Latest / The Trauma Therapist / What is Medical Trauma with James C. Jackson, PsyD

Transcript

What is Medical Trauma with James C. Jackson, PsyD · The Trauma Therapist

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Speaker 1: Welcome to the Trauma Therapists podcast. My name is Gaming Person.
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Speaker 1: I interview incredible people who've dedicated their lives to helping
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Speaker 1: those who've been impacted by trauma. A big thank you
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Speaker 1: to our sponsors and our guests who are supporting this show.
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Speaker 1: So vive for Grade too and one our folks book
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Speaker 1: back to the podcast. Very excited to have as my
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Speaker 1: guest today, Doctor Jim Jackson. Jim Welcome, Thanks guys.
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Speaker 2: It's really good to be with you today and I'm
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Speaker 2: excited to talk to you today and to your listeners
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Speaker 2: about medical trauma.
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Speaker 1: All right. Jim is a clinical psychologist, researcher, and award
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Speaker 1: winning author specializing in trauma, PTSD, and the psychological impact
0:40
Speaker 1: of critical illness. He serves on the faculty at Vanderbilt
0:44
Speaker 1: University Medical Center, where his work focuses on ICU survivors
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Speaker 1: and the long term effects of medical trauma. Doctor Jackson
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Speaker 1: is the author of Clearance, as well as Reclaiming Your
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Speaker 1: Life from Medical Trauma, his latest book offering a practical,
0:58
Speaker 1: compassionate roadmap for survivors of serious illness and ICU stays.
1:03
Speaker 1: Drawing on clinical experience and patient stories, the book helps
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Speaker 1: readers understand post intensive care syndrome process trauma, and we
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Speaker 1: build a sense of meaning and identity after medical crises.
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Speaker 1: All right, Jim, obviously, just a little bit about you
1:18
Speaker 1: share with the listeners where you're from originally and where
1:22
Speaker 1: you are currently.
1:23
Speaker 2: Yeah, sure, thank you, Yeah, thank you. I'm from southwestern Michigan.
1:27
Speaker 2: I don't know how many listeners you have from Michigan,
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Speaker 2: but I'm from right outside of Kalamazoo, a little town
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Speaker 2: called Portage. And I love Michigan, but when I moved
1:37
Speaker 2: to a warmer locale, living there seemed a little bit
1:41
Speaker 2: less good. And I now live in a place where
1:45
Speaker 2: they don't have six months of winter, and that is
1:47
Speaker 2: in Nashville, Tennessee. I've been here for about twenty five years.
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Speaker 1: Awesome, all right, so we're going to get into the book.
1:55
Speaker 1: I'm really curious how you started out, how you got
2:00
Speaker 1: pulled into this field in the first place, and then
2:02
Speaker 1: more specifically trauma and the effects of critical illness and
2:08
Speaker 1: chronic illness secondarily. But how did it all begin for you.
2:12
Speaker 2: It's a really good question, you know. I have Vanderbilt
2:15
Speaker 2: undergraduates who are in our lab here at Vanderbilt, and
2:19
Speaker 2: often they asked me for career advice, and I wish
2:23
Speaker 2: that I could tell them that it's a linear process,
2:26
Speaker 2: right like you set out down a straight path and
2:30
Speaker 2: you know how it's going to work. In my life,
2:33
Speaker 2: that rarely has been how it happens. I came to
2:36
Speaker 2: Vanderbilt to do a psychology residency at a place called
2:40
Speaker 2: the Vanderbilt VA Consortium. And during those days in two thousand,
2:46
Speaker 2: there was a critical care researcher named Wes Elee who
2:50
Speaker 2: was just starting a program focused on outcomes and ic
2:54
Speaker 2: you survivors, mental health outcomes, and he needed a psychologist
2:58
Speaker 2: and I happened to be one, and we had a
3:02
Speaker 2: baby on the way, and I needed a job. And
3:05
Speaker 2: it was really that simple, you know. I dipped my
3:07
Speaker 2: toe in the water. It felt fine, and then I
3:10
Speaker 2: jumped into the deep end and began to study specifically
3:14
Speaker 2: individuals who had been on a ventilator, on a respirator.
3:17
Speaker 2: Often they'd had a condition called sepsis or something called ards.
