Latest / Style Points / Dumpster Fires with Kristin Horton

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Dumpster Fires with Kristin Horton · Style Points

0:10
anesthesia enthusiasts. And I want to pause,
0:13
actually, to mention that I should have chosen
0:15
a different intro phrase for the podcast. Have
0:18
you ever tried saying anesthesia enthusiasts
0:20
out loud? Try it. I normally have to record several
0:26
different versions for every podcast. In any
0:29
case, welcome to another episode of Style Points.
0:32
We don't have an RSI this month. My co -host,
0:34
Nate Moore, has been very busy representing the
0:37
University of Cincinnati at the ASA, as well
0:39
as doing application review for this year's interview
0:41
season. However, I am pleased to introduce one
0:45
of my friends and colleagues, Dr. Kristen Horton.
0:48
She completed her residency and cardiac fellowship
0:51
here at UC and is the chair of the Clinical Competency
0:54
Committee. She's one of the best crisis managers
0:57
that I know. Without further ado, here's Kristen.
1:03
Okay, you ready? How terrible is stuff like this?
1:10
You don't know that yet. Have you done stuff
1:12
like this before? No. I feel like anytime I'm
1:15
asked to ad -lib questions, I just get jumbled
1:18
sometimes, but that's okay. That's how you write
1:20
the sheet. That is why I wrote the cardiac case.
1:22
That was like literally everything that could
1:24
go wrong did go wrong. But I don't want other
1:26
cardiac people listening being like, that makes
1:28
no sense. Why would you do it that way? It's
1:30
like, oh, JK, I just didn't remember it right.
1:31
I don't think any of the cardiac people here
1:34
will question you. I just don't. Kristen, thanks
1:41
for joining us. Everyone seems to describe you
1:45
as a black cloud. Can you tell me a little bit
1:48
about what that means to you? I feel like it
1:52
is. Kind of just this thing where like if bad
1:56
things are going to happen in a situation, I'm
1:58
probably going to be involved. I feel like I
2:02
get put into cases that everybody's like, this
2:03
should go straight forward. And then it doesn't
2:06
for reasons that are mostly beyond my control.
2:10
And that's kind of been an ongoing thing since
2:12
residency. You always seem to be in seemingly
2:17
insane cases where very rare things that, by
2:20
the way, are not your fault, seem to happen.
2:23
And then you are somehow able to manage it and
2:28
get the patient through safely. That's sort of
2:30
been your calling card for a long time. Would
2:32
you say that that's the case? Yeah. So the thing
2:37
that you call them and what I was excited to
2:40
call the title of this episode is dumpster fires.
2:42
Tell me more about that. I think I initially
2:45
heard the term on one of our ICU rotations when
2:47
I was a resident. It was one of the CCAT fellows
2:50
who had mentioned it. And then, of course, it's
2:52
kind of caught. Caught fire, I guess, and mainstream
2:56
memes and whatnot. Yeah, after COVID, I guess.
3:00
Yeah, exactly. And so it just kind of fit. Like,
3:03
you know, normally we were talking like disaster
3:04
cases or, you know, just a terrible, terrible
3:08
case, you know, when I was a resident. And then
3:09
the dumpster fire thing just really seemed to
3:11
encompass of just like, all of this is going
3:13
terrible. Like, it's fine. This is fine. Everything's
3:15
fine. It's burning down around me, but we're
3:17
okay. Kind of encompassed it. And so we rolled
3:20
with it. What do you think it is? How do these
3:24
cases find you? Is it just bad luck or what?
3:27
I used to think that. Part of it, I think, is
3:31
the fact that I dabble, but I do a bunch of different
3:35
stuff, right? So I did cardiac fellowships. I'm
3:37
taking care of the cardiac cases where just by
3:39
nature, they're higher risk cases. I'm involved
3:41
in liver transplanting. Again, higher, sicker
3:44
people. I do OB. I do the OB combined cardiac
3:48
clinic, which by nature puts you at... the situation
3:52
where you're going to be taking care of these
3:53
high -risk cardiac patients having babies. So
3:55
part of it, I think, is my own doing of just
3:57
keeping the skill sets to get me involved in
4:00
a lot of potential shenanigans. And then I just
4:03
feel like some of it is just, I don't know if
4:05
you'd call it bad luck. I guess for the patients,
4:07
maybe it's good luck that I'm there. But definitely
4:13
just a knack for attracting shenanigans. That's
4:16
fantastic. So tell me about some of the memorable
4:19
dumpster fire cases that you've had. What's given
4:22
you that label? There are too many to think about
4:26
coming residency. We'll start as an attending.
