WEBVTT 00:00:10.279 --> 00:00:13.080 anesthesia enthusiasts. And I want to pause, 00:00:13.099 --> 00:00:15.060 actually, to mention that I should have chosen 00:00:15.060 --> 00:00:18.399 a different intro phrase for the podcast. Have 00:00:18.399 --> 00:00:20.679 you ever tried saying anesthesia enthusiasts 00:00:20.679 --> 00:00:26.539 out loud? Try it. I normally have to record several 00:00:26.539 --> 00:00:29.059 different versions for every podcast. In any 00:00:29.059 --> 00:00:31.559 case, welcome to another episode of Style Points. 00:00:32.149 --> 00:00:34.789 We don't have an RSI this month. My co -host, 00:00:34.890 --> 00:00:37.090 Nate Moore, has been very busy representing the 00:00:37.090 --> 00:00:39.770 University of Cincinnati at the ASA, as well 00:00:39.770 --> 00:00:41.990 as doing application review for this year's interview 00:00:41.990 --> 00:00:45.609 season. However, I am pleased to introduce one 00:00:45.609 --> 00:00:48.030 of my friends and colleagues, Dr. Kristen Horton. 00:00:48.429 --> 00:00:51.009 She completed her residency and cardiac fellowship 00:00:51.009 --> 00:00:54.450 here at UC and is the chair of the Clinical Competency 00:00:54.450 --> 00:00:57.090 Committee. She's one of the best crisis managers 00:00:57.090 --> 00:01:00.770 that I know. Without further ado, here's Kristen. 00:01:03.880 --> 00:01:09.299 Okay, you ready? How terrible is stuff like this? 00:01:10.560 --> 00:01:12.939 You don't know that yet. Have you done stuff 00:01:12.939 --> 00:01:15.939 like this before? No. I feel like anytime I'm 00:01:15.939 --> 00:01:18.180 asked to ad -lib questions, I just get jumbled 00:01:18.180 --> 00:01:20.040 sometimes, but that's okay. That's how you write 00:01:20.040 --> 00:01:21.920 the sheet. That is why I wrote the cardiac case. 00:01:22.180 --> 00:01:24.000 That was like literally everything that could 00:01:24.000 --> 00:01:26.750 go wrong did go wrong. But I don't want other 00:01:26.750 --> 00:01:28.250 cardiac people listening being like, that makes 00:01:28.250 --> 00:01:30.189 no sense. Why would you do it that way? It's 00:01:30.189 --> 00:01:31.810 like, oh, JK, I just didn't remember it right. 00:01:31.989 --> 00:01:34.790 I don't think any of the cardiac people here 00:01:34.790 --> 00:01:41.930 will question you. I just don't. Kristen, thanks 00:01:41.930 --> 00:01:45.049 for joining us. Everyone seems to describe you 00:01:45.049 --> 00:01:48.450 as a black cloud. Can you tell me a little bit 00:01:48.450 --> 00:01:52.730 about what that means to you? I feel like it 00:01:52.730 --> 00:01:56.459 is. Kind of just this thing where like if bad 00:01:56.459 --> 00:01:58.700 things are going to happen in a situation, I'm 00:01:58.700 --> 00:02:02.180 probably going to be involved. I feel like I 00:02:02.180 --> 00:02:03.900 get put into cases that everybody's like, this 00:02:03.900 --> 00:02:06.280 should go straight forward. And then it doesn't 00:02:06.280 --> 00:02:09.300 for reasons that are mostly beyond my control. 00:02:10.000 --> 00:02:12.199 And that's kind of been an ongoing thing since 00:02:12.199 --> 00:02:17.439 residency. You always seem to be in seemingly 00:02:17.439 --> 00:02:20.879 insane cases where very rare things that, by 00:02:20.879 --> 00:02:23.280 the way, are not your fault, seem to happen. 00:02:23.949 --> 00:02:28.289 And then you are somehow able to manage it and 00:02:28.289 --> 00:02:30.569 get the patient through safely. That's sort of 00:02:30.569 --> 00:02:32.889 been your calling card for a long time. Would 00:02:32.889 --> 00:02:37.569 you say that that's the case? Yeah. So the thing 00:02:37.569 --> 00:02:40.270 that you call them and what I was excited to 00:02:40.270 --> 00:02:42.469 call the title of this episode is dumpster fires. 00:02:42.629 --> 00:02:45.129 Tell me more about that. I think I initially 00:02:45.129 --> 00:02:47.969 heard the term on one of our ICU rotations when 00:02:47.969 --> 00:02:50.569 I was a resident. It was one of the CCAT fellows 00:02:50.569 --> 00:02:52.590 who had mentioned it. And then, of course, it's 00:02:52.590 --> 00:02:56.319 kind of caught. Caught fire, I guess, and mainstream 00:02:56.319 --> 00:02:59.840 memes and whatnot. Yeah, after COVID, I guess. 