3:21
Speaker 2: They were the sickest of the sick, and in dealing
3:24
Speaker 2: with them, what I noted, again this is almost a
3:27
Speaker 2: quarter of a century ago, what I noted was that
3:30
Speaker 2: often they had recovered physically very well, but now because
3:34
Speaker 2: of the difficulties of being in the ICU, they had
3:38
Speaker 2: brand new problems they didn't have before. And often those
3:41
Speaker 2: problems were of a cognitive nature, that is, they had
3:45
Speaker 2: brain injuries. But very often those problems were of a
3:48
Speaker 2: mental health nature. They had symptoms of PTSD, they had
3:52
Speaker 2: symptoms of anxiety, They were worried about their health, they
3:56
Speaker 2: were bewildered by the brand new chronic illnesses that they
4:00
Speaker 2: were now experiencing. And as I began to engage with
4:04
Speaker 2: those patients in research studies and later in the clinic,
4:08
Speaker 2: as I pulled the thread, the story started to kind
4:12
Speaker 2: of unravel, and that was it was a story in
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Speaker 2: which medical trauma. I didn't have that term. Then, you know,
4:19
Speaker 2: people have since started using it. It was a story
4:22
Speaker 2: in which medical trauma played a central role. These were
4:25
Speaker 2: not veterans of combat. These were not survivors of other
4:30
Speaker 2: things that we think of causing trauma, like sexual assault.
4:34
Speaker 2: These were not survivors of auto accidents. They were survivors, though,
4:38
Speaker 2: of a different kind of trauma, medical trauma. And even
4:41
Speaker 2: as those other conditions left to Mark, I began to
4:45
Speaker 2: learn that these life threatening medical conditions left to Mark,
4:49
Speaker 2: and as my work at Vanderbilt evolved, I moved from
4:52
Speaker 2: working with survivors of critical illness to people with chronic illness,
4:57
Speaker 2: to people after complicated surgeries, total populations of all kinds,
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Speaker 2: and the same truth held, and that is, medical trauma
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Speaker 2: was central to their story. It wasn't the only problem
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Speaker 2: that they had for many it wasn't the prime problem,
5:12
Speaker 2: but it was a key problem. And I decided that
5:15
Speaker 2: someone needed to shine a light on this problem, which
5:18
Speaker 2: was really underappreciated.
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Speaker 1: All right, let me pause you right there, so we're
5:22
Speaker 1: gonna get dive into that. I want to take a
5:25
Speaker 1: step back. How the heck did you get into psychology
5:29
Speaker 1: in the first place.
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Speaker 2: It's great question. I wanted to be a sportscaster. That
5:33
Speaker 2: was my passion.
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Speaker 1: I could see that with you.
5:36
Speaker 2: That was my passion. And I was pretty good, I
5:39
Speaker 2: will say I was pretty good on air. But all
5:44
Speaker 2: the technical things that editing back in the day, and
5:47
Speaker 2: the splicing of film and learning to work a camera,
5:51
Speaker 2: that was very intimidating to me. And I wasn't really patient.
5:55
Speaker 2: I'm not actually patient now, but I very much wasn't patient.
5:58
Speaker 2: I really didn't want to be a sports caster if
6:00
Speaker 2: I had to do a lot other than talk, which
6:04
Speaker 2: seemed at the time to be my singular gift. So
6:07
Speaker 2: I changed majors three or four or five times, graduated
6:11
Speaker 2: from college honestly in five years. By the skin of
6:14
Speaker 2: my teeth. I wasn't hugely focused in the nineteen eighties,
6:18
Speaker 2: but I had taken a psychology class or two and
6:21
Speaker 2: I had really enjoyed it, and after running around the
6:25
Speaker 2: barn a few times, it felt like helping people might
6:29
Speaker 2: really be my calling. So I got into a master's
6:32
Speaker 2: program in clinical psychology, a program in Atlanta, Georgia, really
6:36
Speaker 2: by the skin of my teeth. And while I was there,
6:40
Speaker 2: I met the woman that would become my wife, and
6:42
Speaker 2: she has been a great influence on me. She has
6:45
Speaker 2: focused me a lot, she has pushed me, she's empowered me,
6:48
Speaker 2: and with her belief in me, I quickly realized, I
6:53
Speaker 2: think I can do this, and I don't need to
6:55
Speaker 2: stop at a master's I think I'm going to get
6:57
Speaker 2: a doctorate. And before I knew it, I was in California,
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Speaker 2: suing one and that's how it unfolded. I was discouraged
7:03
Speaker 2: at various times, as people are, and honestly This is
7:07
Speaker 2: a strange story, but a true one. Michelle and I
7:10
Speaker 2: were at a Chinese restaurant one day called August Moon,
7:13
Speaker 2: and I got a fortune cookie, still have it somewhere,
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Speaker 2: and it said the fortune said you will prosper in
7:21
Speaker 2: the field of medical research. And I thought, how random
7:24
Speaker 2: is that? Right? Like, wow, very different than you'll find
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Speaker 2: your true love or you know whatever generic fortune cookie
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Speaker 2: say you will prosper in the field of medical research.
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Speaker 2: And really candidly, I did take that as a sign,
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Speaker 2: and I'm happy to say with humility that I have
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Speaker 2: been able to prosper in the field of medical research.