4:28
Four days in, I did my first TAVR as an attending.
4:33
A TAVR is? It's like a transvenous aortic valve
4:37
replacement. At this time, we were still doing
4:39
them under general anesthesia. And for this case,
4:43
he had severe aortic stenosis getting worked
4:44
up for a kidney transplant. And so he comes in,
4:49
he's complaining of chest pain, but she previously
4:52
had a drug -eluting stent placed. He'd had instant
4:55
re -stenosis before. The stent was like three
4:57
months prior. We got an EKG, no ST changes. We're
5:00
going to be in the hybrid operating room anyway
5:02
with fluoro and cath lab capabilities. So we
5:06
discuss a bunch of things. Decide we're going
5:08
to go ahead with the case. We'll do a left heart
5:10
cath beforehand. Cath him. Corners are clean.
5:14
Stents clean. Yay. Let's proceed with the TAVR.
5:17
There are some complications deploying the valve.
5:19
We had to rapid pace him like three or four times
5:21
up to 180 beats per minute. After the last time
5:25
when we got the valve deployed, he stayed in
5:27
VT after we turned the pacer off, never came
5:29
back. EF was like 10. We crashed onto bypass,
5:32
which just happened to be primed. because the
5:36
perfusionist said they were teaching their student.
5:38
They don't normally prime it, and it's the first
5:39
time we had a crash on bypass in two years. So
5:42
I call in my backup peeps who come racing to
5:46
help and finally get the guy back. We wound up
5:49
leaving on ECMO. And so that was just like a,
5:52
okay, great. This is continued from residency.
5:56
I've had malignant hyperthermia after a wisdom
5:59
tooth extraction. otherwise relatively healthy
6:01
young person i remember seeing that poster yep
6:04
um what else did we do we did um a liver transplant
6:08
that got anaphylaxis before the case started
6:10
uh plenty of nightmare cardiac cases um a severe
6:16
pulmonary hypertension patient getting a c -section
6:18
that crashed onto ecmo anticipated we'd plan
6:21
but still it's a wide variety You've done so
6:27
many of these dumpster fire cases that you actually
6:29
have stickers. Is that correct? Correct. Tell
6:32
me about the stickers. So this actually started
6:34
on a very slow OB day, which is not common for
6:37
me. When me and the current OB fellow, or previous,
6:41
I guess, OB fellow current at the time, were
6:42
talking about just the shenanigans. that i tend
6:46
to get into and we were actually talking about
6:49
tavers and so she had actually brought up the
6:51
idea of that she had seen some dumpster fire
6:54
stickers on etsy and we should hand those out
6:56
for taver cases um that we were in but those
7:00
don't always go that crazily um and so we got
7:05
a sheet of these stickers and i started handing
7:08
them out to page to the residents And some attendings
7:11
who have survived these dumpster fire cases with
7:14
me at the end. So we debrief, we talk about all
7:16
the things. And then they get to pick their color
7:19
of dumpster fire sticker because I think there's
7:20
like nine of them. Excellent. And the first two
7:24
residents really thought it was kind of fun.
7:27
It's some kind of a badge of honor. Like, I don't
7:30
want to have to be here, but if I am, this is
7:32
kind of cool. And so they started wearing them
7:33
on their badges. And I had two residents that
7:36
every time we were paired together, shenanigans
7:38
ensued. So we were the dark cloud duos, essentially.
7:42
And so as they were collecting these dumpster
7:44
fire stickers, they had gotten four or five at
7:48
the time. And so I was like, OK, if you get five
7:50
dumpster fire stickers, you're going to graduate
7:52
to a dumpster phoenix. And so I presented them
7:56
with a. uniquely made dumpster phoenix lapel
8:01
pin at graduation, which they thought was hilarious.
