S1: From Kerkow media
S2: coming up on the show, and I think, again, the
S2: biggest way that this changes my practice is to just
S2: have that much more empathy for our patients and our
S2: providers go through together. And so I'm really hoping that
S2: once we can get through some of the severity of
S2: this and have more of it behind us, I really
S2: do think that as a system we'll be able to
S2: look back and not just think about what needs to change,
S2: but how proud we are of how we stepped up
S2: and saved a lot of people, I think. Dr..
S3: Well, we continue with our special Johns Hopkins series focused
S3: on practitioners and processes, on the absolute cutting edge of medicine.
S3: This episode, we're exploring an aspect of care that goes
S3: well beyond the types of physical medical care that comes
S3: to mind when thinking of treatments for severe illness or injury.
S3: One of the reasons that Johns Hopkins is among the
S3: highest regarded health care institutions in the country is that
S3: they treat the whole patient, not just the physical, but
S3: also the mind, the psyche, the emotions of a patient
S3: and the journey to recovery. Today, you'll meet another Johns
S3: Hopkins specialist. But this doctor brings us the edge of
S3: the art in patient psychological care. This is medicine we're
S3: still practicing. I'm Bill Kurtis. First, of course, my co-host,
S3: the quadruple board certified doctor of
S4: internal medicine, pulmonary
S3: disease, critical care and neuro critical care. And my very
S3: best friend, Dr. Stephen Tayback. How are you doing, Steve?
S1: Hey, Bill. Good to see you.
S3: Nice to see you. Looking forward to seeing you in
S3: person very soon.
S1: Right around the corner. It sounds like
S3: our special guest, Dr. Megan Hosie, is an assistant professor
S3: at Johns Hopkins Department of Physical Medicine and Rehabilitation. She
S3: specializes in helping patients adjust to chronic illness, critical illness,
S3: critical illness, survivorship, acute and chronic pain management, neuropsychological assessment
S3: and rehabilitation, fatigue management and health psychology intervention. Welcome, Megan.
S3: It's nice to have you here.
S2: It's great to be here. Thanks so much.
S3: So, Megan, you mind if we get attacked some of
S3: the unique situations that covid has brought us? Because I'd
S3: be interested in some of the new challenges that covid
S3: has brought your work?
S2: Yeah, sure. So just to give you a framework for
S2: what I usually get to do, I usually get to
S2: work in our medical intensive care unit where our patients
S2: are mechanically ventilated and they may be on medications keeping
S2: them alive. Things like these oppressor's. And of course, they
S2: need life
S4: support that might help other end
S2: organ function like
S4: kidneys, etc..
S2: I get called in to work with the team when
S2: we have patients who are
S4: coping with anxiety, delirium, hospital
S2: demoralisation,
S4: any of these things
S2: that might get in the way of their participation with
S2: the medical
S4: team or
S2: with their rehab engagements. And in the wake of covid,
S2: things have been different in a few ways. So of course,
S2: we have everyone taking on and off this PPE and
S2: that can be quite scary for patients. I know. And
S2: some of your previous podcasts, you might have been talking
S2: with my
S4: colleagues about ICU delirium.
S2: Just as a refresher, this is these changes in attention,
S2: increases in hallucinations and delusions that patients might have as
S2: a result of things like infection, medications,
S4: just being
S2: in a bizarre hospital environment. So any time we're walking
S2: in for these patients in this bizarre PPE,
S4: we've
S2: been finding that a really important tweak is to remind
S2: people what it
S4: is, along with the
S2: general reorientation that we're doing. So, for example, we'll tell
S2: people where they are, why they're there, and we'll say,
S2: I'm wearing these masks. And that's to protect us from infection,
S2: for example,
S4: because
S2: patients having hallucinations and delusions don't really understand what that is.
S1: And that that actually is very counterproductive. Right. I mean,
S1: you're already hallucinatory and
S4: delusional and suddenly
S1: somebody comes in with a paper or whatever you're using
S1: for your PPE that would only fuel one's delusion and paranoia,
S1: I would assume, at that time.