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Speaker 1: What a great story that is. So all right, you
7:52
Speaker 1: talked about the opportunity you had initially. I think when
7:58
Speaker 1: you when you were studying, you said you dip your toe,
8:01
Speaker 1: and then you said you dove in. What about working
8:06
Speaker 1: with these individuals who were experiencing medical trauma? Obviously that
8:11
Speaker 1: wasn't the term at the time, But what about those
8:15
Speaker 1: individuals or that experience drew you or pulled you.
8:19
Speaker 2: Yeah, it's a great question. So in the early days
8:22
Speaker 2: of my work two thousand and one, two thousand and
8:24
Speaker 2: two and three, we were enrolling patients and studies at Vanderbilt.
8:30
Speaker 2: But when we were following them up, and I was really,
8:33
Speaker 2: in those days, the only person that followed them up.
8:36
Speaker 2: I was following them up in their home. So I
8:38
Speaker 2: was driving all over the southeastern United States. I was
8:41
Speaker 2: going to Georgia, Mississippi, Kentucky, obviously, Tennessee, occasionally other places,
8:48
Speaker 2: all the time, multiple times a week. And as I
8:51
Speaker 2: was sitting across the table from these patients, these survivors
8:55
Speaker 2: of intensive care, eating cast or rolls at their dinner table,
8:58
Speaker 2: you know, sitting on the porch after we'd finished an assessment,
9:01
Speaker 2: really getting to know them, I was deeply moved by
9:05
Speaker 2: how derailed their lives were after these illnesses they had experienced.
9:10
Speaker 2: You know, their lives were turned upside down. They were
9:13
Speaker 2: often afraid to go to the er because they were
9:17
Speaker 2: worried that they would be sent back to the ICU.
9:20
Speaker 2: They were reacting to every single noise that they heard
9:24
Speaker 2: because it sounded like a noise in the hospital. You know,
9:27
Speaker 2: they were clearly hypervigilant. And as I got to know them,
9:31
Speaker 2: many of them quite well, I was touched. I was
9:34
Speaker 2: touched by the severity of their problems. I was touched
9:37
Speaker 2: by the fact that they didn't feel like they had
9:40
Speaker 2: any resources or anywhere to turn. And when that happened,
9:44
Speaker 2: I thought, you know, the least I can do is
9:47
Speaker 2: not dip my toe in, but jump in the deep
9:49
Speaker 2: end of the pool and really figure out how we
9:52
Speaker 2: can help those people. And that led to a lot
9:55
Speaker 2: of developments. One thing it led to was to the
9:58
Speaker 2: creation of a clinic for ICU survivors that I co
10:02
Speaker 2: founded with my friend and colleague, doctor Carlo Stephen. It's
10:05
Speaker 2: called the ICU Recovery Center at Vanderbilt, and that clinic
10:09
Speaker 2: has been going for about thirteen years now, and it's
10:13
Speaker 2: been dedicated to ice YOU survivors, and not only them,
10:18
Speaker 2: but to people with life threatening illnesses of all kinds
10:21
Speaker 2: who have complicated problems cognitive and mental health and physically
10:26
Speaker 2: physically driven problems. And people have come to us in
10:29
Speaker 2: the clinic really from all over the United States, from
10:32
Speaker 2: probably thirty different states, and it's been a privilege to
10:35
Speaker 2: try to address these challenges they have. And a recurring
10:39
Speaker 2: theme that I hear from them is when I talk
10:42
Speaker 2: to my PCP, when I talk to my counselor when
10:45
Speaker 2: I talk to my subspecialist about these problems, I'm having.
10:50
Speaker 2: They don't know what to do with me. They've never
10:53
Speaker 2: heard the term medical trauma. They don't know what post
10:55
Speaker 2: intensive care syndrome is, and on and on and on
10:58
Speaker 2: it goes, So.
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Speaker 1: Me, okay, so clarify this if you can. What the
11:08
Speaker 1: hell are we talking about here? So these people go
11:10
Speaker 1: into the ICU, what do they When you think ic you,
11:15
Speaker 1: When I think ic you, you think a high level
11:17
Speaker 1: of care, a high level of amazing care. But a
11:23
Speaker 1: percentage of people are experiencing what we're calling medical trouble.
11:27
Speaker 1: What are they experiencing?
11:28
Speaker 2: It's a great question. Uh, And I should clarify. I mean,
11:32
Speaker 2: I agree with you. I work in the ICU a
11:34
Speaker 2: day or two a week at Vanderbilt, and at Vanderbilt
11:37
Speaker 2: and elsewhere, people get an amazing level of care. And
11:41
Speaker 2: yet that experience of being delirious and having episodes that
11:46
Speaker 2: are you know, essentially episodes of psychosis where people hear
11:51
Speaker 2: things and see things that they think are there but
11:54
Speaker 2: are not really there. Right Like, That's a common phenomenon,
11:57
Speaker 2: and it's very traumatic being on a ventilange and being
12:01
Speaker 2: mindful of the fact that you very well may die.
