, these data prove associations and associations do not equal causation; but still, it is sobering to think that so many who entered a profession to fundamentally improve the lives of others are themselves leading such troubled lives due to their chosen occupation.

Embed from Getty ImagesThe occupational hazards of surgical careers are multiple. We suffer moral distress when our patients experience complications or die whether or not an error occurred. We develop compassion fatigue by bearing witness to our patients’ collective and continuous suffering no matter how successful any individual’s outcome may be. Due to our long and often erratic hours, we suffer from chronic fatigue and sleep deprivation. The physical plight caused by fatigue is complicated by many hours on our feet and maintaining awkward postures in the operating room. By routinely putting our patients before ourselves, we often exhibit illness presenteeism. Not infreqeuently, we face the double bind of choosing between being there for our patients or being there for our family. Meanwhile, whether it’s catching up with billing and coding one day, keeping up with meaningful use another day, or spending days studying subjects totally irrelevant to one’s daily practice for maintenance of certification, delivering care in the modern error mandates many a frustrating task that ultimately does nothing to benefit our patients. Furthermore, there is constant fear of litigation that might ruin us in financially or reputationally. And so, it is not surprising that so many of us are burned out.

Emotional awareness (how are you feeling, how does what you are feeling impact your behavior, and how does what you are feeling impact those around you)

All is not dark, however. There are ways for us to be well and resilient. They require both individual effort and culture change. Importantly, they demand emotional awareness. When we understand how we are feeling impacts both our perceptions and our actions, we can act in a way that props us up rather than gets us down.

I was heartened this past week that the American College of Surgeons chose to put surgeon wellness and resiliency on equal footing with the likes of “what’s new in hernia repair” or “ethical challenges in geriatric surgery.” There were a number of educational panel sessions tackling burnout head on. Whether is was about bouncing back in the face of personal loss, gender discrimination, pathways to help surgeons recovering from alcohol abuse back into clinical practice, or managing fatigue, the program was replete with informative sessions on burnout avoidance. Mindfulness, time management, kinship, and down time were emphasized as was physical fitness.

And for the first time ever, the College had a fitness program. As that youngish female academic trauma surgeon with two kids who has struggled with tending to herself after spending her youth, college, medical school, residency, fellowship training, and early years on faculty essentially ignoring personal wellness, I was delighted that this change was happening at my profession’s annual meeting. It was something of a pilot test offering only a very early morning Zumba and a Yoga class, but it was a start. Sure many surgeons at this meeting probably went to the hotel gym or hit the lakefront running path but these efforts happened without the largest surgical professional organization’s imprimatur (hey I even got an American College of Surgeons yoga mat!) or beckoning. These surgeons are likely the 6 in 10 of us who aren’t burned out. But that doesn’t mean we should ignore the self-neglect of our brothers and sisters in the occupation. So this simple step of organizing these fitness events indicated to all attendees that the College both encourages and supports surgeons taking care of themselves. Embed from Getty Images

Making time for fitness has been shown to reduce burnout so I hope the College expands their offerings this time next year. I invite the College to challenge us surgeons to find time for wellness within the already overwhelming conference that offers 5 days of educational sessions geared at making us better surgeons technically and intellectually. The annual Clinical Congress of the American College of Surgeons has essentially had this format the entire time that I have been attending (every year for the past 12 years). With the pilot fitness program the College chose hours and days specifically to not interfere with this typical format. However, given that all the data shows that prioritizing wellness is a key factor in combatting burnout and that wellness takes on many forms, the College should offer multiple offerings–whether it is meditation, or high intensity interval training, or barre, or a knitting circle, or Zumba, or TRX, kick boxing, or spinning, or running– at different times throughout the conference thereby forcing us to prioritize just as I was forced to prioritize between “surgical jeopardy” and “what’s new in body contouring.”

Slide1It will be hard for us to make these choices but we need the practice. I figure its easier to choose wellness when there are no cases to be done or patients waiting in the ER or clinics to be staffed, when there are no lives at risk other than our own.

