Amanda: Hi, guys. Welcome back to the podcast. I'm Amanda.
Laura: I'm Laura.
Kendra: And I'm Kendra.
Amanda: And today is a huge day for us. We have Kristin Flanary joining us, and we are so grateful. Kristin gave the keynote address at the American College of Emergency Physicians meeting in October, along with her husband. Her husband is Dr. Will Flanary, an ophthalmologist, but you may know him better as Dr. Glaucomflecken on TikTok and Twitter, and I don't know what other platforms he's on. As always, he was incredibly funny. However, she stole the show with her talk about her journey as what she terms a “co-survivor.” It was so moving, and we knew her message would help not only how we interact with family members of our patients, but it could help ourselves. So welcome Kristin to the Drive Time Debrief.
Kristin: Hi. Thanks for having me.
Laura: Oh, we're so excited to have you. Kristin, would you mind just telling our audience a little bit about you, about your background, your training, your family, et cetera?
Kristin: Yeah. So, I am not in medicine. I was actually- I went to grad school for social psychology and cognitive neuroscience, is kind of what I was formally trained in. And then later on pivoted into marketing and communications. I've been with Will since undergrad, so I've been married to medicine the whole way, through from the pre-med years all the way to, you know, the big boy job attending years. And we had our first child while he was in medical school. And then our second child while he was in residency. So we did everything, like, all the wrong ways that you're not supposed to do. But it was a good thing that we did because after our first child was born in medical school, he got testicular cancer, and he had an orchiectomy on one side. And then in residency, after our second child was born, he got testicular cancer again. A completely unrelated case. And he had his second orchiectomy. So at that point, you know, obviously having more children was not in the cards for us. So if we had done it, the “right way,” you know, we wouldn't have been able to have a family. So we were, we were really lucky it all worked out the way it did.
Laura: Yeah, I love that story, and I think it's interesting. One of the things that we talk to our clients about a lot is that, you know, we give ourselves a lot of shoulds and a lot of “the right way,” but really each of us is in charge of our own experience. And so it's so good that you guys listened to your own inner voice to know what was the right thing for you and your family
Kristin: Yeah. And someone had given us the advice that really made a big difference, which was: there is never a good time to have kids. Like they’re always going to be a huge disruption to whatever your life looks like at that moment. So you may as well just do it when you feel like, you know, you're ready to do it. As ready as you can be.
Laura: Exactly. So how did you and Dr. Glaucomflecken meet?
Kristin: We met in college. We were undergrads at Texas Tech University. It's very nerdy. We met through mutual friends in the honors college . So we were both in the honors college and that kind of created this smaller community within a really large university. And so we had a lot of mutual friends just from having, you know, the nature of that being a smaller group. And so eventually we ran into each other and started talking. We actually did a lot of our getting to know each other over AIM, you know, AOL Instant Messenger back in the day? So yeah, the digital thing has always been a big component of our relationship.
Kendra: It was the first online dating, right?
Kristin: Yeah. Kind of was. Like we knew each other in person, but we mostly talked through, yeah, chatting.
Laura: Yeah. So was he as funny, was he funny when you first started dating? Did you know immediately that he was a funny guy?
Kristin: Yeah, that was pretty obvious. Actually, the first time I ever met him, he was coming in upset at somebody. I hadn't, I had no idea who he was at this point. He came in and he was upset with somebody because he felt like they owed someone an apology, and, you know, hadn't given it satisfactory, you know, to his standards. And so he came in and was demanding that this person apologized. And so that certainly made an impression of like, you know, the kind of person that he was. But yeah, then when I got to know him better, yeah, he was cracking jokes all the time, and I went to some of his standup comedy sets that he was doing at like open mic nights and things like that. So yeah, humor has always been a big part of it.
Amanda: Speaking of, I saw on one of his platforms that you guys were in a little bit of a rough patch because you slept in your contacts.
Kristin: I did. I forgot. I, you know, I am a creature of habit, and I have routines. And I got outta my routine because we were traveling, and I just didn't remember that I had not taken up my contacts before we went to sleep. And so I had to tell him. I had to break the news to him the next day. You know, just. I need you to sit down. I have something very serious to let you know. I slept in my contacts last night.
Kendra: I'm glad to see you guys work through that.