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Speaker 2: It's hugely traumatic. The nature of the critical illness, which
12:08
Speaker 2: is often Hey, it's Wednesday, and on Monday I was fine, right, like,
12:14
Speaker 2: I was living my best life and I got infection
12:17
Speaker 2: and Wednesday I wake up with a tube down my throat.
12:20
Speaker 2: I have no idea where I am. I have no
12:22
Speaker 2: idea how I got there. Those are the sorts of
12:26
Speaker 2: traumatic experiences that people have and they are left to
12:33
Speaker 2: try to make sense of what has happened. And that's
12:36
Speaker 2: even in the context of the best care. You know,
12:40
Speaker 2: there are some situations where we can do the very
12:43
Speaker 2: best we can and it's still really hard, and critical
12:46
Speaker 2: illness is one of those. Cancer would be another one.
12:48
Speaker 2: I think.
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Speaker 1: So is this something that has been left out of
12:57
Speaker 1: the treatment and care that I see you as delivering.
13:01
Speaker 1: Is this kind of not really frontline care? Is it
13:07
Speaker 1: just are they just thinking, well, we're just dealing with
13:10
Speaker 1: we've got to deal with and I'm sorry, but I
13:14
Speaker 1: mean to be blunt like that, but yeah, people are
13:16
Speaker 1: going to get traumatized.
13:17
Speaker 2: Yeah, I think I think there is a recognition that
13:20
Speaker 2: people will get traumatized and that we shouldn't be fine
13:23
Speaker 2: with that, right, Like, we emphatically should not be okay
13:26
Speaker 2: with that, and that despite our best efforts. There are
13:31
Speaker 2: going to be some emotional injuries, and those injuries are
13:36
Speaker 2: injuries that I think we can attend to thoughtfully in
13:40
Speaker 2: the ICU if we have the resources to do it.
13:44
Speaker 2: You know, for instance, when I see people in the ICU,
13:47
Speaker 2: I'm trying to set expectations. I'm trying to help them
13:51
Speaker 2: brace for what is coming. I'm trying to help them
13:54
Speaker 2: manage their anxiety. We're talking to families about more effective
13:58
Speaker 2: and less effective ways to provide support. So I think
14:01
Speaker 2: all of those things make a difference. Things that you
14:04
Speaker 2: might broadly call trauma informed care interventions, those make a difference.
14:09
Speaker 2: But it's really hard. You know, the nature of the
14:11
Speaker 2: critical illness is hugely hard. And as a consequence of
14:16
Speaker 2: it being hugely hard, you know, the science varies a bit,
14:22
Speaker 2: but you can find studies, many studies of PTSD, in
14:25
Speaker 2: particular in ICU survivors, that would say that it occurs
14:29
Speaker 2: in up to one in five people. You know, there's
14:33
Speaker 2: some studies that would say it occurs in even many
14:36
Speaker 2: more than that. You know, depression and anxiety is common.
14:40
Speaker 2: I think you hit on it. You alluded to this
14:42
Speaker 2: minute ago, and I think you're quite right. For a
14:45
Speaker 2: long time. The paradigm in so much of healthcare has
14:49
Speaker 2: been we are trying to help you. Let's talk about oncology.
14:53
Speaker 2: We're trying to help you survive your battle with cancer. Right.
14:56
Speaker 2: We want you to survive. We want you to survive
14:59
Speaker 2: the ICU, and very often there's a well meaning, but
15:03
Speaker 2: I think misguided dynamic, which is you survived. That's a
15:08
Speaker 2: great outcome. My job is done, yeah, exactly. And often
15:12
Speaker 2: in the ICU patients they don't come back and talk
15:14
Speaker 2: to the doctors who who treated them because they were
15:17
Speaker 2: life flighted from, you know, five hundred miles away. So
15:20
Speaker 2: it's easy to imagine, Wow, they left the ICU, they
15:24
Speaker 2: were pretty happy. I think they must be fine, right,
15:27
Speaker 2: And then when you interact with them, they often say,
15:30
Speaker 2: oh my gosh, like if I knew what would have happened,
15:34
Speaker 2: if I knew what my new life would be like,
15:37
Speaker 2: I'm not sure I would want to have survived. I mean,
15:40
Speaker 2: we don't hear them, but we hear it occasionally.
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Speaker 1: All right, let me just remind everyone I'm speaking with
15:48
Speaker 1: doctor Jim Jackson. He's a clinical psychologist, and we're talking
15:52
Speaker 1: about his book, Reclaiming Your Life from Medical Trauma. So
15:56
Speaker 1: let's get into this book here, and I want to
15:57
Speaker 1: hear some stories. Why did you write this book? First off?