S2: We think it's still very early in the process. So
S2: we haven't
S4: been able to debrief or
S2: talk this through with a lot of our patients. But
S2: what we know from previous SARS and H1N1 epidemics is
S2: that people do report those hallucinations and delusions in the
S2: PPE as well as the isolation
S4: are additional
S2: risk factors for negative mental health outcomes.
S1: Aside from introducing yourself any other techniques that can give
S1: you leverage on a patient who might be half in
S1: and half out of
S4: reality to help ease
S1: their mind and their psyche?
S2: I think the main thing that we spend time telling
S2: patients
S4: is you're at Johns Hopkins. And in the context
S2: of conversation, we might say, and now that it's noon
S2: at Johns Hopkins, we'll do X and Y and Z,
S2: for example, if the nurse is breathing or providing a medication,
S2: they'll remind them what they're about to do. They will
S2: briefly mention that they're breathing with the help of events
S2: because often patients don't really have a sense of what's
S2: happening with that. And then finally, a really important one
S2: in the wake of covid is reminding people that their
S2: loved ones may not be in the
S4: hospital because of the
S2: visitor restrictions
S4: and letting
S2: them know, hopefully, that all of their loved ones are safe.
S2: A common delusion for patients is for them to think
S2: that something really terrible has happened to a loved one.
S1: You know, been in practice for twenty nine years and
S1: I've not seen your
S4: position in any
S1: hospital. I've. Work that and I've worked with several over
S1: the years and actually what happens in the academic center
S1: is it takes time to filter down to the community
S1: and ultimately it should, because that's the whole point.
S4: And so right
S1: now, we're in the process of trying to minimize delirium
S1: by keeping our patients awake at all times and minimizing sedation.
S1: But what we don't have is you the
S4: resource from the psychological
S1: support. And so that's something that's being taken care of
S1: as
S4: best we can by nurses
S1: and
S4: physicians. So what advice do you
S1: have to us? Who are we are in this watershed
S1: area where we're trying to keep our patients awake, but
S1: then how are we going to give them the same
S1: kind of support that you were giving when we really
S1: don't have those resources?
S2: I think that right
S4: now my perception
S2: is that we're in a space where we don't give
S2: the nurses and docs a whole lot of time to
S2: be doing this extra emotional support. So that's a big
S2: shift just from a basic psychological and behavioral perspective. Whenever
S2: we ask a person to change their behavior, to stop
S2: doing something, we have to give them something else to
S2: be able to do instead.
S4: Right. And so I
S2: think ABCDE F model is one of the most common
S2: things that we
S4: rely on. So involving family, perhaps
S2: including things
S4: like Zoome and allowing
S2: the family to be a part of the patient's care
S2: whenever possible. Again, that providing really basic reorientation for patients
S2: who are delirious,
S4: ensuring
S2: that the
S4: environment is conducive as
S2: it can be to keeping people alert and awake. So
S2: that means the setting matches the time of day.
S4: So if it's morning, we
S2: have shades open. If it's evening were quiet and really
S2: promoting sleep, I think that that also means just a
S2: mindset that says this person might be having one of
S2: the very worst days of their life. And so
S4: when they're awake, alert
S2: and potentially not fully engaging with us or sort of
S2: what we would say, like refusing or being non adherent,
S2: sort of thinking through with the patients about why
S4: that might be, and sort of
S2: eliciting some ways that we can
S4: change that if the patient's
S2: not delirious.
S3: So getting back to a place that has nurses who
S3: have lots of other things to worry about, who do
S3: you suggest hop in and try to accomplish some of
S3: your recommendations?
S2: Well, I think what we're increasingly finding
S4: is that a lot of these efforts
S2: are what we call transdisciplinary.
S4: So just
S2: knowing the basics of the ABCDE
S4: F Bundall
S2: is something that can be known and acknowledged team wide.