Kristin: Yeah. Thank you. It was a rough, rough time.
Laura: So relatively few people amongst all your millions of adoring fans know the details of the medical issues that you guys have been through together. Do you, do you wanna share some of that experience with our listeners?
Kristin: Yeah. So there were the two cases of testicular cancer that I mentioned before, and those were definitely eye-opening. It's cancer, but it's one of the good cancers, right? So testicular cancer is obviously very curable, and so that was good. But it was still, you know, I think in the medical community there is that thought of, well, this is, this is easy, this is curable. You're not in any sort of real danger. But it still has a whole set of psychological effects. You know, it shifts your identity. When you're in your twenties, you just feel like, you know, you should be at the peak of your health and strength. And you still have a little bit of that sense of invincibility that people do when they're young. And when something like the word cancer happens to you, it takes all of that away and it makes you have to find a new identity. And it makes you doubt your safety and your security in the future.
You know, like, well if this is what's happening in my body in my twenties, can I trust my body for the rest of my life to keep me healthy? Or is there something wrong with me that, you know, especially when you get it twice. That's almost unheard of. Just statistically it's very, very rare.
So, that was a little taste of what was to come, I would say. And then when the pandemic started May of 2020, he…so it was the night after Mother's Day, and we went to bed on Mother's Day. And then at 4:45 in the morning, I woke up because he was making these really loud noises, and I thought that they were, I thought he was snoring. And I was, you know, groggy. I was coming out of a deep sleep all of a sudden, so I just kind of like pushed him over, you know, like you do to try to get someone to stop snoring. And he wasn't responding to that. And then I started kind of shaking him, and he wasn't responding to that. And I was shouting his name and nothing.
And so then I got really concerned, and I called 911. And it turned out that, you know, I learned later those noises were agonal respirations, which I had no idea what that was at the time. But the 911 operator is the one who recognized that he was having a cardiac arrest in his sleep. And so she guided me through doing CPR on him, and I did that. I couldn't move him. He was on the bed, so that wasn't ideal. But I had had a cervical disc replacement just a couple of months before. And I have hypermobility, so I'm not very, like, stable on a good day. And then he's, I don't know, 13-14 inches taller than me, has a good, at least a hundred pounds on me. And there's a nightstand right next to the bed, and I just did not have any confidence in my body's ability to get him off the bed safely without just hurting us both. And so, I just had to do it on the bed.
And I did CPR for 10 minutes before paramedics arrived. And then they shocked him, I think, five times. Had to give him, I think, three rounds of epinephrine and some amiodarone. And they got his heartbeat back before he left the house. And, then they put him in an ambulance and rushed him off to the hospital. And that was all just like a big blur.
And meanwhile, our two children, they were eight and five. They were asleep in the next room, or I thought they were asleep. Turns out they weren't. But thankfully we had done enough bedtime training that they knew they weren't supposed to get out of bed yet. So they didn't, and I'm so, so thankful that they didn't, even though they were hearing all these weird noises. They saw the paramedics come in, and it was the height of the covid pandemic at the very beginning, you know, when we didn't really know much about it. And so they were in full hazmat suits with hoods and everything, and they just saw, you know, the lights outside. And then these people in these weird outfits come in and, and I had told the 911 operator that they were there. And so she had let them know that so that they could shut their door. So one of them shut their door, and like as he was pulling the door shut, he made eye contact with my older daughter who was eight, and just kind of didn't say anything and just pulled the door shut.
So obviously once he was gone to the hospital, I had to go in there. And figure out what the heck to say to them about, you know, all that stuff that had just happened. So yeah, it was a crazy, crazy time. And then, my experience once I got to the hospital was even as traumatizing, or further traumatizing, as the cardiac arrest itself. It was trauma, just plain and simple. It was, it was trauma and so, Over the next few months, I just, you know, was processing everything and trying to, trying to get through all of that. And, and that process really led me to realize that there's nothing out there for people like this, you know, for people who are in these situations.
There's a lot of medical attention, and he got wonderful medical care. Ended up completely physically and neurologically intact. Completely recovered. So, you know, absolutely no complaints about the medical side of things. But I think in the medical process, a lot of the humanity and the psychological pieces are just not there. They're just kind of not built into the system at all. And so you fall through these huge gaps that end up really doing a lot of damage.
