Dr. Sasha K. Shillcutt - Restoring in 2021: Thriving After a Year of COVID-19

with the departments of anesthesiology, critical care, and pain medicine and general surgery. It is my great pleasure to introduce our speaker this morning, Dr. Sasha Schillcut. Dr. Schillcut is an attending cardiac anesthesiologist and a professor of anesthesia at the University of Nebraska Medical Center. Dr. Schillcut obtained her medical degree from the University of Nebraska and completed her residency in anesthesiology at the University of Nebraska Medical Center. She has been completed in executive fellowship in Parioperative Echo Cardiography at the University of Utah Medical Center. Since completing her training, she has been on staff at the University of Nebraska Medical Center where she is the vice chair of strategy and innovation for the Department of Anesthesiology. She has done a substantial amount of research and has published extensively in the field of Echo Cardiography and cardiac anesthesia. She has also published broadly and is a renowned international speaker on the topics of well-being, resilience, gender equity, and leadership for medical professionals. She has received a number of awards for her achievements, including the American Medical Association's Women Physicians Inspiring Physicians Award. We are so lucky to have her speak to us today. She is going to be talking on thriving after the COVID-19 pandemic. Thank you so much, Dr. Schillcut, and I will turn things over to you. Thank you, Dr. Rhee. That was a very nice introduction. I'm honored to be speaking to all of you this morning, this beautiful day in January, where I just came up to my office and there was a howling wind. I was like, oh goodness, I need to fix this in the next five minutes and somehow the window had opened and there was a gust of air coming in. I thought, okay, this is maybe this is a way of just saying everybody wake up today and you've got to be on your toes. It's like any other day that we have been going through for the last couple several months. And so I'm honored to be speaking with you today and I want to encourage all of you to take the next 30 minutes and go inward, which we rarely do in medicine, especially I think in our specialties where the minute we walk into the hospital, we are thinking of getting our case started seeing that next patient, seeing the patients in clinic, doing rounds. And we're so focused on everyone else in medicine that we rarely take time to take our own pulse. So for the next 30 minutes, I'm going to challenge you to put aside all of the distractions that are going on today, all of the things that you need to fix in the next hour and think about taking your own pulse and really calm yourself this morning. And just like this gust of wind kind of woke me up this morning, I hope I can be that guest of wind for you and wake you up a little this morning. So I'm going to be talking today about really how burnout has impacted a physician's career, but I'm not going to go into immense data because all of you know it already. It's everywhere. We're going to talk about how you can really see strategies individually in yourself and in others to think about how to change the trajectory of your career in a positive manner. And then we're going to talk about resilience and how oftentimes challenges and setbacks, which I think for any of us that is probably we could define 2020 as challenges and setbacks, and have really could inspire us to thrive in 2021. So most of the time, you know, for the first decade of my career, I talked when I stood on a stage or when I gave a talk like this, all I did was talk about everything above the iceberg. All of my grants or my research or my publication, I was doing or, you know, all of the clinical pathways and the practices that we were developing and echocardiography. Everything that I talked about was all of my success. I did would never have stood up in front of such a prestigious group as you all, which you are some of the, you know, finest surgeons and anesthesiologists in our country and talk about any of my failures. I wouldn't have talked about I wouldn't have talked about sacrifices or I wouldn't have talked about things that I have struggled with either mentally, health wise or really overcoming in medicine. All I did was show the, you know, the top of the iceberg, but today I want you to stop and I want you to take your own pulse and I want you to think of what I'm going to talk about in the context of one, an end of one and that one is you. And we're going to talk about all the things underneath the iceberg. So I love this, I love this statement. I remember having this little meme way back in residency above our resident lounge door every time you went in and out, someone had put this statement on a piece of paper. And it would make me laugh and I would think like, okay, I just got to get through residency, you know, and then it was I just got to get through fellowship and then I became a junior faculty and was facing multiple board tests and I thought, okay, I just got to get through all my board exams and become certified and pass my orals and all these things. And then it'll be like the mecca of medicine. And what I found and I'll share with you is that what I did in the first 10 years of my career while I looked really good on paper led me to a place of severe burnout. And in 2013, I would drive to the hospital every day, pull into the doctor's lot, turn off my car at 630 in the morning and cry for about two minutes and think to myself, how am I going to get through this day? And I would go to work just going to the motions, trying to take care of the next patient, trying to do the next answer the next research question, trying to work on my papers at night. And then I would come home, I would pull into my garage, I would turn off my car and I would cry. And I would think the minute I walk in the door, I have four little people who are going to come up to me and they're going to need me. And I don't know how I'm going to get through this night. And that was my life and had become my life. And I had over achieved the iceberg to the point of complete and total burnout. And I hit rock bottom in 2013 and I took a year to change significantly things in my life because I was so scared of the fact that every day I woke up wanting to quit and I'm not a quitter. And so I realized I had to change some things