16:04
Speaker 2: Yeah, so I had written a book about long COVID
16:08
Speaker 2: about three years ago now, and the feedback I got
16:14
Speaker 2: from many people, many patients, was it was helpful. It
16:17
Speaker 2: was really empowering. And it occurred to me that these
16:21
Speaker 2: medical trauma survivors that I had been dealing with, and
16:24
Speaker 2: that many of us in the field are increasingly dealing with,
16:27
Speaker 2: that they didn't really have a solid patient facing resource.
16:31
Speaker 2: There was a book or two written for clinicians, but
16:34
Speaker 2: nothing for patients. And frequently I would get emails and
16:38
Speaker 2: other people in the field. I would get emails from
16:40
Speaker 2: people who would say, I think what I've got is
16:43
Speaker 2: medical trauma, but I don't exactly know, and I need
16:48
Speaker 2: a guide, you know, I need a resource. Can you
16:50
Speaker 2: help me? And occasionally it would come to Vanderbilt, but
16:53
Speaker 2: often that wasn't practical, you know, for whatever reason. And
16:57
Speaker 2: I really felt like there were useful things to say
17:01
Speaker 2: to these patients and their families and that it would
17:05
Speaker 2: be be a loving thing, really, it would be a
17:07
Speaker 2: kind thing to develop a guide for them, And that's
17:12
Speaker 2: really why I wrote the book Reclaiming Your Life for
17:14
Speaker 2: Medical traumas dedicated to patients, as dedicated to patients and
17:18
Speaker 2: families who I experience as so resilient and so brave,
17:24
Speaker 2: often in the face of really difficult things. And you know,
17:29
Speaker 2: I think you mentioned practical in the introduction. The book
17:35
Speaker 2: is designed to be very practical. Often in academics, you know,
17:39
Speaker 2: I'm in my office here at Vanderbilt. Often in academics
17:42
Speaker 2: we talk in abstractions, We talk very esoterically about complicated things,
17:49
Speaker 2: and I find that often unhelpful from the point of
17:53
Speaker 2: view of patients. So this is intended a lot of
17:56
Speaker 2: my analogies have to do with food, so forgive me,
17:58
Speaker 2: but this is intend to put the cookies on the
18:02
Speaker 2: shelf where people can reach them, right, Like, this is accessible,
18:06
Speaker 2: and it's a story in the book. It's a story
18:10
Speaker 2: of realism and hope. And would I would hold those
18:15
Speaker 2: two things together, Like, reclaiming your life from medical trauma
18:20
Speaker 2: is no simple thing, right, as you know from interviewing
18:23
Speaker 2: countless people with expertise in trauma and PTSD, reclaiming your
18:27
Speaker 2: life is no simple thing, and making progress is indeed possible.
18:35
Speaker 2: So trying to hold both of those things together, that
18:38
Speaker 2: it's not about rainbows and unicorns. Right, It's not simple,
18:42
Speaker 2: and it's satisfying, and you can find a way to
18:46
Speaker 2: live a meaningful life even in the midst of difficult things,
18:51
Speaker 2: even in the midst of medical trauma. And I think
18:54
Speaker 2: that last idea is really a central theme, really one
18:58
Speaker 2: of the central themes of my life, as somebody who
19:00
Speaker 2: has a chronic illness. That is, in an ideal world,
19:04
Speaker 2: we could take a giant eraser and just make every
19:07
Speaker 2: symptom go away, right, we just erase it from a whiteboard.
19:09
Speaker 2: In the actual world, that's not how it works, and
19:14
Speaker 2: we should seek to reduce suffering, absolutely, But if we can't,
19:19
Speaker 2: there's still a way to live a meaningful life. That's
19:22
Speaker 2: that's the theme of the book.
19:24
Speaker 1: Share with us, Jim, if you can an individual who
19:29
Speaker 1: maybe stood out to you or inspired you, or maybe
19:33
Speaker 1: even solidified this idea of I need to I need
19:38
Speaker 1: to do this work.
19:40
Speaker 2: Some years ago. I appreciate the question, and I'll change
19:43
Speaker 2: the details a bit, as I do in my book
19:45
Speaker 2: to preserve confidentiality. But some years ago we had a
19:48
Speaker 2: patient at Vanderbilt, and I think about her a lot
19:52
Speaker 2: candidly and she had been in in in the Caribbean.
19:57
Speaker 2: She'd been in a place out side of the United States.
20:01
Speaker 2: She'd become rapidly ill young woman, and had been life
20:06
Speaker 2: lighted to Vanderbilt actually from hundreds and maybe thousands of
20:11
Speaker 2: miles away, and she had a profoundly severe critical illness,
20:15
Speaker 2: and among many other things, it resulted in the amputation
20:20
Speaker 2: of most of the toes on one of her feet.