S2: So if anybody comes into the room and notices this
S2: patient hasn't talked to their family member in over forty
S2: eight hours or this patient is sort of sitting in
S2: the dark and appearing delirious, what are the basic environmental
S2: strategies that we can do? I think that that's something
S2: that everybody on a care team can start to pick up.
S2: My area of research is in looking at self-management protocols,
S2: meaning can we teach the patients how to manage their
S2: own anxiety, how to ask the questions in a really
S2: focused way so that they get the information that they're
S2: looking for, for their docs? Can we give them ways
S2: to do self-monitoring of symptoms as they start to go
S2: home to reduce readmissions?
S4: So we're hoping that
S2: partnering with a
S4: psychologist can help the
S2: patients learn to self manage. But we need more data
S2: on that. And I think once we have the data,
S2: then we'll be able to have more places advocate to
S2: have somebody
S4: like me that will help
S2: from not only a monetary standpoint to help administrators understand
S2: why you might need somebody taking care of the mental
S2: health aspects of the patient. But it also would give
S2: the teams more confidence that they don't have to feel
S4: like they have to do all of these
S2: parts. Right. As you were mentioning, the nurses are being
S2: asked to do more and more things all the time.
S2: And so implementing a relaxation strategy or being with the
S4: patient for the full course of event weening
S2: trial is really a lot to
S4: ask them. And so what
S2: we're starting to say is, can we flesh out that
S2: members of the team and make this a more transdisciplinary
S4: effort?
S1: So what strategies do you implement for patients who are
S1: actually in the ICU in terms of anxiety, awareness and
S1: perhaps self-control versus when they finally get out of the ICU?
S4: But what is the difference there?
S1: Or are they are they similar?
S2: So there are some differences. And of course, we can't
S2: treat the anxiety until delirium is treated. So that's sort
S2: of my first step.
S4: Always when I get
S2: to meet the patient is to sort of make sure
S2: they're not delirious.
S4: The next step
S2: might be to learn about what their life was like
S2: before they came to the hospital, including if they have
S2: any mental health history like depression or anxiety and learning
S2: about what they were using to do to help themselves
S2: relax or feel like they
S4: had control
S2: over their
S4: environment before.
S2: So those are all
S4: some of the basics for
S2: patients
S4: who might be having
S2: difficulty liberating from the vents. And if the team thinks
S2: that the primary driver of that is anxiety, mostly what
S2: we're talking about is distraction. So for people with really
S2: acute anxiety. In the face of trouble, liberating from the vents,
S2: we don't work on relaxation
S4: techniques, we don't
S2: focus on
S4: breathing, because the
S2: paradoxical thing is the more the patient thinks about that,
S2: the more scared they get. So we really put into
S2: place a
S4: plan to do
S2: things like zoom with a family member
S4: to get music
S2: going that they really like to have some other stimulating activity,
S4: like coloring anything
S2: else to get their mind off the breathing until they
S2: can liberate from the bends. Once people are liberated from
S2: the vent, it becomes a different ball of wax. Then
S2: we're talking about breathing,
S4: retraining, relaxation
S2: strategies and something that we call exposure to overcome anxiety.
S2: The exposure is something that I get to partner with
S2: physical therapists and sometimes physicians on. We acknowledge that the
S2: patient is feeling more scared. Getting back to doing stuff
S2: after you've had breathing difficulty is inherently scary. We take
S2: it bit by bit
S4: and say breathing is
S2: going to feel
S4: weird.
S2: It might feel like you're a bit dizzy or hypertensive,
S2: but every day we're going to push it a little
S2: harder and you're going to gain your confidence in your
S2: body back.
S1: What are some of the mistakes that US health care workers, physicians,
S1: nurses do at the bedside? What are our
S4: biggest infractions,
S1: if you will, that actually
S4: cause your job to
S1: be harder and escalate the patient's anxiety as opposed to alleviating?