and I know that there are institutional things that lead to burnout and there are individual things that lead to burnout. I'm going to talk about individual strategies today because that's what I feel like I can control and I can help you with today. I know there are leaders listening and I hope from an institutional standpoint, you will take some of what I am talking about and apply it to the people who follow you. So a lot of times when we hear about burnout, there's this generational discussion because older physicians who are listening today who remember what it was like, you know, you have always been working long hours. We've always worked long hours in medicine. We've always taken calls for been in house for 24 to 36 hours. We've always had 16 hour days, but there are definitely things that have changed even in the last 15 years of me practicing anesthesiology that have led to what we call now work compression and that work compression is making us completely emotionally and mentally exhausted by the end of our day. So number one, we have information overload. I don't know if there's ever been a time in the history of having my phone that I have felt the need to be on top of all the information coming at me as it has been in the last year from the way that we walk into the hospital. Just to get into our scrubs has changed in the last year. Every single step that we have taken in the last year has radically changed the way that we send we school our children has changed the way that we get groceries has changed the way that we go to worship in our places of worship or that we travel or that we see family. So basically the way we decompress has changed so that has led to massive information overload and quite frankly we are way too accessible to our work spaces. I mean, I don't know about you, but if somebody sends me an email and I don't answer and say I'm post call so I'm at home, I've been up for 24 hours, I'm at home, they send me an email, they need an answer. Then they start texting and if I don't respond, then they start calling. Now it used to be when I started an anesthesiology 15 years ago, I would go to the hospital, I would work my shifts and I would actually lead my teacher in my O.R. locker. Nobody could get a hold of me, right? So it's there, it's changed in the way that we are viewed as an employee and as a colleague has changed and the information coming at us and the way for people to constantly get to us has radically changed. The second major impact to burn out in 2021 is occupational hazard stress. This has been proven in multiple studies. I mean, this is my everyday patient that you're seeing right here. This is the patient that I take care of and don't even think twice about every day. Now it used to be when I couldn't get some, we couldn't get people off bypass. We said goodbye in the O.R. And now I know my patients because I have taken care of them seven times for bringbacks and ECMO and decannulation and placement of a perk bad. I get to know the family, I get to know all of the players and I'm tied to this person emotionally much more than I was 15 years ago. And that has is the same in almost every specialty of medicine. So the hazard stress and the emotional stress that we take on because our patients are living longer is radically different. And then the lot, the third biggest impact to burn out for all of us is we have limited resources and longer hours. We have to do more in the same amount of time. So, you know, I just did last week, I was on call for 24 hours. I did three hearts in a row and two emergencies. And I got home after 24 hours. And I kept, I delivered everyone to the ICU miraculously with a combined DF of, you know, 15%. And I probably transfused, I don't know, 50 to 60 units of blood and over those patients. Now I came home the next day. And when I logged into epic. There was not a thank you. Nobody said, Sasha, great job. You just delivered, you know, four E's, three, four E's all the way to the ICU and they're stable and they're coming off the grips and they're breathing. Okay. No, that was not the red flag. What I got was Dr. Shulkut, you did use, you forgot to scan blood number X7Y2Z. And you didn't document that the antibiotic was redosed on this patient at 3 a.m. And, you know, the red flags. So everything that we have to do now with the EMR and with documentation is feedback that we are getting. And it's a measure of what it feels like we're doing how we're doing our job, even though that is oftentimes not the case. So burnout has impact, right? It has significant impact over 20% of physicians experience what we call serious mental health problems in their career. 50% of physicians in 2016, the data's gotten a little bit better marginally, but not much, especially for our two specialties. 50% if you ask them today, this is terrifying. Do you want to go to work tomorrow? Do you feel happy in your job if you that you're going to go to tomorrow? Say no. I don't know about you, but that's pretty significantly makes me very worried and sad for the state of medicine. And then we have suicide. You know, this is always the point of the talk when I'm in a live meeting, seeing all of you. I will ask how many of you know someone that has taken their own life and has died from suicide. And everyone almost raises their hand. I can tell you this was a wake up call to me in 2013. I was burned out. I was empty. And I had a colleague who I knew who I respected. I admired. I looked up to. She was someone I wanted to be like, take her own life. And she was suffering from depression for years and untreated and no one knew. And it was the fifth now person in anesthesiology that I have personally known. And it just it just shook me to my core. And it made me say, I cannot keep going at the pace I am. I am completely unhappy. I am falling apart inside. Even though on the outside, I look like everything's I'm holding it together. And it made me change my daily life, how my work life, all of the things I took on. And the most important thing, honestly, it has changed, it has changed the way that I am to others on my team, how I interact with the surgeons I work with, how I interact with my colleagues. So I want you to just take your own. There are many factors that lead to us feeling worn out, certainly in 2020. All of these are like magnified. So it's like, we didn't dilute any doses in 2020. It's like everything we are