20:24
Speaker 2: And she was young. What we know is that medical
20:27
Speaker 2: trauma can be particularly challenging for people who are young,
20:31
Speaker 2: because if you're ninety years old in the ICU, you
20:34
Speaker 2: kind of expect to be sick, right, But if you're
20:37
Speaker 2: twenty two years old, it's a different thing. So she'd
20:39
Speaker 2: been in the ICU, usually sick, lost most of the
20:41
Speaker 2: toes on her foot, and she was a big surfer,
20:44
Speaker 2: that was a passion of hers. And she struggled a
20:48
Speaker 2: lot with anxiety and depression PTSD as well, believing that
20:53
Speaker 2: she could never reclaim her life right, never return to
20:57
Speaker 2: a meaningful life. And I worked with her, other people
21:00
Speaker 2: worked with her to support her. She was delightful, and
21:04
Speaker 2: she transitioned h away from Tennessee and and did what
21:08
Speaker 2: she did, and a year or so later, I got
21:13
Speaker 2: I got an email from her and it had a
21:15
Speaker 2: had a video attachment, and and I really cried when
21:20
Speaker 2: I when I opened it. It was a picture of
21:22
Speaker 2: her on a surfboard. She was surfing. She's surfing. It
21:24
Speaker 2: was so beautiful. And there was a comment in the
21:28
Speaker 2: email and it said basically, it said, you know, I'm
21:33
Speaker 2: proving that you don't have to just survive after a
21:38
Speaker 2: disruption like this, but you can actually thrive. And and
21:42
Speaker 2: I love that. And you know, if she was with
21:45
Speaker 2: us today, I think she would say that all the
21:47
Speaker 2: reconstituting and dealing with a new identity and dealing with
21:50
Speaker 2: the trauma was was gigantically hard, and that she had
21:55
Speaker 2: found a way to embrace this new life in a
22:00
Speaker 2: manner that reflected real beauty. And so I think of her,
22:04
Speaker 2: you know, honestly, probably not a month goes by that
22:06
Speaker 2: I don't think of her. And in some ways, she's
22:10
Speaker 2: one of many patients in writing this book that I
22:13
Speaker 2: have really wanted to honor. And her story isn't necessarily typical,
22:18
Speaker 2: like not everybody who loses their toes is back on
22:22
Speaker 2: a surfboard a year later, But I think her story
22:24
Speaker 2: is really potent because it shows what can happen, right,
22:29
Speaker 2: what can very hopeful, Yeah, super hopeful.
22:32
Speaker 1: So as I'm looking at this and thinking about this,
22:37
Speaker 1: we have the ICU where this incredible amount of care
22:41
Speaker 1: and depth of care is taking place, and oftentimes or
22:50
Speaker 1: even because of that, people are experiencing trauma. It's traumatic.
22:55
Speaker 1: Like you said, you give us examples of just the
22:57
Speaker 1: fact of being waking up with an imagine that happening,
23:01
Speaker 1: waking up with a tube down your throat. But is
23:06
Speaker 1: there a point at which the ball is being dropped
23:11
Speaker 1: in a sense, are they not providing enough psychological care
23:17
Speaker 1: in that moment?
23:18
Speaker 2: Yeah, I think that's right. I do think that's true.
23:21
Speaker 2: I mean we could we could count on a hand
23:24
Speaker 2: or to the excellent psychologists around the United States who
23:29
Speaker 2: work in an ic setting. My friend Megan Josey at
23:31
Speaker 2: Johns Hopkins, my friend Aaron Hall at Geisinger Medical Center.
23:35
Speaker 2: It's shortlist, though, and where mental health professionals are working,
23:41
Speaker 2: they're making a huge difference. But it's partly a resource problem.
23:45
Speaker 2: I think it's not necessarily a lack of will problem,
23:49
Speaker 2: but it's a resource problem. At academic medical centers there
23:53
Speaker 2: are often many psychologists around, but there are vast numbers
23:59
Speaker 2: of ICUs. The majority of ICUs are not at Vanderbilt
24:02
Speaker 2: Medical Center, They're not at Yale, they're not at MGH, right,
24:05
Speaker 2: they're not at Columbia. And many of the hospital systems
24:10
Speaker 2: that have ICUs don't have a single psychologist on the
24:13
Speaker 2: team at all or hardly any So we've got to
24:16
Speaker 2: find a way to bridge that gap. But I think
24:19
Speaker 2: the other issue is there is still a little bit
24:23
Speaker 2: of a lack of awareness, I think, and that is
24:27
Speaker 2: a lack of awareness of the magnitude of the problem
24:31
Speaker 2: represented in the ICU, And I would I would zoom out,
24:35
Speaker 2: and I would say there's a lack of awareness of
24:38
Speaker 2: the problem represented in so many populations, right in people
24:42
Speaker 2: with autoimmune diseases who were never in the ICU, let's say,
24:47
Speaker 2: but who are battling with the very real trauma of
24:50
Speaker 2: a chronic illness right in a birthing suite where someone
24:56
Speaker 2: has had an emergency C section, right, And that's gigant traumatic,
25:01
Speaker 2: And it's very likely with that patient that in the
25:04
Speaker 2: hospital someone gently and thoughtfully nurtured them. But when they
25:09
Speaker 2: leave and they come back for their follow up, it
25:12
Speaker 2: kind of falls off, right, So I think in general,
25:16
Speaker 2: we need to do better. We need to do better.