“The World Ain’t All Sunshine and Rainbows, Sweetie.”

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“The world ain’t all sunshine and rainbows. It is a very mean and nasty place. It will beat you to your knees and keep you there permanently if you let it. You, me or nobody is going to hit as hard as life. But it ain’t about how hard you’re hit, it is about how hard you can get hit and keep moving forward, how much can you take and keep moving forward. That’s how winning is done!” – Rocky Balboa

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I have written before about how I think we over-coddle our kids these days, always making them feel like winners even when all they are is a solid mediocre. It’s rare these days for our children to feel like they did anything less than come in first; so, the sucker punch of not winning, when you tried really hard and truly, deeply thought you deserved to win, is a totally unfamiliar feeling.

Recently, my 11 year old daughter and her tween ethnic dance group participated in a competition. These girls practiced on their own well in excess of what the teacher demanded. They propped each other up. They were ready to hit is out of the park on the day of the show. And you know what? They did. It was a well-coordinated symphony of smiles and movement with pops of color in an eye-pleasing fashion. It was truly a joy to watch.

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The girls were the last in their age group and genre to perform so when they hit the final dazzling pose of the dance I thought for sure they were going to win. But they did not. They didn’t even place. Everyone, girls and parents alike, was very disappointed. Like many, I was not sure why the girls didn’t win and it did bug me. So I said to my daughter in the aftermath of the dance competition, “That sucks but you practiced a ton, did a great job, and should be proud of that and move on.”

Personally, I thought this was a parenting highlight for me.

Someday my kid might not get into Harvard and she will be disappointed. She may not ever know the algorithm of the admissions committee but I want her to be proud of the accomplishments that gave her the feeling that she was competitive enough to apply. Someday the guy she has a crush on may end up dating another girl and she will be disappointed. She may not ever know what he saw in the other girl that she lacks but I want her to know that she is charming and beautiful and worthy of so many boys’ interests. Someday my adult daughter will apply for a job and walk away from the interviewing thinking she nailed it. But she still might not get the job.

Sometimes no matter how great and amazing and talented we are, we don’t get chosen. Occasionally, it is because we actually think we are better or more competitive than we really are; but, more often there is just an idiosyncratic way that these things play out in they eyes of those doing the choosing whether or not the choosers are utilizing strict guidelines.  In the weeks after the competition, I have silently followed along as a number of other parents a launched an email trail of their disappointment. The initial disappointment brimmed into anger and then to demands to know what the judging criteria were, what the ethnicities of the judges were (in case they could bias the results), etc. There is a draft letter now that is presumably being sent to the leadership of the organization that hosted the event.

I get the disappointment but I don’t get the zeal to defend the girls’ honor so to speak. I have no idea if the other girls feel that same way as their parents. But, I do know that I don’t want my daughter to expect her parents to get into fighting mode whenever things play out in a way that doesn’t go her way because it’s a life skill to know when to move on. And, while I do want her to be brave enough to fight the fight when warranted (think Civil Rights Movement, Marriage Equality….,) I don’t want her to get worked up in a tizzy every single time things don’t go the way she was hoping.  Life is simply too short to be in fighting mode that often. Rather I want her to learn to be proud of the interest, and the effort, and the lessons learned from each and every experience whether or not she walks away with a championship ribbon.

If we don’t let our kids experience disappointment and maybe even occasional heartache–fair or unfair– they will always believe that life is all sunshine and rainbows. I hope I am raising my kid to weather the clouds and storms that will surely occasionally cast a shadow on her adult life so that she can be resilient and keep moving forward. “That’s how winning is done.”

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available at: https://www.pinterest.com/pin/386746686722545123/

Rants of a Snow Beleaguered Trauma Surgeon

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As the snow continues to fall and fall and fall in my neck of the woods and the snow piles get higher and higher, my days and nights on call are filled with more and more poor souls injured (and occasionally killed) due to Snowmaggedon. So please listen up and do as you’re told so we can avoid a chance meeting in the trauma bay.