Laura: Yeah, that 's just so interesting. There is a concept of secondary traumatic stress that we talk about a lot in emergency medicine because we experience other people's stress so much, you know, their trauma all the time, and we just kind of carry that with us. But what you endured really was your own, your own trauma going through that with him. And I just, I think so much about that 10 minutes that you're doing CPR. For anyone who's ever done CPR, the idea of doing effective CPR for 10 minutes straight on someone who is so much larger than you are, and doing it on a surface that's not hard and immobile. And you have hypermobility issues. I am just curious, like, what is going through your mind? How, how do you get yourself through that 10 minutes? What, what, what is the narrative you're giving yourself while you're trying to administer the CPR to your husband?
Kristin: It was really an out-of-body experience, you know. I kind of have a, like a dual, there's the immediate, like, here's what I need to be doing right now. And, and I'm just kind of very calm, you know, thinking through. Apparently, I don't know, I'm good in an emergency. I don't do anything to be that way. It's just what happens. I just get very calm and start thinking through all the logistics and the, you know, whatever. I was giving 'em the garage door code, and I was telling them which corner of the house we're in and telling 'em the kids are there, you know, all of that stuff. Just sort of the laundry list of things. I think a lot of moms can relate to that if you just switch into that mode of, okay, here's what needs to get done. So there was that piece and then there was another piece that was sort of the out-of-body, just incredulous, right? Like, just couldn't believe this was happening. He was 34. He was perfectly healthy when he went to bed. And this, there's no family history of anything like this. Like there's no reason to think this would ever happen. So I'm just trying to make sense of that. And then also thinking back to..it was like one of those, you know, your life flashes before your eyes, but it was our life.
So I was, I was thinking back to college when we were dating, and then he went to med school. I went to grad school, and we worked really hard to find a spot where we could both go together and, you know, all of that. And, and we had worked really hard through the medical school years and the residency years, and we had finally gotten to this place where all of that was about to pay off. I had started my professional career. He had started his, we had these young kids. We had just gotten a mortgage the month before, and then this. And I was like, this is not how this story was supposed to go. Like, no, this is not. No. So I felt really sad for, you know, the little college version of us that had such this, this bright future envisioned together.
And I remember feeling really sad about that. And then also just like, no, you're not leaving me here. This is not how this goes. So I was thinking of my kids. I think that mama bear instinct got activated. You know, I was like, no way that, you know, in a couple of hours I'm gonna go in that room and I'm gonna tell them they don't have a dad anymore. That's just not an option, you know? I mean, none of this is logical because there's only so much that I could do about it, but that's kind of what was going through my mind. and I think that's what, that plus the adrenaline and everything really fueled me to just give it everything I had. And the paramedics- we got to meet with them later and they said when they came in, they saw me, like my feet were coming off the floor with the compression.
Like I was just jumping on him trying to, to, to get, you know, everything where, how it needed to be. Yeah, I don't know. It was just this very weird, it was only 10 minutes, but it felt like a lifetime, obviously. And it was this weird kind of time warp of like thinking back to our past together and everything we had been through and built together. And then thinking ahead to the future and will my kids grow up without a dad? And, you know, what am I gonna do, having to support them all on my own? And, you know, he had gotten cancer twice before he was even 30, so he has no life insurance. And, you know, it was just all of those things- the logistics and the emotional pieces. And it just was sheer instinct, you know, thank goodness for adrenaline and, and for that mama bear instinct, I think that's what really made it possible.
Amanda: So we got to hear the 911 call during your keynote speech, and it was just, I mean, you did such an amazing job. I mean, such an amazing job, and I don't know if we have the authority, but if we do have the authority, I would like to nominate you as honorary BAFERD status, which is bad A flipping ER doc. I mean, because you, you, I mean, you saved a life. You saved a very important life to all of us. Like, I don't know, just.
Laura: Well, truly, I think she is BAFERD because what you're describing about going into this emergency mode, that is exactly what we do at work. So yeah, maybe you were meant to do that. That's awesome.
Kristin: Thank you.
Kendra: Yeah, that's amazing, although you probably never knew you were meant to do that, but…
Kristin: Nope, that was never in the plan. I do have anxiety though, so that's kind of like this byproduct, right? Superpower of like, I'm always thinking about what could go wrong, and what we would do about it, and I'm very practiced in that.