facing was concentrated. You know, as an anesthesiologist every day, we dilute all of our drugs. There was no dilution in 2020. Everything that came at us was full speed and hardcore. And so lack of community, we've never been more isolated, lack of control. We don't even we couldn't even we couldn't get PPE for a while. We couldn't get tests. We had no idea what was going on with all of the government and and large our governing bodies. We were there wasn't a lot of what seems to be fairness or we were questioning that there were conflict in our values, you know, we all were struggling ethically with different things when we were all thinking, you know, are we actually going to have to determine who gets a ventilator. We had massive amounts of workload more than ever before. And so all of these things were very, very difficult for us more than ever in 2020. And so we know that burnout, the reason that our institutions really care about it is because it's so costly. It's extremely costly. We have levels of care in our health system where one floor has a burnout rate for all colors, all staff, perfusion, pharmacists, tech, nursing physicians, everyone on that floor of about 39%. You go up one level in the staircase. You take one flight of stairs up and the engagement and the turnover level or the turnover, excuse me, at that floor is 12%. So we show up every day and how we are and how are the level of care and the work stress of one floor and the environment of one floor is radically different. And so is the burnout. So this is really, really important. I'm not going to go through all, but for those of you that maybe have not been in a no, you know, there's more than just suicide. There's depression. There's alcohol and substance abuse. Certainly in our specialty and anesthesiology, male anesthesiologists have the highest rate of alcohol substance abuse and suicide of all physicians, all comers, all specialties, all gender. And we also, you know, all of our work stress and becoming burned out can lead to significant broken relationships. You know, you may think this person's doing great at work and they're showing up and they're doing their job, but they may be really suffering in relationships at home. So now I want you to put yourself on the map. All of us are on this map. Okay, this is the burnout spectrum. We are all here somewhere. We may be moving one direction, but all of us are on this map. Okay, we're all either going this direction or we're moving this direction. So I want you to think of yourself now, not your patient, not your colleague, but you and put yourself on this map. So the first thing that happens when we become, when we start to get overly stressed and we are on the pathway of burnout is we depersonalize. And this happens all the time and unconsciously, you know, residents call me and fellows the night before and we talk about our cases the next day and they'll say, oh, you know, tomorrow we have a, you know, reduced sternotomy six times, sternotomy, you know, patient, he's, you know, he's 32. He has this, this is my trial, gravity, and you know, this is this and that. And they're telling me all about the patient and I'll say, what is the patient's name? And they have to go back and look in the chart. They don't even know what the patient's name is because we depersonalize and part of that we do as a protective mechanism. That one happens is we become overly stressed. Now all of us have some amount of stress. Some stress is good. If I didn't know I was, you know, if I didn't have the deadline of bidding this talk together, I probably wouldn't have finished it on time. Right. So some stress is good. But the number one thing that physicians specifically and nurses, nurse anesthetists, everyone sites as the number one reason for stress. It's not the work hours. It is loss of work control. So tomorrow night, I'm on call. I'm backup call. I know I'm backup call. I know I'm going to be barely so whether I come home at two in the morning or 10. It doesn't really, it's not going to really bother me. It's not going to increase my personal stress. I might increase my fatigue, but it's not going to increase my mental stress. However, if I am just in the OR tomorrow and in normal day and I promised my son I'm going to pick up six and take him to a basketball game at seven. And I am there till 10. That is a whole other can of worms. I've now broken promises to my son. We have a strained relationship. I have to call in the middle of my stressful day when I'm helping emergencies and figure out who's going to pick up my son because that was going to be my job. I have to get him to point from point A to point B. I am worrying now in the background of broken promises. So that is loss of work control. It is not that we do not know how to work hard. I mean, whenever I hear that I want to explode. We know how to work hard. All of us have been in the operating room for hours, upon hours, upon hours, taking care of complex, critically ill patients. And you don't find any of us going, I just don't want to work right now. I just, I just need to go home right now. Right. We finished the job. We get it done. That's what we do. So that is what how so we have depersonalization, which is probably just environmental from the practice of medicine. How we model that to people. So what do I do now? I say, what is our patient's name? What is he do for a living? Does he have children? Is he does he have a partner to try to make that a person to bring value to what we're doing? We're taking care of Joe tomorrow. He's a dad of one. He works in tech. He has a mitral valve that's severely stenotic. We're going to take great care of Joe. That is a different value of our day than we have a 12 hour case tomorrow. Then then what happens is we have it's the Swiss trees effect. It's the same that happens with medical errors. It's the same thing with burnout. It's not one thing. It's not one bad call or one bad or interaction that sets you on this path. It's multiple things. What happens is you find yourself burned out. This is important because it wants you to think of yourself. You become completely exhausted. You become completely cynical. Then you become inefficient. Men and women have different expressions of burnout. These are general terms. Not all women, not all men. I understand that. There are some gender differences. Men tend to get cynical first. They get angry. Women