25:18
Speaker 2: And one of the things I'm hoping that reclaiming your
25:22
Speaker 2: life for medical trauma will do. The one of the
25:24
Speaker 2: things I'm praying it will do is it will shine
25:27
Speaker 2: a light on what I think is a hugely underappreciated
25:31
Speaker 2: public health problem, right, and that is that trauma isn't
25:35
Speaker 2: just combat, right, Trauma isn't just a motor vehicle accident.
25:39
Speaker 2: Trauma is wide ranging medical experiences. And sometimes that trauma
25:45
Speaker 2: may be a small tea, right, if we want to
25:47
Speaker 2: use that term, and sometimes that trauma might be profound.
25:52
Speaker 2: But I think, you know, what I've learned is I
25:55
Speaker 2: need to be careful and not assume how signal for
26:00
Speaker 2: again to trauma might be, right, because there are some
26:02
Speaker 2: things that my patients had been completely derailed by that
26:06
Speaker 2: I initially thought were not hugely problematic, right, But they've
26:11
Speaker 2: they've rocked their world. Equally, I've had patients who've been
26:14
Speaker 2: exposed to extraordinary trauma and seem to be okay. So
26:19
Speaker 2: there are all these paradoxes, right, And I think the
26:22
Speaker 2: truth is there are people with medical experiences of all
26:26
Speaker 2: sorts where those experiences have left to mark, and crucially
26:31
Speaker 2: that mark leads to lasting struggles in their day to
26:34
Speaker 2: day functioning and in their relationships.
26:37
Speaker 1: As we kind of wind down here, Jim, what is
26:41
Speaker 1: it that allows you to do this work?
26:45
Speaker 2: Yeah? I love the question. I went to see my
26:49
Speaker 2: own therapists just a couple of days ago. Actually it
26:51
Speaker 2: had been a while since I had connected with her,
26:55
Speaker 2: and that was a source of such support. Leaving her office,
27:01
Speaker 2: I realized, you know, I maybe need to get back
27:04
Speaker 2: a little more regularly right than I have been. That's
27:08
Speaker 2: been hugely helpful. I've got a family and friends that
27:12
Speaker 2: support me. I'm part of something called the Critical Illness,
27:16
Speaker 2: Brain Dysfunction and Survivorship Center. It's a research group that
27:21
Speaker 2: is filled with people. We're all pulling in the same direction,
27:24
Speaker 2: and we're interested not only in science, but also in
27:29
Speaker 2: creating a culture where we support each other. And I
27:31
Speaker 2: think the other thing is excuse me, I think the
27:35
Speaker 2: other thing is my faith. I talk a lot about
27:39
Speaker 2: my faith in the book in a way that I
27:41
Speaker 2: think is careful and thoughtful. I never want to impose
27:45
Speaker 2: it on anyone else, but for me, it imbues in
27:48
Speaker 2: me a sense of purpose, and that sense of purpose
27:52
Speaker 2: is what keeps me going right, Like, you can have
27:55
Speaker 2: a strong sense of purpose. And if you ignore boundaries
27:58
Speaker 2: and you don't attend to your own mental health needs,
28:00
Speaker 2: and you ignore warning lights, that sense of purpose is
28:04
Speaker 2: only going to get you so far right, Like, you
28:06
Speaker 2: need more than a sense of purpose. But if you
28:09
Speaker 2: have a sense of purpose, which my faith provides, and
28:12
Speaker 2: you build around you supportive structures and support systems, and
28:18
Speaker 2: when these yellow lights are blinking, you attend to them,
28:21
Speaker 2: I think you can do really hard things. And I'm
28:25
Speaker 2: grateful to be able to do this work. Some years
28:29
Speaker 2: ago I talked about this in the book, and I'll
28:31
Speaker 2: be really quick. I had a car. We'd moved here
28:33
Speaker 2: from California. I had a car and the check engine
28:37
Speaker 2: light went on one day, and I took a post
28:39
Speaker 2: it note. I had some post it notes in my car,
28:42
Speaker 2: and I took a post it note, and I covered
28:43
Speaker 2: the check engine light up and I just kept driving
28:46
Speaker 2: because I was really busy and felt fine, right, I'm
28:50
Speaker 2: not seeing the warning light. And one night, about five
28:54
Speaker 2: months later, the engine seized up and the car started shaking,
28:58
Speaker 2: broke down, and the next day I sold it to
29:01
Speaker 2: the scrapyard for fifty dollars, right, I had ignored the
29:04
Speaker 2: warning lights. And I think what I've realized is in
29:09
Speaker 2: this stressful work caring for people with medical trauma, for
29:13
Speaker 2: me and other providers, there are warning lights, right, warning
29:17
Speaker 2: lights that your life is out of balance. And when
29:19
Speaker 2: your life is out of balance, that's not good for you.