Kendra: And mentioning that, it is interesting that you say, you know, I have this side effect of anxiety. I always think about the worst case, but in hearing that, it's interesting because in the article. You wrote an article, and we'll link to it in the show notes, but in it you state, I had just accomplished the hardest thing I ever had to do, but that record was about to be broken again. So tell us what happened next.
Kristin: Yeah, so that was in reference to having to go into my children's room after he was taken to the hospital and just tell them something. And at that point I had no idea if he was going to survive. I had no idea if he did survive, if he would still be, you know, neurologically intact, if he would still be the person that we knew, and if he would remember us, if he would be able to function at all. I had no idea, zero information about any of that at this point.
So I went in, and the normal thing in the morning is to give them a hug, say good morning, maybe help 'em get dressed, ask what they want for breakfast. And, you know, so I was trying to kind of keep it as close to that as possible just to, to help them feel a little safer. And that, you know, the routine is still there. Mom's still acting normal. But obviously I had to explain to them what all these people were doing here and why they saw the flashing lights outside. And you know, where's daddy? How come he's not coming in? And so I had to tell them.
And actually I should back up. There was a paramedic who was assigned to be kind of the liaison between. They, they had taken him downstairs at this point to work on him on the hard floor, and he would go back and forth, this liaison, between helping the paramedics downstairs and then when he had a minute, he would come up and, and update me about what was going on. And so at one point I was talking to him, and he asked me if I had any questions. And I remember, I mean, I was listening to these medical terms, ventricular fibrillation, cardiac arrest, all of this stuff. I didn't know. I, I, at that point, I still thought a cardiac arrest is a heart attack and, you know, just all that same stuff.
But none of that was what my questions were about. My only question that I had for him was, what do I tell my children? Because I thought, you know, you have more experience in this than I do. I've never done this before. You go into people's homes all the time and, and maybe you've come across something that, like, works. Like how do you explain this to eight and five years old? So he did his best to, to answer, and I used some of what he said. And it was just, you know, dad got sick and he needed some special equipment to be able to help him that we don't have here, and they have that at the hospital. And so they took him to the hospital and they're gonna take good care of him there. And, I'm gonna go in a little bit and, and check on him and see how he's doing,
So I was trying to steer away from any signs that would lead. They're very smart kids, and people underestimate kids. They can put pieces together a lot better than you think they will. So I was just trying to steer clear of anything that would indicate that he might not survive, at least at that point. Because I wanted more information first before I gave them. I didn't wanna scare them if he was going to survive. There was no need to make them go through that trauma of thinking that their dad might not survive. But obviously if he wasn't going to survive, I would need to prepare them, you know, as best I could to deal with that. And, and I just didn't have that information at that point. So I just tried to keep it really neutral.
And then, yeah, over the course of the next few days as we got more information, I would try to, you know, give that out in, in small doses in age appropriate ways. But yeah, that was, that was so tricky, and I made mistakes, and there's no, like, perfect way to do any of that where they're just not going to have any emotional effects from it. But yeah, I did the best that I knew how to do in the moment.
Kendra: And I think the fact that you're a mom, just like you said, you alluded to your mama bear instincts. It's, it's on one hand trying to protect them, but then on the other hand, trying to, you know, form that sense of community and honesty and trust, right? It, it's a tricky thing. So a ton of grace there, a ton of grace, but so fast forward and Will survives and makes it through. But in those days following you describe something odd happened. What do you mean by that?
Kristin: Yeah, so when you're in crisis mode, at least when I am in crisis mode, I can't speak for everybody. You know, it's what I described before of just the laundry list of things that need to happen. And so that's where I had been mentally for, I think it was three days that he was in the hospital. Just going through all the things that had to be done. And then when that was over, and he came home and he was, he was okay. You know, he had some, obviously, some memory deficits at the beginning. But they assured us that that all seemed, you know, given everything they knew about his test results and things, that those should go away and he should start getting his memory back.