S2: You know, I think that nurses and docs are really
S2: doing anything specifically wrong. Again, I think that this is
S2: some of the environment that pulls for some of the
S2: challenges for patients.
S4: So any time we're
S2: moving around really fast and doing stuff without incorporating
S4: them is a time when
S2: we're setting somebody up for anxiety. So, for example, any
S2: time we're thinking about placing a catheter, any time we're
S2: thinking about doing take care, any time we're thinking about
S2: administering a med on the provider side, this is something
S2: that we do day in and day out all the time.
S2: But for
S4: patients, this is all
S2: brand
S4: new. And so any
S2: time we have the
S4: opportunity to even do
S2: something as simple as next, I'm going to take and
S2: then explain whatever the medication is. This is going to
S2: help you with X and then as a result, you'll
S2: experience Y. So, for example, today we're going to help
S2: put in a catheter.
S4: This is going to help you pee.
S2: You know, it's going to feel like a pinch for
S2: a second and then you might not notice it after that.
S2: You know, these kinds of very simple, looping them into
S2: whatever we're doing throughout the day can help people stay
S4: oriented, stay confident
S2: and still feel like they have some control.
S3: But we're going to take a very quick break. We'll
S3: be right back with the psychological side of ICU stays
S3: with Johns Hopkins, Dr. Megan Hosie.
S2: A moment of your time, a new podcast from Kerkow Media,
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S3: OK, we're back with Johns Hopkins, Dr. Megan Hosie. Megan,
S3: let's talk about covid for a minute. So let's start
S3: here with how you manage the family, the fact that
S3: you couldn't visit your loved one, you were apart, and
S3: you needed minute by minute reports on how they were
S3: doing and you wanted to interact with them. How did
S3: you deal with the stresses on the family?
S2: So for me, the families
S4: were our most valuable asset, again, with
S2: our patients being more deeply sedated in the early
S4: stages of covid recovery.
S2: The families were really our only window to who these
S2: folks were before they became ill. It was the case
S4: until we opened up our
S2: visitor restrictions within the last week or
S4: so that I would spend an
S2: hour on the phone with
S4: families learning about
S2: who their loved one was, what
S4: they were up to
S2: on a day to day basis before they came to
S2: stay with us and really trying to figure out how
S2: can we help this person
S4: be more comfortable now that they're
S2: with us. So learning about things like what brings them joy,
S2: what brings them comfort, what brings them relaxation?
S4: From my vantage point, your work with
S1: family, I think is
S4: paramount because the
S1: families are equally sometimes more anxious than the
S4: patients are, and they
S1: will convey that anxiety
S4: unintentionally to their loved
S1: one when they talk to them in the ICU or
S1: when they zoome with them in the ICU. So if
S1: you can allay the family's fears and concerns
S4: enough or instruct
S1: them on how to communicate with their loved one that's
S1: in the ICU, it's really a game changer. I applaud
S1: what you're doing.
S4: We need to clone you and
S1: distribute you to multiple hospitals in the area.
S2: Well, thank you. I hope that's the case. And I
S2: totally agree with what you're saying.
S4: Family members in most
S2: instances, so want to advocate for their loved ones, so
S2: want them to get the best care possible.
S4: And so there are just a
S2: few things
S4: families do that are
S2: very modifiable, I find.
S4: So a first one
S2: is sometimes patients and families might follow the lead of
S2: providers and get really hung up on specific medications or
S2: specific lab values and really want to be invested in that.
S2: When there are other bigger picture
S4: issues going on in other different
S2: ways, they can support the patient. And so in those instances,
S2: I might say something like, I know how hard this is.
S2: I know you're advocating for your loved one and that
S2: this is scary.
S4: But for just
S2: a few minutes, I'm going to ask you to take
S2: off this medicine hat, this physician hat, this nurse hat,
S2: and I'm going to ask you to put your wife
S2: hat on. Another thing we often
S4: see either if the
S2: patient's family member is on Zoome or if they're in
S2: person is quizzing.