29:22
Speaker 2: But also it's not good for your patients. So I
29:24
Speaker 2: try to be better at checking those warning lights and
29:28
Speaker 2: not covering them up with posted notes anymore, because that
29:31
Speaker 2: doesn't actually serve anyone very well.
29:34
Speaker 1: Then, all right, So as we kind of wind down here,
29:38
Speaker 1: who's the book for?
29:39
Speaker 2: The book is for the many, many patients in their
29:43
Speaker 2: families who are in the throes of medical trauma. As
29:48
Speaker 2: I travel around the country, as I ride in the
29:51
Speaker 2: back of a lift, as I sit next to somebody
29:53
Speaker 2: on the airline. When I broached the topic of medical
29:57
Speaker 2: trauma when I talk about the book, this is a
30:01
Speaker 2: broadly resonant theme with people, right, Like, people say, Hey,
30:05
Speaker 2: I was in the ICU, or you know, my mom
30:08
Speaker 2: has really struggled after that miscarriage, or you know, whatever
30:12
Speaker 2: it might be. When my dad developed dementia, that was
30:15
Speaker 2: really hard on me, right, So people relate to the
30:19
Speaker 2: idea that medical difficulties they leave a mark. So the
30:22
Speaker 2: book is for those people and is practical and accessible.
30:25
Speaker 2: I think the book is also for clinicians who want
30:29
Speaker 2: to quickly get a useful lay of the land and
30:33
Speaker 2: who are open to the idea of learning about a message.
30:37
Speaker 2: That message is man. You know, they're a huge range
30:41
Speaker 2: of problems that we know how to solve, right, like
30:43
Speaker 2: people know how to treat PTSD, right like people know
30:45
Speaker 2: how to treat anxiety and depression. And that's the part
30:49
Speaker 2: that I try to emphasize that we can address these issues,
30:54
Speaker 2: but we can't address them if you don't look for them.
30:56
Speaker 2: So the book is for providers who are interested in
30:59
Speaker 2: learning something that they might not be aware of about
31:02
Speaker 2: medical trauma.
31:03
Speaker 1: Awesome. How do people learn more about you and the book?
31:07
Speaker 2: Yeah, So they can order the book of course on Amazon.
31:11
Speaker 2: It's in any major bookstore as of as of April
31:16
Speaker 2: twenty eighth. They can come to our website www dot
31:22
Speaker 2: icudelirium dot org. They can find me on substack. They
31:28
Speaker 2: can find me on x although I'm not there very
31:31
Speaker 2: much anymore. So the website I seeudelirium dot org. They
31:36
Speaker 2: can find me at Vanderbilt. Again, they can buy the book.
31:41
Speaker 2: If they need support, you know, they can be referred
31:45
Speaker 2: to the ICU Recovery Center. You know, I'm very accessible.
31:49
Speaker 2: If I get a thousand emails on the heels of
31:52
Speaker 2: this podcast, might take me a while to respond, but
31:56
Speaker 2: my commitment is to respond to all of them because
31:58
Speaker 2: I think, honestly, as healthcare providers, it's the least that
32:03
Speaker 2: we can do. I mean, this is a privilege, honestly,
32:05
Speaker 2: and it can be hard, but this is a privilege
32:08
Speaker 2: caring for people with these significant needs, and I am
32:13
Speaker 2: I'm hopeful that as a result of this podcast and
32:16
Speaker 2: many others, that people will reach out and that we
32:20
Speaker 2: will be able to connect them with the resources they need.
32:22
Speaker 2: Because a guy, when they get connected to the resources
32:26
Speaker 2: they need, not surprisingly they get better.
32:30
Speaker 1: We'll have all those linked up here at the show
32:32
Speaker 1: notes page at the Trauma Therapist podcast dot com. Jim
32:36
Speaker 1: sure love to have you back. Thank you so much
32:38
Speaker 1: for being here and the work you're doing. It's inspiring.
32:41
Speaker 2: Yeah, my pleasures. Thanks for your kindness.
32:43
Speaker 1: Thank you, all right, all right, take care