And so once that was over, then it was like, it hit me. And then my brain had to do the processing of what had just happened. You know, that was when I could really sit and think. And it just, and it's not really voluntary, right? It's just something that happens when you've been through trauma. So, it was strange for me because I lost words, kind of. I mean, I wasn't mute. I could respond to people. I could say things. But unless it was within the context of all those logistics and the day-to-day stuff, I just had the hardest time being able to make sense of what they were saying. I couldn't follow a conversation. They would talk and I would look at them, but it's like a silent film or something, right? Like it just was not going in, and I couldn't really make anything go out either. Like I couldn't participate in a conversation, I couldn't. I had nothing to contribute. And it was just this kind of silence. Right?
And that's something that really interests me and I, I want to look more into and kind of incorporate into my work moving forward is just the, the neuroscience of trauma. And especially as it relates to language, because you know, when you're going through those situations, your brain is allotting resources where they need to go, and language is not necessarily the most important thing. And, and you know, I think there are some studies, and I need to look into this a lot more, but I think there's stuff showing that that happens, right? That that's common in trauma. And there's neurological mechanisms underneath it. So I had, that had never happened before. I had never been in a, a situation as traumatic as this before.
And so I called that my Quiet Place because it was, it was, it just was this silent, you know, no words coming in or out, really hard to make sense of things. And it was not until I found other people's words that had described something similar to what I had been through, that I was able to come out of that.
So that, I mean that, and that's why I think it's important enough to incorporate into my work moving forward is that: the words are what get you out of it. The words are what go away, and then the words are what get you out of it. So they're really important. And what I found was a guide, a lay responder guide, written by a paramedic in Canada. His name is Paul Snobelen. He works in the region of Peel in Canada, and he put together this guide based on all of his experience talking to lay responders who had performed CPR and the questions that they actually had in those moments.
And it's a lot of just, what did I just see? Like why did they turn this color? Why did they make that noise? What, you know, just a lot of the, the very basic logistical questions that to a physician, you know, you guys all learned that a long time ago, and it just seems second nature now. But to a lay person is, is traumatic to see. So that helped.
And then I also found a paper called The Forgotten Patient by Katie Dainty in Kirsty Haywood. And that really put a label on what it was I had experienced. You know, it, it was confusing to me that I was having such a hard time with it. And it was hard to explain to other people because it hadn't happened in my body. It hadn't happened to me, but it did happen to me. It was just a different. You know, I didn't have a cardiac arrest, but I- trauma from that cardiac arrest. And so she, she labeled it that way, as forgotten patients or co-survivors. That's where I got that term. And so that really helped, to be able to have a label because then you can explain it to other people. And it's descriptive, and it gives them an idea of what it's like in a very, you know, just one word does all of that.
And then the last piece that came about six months after. I read Rana Awdish's book, In Shock. And she is a physician and also a patient of serious illness, critical illness. And so she has experienced the healthcare system from both of those angles, and she writes a lot about her reflections on that. Of, you know, the experience, her experiences of the gaps in the system as a patient, and then reflections on that from her physician perspective. And that was really, really helpful because, you know, I mentioned before my experience at the hospital and with the hospital system was as traumatizing, if not more, than the cardiac arrest itself. And so it was really helpful to be able to put words to, to that. And, and to see, it was validating because I, I saw, oh, this is not just me being overly sensitive or something. Right? This is actually a thing, a real thing that other people have experienced too. And her way with language is just beautiful. And so she wrote about it really articulately and, and almost poetically, you know, and so it was, it was nice to be able to kind of put a, a final bow on that piece of it.
So those three things really were what helped me get out of The Quiet Place and, and start to move on.
Laura: Hey, I have a question. So, have you identified the things that happened in the hospital system during his care that were particularly traumatic to you? And along with that, do you have any words of wisdom for those of us who are caring for these patients and their families to help prevent that kind of trauma?
Kristin: Yeah. The good news is it's, it's easy. It's just little things that are currently just overlooked. You know, there's no big overhaul. I don't think that needs to happen. It's just people need to be aware. So for example, I was, I was let in, and I didn't know why I was let in because it was the beginning of Covid. But I just knew that the paramedics had given me a little card that was supposed to give me access. And they had told me, you know, this, nobody's allowed in, but this will let you get in. So it's like hand them my little golden ticket. And even the people at the door didn't know why they were supposed to let me in.