tend to withdraw. This may be the male surgeon who's acting out, who's acting really rude, who's not being himself, who's short with everybody, who's yelling in the OR, cussing in the OR. I work with several surgeons on a close basis I have for years. I used to think what is his problem? He is being such an ass today. Now I say, he's really tired. I've got to check in with him. We have conversations and I'll say what's going on. He's like, oh my gosh, Dash. I'm so tired. I haven't seen my wife or the kids in five days. I've been spending the night in the ICU because my patients are really struggling. I've had this complication and then this patient and this happened. I see that they're not a jerk. They're tired. They're burned out. And then what also I see is I'm women are more likely to withdraw. So maybe there's a woman in your department who was very engaged on a committee or very engaged with this teaching and all of a sudden she just starts pulling back. She may get labeled as inefficient, even lazy. She may just be, she's more likely burned out because this is what I want you to remember today, especially if you're a leader. Lazy people don't burn out. They don't. You do not need to worry about the legacy people. Everyone has them in their department. And I'm sure if I could see your faces, some of you are probably giggling right now, but it's true. The people that burn out are your high achievers, the people who are engaged, the people who are working extra who really truly care about their trainees and the department in the morale. That's who burn out. That's who you have to worry about. So if you're like me, I get to the hospital every day at a specific time. I'm so good. And we all are getting to my, my slot in the parking garage and knowing how long it takes me to run into the Starbucks, give eye contact to the brista who can make me my almond milk latte. And so by the time I get up there, it's already made. I just hand her the money. Sometimes I don't even pay. I push you nose. I'm coming back and I'll pay it noon. And then I, you know, run to the hours to get scrub so that I can hurry up and make sure everything's ready and log in and make sure everything is okay overnight with my patient that I can check in with my email and make sure I don't have to put on any administrative fires before I start my day. And heaven forbid something goes awry. Like I can't get scrubs out of the machine or the resident tells me they put the art line in the side of the surgeon's going to harvest or they just gave, you know, accidentally 500 CCs of fluid to my patient heart failure and pre-op. I mean, I can start out my day feeling like a million dollars. And this is what I look like at the end of my day. I mean, how many of you come home feeling like this? And the problem is that we have idolized this. We have idolized this position. We have made this position be the hero of our practice of medicine. If you go into any lounge in any physician lounge or any nurse lounge in any hospital, we're all sitting around bragging and sharing more stories about how tired we are and how long we've been up and how we did this and then we did that. We didn't get this, you know, we haven't eaten anything in 24 hours and we wear it like a medal of honor. And I'm here to tell you, that is not healthy. You know, we're supposed to be all of these things, but this is like impossible. And this is the perfection that we are all trying to achieve is this person that looks like this. If you think of that, we have a lot of things going first in medicine, a lot of things have improved, but we have not been able to fix this. This, okay, you're the hero, you're burned out, you're overworked, you're stressed, you're tired, you're beat up, let's all of us applaud this person and let's teach our medical students that this is what a physician is. I'm just going to, you know, call foul on this right now and say, we haven't changed this and we need to. Okay, so I'm an echocardiographer, I can't ever give a talk with that a little echo. This heart right here is beautiful, as you can see, everything's contracting. You put this heart under stress, no problem, it's going to act appropriately. This is stress, stress is going to increase the contractility, right? It's going to increase the number of red blood cells, leading the aorta. We love it. It's burned out, very different burnout, you know, you've got two myocytes, maybe Bob and Joe they're contracting on each side, not going to handle stress well. So you need to understand this about yourself. This heart can handle stress, this heart can handle someone saying, um, guess what, stone so just got called to a family emergency, I need you to step in and do this case. This heart, how's that, how are they going to handle it? How's this person? So stress and burnout are very different. It's important because I get this question a lot. So I added this slide to this talk that I've given numerous times because I want you to not just see it in yourself, but in others around you, a burned out stress person is over engaged. They're hyperactive. They are acting with urgency. They may have the loss of energy and they typically have a lot of anxiety. And these people chronic stress, we know we've to physical damage, coronary artery disease, diabetes, hypertension, burned out people, yourself or others completely disengaged. This is the person that passes you in the hallway and you know, I've been this person and so I get it. They can't even give you look at you. They don't even have the physical, emotional energy to give someone eye contact because that person may ask them, how are you doing? Right? Like this is this is called what I call the target self checkout line. Like, you know, you don't want to talk to anybody. Not even the person that targets is checking you out. You just want to go to the self checkout. You don't have the energy to physically look someone in the eye. They have blunted responses. They feel totally helpless and hopeless. They have lost the motivation. You know, so this is that person that may have been like going 100 miles an hour for years and years in your department. And now you can't even get this person to show up to a meeting. They have detachment and they have emotional damage and they typically, you know, these things lend to numbing behaviors, which can be alcohol abuse, substance abuse, overeating, anything to escape. And