8:04
And we've continued to do so. And I now have
8:05
three dumpster phoenixes that I have mentored.
8:07
That is fantastic. Do you have their names? Do
8:12
you know who the dumpster phoenixes are? Can
8:14
you tell us? Cameron Harmon, who was an oral
8:16
prior resident. Sean Nguyen, who's currently
8:17
one of our faculty now. And then Jamie McGrath,
8:20
who's doing a cardiac fellowship. Yeah, yeah,
8:22
that certainly tracks. I can certainly imagine
8:25
all three of them being dumpster phoenixes. You
8:30
basically graduated during my first year of being
8:34
an attending. And then you did your cardiac fellowship
8:37
during my second year of being an attending.
8:40
And right after that, you won the Golden Apple
8:43
Teaching Award your first year out. And you've
8:46
been involved in the residency ever since. And
8:48
also you took over the clinical competency committee
8:51
for me. With all the time that you've spent teaching
8:54
and helping residents. through these disaster
8:58
situations, how do you stay calm in those moments?
9:02
I think a lot of that goes way, way back to when
9:07
I was a kid and how we got interested in medicine,
9:09
which is a little bit of a different story. But
9:12
my grandmother used to basically say like, look,
9:16
you have to stay calm in these situations. Like
9:18
calm may save you, panic is going to kill everybody.
9:23
What kind of situations were you in when you
9:25
were a kid that calm was going to save everybody?
9:29
My Nana lived on a dirt road in the middle of
9:32
nowhere. The closest hospital was about a 45
9:35
-minute ambulance call away. And in the summer,
9:38
people would come careening off this dirt road
9:40
into her yard. We were living with her at the
9:43
time. I was about seven. And so we would go out
9:45
and pull people out of these cars, out of the
9:47
ditch, and basically triage them until the ambulance
9:49
would get there. We're holding pressure on lacerations.
9:54
People are bleeding everywhere. People are screaming.
9:57
I'm seven. We're trying to help. Right. And it
10:02
didn't happen like a ton of time, but it happened
10:03
enough. That was where my initial interest in
10:06
medicine started, too. But it was like, you got
10:08
to stay calm. Was it like a weekly thing that
10:10
there was a. Big disaster outside your house?
10:12
At least once or twice a month in the summer.
10:15
I feel like that's a pretty good gauge. This
10:18
seems like a failure of civic engineering. It
10:21
was. And they eventually just totally bypassed
10:24
that. So now it's a dead end road. And they paved
10:26
over and did a highway nearby. That's probably
10:29
better. Yes. But it took a while. And so I think
10:33
just from then, it was almost like a switch would
10:35
flip. And so I just try to take out any emotional
10:37
investment and just think. And I feel like that
10:41
helps. And then going through med school and
10:45
like rotations and seeing the other anesthesiologists
10:48
when I was doing those rotations, you know, things
10:50
hit the fan and everybody's panicking. I feel
10:52
like everybody in the OR looks to the anesthesiologist
10:55
to be the calm one. And my mentors and the people
10:59
I really respected were always just like super
11:01
calm. And so I think trying to prepare for things
11:05
and being pretty confident in my training helps
11:07
me at least outwardly. model calm because if
11:09
you are also outwardly panicking uh everybody
11:12
else maybe too that makes a lot of sense and
11:15
i've talked to a lot of other anesthesiologists
11:17
on style points about maintaining that outward
11:22
sense of calm even though maybe inside it might
11:25
not be maybe the same um do you find that over
11:31
time you have more of a sense of calm than you
11:34
used to or 100 I think for the vast majority
11:38
of situations. Legit, actually calmer internally
11:43
than when I first started. And some of that's
11:46
just experiencing things and seeing things before
11:49
and kind of knowing what to do and having a wider
11:51
differential and things like that. So how do
11:54
you teach other residents how to prepare for
11:59
these type of situations? I think the first thing
12:02
is to think about. the possibility of getting
12:06
into these situations. I know, like, as a resident,
12:09
soon after I was dubbed the Black Cloud and bad
12:13
things just kept happening, every case I would
12:14
go into, I'm like, okay, what is the nightmare
12:16
scenario that could happen out of this case?