1) Are you an essential employee? If you have to think about it you’re probably not. I know it’s hard for your ego but your ego needs to be contained in an intact skull so consider the risk benefit ratio of your dead body vs going to work before hitting the roads.

2) You think running outside is waaaay more fun than running on treadmill? Yeah, I do too. But when the sidewalks are covered and the shoulders are shot, you’re just as much bait for wayward cars as a squirrel; so hop on a human hamster wheel and get your run on inside.

3) Are you blessed with super powers? No? I didn’t think so. So don’t try to defy gravity clearing snow off your roof. Use proper restraints or hire a professional to do that job because the snow doesn’t break your fall as much as it breaks your bones and internal organs.

4) Speaking of superpowers, what’s your kryptonite? Yup, it’s your snowblower.  If it breaks leave it be. There are only two outcomes if you try to fix it, neither of them good. It will either stay broken or it will start again but your hand will be sacrificed. So grab a shovel instead.

5) See those icicles twinkling along the side of your roof line? I know they look pretty but remember they can impale you so just stay away. Far far away. Unless of course you are planning to get into a bar fight in which case the icicle is a pretty even match for the broken beer bottle.

6) Do you ever ski, snowboard, or bike without a helmet on? (If you do, just stay the hell away from a trauma surgeon’s blog!) Why would you treat any other high speed leisure activity any differently? So grab helmet before you head to the hill for some sledding.

Sure things need to get done in poor weather. Sure you need to protect your home and the valuables contained within it. Sure you need to clear your driveway and sidewalk. Sure you need to unwind and have some fun.

Just realize this winter wonderland can be fraught with dangers. Don’t be lulled by the twinkle of the glistening white powder. Be safe.

A Plea for Snow Days & Common Sense

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My part of the country has been pummeled with snow in the recent past. Many local school districts had to cancel school 4-5 days in just over a week due to two substantial storms. The forecasters are predicting yet another 12-18 inches just in time for the start of the next school week. At this rate, we might be sending our kids to school on the 4th of July!

Sigh.

Yes, there are lots of reasons to sigh about this, even among the most ardent of winter warriors and snow lovers. There are already 50+ inches of snow outside my door (not including the plow piles, many of which reach well above 6 ft). There is nary a sidewalk or shoulder to be found. Many local roads can only accommodate one way traffic at a time and turning corners is down right hazardous with all the obstructed views.

All of this danger is when the snow isn’t actively falling, when the winds are not whipping flakes into a fury, when a slick, slushy layer is not sticking to the roads. When the bad weather is actively happening things get really hairy. And it’s typically on these days, when conditions outside really compromise the safety of kids at bus stops or walking to school or of any vehicle or persons on the road, that we get a snow day.

The other day, on the heels of our many recent snow days, the local NPR station had a whole call in segment on the burden of snow days on families. Caller after caller lamented the challenges for working parents, single working parents, parents of disabled children, parents without telecommuting options, parents with part-time or hourly jobs (who simply don’t get paid if they don’t go into work), parents whose own parents can’t provide back-up childcare…. It went on and on.

The radio hosts and some callers discussed viable options for snow days such as alternating days with neighbors so that at least some of the folks in the neighborhood could go to work. Others spoke of progressive employers who offer on-site back up childcare  or access to on-demand in-home care through external agencies. Some suggested schools should stay open despite inclement weather to provide kids safe place to be in a storm and make sure they don’t go hungry.

I suppose I should have been sympathetic to these snow day woes and interested in the proposed solutions as the parent of two school aged children who often must be at work no matter how inclement the weather is, but instead I was bothered by the idiocy of it all.

Let me tell you why.

It looks peaceful but the roads are treacherous.

It looks peaceful but the roads are treacherous.