And so I asked the receptionist, I mean, the things that you're- I don't know why I was even asking about it, but I asked, why am I allowed in? Nobody's allowed in and they don't seem to think I should come in. And, and she just said I don't know. But then I saw a sign on the door that said, you know, a list of criteria for who could come in. And the only one that fit in my case at all was end-of-life case. That was the first time that I had, you know, just, it sort of just hits you in the face in a really blunt way. You know, like, oh, I'm allowed in because they think he's gonna die, is what I interpreted that to be.
So then she, she brought me in, handed me advanced directive paperwork, and I was like, I think it's a little late for this. I don't know why I need this. She escorted me back into this waiting area, and I'm hopeful that this was just because it was the covid, like very beginning, right? Three months in, no one knew what to do. Protocols were all up in the air at this point, but she let me into this little waiting area, and it was in radiology. And whenever I speak about this to an audience of physicians, I always do a little pop quiz of why that's a problem. Very rarely do people know why that's a problem. And it's that the walls are lined with lead in radiology and so they cut off my cell phone signal.
So here I was all alone cuz no one could come in with me. I couldn't be with him. I was just in the building, and they cut me off from my entire support network outside the building. And I was also the family, you know, liaison for the information. Everyone, of course, is horrified and very worried and scared, and they want information. And so I was doing my best to update them, let alone just try to talk to somebody so I'm not alone, you know? So I, I would leave the room that they put me in where the doctors would come give me updates. I would walk down the hall just a little bit, and I could get, in this spot down the hall where I could get a little bit of signal, but I could still see the door to that room, so I could tell if someone was coming in to give me an update.
So I would use the phone, you know, text or, or call or whatever I needed to do in that spot down the hall. And then I would walk back into the room and wait some more until I needed to use it again. And just kind of do that for a little while. And I don't know how long it was, but it wasn't that long, maybe an hour that I had been there that the same receptionist came and told me that I had to leave the hospital. Because, since I was going out into the hallway there, it was “making people nervous” because they didn't know if we had covid. So, and I was masked, but we didn't know if masks were even effective at that point. So I can see that perspective, but I also think there are way better ways to handle that situation. From the very beginning through to the end there. Like I don't think I needed to be asked to leave.
And then before that, you know, one of those updates, the cardiologist came in. And again, I have zero complaints about any of the medical care he received. I'm very grateful to all of these people for, for the work they did on my husband. And I, and it's a hard conversation to have, so I don't wanna blame or shame anybody. Like this is all just like, you know, me talking to my kids, I'm not gonna get it perfect. I understand. You know, these are hard conversations to have with patients and families, and you know, it's not gonna be perfect.
But one of the things that he told me was that he would have liked it better if I had seen him collapse, because then we would've known how long he was down before CPR started. And that felt like, like blaming me somehow for not doing this correctly, you know? And I know that was not his intention, but that's kind of the point, is that your words have unintended effects sometimes. So you need to be very careful about your word choice. And he also was giving me all the statistics of, you know, only one in 10 out of hospital cardiac arrests survive. And, and just making it seem very bleak. And I think he was just trying to prepare me, like I would've wanted to do for my children, if I'd had the information that he knew in his brain.
The thing is I felt like those were averages, those were, you know, statistics. They were not his individual case because what I knew about his individual case is that I had done 10 minutes of CPR, and I knew that as soon as they got his heartbeat back and got him in the ambulance, he was unconscious, but he was still tearing at the tubes and things that they had on him. And even in the hospital he continued to do that. Like he was showing signs of life and signs of fighting. And he was young and healthy and, you know, had all these things that were going for him. That could have given me a little more hope and a more realistic expectation for his particular case, you know? And none of that was mentioned, and it seemed like, because that was the information he was giving me, maybe he was not aware of that. And so that made it feel like, well, you know, we are fighting. I fought so hard, and he's fighting so hard. How come you're not fighting? Why are you using language that's giving up? You know? And I, I don't think he was medically not fighting, but it just kind of sends that message, you know, of like, I don't know if you’re trying as hard as we are at making him come home,
So just little things like that. And then, once I got home, and over the next three days I was waiting for updates. And of course they're very busy, and it's hard to get updates very often. And then when you do get the updates, you can hear in their voices that they're busy and they wanna get to the next patient, and they're just trying to get off the phone with you. And they're using a lot of language that’s foreign to you. And so you're having to ask them to wait, can you say that again? Or can you spell that, or whatever, so that you can go look it up later so you don't have to bother them with more time on this phone call. And you know, just things like that really make you feel like you're just a cog in this huge system, and you're not the thing that's important, you know? So little, little micro messages like that that just add up.