12:18
Like, I know it's a lap appy, but, like, air
12:20
embolus, right? Like, that could happen. And
12:23
so that would be part of the stuff I would focus
12:24
my reading on for that day of, like, I can't
12:27
prevent the disasters, but how can I prepare
12:28
for them? And so talking to the residents about
12:31
even if it's, you know, a basic lap appy, Try
12:34
to think about what could go wrong. I mean, there's
12:36
always the anesthesia things, right? Difficult
12:37
airway, malignant hyperthermia, crazy things
12:39
that we don't expect to see. But what are the
12:42
things that just from a surgical standpoint could
12:44
also go wrong and preparing for that? And having
12:48
read about it or thought about it before, I think
12:50
just in itself lends to a little more feeling
12:53
of I know what's going on and a little less tendency
12:55
to panic and be like, oh, my God, what's happening?
12:58
When you're in some of these critical dumpster
13:01
fire scenarios. One of the things that residents
13:05
say that you'll do is you are still teaching
13:08
even in those moments. How do you get into that
13:12
mindset of teaching and still modeling calmness
13:16
for the team? I just talk out loud. Everything
13:19
that's going through my head, clinically, not
13:23
the emotional side, but everything clinically
13:24
is going through my head. Here's what's happening
13:27
now. You know, I think, you know, here's my differential
13:30
of eight things that could be going on. Here's
13:31
what we need to be thinking about. Here's what
13:33
we need to be doing. Or just here's what I'm
13:37
doing. We'll talk about it in a minute as to
13:39
why, if, you know, time is really of the essence.
13:41
But a lot of it is just going through my thought
13:43
process out loud. And they just tend to be bystanders
13:48
who are benefiting from that. Yeah, that's fair.
13:52
Sometimes residents will be. trying to do things
13:55
to help, but they might be struggling a little
13:57
bit, whether it's putting in a line or with an
14:00
airway. How do you determine where the line is
14:03
for when you need to step in and do something
14:05
versus letting them maybe struggle a little bit,
14:08
making sure that they are getting a good learning
14:12
opportunity from it? I think that's a really
14:14
hard thing to balance sometimes. And that's one
14:17
of the trickier things, I think, for switching
14:19
from like being a resident and becoming an attending
14:21
is knowing where that line is. And I was much
14:24
quicker to jump in earlier than I am now. And
14:28
now I think the biggest thing is patient safety
14:29
or at least patient tolerance, because like we
14:32
do Neuraxial up on OB. Obviously, if the patient's
14:35
not tolerating it well, this is no longer a good
14:39
learning opportunity. Like we need to get this
14:41
in and get this done. So patient safety does
14:44
come first. And I don't want to I will not let
14:46
it get to a point where I don't think I can rescue
14:48
the situation. So if I know they have. low reserve,
14:52
and they're going to desaturate, you know, pretty
14:54
quickly, like you get one shot. If they're an
14:56
easy airway, easy mask, I have no concerns. Sure,
14:59
take two or three as long as we're not damaging
15:01
the airway. Same thing with lines. If you have
15:04
good technique and it's just a struggle with
15:06
getting a wire in or something like that, I'll
15:08
let you keep going. If you can't keep your needle
15:09
in view or you've caused a hematoma or only have
15:11
one or two shots, maybe I step in earlier. That
15:15
makes a lot of sense. You are the chair of the
15:20
Clinical Competency Committee here. That means
15:22
that you are ultimately responsible for checking
15:26
residents off, making sure that they are competent
15:30
clinically across a wide variety of domains.
15:34
But, you know, sometimes residents can struggle.
15:37
You are known, though, for having good conversations
15:40
with residents when they are struggling, and
15:42
you've been a mentor to a lot of people. How
15:45
do you approach... Some of these conversations
15:48
with residents that might be struggling with
15:51
something or who are beating themselves up about
15:54
a situation that didn't go well. Definitely on
15:57
the beating yourself up, I can relate. There's
15:59
a lot of imposter syndrome that I feel like does
16:01
not get talked about very much in this specialty.