I know what it’s like to have to travel through treacherous conditions to get to work. I own an all-wheel-drive car. I live close to work. I know enough to leave plenty of time. Yet, I have still experienced my life passing before my eyes as I slip, slide, and fishtail the 4.5 miles to work on those days when patient care requires me to be at the hospital. I know what it’s like to hunker down at work with 4 days worth of clothes and rations when anticipated conditions suggest it would be unsafe for me to travel back and forth from work. I have no choice. This is what I signed up to do. You may need me, and I will be there for you in the trauma bay.

But you know what…don’t the majority of us have a choice? In fact, should it even be a choice to put oneself and others at risk if what you are going out of doors for is considered non-essential work (to use a state of emergency term).

I know that nearly 100 people died with thousands more injured during the Blizzard of 1978. I know that the pro-active state of emergency declarations due to accurate prediction of epic storms (yah 21st century weather forecasting technology!) in the modern era (first, two years ago this week and again last week) has kept many people safe. I know this because I had to be at work and it was eerily quiet in the trauma bay. I also know that on these other days of seemingly non-epic storms, when the predictions for danger aren’t as dire, that the ED is like a war zone, filled with people who ventured out only to get injured, some in fender benders and others in major pile ups. I know that some of those injured people die no matter how hard we try. I know from my most recent call on a snowy, though not state of emergency, day what it’s like to code and code and code a 30 year old whose Civic was no match for a semi on a treacherous interstate, only to declare him dead. I know the sinking feeling of getting that message that your child’s school bus has been in a crash on a day that school was not cancelled despite the falling snow. (Luckily it was minor and no one was hurt but it could have been very different with 40 kids piled into the ED and the trauma bays instead of driving their caretakers up a wall at home on a snow day). 

My daughter's bus stop circa this morning. No where to stand.

My daughter’s bus stop circa this morning. No where to stand.

So that’s the thing about snow days. I get that they are inconvenient all around. But it’s not just about keeping our kids safe, not just about the walkers who don’t have cleared side walks or lack of space at designated bus stops. It’s about the safety of everyone else around us too. To me, preventing one injury, even one death, is worth all the inconveniences. Back-up employer-based childcare (though wonderful when your nanny gets sick on a normal weather day) involves putting both you and your child (children) at risk on the drive to your workplace. Calling in a care provider in a pinch puts that person on the road and then you too will make have to make your way to work in poor conditions. As we learned this week, public transportation isn’t always a viable option to avoid the roads and be safe. Similarly, while the carpooling equivalent of watching kids on a snow day in the neighborhood seems great, how would the ones who drew the short stick and got stuck with the kids (this to me was the tone of the call in show) feel when the other mom or dad across the way never came home that night (and not because they were on call at the hospital)?

Are these inconveniences too terrible in the name of safety? Because I do believe that if it’s too dangerous out there to get our kiddos to school then it’s likely too dangerous for the rest of us (unless, of course, you are a considered an essential worker like I often am). What does it say about our world today that in some districts families are so strapped to put food on the table that putting kids in harm’s way in order to be fed is preferred over a snow day? Why do we tolerate employment policies that punish the least affluent among us in hourly or part-time jobs with lost wages (or worse, threats of termination after so many missed days) for something as legitimate as unsafe travel conditions? Are those industries not involved in the assurance of public safety (our dedicated fire, police, and EMS providers) and necessary urgent/emergent/long-term care (our inpatient, ED, and SNF/LTAC/home services nurses, doctors, aides, etc.) so important that they can’t take the financial and/or productivity losses of a few extra snow days here and there to have fewer injured (or possibly dead) employees?

Parking for many of our surgeons inaccessible.

Parking for many of our surgeons inaccessible.