it's really important that you understand the difference because all of us are on this spectrum somewhere. So the positive news now coming at you is that our own ability to be resilient after everything we've gone through in 2020 is immense. Human capacity to build resilience is quite incredible. And it has nothing to do with your personality. It has to do with your choice because some of the most resilient people have signed the most. So you can choose today, even if you're working in an imperfect work environment, I get it. No work environments perfect. Even if you're working with very difficult teammates, even if you're working on an impossible case, you can be and choose resilience today. It's dynamic. It's not like something, you know, we used to think confidence and resilience and all these positive attributes of people were doled out at birth like, okay, Sasha, this is your amount of resilience that you get at birth. And this is your amount of confidence. But we know that that's not true. So what is resilience? It's toughness. It's positivity. It's mental stability. It's all the things that we can choose to embrace despite our circumstances. You know, I think a lot of people are kind of waiting for today. There's a lot going on today. And the reality is that, you know, when you wake up tomorrow, probably for individually in your life, not a lot's going to have changed. But you, you're the choice and your outlook may have changed. And that's the most important thing. Resilience is not people who just see unicorns and glitter all the time. That's a bunch of the lucky. People that are resilience have complications. They have trials. They experience hardship and they experience pain and they experience grief. They have sleep disturbances. They have varying degrees of stress in their day. And, you know, at this point, I normally want to share a story. I'm going to go through this slide and then I'm going to share a story with you. I'm a storyteller. I love telling stories. If you come to any dinner in my family, it doesn't matter who you are. You're going to hear lots of stories because I come from a long family of storytellers. And I think people change when they hear stories. So I'm going to share a very personal story with you today that I typically only share to physician groups. So this day, this study, though, I want to set up for where I'm going. This is a study that was done on surgeon psychiatrists and family practitioners. Basically what they did was they looked at people in the same environment. So they tried to control for the same clinical environment, OR environment. So they took surgeons that worked with the same teams of nurses and texts and scrubs and anesthesiologists and they took family medicine docs that did the same thing. And I think that there was a lot of difference in complications or cancellations of their patients or work stress or work hours. But there was a significant people that were had a positive outlook that got positive peer evaluations by the people they worked with. And they were all said they were much more joyful. And the what they found in all three of these different specialties was that those physicians basically had a positive response to stress. And what that means is they didn't say, oh, yeah, I just had a complication or oh great, my face just got bumped. They just expected to have some of that. So they had realistic expectations other day. So they had a built in margin of error. And the other thing they had was social resources. They had family and colleagues. They cited one colleague that they could confide in when they were having a stressful day or a hard day. And they had a positive response to stress, which means they had a setback. They stayed in that place of grief or feelings of failure or feelings of inadequacy or feelings of imposter syndrome. And then they can't they they moved forward. It's not that they never got knocked down. It's that they got knocked down. They stayed there for a while. And then they got back up. So this is another study that kind of shows the same thing. And the story I want to tell you that in my first year on faculty, we had a lack of leadership. We had a lack of a chair. We had multiple interim chairs. And it was a very difficult time in our department. And actually we had about four interim chairs and five years. So lots of turmoil, a lack of leadership and a lack of clear work structure. And what the call system we had. And when I give this talk to people that aren't surgeons and anesthesiologists, they don't understand this. But I love that all of you do. We had a flat call system where basically we had three to four anesthesiologists every night. I'm called faculty and it didn't matter what the case was. You did it. So I'm a first year out cardiac anesthesiologist. I've just done my fellowship. I'm ready to go in the OR cardiac OR. But I have to do every case that comes in whether that's a three kilo baby or whether, you know, whatever case that is. So this was our system. And to be honest with you, I have always been a high achiever. I had never really failed in my life. And I don't say that bragging. I just, that's the truth. I was AOA. I was chief resident. I just, I was the resident that the faculty would say, oh, you know, pull session. And she should do that case. I loved all the difficult things. I was like, give it to me, bring it to me. I'm not afraid. And of course it was three in the morning because that's when terrible things happen. And at three in the morning, I was doing a very difficult case. And I called for help back up my backup person was an outpatient someone who did outpatient anesthesia, not even been in our hospital. They were just randomly on the call schedule a few times a year. So they were not familiar with our ORs. They were not familiar with the pediatric case. I was doing which was a very was probably one of the most complex surgeries you can do. And I lost the patients airway. The patients airway became completely clotted off with blood. The patient went to Fordhard failure and couldn't ventilate, couldn't ventilate the tube clotted off and long story. The patient died. And I have never felt such despair in my whole life. And I had to face what just happened. And the surgeon at the time was very esteemed older surgeon, very angry. And the minute a clamp went on the aorta thing started going south, he, you know, I was frozen