16:04
And I think when things don't go well, especially
16:06
with residency and training, your first thought
16:08
is, what did I do wrong or what could I have
16:10
done better? As far as, you know, stuff that
16:13
comes up in clinical competence committee, a
16:15
lot of times I'll go back and try to talk to
16:17
whoever put in evaluations or whoever talked
16:20
to me that would suggest somebody is struggling
16:22
to get their background first. And then I really
16:25
like to do these as sit down things. So I'll
16:26
try to pull the resident aside when we have time
16:29
and we're not, you know, dealing with clinical
16:32
constraints or, you know, in the OR taking care
16:34
of a patient and trying to have an emotionally
16:35
charged conversation. Starbucks is often involved.
16:40
And just sit there and talk like, hey, you know,
16:43
either I heard this or like, you know, I was
16:46
made aware that maybe you're having a little
16:47
bit of a rough time. Like, can we talk about
16:50
this? How do you feel things have been going?
16:53
And then kind of trying to interweave it from
16:55
there to try to get their view on it before just
16:58
jumping in and being like, well, I've heard X,
17:00
Y, Z. That makes a lot of sense. A lot of times
17:04
I find that context is really. with a lot of
17:09
the things that we discuss with the residents,
17:12
making sure that we're on the same page as them,
17:15
making sure that we understand the whole situation
17:19
because often there can be a little bit more
17:22
than meets the eye about any one evaluation or
17:25
situation. So one of the things that I remember
17:30
that we've talked about in the past just in passing
17:33
is sort of your pathway towards medicine. And
17:36
I've always thought it was very interesting.
17:38
I wonder if you'd be willing to share maybe the
17:41
time after you saved all the traumas that showed
17:44
up at your front door and before you made it
17:47
all the way to anesthesia residency. Sure. So
17:52
yeah, so pulling people out of my nana's yard
17:54
was kind of the beginning. She was always very
17:56
interested in medicine, but did not. I had the
17:59
opportunity to even finish, I think, even middle
18:01
school. And nobody in my family had ever gone
18:05
to college, so, of course, med school was a pipe
18:07
dream. But she would watch all these medical
18:10
documentaries, and I always thought it was, like,
18:11
super cool. Got through high school. I went to
18:15
a very small high school. Your career path was
18:18
essentially you could work at the prison, the
18:20
boot camp, or the barge on the river. They really
18:22
didn't talk to you about college. I happened
18:25
to get... An opportunity to participate in a
18:29
scholarship competition from a neighboring county
18:32
college for like underprivileged kids, essentially.
18:37
And so I did that and it was like an interview
18:39
and an essay competition that you had to write
18:41
there and actually won, which was incredible
18:45
because I had previously gone through MEPS and
18:48
was going to join the Air Force to get to college.
18:51
And so they got I got the call that I won in
18:55
March. I guess it was 2006, maybe. Do you remember
18:59
what your essay was about? It was something about
19:03
Martin Luther King. Like Martin Luther King said
19:06
something about, you know, it's a true, a man's
19:09
true character is not revealed in times of peace,
19:11
but like in times of strife. That's definitely
19:15
paraphrasing. But like. We'll accept that. Pick
19:18
three, give three examples of people that you
19:21
think meet this criteria or, you know, fit the
19:23
situation. And so I chose Abe Lincoln, Martin
19:28
Luther King himself, and then one of my personal
19:29
friends as like a historical. Here's why he said
19:32
this. And here's like how we relate this to like
19:35
the common person. And so they thought that was
19:38
good. So, yes, I got that. They said it was going
19:42
to be a Fulbright scholarship. That was super
19:44
exciting. Couldn't believe it. Thought they were
19:45
kidding. Called my mom in tears, I'm pretty sure.
19:48
And I was very excited. Talked to my recruiter.
19:53
He was like. Cool. You haven't gone to boot camp
19:55
yet. Like, you're out. Went to college. Signed
20:00
a contract saying I would do four years or owe
20:02
them money back. Reasonable. Then found out they'd
20:04
never put anybody into med school. They had a
20:07
very successful nursing program, which, great.