Notably, many healthcare systems are no better, keeping their elective schedules and outpatient clinics running despite inclement weather. Yes, there is pressure to attain patient satisfaction but why should we put all the doctors, nurses, admins, patients, and families at risk for hernias, and wound checks, and well visits, and routine follow-ups for chronic diseases that could easily wait for another day. Yes, that means when the next clinic day or OR day is quintuple booked workers will have to work harder and stay later and patients/families will have to be more patient but at least we won’t be coding someone who was headed in for a non-life-threatening issue during a snow storm. Those unfortunate enough to experience life threatening issues on those days will have access to the rest of us fire, police, EMS, ED staff, trauma surgeons…. I promise.

So, when our superintendents who have considered the forecast, reports of road conditions from our DPW, and the possibility of keeping the schools open until July give our kids a snow day, why not just declare it a snow day for everyone except those few essential workers who must compromise their own safety to get to jobs that provide services for everyone else’s safety and well-being?

Me in the trauma bay during Storm Nemo, February 2013.

Me in the trauma bay during Storm Nemo, February 2013.

Not every storm warrants a state of emergency and not every snow fall warrants a snow day. And depending on where your home is located relative to your workplace, the two may not both be experiencing the same weather conditions. But when things are rough out there, let’s quit complaining about the burden of snow days. As a whole we need to exercise more common sense and implement policies that keep families and workers (even if they don’t have school aged children) safe and out of the trauma bay.

Driving tips from your friendly neighborhood trauma surgeon

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No one ever wants to meet me…Well, at least inside of a hospital.  If you are meeting me in a hospital, it is likely because you have been stabbed, shot, assaulted, or in a car accident.  Although the only advice I have about avoiding the first three mechanisms of injury is to stay away from “two dudes” and not try to sell Bibles on the street at 2 am, I do have some more specific advice when it comes to car accidents.  In my non-scientifically proven experience, the majority of my patients are in the hospital due to someone’s bad decisions – either their own or someone else’s.  And don’t get me wrong, I make bad decisions all the time.  For example, I ate a chocolate doughnut this morning for breakfast. However, no one ever expects their seemingly small bad decision to text their husband, or try and beat that red light on the way to work to result in their meeting me at the hospital.  But it happens.  Every.  Single.  Day.  So, stay safe America, and here are some trusty driving tips from your friendly, neighborhood trauma surgeon.

1.  Seatbelts are good, especially if you are pregnant.

I am not going to go into how many pregnant women (just in the last year alone) I have seen ejected from vehicles during car accidents and try to describe the tragedy that ensues.  However, no matter who you are – old, young, short, tall, overweight, or what trimester of pregnancy you are in, wear your dang seatbelt.  It saves lives, and there is absolutely no excuse whatsoever to NOT wear one.  So, can you please just wear it?  Tire marks across your belly are just not a good look.

2.  Texting is bad.

I know it is hard for some of you young grasshoppers to imagine, but back in “the day”, phones needed to have wires.  Therefore, they were only located in places with walls and telephone jacks.  Meaning, somehow, I was successfully able to be a teenager and not communicate with anyone for the 15-20 minute drive between my house and my destination.  And, believe it or not, my social life did not suffer.  There is nothing in this world so important to make you pick up your phone at all while driving.  Life seemed to go on just fine before this capability, and you have a much higher chance of your life continuing to go on if you forget that this capability exists.

3.  Let’s talk about alcohol.

I get it, alcohol seems to have some pretty magical powers.  It will give the average Joe the comedic powers of Jerry Seinfeld.  It can even make your 60 year old neighbor look like Heidi Klum.  But it will not make you a long-lost member of the Andretti family.  In fact, it won’t make you a better driver of any vehicle in any way, shape, or form.  It will make your reaction times slower, and your likelihood of being involved in or causing an accident exponentially higher.  This is true for driving cars, mopeds, motorcycles and yes, even golf carts.  Let me also tell you, from my non scientifically-proven experience: You will probably be fine. But, your friends riding with you, or the person that you hit with your car will not be.  And living with the guilt of confining your best friend to a wheelchair for the rest of his or her life is probably something you don’t want.  With so many designated driver services out there right now, there is just no reason to drive yourself after you have morphed into your Jerry Seinfeld alter ego.