with fear and shocked. And he said, we're going to talk to the family and don't you cry. Because if you cry, everyone's going to know the truth that this is your fault. And looking back, I actually can't believe he sent me. I was pretty devastating on me and it set me up for a lot of things. But I know I know him and he was very angry. I know he probably wouldn't say those words to anyone now. He's changed. But in the moment, he was extremely angry and he was projecting it on me. And I just thought, well, it's my fault. You know, I didn't even think about all the other things that had happened for this outcome. I just knew it was my fault. So I went home the next day and I sat on my couch and I just fell apart. I had never failed like this. I had never experienced something like this. And I just told my husband who called me to check on me. I got a quit. I'm going to type my letter today because I can't go back there tomorrow. And my sweet husband was like, okay, you do whatever you want now in his mind. He was having stroke. Okay, we have loans. You've got to like show up tomorrow, but he was really supportive. And so I went that at my computer and typed my letter with designation. And I was so apologetic and I was so ashamed. And I was so grieving and trauma and shock and I had no idea how I was going to face my partners and my colleagues. So I wrote a letter of resignation. And at about nine o'clock, I was getting I was getting in bed. And the phone my home phone rang. And I thought, who's calling the home phone at nine o'clock at night? I answer it. And it was the oldest member of my department. And this man had a phenomenal career in anesthesiology brilliant. One of the best pediatric anesthesiologist in our department has ever known he could do anything. He was phenomenal. And I don't I wouldn't say he was a mentor to me for years and years. We weren't even that close. But he called me and he said Sasha, how are you? And I couldn't even speak. I just I couldn't even talk. I just cried. And he said, I know how you feel. And I'm going to meet you tomorrow. I still get emotional when I share this story every time. But I'm okay. Y'all don't need to worry about me. Don't don't worry. I cry every time I tell this. And I hope I always do. He said, I'm going to meet you tomorrow in the parking garage. And we're going to walk in together. And he showed up for me and he taught me what was resilience really was. He was the only person in my department, the only person in my department that kept me in my department. If he had not done that, I can tell you right now I would have resigned. I know I would have. Now, I didn't get over what happened in a day. I didn't get over for several years until I realized that I actually had PTSD from this event. And I needed to get some help. But what I did was I thought, okay, I'm going to just achieve myself to a point of achievement. I'm going to become the youngest professor. I'm going to become all these things. And then maybe I can atone for this mistake that I made. Which led me to burnout. And I I shared that story with you because I want you to know that I am more resilient today than I was 15 years ago. There is no way if you told me, you know, 10 years ago when this happened or 12 years ago that I would have shared that story with anyone. Anyone I couldn't even share it with. I was so I couldn't even get through a sentence and I had such shame. I would never have believed you. And now I share that story with physician groups all the time as an example of how we can build resilience. So I know that we're running out of time and I just I'm going to get to my last slide here for you. I want to encourage you that to remove something in your life. If you are really exhausted and you are burned out and you have listened going, I'm exhausted, I'm burned out. This is me. It's not about adding something, you know, it's not about adding yoga. I mean, give me a break, right? We don't need yoga. We don't need modules on wellness. We need to actually remove something in our life and we need to look out for one another and be a community for one another. So I would tell you, you know, mentally check yourself. How's your baseline. This is a day to day thing. When I pull into the parking garage now, it's much different. I put my hands on the steering wheel and I do a minute of breathing and mental check in. And I say, OK, how am I, how am I right now before I get out of this car. How am I. I check on my sleep. You know, how are you sleeping? I check on my partner sleep. And I only care for every day. The people in my view. We can't care for everybody, but we can care for our team, the people in our view that day. How expect to have various stress in one day. That's normal. Bring back laughter. It's OK to laugh after 2020. You know, somebody's laughing and everybody kind of looks at that person. Like what's what are you doing over there? That's not really appropriate. Right. And then there's a lot of evidence that shows that resilient people, people that find wellness and resiliency after horrific things happening that to them, whether that's 2020 to all of us. Or whether that's what happened to me, they find purpose again and they don't find purpose doing everything. They find purpose doing three simple things a day. Give yourself that goal. Do meaningful work for you. Sleep when you can. Be aware of those numbing behaviors we talked about. If you find yourself coming home at night and just Netflix and wine every night with drawing from your family, not being able to have a conversation. Be aware. Just know that. Know that's a sign of burnout. That you're going that wrong direction. Don't underestimate community. Look out for one another. Look across the drape. We are not each other's enemies. We're each other's colleagues and friends. Some of my closest, you know, I spend more time with the surgeons than I do my husband some day, most days. So build that community, build that relationship with each other and then control what you can. So thank you for bringing me on today to speak to you and I will open it up now for any comments or questions. I hope that I've given you something to think about today as you've gone through your day. Thank you, Sasha. That was an outstanding talk. And thank you for sharing your very relatable experiences and reminding us all that especially in the midst of this pandemic, we are all prone to