20:09
Not what I wanted to do. So I figured out what
20:13
classes I needed to take the MCAT. Took a little
20:16
finagling. Had some professors that really jumped
20:18
in and helped. Had to take physics one and physics
20:20
two at the same time. calculus advanced level
20:24
by myself because they didn't actually teach
20:26
that because we didn't have enough people to
20:28
be in the class. Fun times. Took the MCAT. Didn't
20:32
do so hot. Didn't even apply that year. Took
20:36
a summer off. Taught myself the rest of the organic
20:39
chemistry book and worked construction and built
20:42
cars during that time to pay for things. Managed
20:47
to Get an interview at University of Tennessee
20:51
Health Science Center. I did not know you're
20:53
supposed to apply to like 30 med schools. I think
20:55
I applied to three. Got that interview, went,
21:00
had to do a program during their summer that
21:02
was incredible. That was basically like, we're
21:05
glad you graduated top of your class of college.
21:08
But for all we know, you colored inside the lines
21:09
because they don't have a track record. So basically,
21:13
if you can hack it for this pretend med school
21:15
course in the summer, then we'll let you in.
21:17
And so I did that and that went well. Got to
21:20
med school. Yay. Wow. That that is pretty incredible.
21:27
And as one of the associate program directors,
21:31
I I read personal statements all the time. And
21:34
I I was I wouldn't have been in the. program
21:40
director's office at that time when you were
21:42
applying, but I would have loved to see a personal
21:44
statement like that. I bet that was a really
21:48
good one. I like to think so. I got asked to
21:51
talk about the road, and one of the people interviewing
21:53
asked me to comment on the cabinets they were
21:55
building for their kids' room. I was like, you
21:58
know what? That's fair. Like, it's not everyday.
22:00
You see, I work construction for three summers.
22:02
And maybe you could fix my car, too, while you're
22:04
on it. Potentially. I'm really good at YouTube.
22:08
That is something that I... tell a lot of my
22:10
patients before they go off to sleep is that
22:13
I looked up how to do anesthesia on YouTube right
22:15
before, so they should feel comfortable and confident
22:18
with their anesthesia care. How do you think
22:22
your background has really influenced the way
22:24
that you connect with both trainees and with
22:28
your patients? I think it makes me more relatable.
22:31
I try to hold on to that. I think a lot of Stuff
22:36
gets lost in communication. I remember, like,
22:38
my nana had to be, had to have a bunch of surgical
22:41
procedures and, you know, stuff like that and
22:43
hearing them talk about, well, I don't know what
22:46
the doctor said. They said a bunch of big words
22:48
or, you know, being there and hearing a bunch
22:49
of big words that nobody knows what they mean.
22:52
And then even seeing it on this side when you're,
22:54
you know, anesthesia is a very team sport, but
22:56
we often operate in isolation. And so I remember
22:59
being on call with one of my co -residents talking
23:01
to someone who had a history of IV drug use and
23:04
was in the burn unit and having a lot of pain.
23:06
And this co -resident launched into a discussion
23:09
about opioid receptors and down regulation and
23:12
why this wasn't going to work. And I'm just sitting
23:14
there thinking, prior to med school, I would
23:16
have had no idea what that means. My mom, if
23:18
you're talking to her, has no idea what that
23:20
means. And it was kind of funny because after
23:22
they got done talking, she's like, can you tell
23:25
me what he just said? Because none of that makes
23:26
sense. I'm like, nothing we give you is going
23:28
to be as good as what you were using. Right.
23:30
And so I think finding a way to break it down
23:32
to very simple terms for anything, whether it's
23:35
clinical stuff or just, you know, the hard discussions.