4.  Speaking of the Andrettis…

Speeding really will not get you there any faster.  And I can prove this mathematically.  The average commuter travels 15 miles one way, with an average trip lasting almost 26 minutes. Increasing speed by 5 – 10 miles per hour for short periods of time is not going to shave your commute off by half.  So, if you truly are running late, driving faster is not going to make up any considerable amount of time.  You, in fact, will still be late.  And let me tell you, being 10 minutes late to work is waaaaay better than not showing up at all.

5.  And on the topic of work…

If yet another Snowmageddon has arrived at your doorstep and your job doesn’t involve saving lives or ensuring public safety, you have many viable options.  Sleeping in late, watching an omnipresent Law and Order marathon, climbing the walls because your children are at home (yet again) – all acceptable activities.  However, driving to work with your car functioning as a bobsled is NOT one of them!  Stay at home peeps.  Just lock yourself in the closet with some wine and cookies if the kids start giving you homicidal tendencies.

Think I am exaggerating?  Don’t want to follow any of the above advice? Don’t worry.  I will still be here… at the hospital… waiting to cut off all your clothes, see you naked, and then charge YOU for the experience.  Oh, that doesn’t sound like fun?  Oh, well in that case, re-read the above, and we can meet for coffee instead.

Stay safe!

Can women be professionals? Advice from a woman in a “man’s” world.

Merriam Webster defines professionalism as “the skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well”.

In the past 3 weeks, a few things have happened that have brought this topic to mind.  To give you a couple of examples:

While watching the celebrity apprentice, my au pair made the comment that it wasn’t fair for the teams to be split by gender – that the women were at a disadvantage.  I expressed some surprise by this sentiment (being a product of an all-girls’ high school and all), and asked her why.  She replied, “Because women don’t work together well.”

Two weeks ago, one of the ER nurses asked me if I had been a nurse before I became a doctor.  One of the best indirect compliments I have ever received.  This is a “big deal” so to speak because growing up, (and by growing up I mean in medical school and residency) as physicians you are taught certain life “truths”, which vary by specialty and by gender.  One of these “truths” is that nurses and female doctors do NOT work well together.  It is whispered about and discussed as fact, passed down from generations of residents before you – nurses will give you a harder time, they are nicer to the male doctors, don’t let your nurses call you by your first name because then they won’t respect you, etc, etc.

Another friend who has been very successful at her job and has all the evaluations to prove it is leaving this job.  Partly because her evaluations are filled with not just job performance reports but also reports about her personality.  Personality?  Really?!  I don’t mean unprofessional behavior – cursing, being verbally abusive, etc, I mean personality.  Like, your personality is “too assertive”, etc.

So this really got me thinking – can women really NOT work together?  Are we NOT able to give or receive constructive criticism and feedback professionally?  Are we subject to interpretations of our job performance based upon how well-liked we are instead of how efficient, productive, and skilled we are?

Every Friday morning, I attend “M&M”, aka morbidity and mortality conference.  This conference is well-known to surgeons everywhere.  In this conference, complications are presented in a PowerPoint format, with at least a 34 sized font, and flashed up on a huge screen in front of all the surgeons in our department to dissect, comment upon, and quite frankly, judge.

So for those of you not in medicine, let me try and describe it to you in a way to makes this process hit home.  Think of your last mistake at work – maybe you missed or forgot a deadline, flubbed a presentation, didn’t make the best impression on a client.  Any mistake you can think of –  large or small.  Okay, got one in mind?  Now, think of a detailed report on that mistake… a timeline describing all of your missteps or mistaken thoughts… when these occurred, whether they were witnessed or not, your boss’ account of what happened, your secretary’s impressions of what happened, the outcome of the mistake, and a poll of similar people in your position around the country and whether or not they have made that same mistake also.  Your worst and most embarrassing moments, picked at, highlighted, judged, written down, projected on a screen, and worst of all – viewed by everyone in your office, company, etc.  Have chest pain yet?