burnout. Just how to recognize that in ourselves and others. Does anyone have any questions or comments? No comments. I know. I know. I think I think it's just been it's a lot to take in this year. And I think if I could always tell people like they're like I'm so tired, I'm so burned out. What do I do? And I always say take something away. Don't add something. Maybe that's a manuscript that you that's going, you know, I kind of cringe on Twitter when the pandemic happened and I saw these people say, oh good, we're going to like publish more because we don't the ORs aren't running. I'm like, okay. Can we just like all take a breather right we're all over a tiver. Let's stop and maybe remove some things. Maybe maybe this next couple months is not the time to that you should work on this manuscript or take on a new project at work, you know, we've all been under such stress and trauma the last year that I think we need to really take a breather and remove things. So if you're feeling that pressure, think about what you can remove in your day. I just want to thank you for this presentation. I think it's excellent. You know, we are doing a lot within our Department of Anesthesiology try to build community and encourage interaction, etc. You mentioned a couple things. Are there are there specific things that you all are doing within your department that attempt to encourage sort of the support and building of community that you sort of refer to in your lecture. Yeah. So we've started two programs and I think you guys have a similar program. We started one called battle buddies that you know the University of Minnesota has published a paper on this. Once COVID hit, they kind of took on the military approach of battle buddies and basically not leaving anyone behind because there's so much data to show that if you have one person that you can talk to just one that can you can be authentic with and share without repercussions of, you know, it coming down on you. It is it shows that those people stay connected and they don't typically tend to burn out or develop negative behaviors or negative disease processes. So we've started a battle buddy. Everybody had to do it. Like even our leaders from trainees to fellows, CRNAs, everybody. And we post little reminders once a week just checking with your battle buddy. It can be a text. It can be anything we've given people a very simple script like three questions. And everybody kind of lasted the beginning, but honestly after the events of the Capitol two weeks ago, there was a lot of talk of, oh my gosh, it was actually kind of nice to have somebody to talk to about how you were feeling. So we've done this battle buddy program very simple, not trying to force wellness on anyone. And then the other thing that we've done, which we needed to do, we probably should have done 10 years ago is have a peer support plan. So we've identified one or two people in each of specialty of anesthesiology that are have a great clinical skills and a great clinical reputation and maybe a little age on them to be a peer support. So, you know, instead of when we have a tragedy and unexpected outcome or a difficult interaction in the OR instead of it just being like, oh, okay, thanks for sharing now go get so and so out of the cast lab. We actually have a plan where we remove that team and we kind of have a debrief and the peer support. We have two peer support persons case somebody's out on vacation or something that can connect with each, each one member of the team. And I think that's really important because what we know about PTSD is first of all anesthesiologist and surgeons have the highest PTSD rates of any specialty. And so we are very prone to it and it's because we have a narrative that forms like the narrative that formed in my mind was all this was my fault. And that narrative takes a couple weeks to form. So it's actually important that if you have a peer support person that you give the person time to recover the team to recover and then you follow up with them in a couple weeks and talk to them and it's not an M&M. It's not a root cause analysis. It's how are you doing because most of the time we have developed false narratives, especially our trainees and they'll say, well, you know, I just feel bad because it was my fault because I gave the insulin and you're like, wait a minute. That had nothing to do with what actually happens. So you can kind of redirect some of those narratives from just a peer simply a peer support system and, and, you know, coming at that angle, not like an M&M or something like that. Thanks. Dr. Schokke, I want to thank you for a wonderful presentation. I think one of the things that we have to focus on is none of us went into medicine to deal with the MR. None of us went into deal with those you talked about, but the blood numbers and what have you. And I think you're talking about personalizing what you were doing and knowing Joe's name and what Joe's history was. You know, that's what we need is a gratification that drove us into medicine and surgery and anesthesia. So I think the other thing that is necessary is, you know, not totally focusing on the minutia of the MR, but trying to help our faculty recognize what they're accomplishing with their patients, with their families and bring some personalization as you said into that because it's that that gives us a gratification and will help, you know, come back to the fatigue and, and the burnout that's an issue for so many people. And are there any ways beyond what you said about personalizing with the patients you're going to take care of the next day, but within the department, we always hear about problems. We never, we never hear about the victories that should be, should be focused upon as well. I love what you said. You, you summarize it very eloquently. I agree with everything and, you know, we have quality and we have M&M and we have all the things that we, you know, on our quality every month, the first thing is all of our discrepancies are shown and all of our, and so we've, we talked about, you know, we need to start. There's some data that actually shows if you tell people they're working hard and you show people they're, they're in medicine, how hard they're working or the level of acuity they're taking care of that in itself is affirmation. So we started doing that. So we started doing some things like, okay, this month, this is how many