23:39
Here's what I'm seeing is really relatable. And
23:42
I really try to hold on to the experiences that
23:45
I had as a resident and put myself in their shoes
23:47
because I feel like people tend to forget what
23:49
that's like. And I hear often, like, I'm so happy
23:53
that you remember what that's like or that you
23:54
can put yourself back there. And then if I'm
23:57
explaining anything, I pretend I'm explaining
23:58
it to my mom. Very simple. And I try to put things
24:01
in simple terms of, you know, electrical things,
24:04
plumbing, pipes, tubes, buckets. I feel like
24:09
that helps. That's how you won your Golden Apple
24:11
Teaching Award. Yes. Chaos is something that
24:18
you're really good at managing at work, but you
24:21
also have two little kids at home. Yeah. How
24:24
do you manage your home life? Is it as much of
24:30
a dumpster fire there trying to put your kids
24:32
to bed versus maybe an aortic dissection? At
24:37
times. At least at the aortic dissection, for
24:39
the most part, the pathophysiology follows general
24:42
rules. I have all of the tools at my disposal,
24:45
and I know what to expect. Whereas bedtime with
24:49
my three and a half year old, not always the
24:52
case. He will straight up call you out. Not if
24:55
you even skip a page while reading one of his
24:57
five books that he not only demands but counts
24:59
down. We'll call you out if you've skipped a
25:02
word. Yeah. And, you know, God forbid you don't
25:07
have the toast or the bagel that he requests
25:10
at 852 because it's bedtime, you know. And he
25:15
will say, you need to go to the store. Lovely
25:19
input, child. But no, I manage the chaos at home.
25:22
One, with the help of my husband who does work
25:25
from home. The kids are in daycare, but he is
25:27
phenomenal at doing the running and taking care
25:29
of them and stepping in when I can't because
25:31
I'm here. And bedtimes hit or miss. You know,
25:36
my kids don't have as set of a routine with bedtime.
25:39
There's not like a series of five books to read.
25:42
But they will a lot of times pick out. a new
25:46
or different book that they want to read. And,
25:49
uh, with my four, almost five -year -old now,
25:53
uh, she will sometimes pick books that are too
25:58
long and we have no chance of getting through
26:02
that before bedtime. So I, I will admit that
26:07
I have skipped a page or two on occasion. We
26:11
have removed some of the very, very long books.
26:14
Or we tell him that he's only getting one that
26:16
night. My husband loves to read St. George and
26:18
the Dragon to him. That is a long book. Buddy,
26:21
you get one book tonight. Or you can have five
26:23
books and we read more. Yeah, you have to think
26:27
of system level solutions for these sorts of
26:29
things. Just take it out of the options menu.
26:34
How has being a parent changed how you approach
26:37
crisis management at work? Or has it? I don't
26:40
think it's approach crisis management. I think
26:42
it's... or I don't think it's changed how I approach
26:44
crisis management. I do think it's changed how
26:46
I communicate with people. I think communication
26:49
is very important anyway, but having to explain
26:53
to a three -and -a -half -year -old how you do
26:56
things really helps break it down. And it may
27:00
be something as simple as, like, he loves to
27:02
start the bottle washer. He knows you put in
27:04
the tablet, you push this button, you hold for
27:05
three seconds, you push the next button, you
27:07
start the next button. He's got it. So definitely
27:09
talking to, especially like the CA1s as they're
27:12
starting procedures and things like that, I think
27:14
about how do I explain this to my three and a
27:15
half year old? Not, I don't have to dumb it down,
27:17
but like really clarifying the steps. And maybe
27:22
in a crisis situation, being a little more clear
27:24
about what I want. You know, I think instead
27:26
of saying like, we need bicarb, I want three
27:28
amps of bicarb. I think that's help, maybe. Yeah,
27:32
that makes a lot of sense. Clear, persistently
27:35
clear communication is one of the... Things that
27:38
often will come about when people are going over
27:44
incidents that happened or when Sean Josephs
27:48
is talking about things that went wrong during
27:50
Grand Rounds. A lot of times it comes down to
27:53
a communication issue. So that makes a lot of
27:55
sense. So with all the things that happen in
28:01
a given week for you, how do you recharge? Get
28:07
back to feeling like yourself after a long week
28:09
at the hospital and at home. Despite the fact
28:14
that tiny humans are a lot of work, I love going
28:17
home and playing with my son. My daughter's just
28:19
turned eight months. She's fun. She's not super
28:21
interactive. Sure. But, you know, seeing her
28:24
smile and do her little velociraptor screeches
28:27
when you're playing with her is always great.