S4: So, you know, the
S2: patient might look uncomfortable. And if we haven't done enough
S2: coaching for the family to say, look, when we go in,
S2: you're going to see X, Y and
S4: Z, and sometimes
S2: that means the patient looks breathless or the catheter might
S2: not be sitting quite the right way. So they might
S2: look like they need adjusting these types of things. If
S2: we don't do that ahead of time, you might see
S2: a family member walk in and do something that looks
S2: like this. Are you having a hard time breathing? Do
S2: you need to get up? Do you need your pillow adjusted?
S2: Are your underwear too tight? And then the patient is
S2: completely flooded and overwhelmed.
S4: So just coaching the
S2: family on how to follow the patient's lead, how to
S2: keep quiet, calm environment, just knowing that patients follow us
S2: if we're scared, they're going to be scared. So us
S2: being confident and calm is the number one way to go.
S4: What we see is our
S1: biggest one of our biggest challenges is Dr.
S4: Google is you have family
S1: members who want to control the situation. They know more
S1: than we do because they've read it online.
S4: And so they have
S1: all sorts of a checklist for the physicians. Why are
S1: you not doing X, Y, Z? It says online you're
S1: supposed
S4: to be, which is
S1: fine for them to question me as a physician. I'm
S1: OK with that. I'm happy to feel those questions. But
S1: oftentimes well-meaning, they'll say to the patient lying in the bed,
S1: your doctor is doing the wrong thing because I just
S1: read it online. You're supposed to be doing X, Y, Z.
S1: How unnerving is that for a patient lying in bed
S1: thinking that they're with the health
S4: care system that's ignoring
S1: what needs to be done?
S2: Yeah, in those situations, I think exactly what you're seeing.
S2: I'm happy to take any questions
S4: you have, and I want us
S2: to think together about how to help your loved ones
S2: feel the most comfortable in this situation. Some of this
S2: stuff is in their control,
S4: like when they get
S2: up for pity, when they do oral
S4: care, some of this stuff is
S2: not in their control.
S4: And so if we kind of let
S2: them have control over the things that they can and
S2: sort of shield them from this other stuff that's not
S2: in their control, we think that that's going to be
S2: better for their mental health outcomes and for their ability
S2: to sort of work with us as we move forward.
S4: How important is
S3: injecting or helping to
S4: inject a positive
S3: attitude into the patient?
S2: So from my perspective,
S4: it's not as
S2: important for the patient to have a positive attitude. I
S2: think the most important thing that a patient should have
S2: is a set of goals and a team of people
S2: who can sort of help them strive towards the goals.
S2: And positive attitudes are things that kind of come
S4: and go throughout
S2: hospitalization. It's totally normal if a patient feels really great
S2: about where they're at one day, have a medical backslide
S2: and feel a little bit
S4: pessimistic the next
S2: day, I think that that's totally
S4: part of the process. The most important
S2: thing I think, to help people cope again is to
S2: just listen to where they're trying to get
S4: to and make sure that
S2: we're doing everything in
S4: our power to get them
S2: to that outcome or to that goal.
S1: I think an adjunct to that which I actually learned
S1: when my father developed
S4: cancer now 20
S1: some odd years ago, and I was going to give
S1: him honestly, this is what you have the statistics
S4: and I could see the color drain
S1: from his face. And my mother look at me and
S1: I realized what was missing from me trying to be honest,
S1: was I was taking away all hope. And what you're
S1: getting at, Bill, is positive attitudes are going to come
S1: and go, right? You're going to have good days, bad days,
S1: discouraging days at the bottom line of the whole thing.
S1: I think it's important that patients feel hope and that
S1: you are able to convey to
S4: them that you have
S1: today. We backslid, but don't let that take you down
S1: a rabbit hole.
S4: This is normal.
S1: You're going to get better and worse, better and worse
S1: and sort of an undulating, oscillating fashion until we get
S1: to the finish line and you will get to the
S1: finish line. Obviously, you don't say these things if it's
S1: clear that there is no hope.