Well, this is what your surgeons do every single week.  Luckily, most of us don’t have our own complications presented every week, but it happens to all of us.  And, we all have to learn to be “professional” about it.  In other words, we have to be sensitive enough to our mistakes to not make them again, but not so sensitive that we can’t move on emotionally and be productive.  In other words, not take things too personally.  We have to understand that these mistakes we make are actions, not personality traits.  I am not a “bad” person because I made a wrong decision.  One of my favorite surgeons from residency always said, “The last thing a patient needs is a surgeon who feels sorry from himself.”

Okay, okay, so what the hell does this have to do with women as professionals?

I can clearly delineate and separate professional actions and personal happiness, because I have been trained to do so.  Quite frankly, given my years spent attending and participating in M&M conferences, this “skill” is critical to emotional survival and professional success.  I have to keep the emotions at bay so I can accept the criticism in order to make myself better.  I am not perfect.  All I can hope is that I will be better tomorrow than I am today, and sometimes I need help with that.  And sometimes that help is in the form of criticism.  However, most women don’t have to sit through an M&M conference every week, and I feel struggle with this ability to separate the professional from the personal.

Let me be blunt, Women will never achieve the same levels of professional success as men, until we act professionally TO EACH OTHER, and think and judge OURSELVES as professionals.

So, do I have this all figured out?  Hell, no.  But here are some thoughts and advice on what has helped me.

All female relationships can be tricky… if we let them be.

As a species, most of us are plagued to some degree by insecurity.  We are taught at a young age to be people pleasers, and ergo a lot of us judge ourselves by how well we please other people.  In addition, we unwittingly often compare ourselves to other women, regardless of the differences in our situations.  For example, I found myself one morning, sitting in the pediatrician’s waiting room, comparing myself to another mom with a similarly aged child.  I had just finished working over 24 hours, and looked every inch of it.  She was enviably thin; her hair, her makeup and her clothes were well appointed and fashionable.  Her toddler belonged in a GAP ad.  I looked slightly homeless with my child still in his pajamas and covered in maple syrup from the pancakes I had bribed him with on our way to the appointment.  I caught myself judging how I am as a mother and as a woman based on the appearance of a complete stranger in a damn waiting room.  I have two degrees, am a double boarded surgeon and found myself in a thought process that was a complete waste of 5 minutes of my life that I will never get back.  I don’t know this woman, so why the hell was I envying her?  Because, regardless of education, our successes and accomplishments, that is what many of us do.  We judge our worth, our success at life, by how we compare to other women.  And this, is absolutely absurd.

When two dogs meet, there are cautious glances exchanged, followed by some evaluation at a distance, then some butt-sniffing, and ending with a silent acceptance of the other animal’s existence, or some baring of teeth, or some tail wagging.  We, as women, are similar – well, without the butt-sniffing (in most cases).  When we meet another woman, often times our insecurities dictate our behavior and our opinion of her… however unfounded those opinions might be.

Now place all these behaviors and thoughts in the professional world, and let’s complicate matters by adding a real, or implied hierarchy.

Overall, this milieu can lead to a level of discomfort amongst women who are all on the same team, but with different roles and qualifications.  However, I am here to tell you that this discomfort can be overcome.  I am blessed to have worked with an amazing group of nurses throughout my career, and even though we aren’t “supposed” to work well together, we do.  In fact, I count many of them as very close friends.

My advice for success in the professional world as a woman, whether you work in a predominantly female world or male world is:

Have the confidence to separate the actions from the person.

In other words, learn how to give and receive negative criticism professionally.  Whether you are the one that “messed up”, or you are the person giving feedback to a colleague, separate the personal from the professional.  She or he isn’t “mean” because they gave you constructive criticism or had to address an issue with you.  If you have an argument or disagreement with a colleague about a project, is she or he really being “difficult” or are you just two people with two different opinions and perspectives?  You don’t need to and ask your boss if he or she is “mad” at you because you failed to meet a deadline or ask your colleague if she doesn’t “like” you because you had a disagreement.  Keep it about the job!  Ask instead how you can improve, what could you have done better.