28:28
My son is a joy. I mean, he likes to. He's got
28:32
a great imagination. So we go outside. We play.
28:35
And we run around, hide from monsters, whatever.
28:39
And then once the kids are finally in bed, even
28:41
though that's, you know, fun to play with, like
28:44
you need a break. So, you know, that's time for
28:48
like me and my husband to kind of reconnect and
28:49
recharge. We watch a lot of TV, a couple different
28:53
types of series we got going on or play video
28:56
games together. That's definitely a great way
28:58
to connect. Can confirm. So. What advice would
29:03
you give for residents who feel like a black
29:05
cloud is following them or that they seem to
29:08
find themselves in dumpster fires all the time?
29:10
Yeah, I don't think I am ripping off a song or
29:14
a movie lyric, but my own personal mantra is
29:16
you cannot change the weather, but you can prepare
29:18
for the storm, especially as it comes to, you
29:21
know, black clouds. And that's really it. I feel
29:25
like, you know, they've actually done studies
29:27
looking at so -called black clouds in the ED.
29:31
Typically, and they found that there's actually
29:33
not a difference in like call shifts or the amount
29:36
of patients that like they have. It's just somehow
29:38
they seem to get worse patients or things of
29:41
that nature. So like if you if you feel like
29:44
you have acquired said black cloud energy, prepare
29:49
for it. Read about emergencies, the things that
29:51
are rare, the things that you don't expect to
29:52
happen and go into each case thinking what's
29:54
the worst case scenario. So if you could go back
29:59
and give yourself. Right around graduation, right
30:04
before fellowship, a piece of advice for becoming
30:07
a new attending, being a new graduate. What advice
30:10
would you give yourself? Imposter syndrome is
30:13
real and it's not your fault. I legit probably
30:17
had an existential crisis thinking, am I really
30:20
just this bad at my job that all these bad things
30:22
keep happening? And it was nothing in my control.
30:26
But it kind of feels like that. And don't be
30:30
afraid to reach out for help, which I've never
30:32
have been. I'm always quick to call for help
30:33
if I feel like I'm in over my head. I have no
30:36
shame in that. But I think reinforcing that because
30:39
I do see that as a problem with people as they
30:41
graduate. They feel like I'm the new attending.
30:43
I have to prove myself. I shouldn't call for
30:45
help. Don't be afraid to call for help. That
30:47
is something that I've shared with a lot of our
30:49
new attendings as well. And fortunately, I think
30:52
that that's a really strong part of the culture
30:55
here. calling each other, running things by each
30:58
other. I have certainly run plenty of things
31:01
by you. Lastly, what kind of style points, just
31:08
backing up a little bit and not just talking
31:10
about disasters, but what kind of style points
31:12
or piece of advice would you have for residents,
31:17
medical students, and anesthesiologists in general
31:19
that have helped you with your life, with your
31:21
career, and everything else? Organization. I
31:26
still do like my resident write -up of my patients
31:29
beforehand. It's not as detailed as it used to
31:32
be, but I still have all my like basic concerns.
31:34
And that's why I can, you know, if I'm running
31:36
three rooms, I can take a quick peek. Oh, here's
31:38
my risk factors. Here's what I'm worried about.
31:43
You got to take care of yourself before you can
31:46
take care of other people. It seems super cliche,
31:48
but if you're totally burned out, like that's
31:50
not going to help your patients. So put the oxygen
31:53
mask. on yourself first when the plane starts
31:56
to crash. Yeah, yeah. I don't know. I throw out
32:00
so many tidbits in drop of just like little things
32:03
that I'm like, oh, this will make your life easier.
32:04
Like your stylet will actually fit in the back
32:07
of the plumb pump and you can use that to make
32:09
a hanger for your drugs when you don't have the
32:11
metal piece. Absolutely. Yeah, there's a lot
32:15
of little stuff like that that I really like
32:17
showing people as well. Well, Kristen, thank
32:21
you so much for joining us. I really enjoyed
32:23
talking to you. Thanks for having me. Thanks
32:28
for listening to another episode of Style Points.
32:31
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