S4: You don't want to mislead patients.
S1: You don't want to do that. But one can't know
S1: for sure on your patients.
S4: Even if they're on multiple
S1: pressors and their kidneys are
S4: failing, there's still reason
S1: for hope. Otherwise, we wouldn't be in the ICU doing
S1: what we're doing. And it's important, I think, to
S4: continually communicate
S1: the fact that we are hopeful
S4: that we have seen people worse than you
S1: who are walking around today and living normal lives. And
S1: that's what we're going to get you to. That's our goal,
S1: is to take you there.
S4: You can't take
S1: away that hope that we all feel as practitioners.
S3: So, Megan, during the year and change of covid, how
S3: did you deal with the
S4: idea that a patient
S3: was watching television and they were watching mortality rates and
S4: sometimes commentators
S3: on TV who really didn't know what they were talking
S3: about and the patient either losing hope or let's be honest,
S3: there were people who weren't in the hospital and they
S3: coughed and they suddenly said, oh, I'm going to die
S3: of covid. So now you multiply. This time someone who
S3: is actually in the ICU, they're watching CNN with all
S3: the numbers on the right hand side and all of
S3: a sudden you're competing with the media for the attention
S3: of the patient. Was that happening a lot during the process?
S2: This is triggering a memory of of May for me.
S2: So I remember one of our amazing nurse practitioners in
S2: the medical intensive care unit saying there was a period
S2: of time where we were calling it fall off a cliff. Right.
S2: They were managing at home, managing at home, and then
S2: all of a sudden they were in the E.D. and
S2: they were being intubated with this. And it would
S4: happen within hours.
S2: So we were having a series of patients
S4: who were sedated
S2: for a longer period of time, were starting to wake
S2: up and we were having conversations with them
S4: that, you know, you've been in the
S2: hospital for this long. You're now a bit weak physically,
S2: and we're helping you train to get off the vent.
S2: So they would be having these very strong reactions to
S2: how long they'd been sedated. How did I even wind
S2: up here? And there were a couple of points where
S2: the nurse practitioner
S4: said people are
S2: panicking when they when we tell them that they're here
S2: because of
S4: covid like they didn't do
S2: this. But there were points where the nurse practitioner was
S2: saying is, is it worse to tell them that they're
S2: here because of covid? So it was scary for a while.
S2: And what I will say is that really quickly,
S4: once people were coming
S2: off the sedation, were recovering, we were pretty able to say, like,
S2: we think you're stable and you're going to have a
S2: good
S4: outcome in a lot of
S2: those situations. We saw a lot
S4: of I think
S2: I would call it like a double edged sword. So
S2: we saw a lot of gratitude and patients just going.
S2: I mean, I was one of the
S4: few who made it in these early
S2: days.
S4: And the other side of
S2: the sword was a bit of survivor's guilt. I think,
S4: like what made me so
S2: lucky. Why did I get to make it, especially in
S2: the early days? Again, we're seeing this less
S4: now, but where we would
S2: have multiple family members affected and perhaps one died and
S2: one didn't.
S1: Dr. Hosie, how has this changed your life and your
S1: perspective on practice? And are you suffering? Do you feel
S1: any PTSD from what you've been through the past year?
S2: I've never seen anything like this ever. And I think
S2: the way that it's
S4: changed my life
S2: is I feel very grateful for the medical system that
S2: I work in. I'm very inspired by all of the
S2: practitioners that I get to work with. I mean, people
S2: who in the early days said I might be negatively
S2: affected by this, but I'm going to put on my
S2: PPE and I'm going to do the best I can anyway.
S4: That's very
S2: inspiring. I think the way that it
S4: changes my practice
S2: in
S4: that it deepens
S2: some of the things that we already knew, how vulnerable
S2: it can feel to be in the hospital, how somebody
S2: whose prognosis or trajectory can change in
S4: a day in either
S2: direction. I think these are things we knew already, but
S2: have seen so much more of it now. I think
S2: you're your final question
S4: was about PTSD.