Amanda: So I didn't even know, I had never heard of this term, but what you're describing as a nocebo effect. There's a placebo effect, you know, that we're all very familiar with that, you know, sugar water, and it makes you better because you believe that it will make you better. Nocebo is, and I know that I've done this and I, I hate it, but I learned about it several years ago. Nocebo effect is when we do that. We give you this, the grim statistics. And we were taught to be upfront and transparent in that way, but there's 1% that makes it, and why wouldn't it be your husband? So that is something that now I am aware of. And, but no, we weren't taught any of that. So I love that you're bringing this up because there are still some people that aren't the 98% that don't make it. And so why on earth would you crush somebody's hopes and dreams? Because it does crush their hopes and dreams when it's coming from somebody of authority like we are.
Amanda: So that was something very huge for me. And then sadly, my dog got hit and was a trauma code, like a trauma in residency, and the emergency vet called me and talked me. I was like, they gave me more attention as the dog owner's mom. And it was so soothing to me. Will said, during your speech, that it happened to YOU. He fell asleep and then woke up after being cooled. Doesn't remember any of it. The person that survived the trauma was you.
Amanda: And that it's just so helpful to like, don't forget about everyone else, including ourselves. For the physicians, there's a parallel between the co-survivor's quiet place that you're describing and the vicarious trauma that we experience many times. And I used to come home and be like, well, I should be grateful that my kids are okay after, you know, somebody's baby just died. But what I didn't realize was that I'm also an innocent bystander involved in a crash.
One of our clients was, she's an OB. You know, an OB is very happy most of the time, but when it's sad, it's devastating. Right? And she said she was riding her bike one time and she. She felt like it was God that told her, like cuz she was talking about, in her mind, she was trying to work it out. Like, listen, no, nothing went wrong. It's like a very responsible semi-truck driver that hit an oil patch and like just took out a bus.
Like it's not, it's nobody's fault, but it happened. And yeah, the voice said to her, you were also in the bus. And I was just like, oh my God. That's exactly what it feels like. And we don't give ourselves credit. We don't allow ourselves to grieve and be human and take care of ourselves too. Do you have any advice, not only for healthcare- delivering, you know, care to the co-survivors, but do you have any advice for us too?
Kristin: Yeah, I, you know, it reminds me of when Will was in medical school. He's always, you know, he has very high standards for himself, and he's a hard worker. And he's ambitious, and he's very hard on himself when he doesn't get to meet his own standards. And, and he is kind of got unrealistic, you know, he, he feels like he hasn't met his own standards, when really he's doing very well.
So I've always had to be the one to say, you know, look, look at all these, just to kind of bring it back to reality, right? So one of the things that I, that I've always said to him since med school is, you know, medical training can consume you. And this career can just consume you, and it, it makes you, you know, this is such a strong identity that you're a physician because you have to build up that really strong identity and the thick skin and, and you kind of compartmentalize things in your mind in order to just get through your day.
But I would remind him often that, you know, don't forget that before you are a med student, a resident, a physician, a nurse, whatever it is before you are that, you are a human. And this career puts expectations on you that are inhumane. They are inhuman, right? Like they are not realistic for human beings. So just trying to give yourself that grace of this is a perfectly normal human response that I'm having, and I'm not some kind of robot or some kind of god, or some kind of, like, unaffected thing. I'm a person and yes, this is going to affect me. And that's a good sign if it's affecting you because it shows you're still in touch with your humanity.
So whatever it means, you know, for you as an individual to be able to keep in touch with your humanity and be able to function and do your job, do that thing. Be very aware and habitual about doing that thing, plugging into your humanity and processing those emotions that come with your job. If that's going for a jog, if that's being in therapy, which I'm a huge advocate for just because you are, you're seeing trauma every day, why wouldn't someone, I mean, there's nothing wrong with being in therapy. It's like taking your car to the mechanic, right? It's just keeping everything well oiled and functioning.
