Wednesday, April 20, 2016


        This may be old to some, but I watched a heartfelt video from a presentation Tim Leeuwenburg gave at a few months back on dealing with our vulnerabilities “ALL ALONE ON KANGAROO ISLAND” Without giving the talk completely away he goes through his journey of anguish and shame during a misdiagnosis, leading to a patient who went septic, and subsequently became paralyzed, only to learn a nurse at the receiving facility told the wife she should sue him. After a two-year ordeal (alcohol, suicidal ideation…) he was able to reconcile with his patient and his wife. Later he describes his ability to look differently at life leading to his ability to maintain empathy and compassion at a different level. Sadly, he received the typical support we all do when we endure a tragic situation resulting from our own mistake.
       I began to recall the ACS papers a few years back on burnout in surgeons and the high association with medical errors, subsequent distraction, more errors, abuse and potentially suicide. About the same time the ASA published a paper in 2012 about how rare it is for an anesthesiologist to take the day off after having just witnessed a tragedy in the OR. I recently conversed with a CRNA who relived a story with me, whereby he watched an unfortunate mother die of hemorrhage after a delivery complication, and simply had to move onto the next case. My point is that, last year I chatted with a local Sherriff Deputy who was a State Trooper and asked him how they handle this in the police service. He relayed to me the story of how he was called at 2am on a 10 degree January day to a scene where an intoxicated driver speeding the wrong way on the interstate, slammed into a car with four college coeds. He said he had seen a lot by that point in his career, but nothing prepared him for the scene he walked into. A decade later he remembers vividly that when he arrived, the steam was pouring off the bodies which were severed in two by the seatbelts. I asked if he had to go back to work (like we do). I was surprised when he said that a Police counselor responded to the scene to assess if they were fit for duty. He was clearly not, so they found a replacement for him.  On that note, I asked Dan Linskey (ex Police Chief in Boston and incident commander during the marathon massacre) and he too said their police force relied heavily on on-the-scene therapist to assure that people were fit to go on or needed time to recover. So it seems that our first responder services do a better job of tending to their professionals than we do.
               So back to this video…Dr. Leeuwenburg explains how we are all vulnerable. We often are afflicted by shame or guilt in our profession. These unfortunately unclothe our vulnerability when we are exposed to medical error, administrative frustration (and our less than admirable responses), own expectations, and work-life imbalance. We quickly find a difference between our expectations and reality and are disappointed. As physicians, we idealize perfection and are less than satisfied by “good enough”.  His lessons in the end were to work towards resilience (and not alone but with others). Accept we are not alone in this battle and have empathy towards others who may be suffering (be kind). Be prepared to expose your own vulnerability to help yourself and others. In the end, he displays his transition in dealing with human suffering as he describes his care of a brave fire-fighter with lethal injuries, providing a humane approach and a lasting conversation with the fire-fighter’s wife.

 I hope this video is motivation to change how we deal with tragedy, mistakes and stress in medicine. I really would like to chat with Dr. Leeuwenburg at some point on this.


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