S2: I mean, I would say
S4: in May and June,
S2: I was having some irritability
S4: and I was
S2: having some
S4: dreams about
S2: my patients and their families. And I think the things
S2: that made it easiest to cope with were my colleagues.
S2: So I have a bunch of psychologist colleagues. I have
S2: Dale Needham and Marty Brodsky, who you've had the opportunity
S2: to talk to already. So and all of the colleagues
S2: in the McHugh. So having that
S4: contingent of people
S2: made it
S4: really OK to like unpack knowing that there
S2: were other people who sort of understood what was happening
S2: and would be able to talk to them about it,
S2: made it
S4: better. What made it
S2: harder at that time, though? I think all of this
S2: is getting easier, made it harder. That time was to
S2: go to
S4: work and see the things
S2: we were seeing and hear the things we were hearing
S2: and then have loved ones or family members kind of say, well,
S2: is it really that big a deal?
S4: Is this really
S2: as hard as everyone says it
S4: is? But I think that there
S2: was some real scary early days. But I think I'm
S2: OK now.
S4: And people like
S2: Dr. Tayback know how to treat this so much better
S2: than we did in the
S4: beginning. At least here at Hopkins, we now have a
S4: funnel of support to
S2: pass our patients along to our most
S4: acute covid team can catch
S2: patients on the other side, which makes us feel a
S2: little bit more confident about their recoveries.
S4: And I think
S2: that, again, the biggest way that this changes my practice
S2: is to just have that much more empathy for our
S2: patients and our providers go through together. And so I'm
S2: really hoping that once we can get through some of
S2: the severity of this and have more of it behind us,
S2: I really do think that as
S4: a system we'll be able to look
S2: back and not just think about what needs to
S4: change, but how proud we are of how we stepped
S4: up
S2: and saved a lot of people. I think,
S1: you know, I just spoke a little bit to our
S1: medical staff and our nursing staff. And I think that
S1: was one of the things that really impressed me the
S1: most is I mean, I always make the comparison to
S1: to the military and there's some training about being forward deployed.
S4: We had no training. One day
S1: you're on your couch watching TV and you're enjoying your
S1: life with your family and then
S4: suddenly you're at war
S1: and nobody asked you. But you are on the front lines.
S4: Certainly the nursing staff is amazing to me how they
S1: just
S4: stepped up, put their
S1: PPE on, stayed at the bedside of the doctors, and
S1: we would jump in the room and out of the room.
S1: You know,
S4: quickly, the nurses are
S1: there feeding patients 20 minutes, 30 minutes, and they're just
S1: accepting the realities and accepting the
S4: risks and taking care of
S1: people like they always do. And you do get this
S1: renewed and heightened sense of respect and admiration for the
S1: people that you work with.
S3: Let me ask you this. After some major battles in
S3: a war, one of the things that the VA has
S3: to deal with is PTSD, sometimes a year or years
S3: later
S4: when it really hits, who's going to take
S3: care of the health care workers and focus on making
S3: sure that after they return from this battle that they're
S3: taking care of.
S4: So I want to stay
S2: humble about what all this is going to look like.
S2: I will say so if you want to read some
S2: interesting stuff on psychological recovery after
S4: trauma or potentially
S2: traumatic events, there's this guy at Columbia
S4: called George Bonanno
S2: and he
S4: researches what we called
S2: trajectories of recovery,
S4: meaning that a certain
S2: proportion of
S4: patients or people
S2: hit a traumatic event and they had already been kind
S2: of struggling. Right. So we would call those people who
S2: have chronic challenges. There were a proportion of people who
S2: are doing just fine before and they might persist and
S4: be find during
S2: a traumatic event. There might be people who take an
S2: early hit in their anxiety,
S4: depression, PTSD
S2: levels, but then sort of normalize.