really acute cardiac patients that we took care of and we, we did well because we don't hear that. And so that's what we're kind of doing at an institutional or department level. One of the things that I have found that has probably been in the biggest change in how I am in the operating room. It is, is asking, I always ask my team, what did you do yesterday? And I kind of do a mini debrief on the day before because I may be working with two people that last night they lost a patient and I don't know that. And I may be judging their behavior or how they're acting based on, you know, it's, it's a new day for me, but it's, it's a day that is, they're struggling and the same with the surgeon. I ask every single day, the surgeon I work with, how was your day yesterday? What did you do? Because most of the time we don't do that with one another, we don't have that personal interaction. And the surgeon may have had a horrific case yesterday or a horrific loss in the ICU or day or stress at home. And it just makes number one us be, it's okay for us to be human and to share. But also I think it brings recognition to the fact that we are people. We are not, you know, the die hard physician that should look like this and be able to take everything. And I just a simple question that I asked my team and the surgeon, the surgical team and the members and the surgical team. And, and it's funny because they kind of all the know what's coming now that I'm going to ask that question. We're going to talk about yesterday, but I think sometimes at the end of our day, we don't have the energy to debrief or we don't, you know, we go home, we don't have the energy to even tell our spouse about our day. And one of my good friends is a therapist and she, one of my best friends is a therapist and she says that she counsels a lot of physicians and a lot of people in medicine and does grief. And she's told me Sasha in therapy as therapists, we learn to listen, have empathy. And then we go home and learn and we also learn the second step, which is how to process what you've heard, what you just experienced. You in medicine don't learn that. She's like, all you, you learn, you hear things, you see things, but you don't ever learn the second step that you actually have to decompress and process it. And she goes in it just stacks up for years and years and years. So I think a simple question of how was your day yesterday, what did you do yesterday, getting people to open up and talk is a simple way that I like to address that. Thank you so much for your talk. I just have one quick question. And then recently, it's kind of a change in environment around this session, using the word burnout, I just heard you've heard of Dr. Talbot using the word moral injury. And whereas burnout and more focuses on the individual that were not enough, that we're burning out, the word higher that we're exhausted, but in reality, you know, we all went into medicine with this positive attitude that we want to help people and it's really the system that is. And so negatively impacting all of us and that is tearing us down that, you know, those inefficiencies that drag us down you mentioned after that long day on called the thing that really was so disheartening it was at the end of it, they're worried about oh, that one unit of blood in those five cases that you didn't account for. So I was just wondering what your thoughts were on that. Yeah, I actually really agree with the writer who kind of first pitched that term. And I think it's absolutely correct and I can tell you I've been publishing on burnout and speaking on it now for about four years. And when I first started, it was all at the institutional level and I give toxic institutional level of, you know, institutional changes. I have moved in the last couple years to kind of talking more individually only because I feel like it's more empowering for you as an individual to know when is enough and when to say no and when to pull back and when to be like, you know, this is not the six months that I'm going to be publishing or being academic. I'm just going to really good show up because I'm struggling and give good care in my OR and that's enough. And also I feel like it's important for us to kind of recognize burnout in our partners. But I totally agree. I think, you know, especially for leadership, if you aren't taking the pulse of your, you know, the first step is take the pulse, know what your burnout or your moral injury. And then you have to have your responses in your department. So you got to have your finger on your pulse and I know you have some phenomenal leaders in your department, specifically, I don't know about surgery, but I do know about anesthesiology, Dr. Vincent and others who have their finger on the pulse and you have some great people who work in this space there. I certainly would defer to their expertise, but I agree. We have to change the culture of medicine and we are the culture of medicine and we cannot keep going at the pace that we are in and expect everything to be different. We just can't and we're brilliant in medicine at changing all these things, but then when it comes down to something like a call schedule and how we work on call, we all just say, well, that's how we've been doing it for 30 years. So we're just going to take 24 hour call so, you know, and we just go our cake and we have to be able to be flexible and we have to be able to say, OK, we took our divisions, pulse or departments, pulse and people are struggling right now. So we're going to flex, we're going to pivot and we're going to go this direction or we're going to try this system and we just we don't do that. And we I think it's because it's exhausting. So institutions, the institutional level, you have to be able to make sure that you're taking the pulse and that even there's studies to show even if you tell the people, we're going to fix one problem. Like we're going to affect fix one pain point a year. That's enough. People will stay. They will stay and they will be engaged if they know you're working on the problem. So I think there's a lot of questions or comments. There's been a lot of very appreciative messages in the chat. I think we'll close things out. Thank you for all the insight that you brought to us today. It's a really, really outstanding talk and thank you everyone for joining us. Thank you. Everyone have a wonderful day. Thanks.