And then especially if you're having something, like continued vicarious trauma, why, you know, why wouldn't you try to be working that out? Just because it's healthy for you. Doctors are some of the worst people at taking care of their own mental and physical health ironically. So that's another thing is I always just had to make sure that he is doing that. And I feel like I've kind of taken on that role now as sort of the internet's doctor's wife of like, don't forget to be, you know, take your vitamins and go to that doctor's appointment and make that appointment with the therapist, stuff like that.
So whatever that is, for each individual person of just making sure that you're not stuffing that in a box. Nothing good is gonna come from stuffing your trauma in a box and not dealing with it. That seems like a good solution in the short term, but it's not in the long term, and it's actually better to just face it. And know that you're stronger than you think you are, and you can handle that.
Amanda: So you're talking, talking to three burnout survivors. This is what we're preaching because we did it the way that we thought we were supposed to, and it's,
Kristin: Yeah, the way the system is, it just. It's brutal, and it's not sustainable. But everybody is so steeped in it cuz it's been that way for so many years that it's hard to get people on the inside to see it or to change it. But, and we come from this model where doctors were deified, right? Like in the fifties and sixties, it was just whatever the doctor says and you don't question the doctor and all of that. Now, we're starting to swing the other way, but in some ways I think that's really good because when doctors are deified, it strips away your own humanity as the doctor, right. By definition, if you're a god, you are not a human, and you are immune to human shortcomings and emotions and all of these things, and that's just not true.
It's just not accurate. And if your patients are not seeing you as a human and you're not seeing you as a human, I don't see how that benefits anybody.
Amanda: It doesn't. It sets up this horrible, perfectionist tendencies, right? That are very maladaptive for us.
Kristin: Yeah. And it leads to, you know, physician suicide problems and burnout and really horrible, serious things.
Amanda: Absolutely. That's why we're here. Thank you for joining us. So we're gonna link to your article because it's beautifully written. Is there any other way that people can get in touch with you, or how do they learn more about you?
Kristin: Yeah, so the easiest way is probably find me on Twitter. I am over there quite a bit. You could just search Lady Glaucomflecken, or my handle is @LGlaucomflecken. I know that's a super easy word to spell, so that's should be no problem. If you just start typing like glaucoma, lady glaucoma. Just think of it that way. It should kind of auto-populate for you. And then my email is listed there, but I'll say it here too. You can email me at [email protected]
Amanda: I love it. Thank you so much for joining us. Do you have any closing thoughts before we close out here?
Kristin: I just want to remind everybody that, to just remember that piece of the shared humanity, right? With yourself, with your colleagues, with patients. And then don't forget the families and the loved ones because patients are not cases, they're people. And they are attached to a lot of other people in the same way that you all are. So, you know, try to remember that. I know the system puts so much pressure on physicians to do so many things in such little time. But just, I don't think it has to take a lot of time to connect with people on a human level and just be speaking, you know, one human to another when you're having these interactions.
Amanda: Well, and ultimately that's why we all went into this. We get sucked up into the metrics and all of that sort of stuff. So it, we need to re-center and I'm, you know, sorry if the metric’s off, but let's do the things that matter to us.
Laura: Make medicine tolerable.
Kristin: Yeah, right. It has become, it is, it's just not sustainable. It's intolerable, and I think a lot of it is the system, not the people within it.
Kendra: We couldn't agree more. Thank you, Kristen, so much for sharing your story. Thank you for your bravery and your courage to share this story over and over again. I can't imagine what it's like because every time you share, you probably relive just a little bit of it every time. But there's such an amazing message that comes for it, from it. And, you know, sometimes our mess becomes our message. But I just really honor you for stepping out, for identifying the things in hospitals and with us healthcare workers that we can always improve on from a co survivor standpoint or from the families that go through the trauma and so much that we can relate to. So thank you, thank you, thank you.
Kristin: And thank you for having me and for the work you all do. I think this is awesome.
Kendra: We are so grateful that you found our podcast today and we want you to stay connected. So go to our website, www.thewholephysician.com, sign up for our Weekly Well Check. It's delivered right to your inbox. And our CME course is live, so head over there to check it out.
And until next time, you are whole, you are a gift to medicine, and the work you do matters.