S4: And long story
S2: short, his research suggests that the majority of people
S4: will return to
S2: some
S4: sense of of
S2: normalcy and not have PTSD, anxiety and depression. So the
S2: lessons that I. For that from this hour, for providers
S2: to just be honest with themselves, if you're struggling a
S2: little bit before the pandemic or if you had
S4: any inklings
S2: towards mental health challenges before, this was probably not going
S2: to help. And so getting your self care and acknowledging
S2: that and getting the people around you who will support
S2: you and not judge you on that is going to
S2: be very important.
S4: Right.
S2: So if you had something
S4: before, this probably isn't going to be super helpful.
S2: I say for everybody, if you are having trouble with
S2: your function, like you're dreading going to work, and that's new.
S2: Like if you never dreaded going to work before and
S2: that persists six months after, this is sort of more
S2: behind us.
S4: That's something to talk
S2: to somebody
S4: about. If you are
S2: having lots of trouble in your relationship in the wake
S2: of all of this. That's something to talk to your
S2: partner and potentially
S4: get some help about.
S2: Just, again, if it's really impacting an important part of
S2: your life in a negative way, get help.
S1: I think that's great advice because, you know, we still
S1: live in a
S4: culture where, you know, just
S1: suck it up and stiff upper lip and go do
S1: what you're supposed to do. And that doesn't really work here.
S4: These are different times.
S1: These are
S4: probably
S1: the greatest cultural adversities that we've all been
S4: facing and we're facing it together.
S1: Getting help probably is not a bad recommendation for most
S1: of us.
S4: Yeah, and I think that
S2: that's a, you know,
S4: stressed, anxious,
S2: uncertain. I think that those are all extremely
S4: normal responses
S2: to all of this. Like I mentioned, I mean, May
S2: and June, I definitely noticed a change in myself and
S2: reached out to help for some colleagues and and stuff.
S2: And my red flags, again, just in case it helps somebody,
S2: is that I was I was feeling irritable,
S4: you know,
S2: in that looked like snapping at loved ones that I
S2: don't usually then that's not usually
S4: me, you know, dreams and
S2: nightmares about patients and families that was
S4: new and just kind of chronically
S2: worrying about this stuff and not being able to put
S2: it away. So those were my red flags to kind
S2: of reach out for help.
S4: And so that's what I would invite
S2: folks to do, is just if you're looking at your
S2: day to day and
S4: seeing this is how
S2: I don't feel like myself or this is the way
S2: my loved ones or the people around me have been
S2: giving me, cuz I think that that's when it might
S2: be time to get some help.
S3: Dr. Megan Hosie, thank you so much for joining us today.
S3: This was enlightening. How can people follow you?
S2: Well I am on Twitter so you can follow me
S2: at Dr. Megan who's OK.
S3: Well, we're trying to inch toward the close of the show,
S3: but I've got to ask you for a health care
S3: provider who doesn't feel comfortable going to their own institution.
S3: Do we know of any directions that they can turn
S3: for help?
S2: I really think going to your own physician is really
S2: a good first step. And there are a couple of
S2: organizations now that can link medical providers who are struggling
S2: in the wake of covid with a psychotherapist free of service.
S2: So I would be happy to send you the links
S2: for those.
S3: We'll put that on our website as well. Thank you
S3: so much, Dr. Megan Hosie. And of course, to my
S3: very best friend, Dr. Steven Tayback. Thank you. Always a pleasure.
S3: Getting a chance to spend time with you, even if
S3: it is through these remote methods. I look forward to
S3: getting back to our brunches. We're Still Practicing is produced
S3: and edited by A.J. Mosley, mastering by Steve Rexburg Music
S3: for We're Still Practicing as composed and performed by Celeste Anorectic.
S3: Don't forget to hit the follow button so you don't
S3: have to hunt around for our next episode. And to
S3: all of you in the field of health care. Thank
S3: you for all you've done and all you continue to do.
S3: We'll catch you next week at. From Kerkow media media
S3: for your mind.