Keep the emotions in check… in public, at least.

We have all had those days – when nothing is going right, you made a mistake, disappointed yourself or your boss with your performance, you have had a disagreement with your colleague, etc.  It is completely normal to have emotions, even strong emotions about things that happen at work.  I’m not saying you can’t have those feelings, I’m just asking that you to please not consider the public water cooler as the place to express your unfiltered, raw emotions.  Nothing wrong with crying, ladies.  There just isn’t any crying in baseball.  Hold it together until you are in your office, locker room, bathroom, etc.  It is hard to be taken seriously in a career if you are viewed as fragile, or a bundle of nerves and emotions.

Finally, for the love, let’s learn to Respect, Respect, Respect each other.

Let’s stop calling each other bitches.

Let’s start accepting and embracing our differences.

Let’s stop viewing our mistakes as personal faults.

Let’s start giving and taking negative criticism with CONFIDENCE.

Let’s stop judging ourselves based upon our impressions of other women – This leads to feelings of insecurity, which often leads to actions based on insecurity.

Let’s start having the CONFIDENCE to embrace and support each other, and let’s start proving everyone WRONG.  Functioning as either boss or employee, women CAN work together well, succeed, and LEAD.

I mean, we are the superior gender, right?  😉

Mourning a Profession

This past week, an unimaginable tragedy fell upon a family. A wife lost her husband. (Nearly) four children lost their father. A mother and father lost a son.

Upon a circle of friends. A group of buddies lost their companion. A band lost their guitarist. A neighborhood lost the guy next door. A congregation lost their fellow worshiper.

Upon a highly skilled cardiac team. These heart surgeons, anesthesiologists, cardiologists, perfusionists, nurses, technicians, and many more team members lost both a colleague and a friend.

Upon a hospital. These employees across roles and specialties lost a visionary among them, slain in their own halls.

Upon current and future patients. These vulnerable humans lost someone who just might have saved their lives.

Upon a profession…

I did not personally know Dr. Michael J. Davidson, a cardiac surgeon from Brigham & Women’s Hospital in Boston who was shot dead by the son of a deceased patient, but of course the degrees of separation are few in our educational backgrounds and our chosen profession. Still, I am arguably low on this list of people mourning, grappling with the soul sucking grief of an utterly inexplicable loss of life. But I am feeling it nonetheless. I sobbed listening to the excerpts of the funeral on NPR yesterday. Sat in my car and sobbed after a long day at the hospital.

As a surgeon, I am prepared for a certain amount of risk in my profession. There are communicable diseases. I always double glove, never making judgment on a patient’s risk of Hepatitis or HIV. I am tested for TB annually. I take countless precautions everyday to protect myself (and my patients) from the spread of infectious disease. There are ergonomic risks. I woke up everyday for ten years with back pain. Luckily I was able to fix many of my issues with pilates but many a colleague has required surgery after years of contortion about the OR table. There are psychiatric risks. Rates of burnout are high in my profession. Burnt out surgeons have high rates of clinical depression, substance abuse, and suicide. One study showed the the highest rates of suicide were among young female trauma surgeons with children. That was a sobering statistic.

When I get asked by aspiring physicians, and particularly by medical students considering surgery, why I do what I do, my truly heartfelt answer has always been “Because I get to save lives and to experience the bittersweet joy of a family saying ‘thank you for trying’ even when a life is lost.”

I have lost many a patient. And I have never, not once, before this week, felt unsafe after losing a patient. Not once.

I am on call today. I have already had a patient die despite my best efforts.

And so I mourn. And I sob. For all those people on the list above me who knew Dr. Michael J. Davidson and are experiencing unimaginable grief. And I also mourn for the loss security of my profession, a profession I chose to help others in their darkest moments. I am left in one of the darkest moments of my career.