00:03:00.120 --> 00:03:03.280 Yeah, exactly. And so it just kind of fit. Like, 00:03:03.300 --> 00:03:04.599 you know, normally we were talking like disaster 00:03:04.599 --> 00:03:08.120 cases or, you know, just a terrible, terrible 00:03:08.120 --> 00:03:09.580 case, you know, when I was a resident. And then 00:03:09.580 --> 00:03:11.080 the dumpster fire thing just really seemed to 00:03:11.080 --> 00:03:13.439 encompass of just like, all of this is going 00:03:13.439 --> 00:03:15.639 terrible. Like, it's fine. This is fine. Everything's 00:03:15.639 --> 00:03:17.199 fine. It's burning down around me, but we're 00:03:17.199 --> 00:03:20.180 okay. Kind of encompassed it. And so we rolled 00:03:20.180 --> 00:03:24.569 with it. What do you think it is? How do these 00:03:24.569 --> 00:03:27.150 cases find you? Is it just bad luck or what? 00:03:27.389 --> 00:03:31.289 I used to think that. Part of it, I think, is 00:03:31.289 --> 00:03:35.330 the fact that I dabble, but I do a bunch of different 00:03:35.330 --> 00:03:37.949 stuff, right? So I did cardiac fellowships. I'm 00:03:37.949 --> 00:03:39.469 taking care of the cardiac cases where just by 00:03:39.469 --> 00:03:41.669 nature, they're higher risk cases. I'm involved 00:03:41.669 --> 00:03:44.110 in liver transplanting. Again, higher, sicker 00:03:44.110 --> 00:03:48.050 people. I do OB. I do the OB combined cardiac 00:03:48.050 --> 00:03:52.250 clinic, which by nature puts you at... the situation 00:03:52.250 --> 00:03:53.310 where you're going to be taking care of these 00:03:53.310 --> 00:03:55.870 high -risk cardiac patients having babies. So 00:03:55.870 --> 00:03:57.969 part of it, I think, is my own doing of just 00:03:57.969 --> 00:04:00.150 keeping the skill sets to get me involved in 00:04:00.150 --> 00:04:03.650 a lot of potential shenanigans. And then I just 00:04:03.650 --> 00:04:05.650 feel like some of it is just, I don't know if 00:04:05.650 --> 00:04:07.250 you'd call it bad luck. I guess for the patients, 00:04:07.370 --> 00:04:13.150 maybe it's good luck that I'm there. But definitely 00:04:13.150 --> 00:04:16.759 just a knack for attracting shenanigans. That's 00:04:16.759 --> 00:04:19.579 fantastic. So tell me about some of the memorable 00:04:19.579 --> 00:04:22.439 dumpster fire cases that you've had. What's given 00:04:22.439 --> 00:04:26.060 you that label? There are too many to think about 00:04:26.060 --> 00:04:28.639 coming residency. We'll start as an attending. 00:04:28.680 --> 00:04:32.100 Four days in, I did my first TAVR as an attending. 00:04:33.180 --> 00:04:37.040 A TAVR is? It's like a transvenous aortic valve 00:04:37.040 --> 00:04:39.480 replacement. At this time, we were still doing 00:04:39.480 --> 00:04:43.040 them under general anesthesia. And for this case, 00:04:43.060 --> 00:04:44.879 he had severe aortic stenosis getting worked 00:04:44.879 --> 00:04:49.519 up for a kidney transplant. And so he comes in, 00:04:49.579 --> 00:04:52.939 he's complaining of chest pain, but she previously 00:04:52.939 --> 00:04:55.420 had a drug -eluting stent placed. He'd had instant 00:04:55.420 --> 00:04:57.420 re -stenosis before. The stent was like three 00:04:57.420 --> 00:05:00.959 months prior. We got an EKG, no ST changes. We're 00:05:00.959 --> 00:05:02.920 going to be in the hybrid operating room anyway 00:05:02.920 --> 00:05:06.160 with fluoro and cath lab capabilities. So we 00:05:06.160 --> 00:05:08.480 discuss a bunch of things. Decide we're going 00:05:08.480 --> 00:05:10.439 to go ahead with the case. We'll do a left heart 00:05:10.439 --> 00:05:13.899 cath beforehand. Cath him. Corners are clean. 00:05:14.420 --> 00:05:16.899 Stents clean. Yay. Let's proceed with the TAVR. 00:05:17.500 --> 00:05:19.560 There are some complications deploying the valve. 00:05:19.680 --> 00:05:21.759 We had to rapid pace him like three or four times 00:05:21.759 --> 00:05:25.079 up to 180 beats per minute. After the last time 00:05:25.079 --> 00:05:27.319 when we got the valve deployed, he stayed in 00:05:27.319 --> 00:05:29.519 VT after we turned the pacer off, never came 00:05:29.519 --> 00:05:32.759 back. EF was like 10. We crashed onto bypass, 00:05:32.920 --> 00:05:36.139 which just happened to be primed. because the 00:05:36.139 --> 00:05:37.980 perfusionist said they were teaching their student. 00:05:38.100 --> 00:05:39.579 They don't normally prime it, and it's the first 00:05:39.579 --> 00:05:42.920 time we had a crash on bypass in two years. So 00:05:42.920 --> 00:05:46.100 I call in my backup peeps who come racing to 00:05:46.100 --> 00:05:49.779 help and finally get the guy back. We wound up 00:05:49.779 --> 00:05:52.399 leaving on ECMO. And so that was just like a, 00:05:52.439 --> 00:05:55.019 okay, great. This is continued from residency. 00:05:56.360 --> 00:05:59.120 I've had malignant hyperthermia after a wisdom 00:05:59.120 --> 00:06:01.870 tooth extraction. otherwise relatively healthy 00:06:01.870 --> 00:06:04.850 young person i remember seeing that poster yep 00:06:04.850 --> 00:06:08.589 um what else did we do we did um a liver transplant 00:06:08.589 --> 00:06:10.529 that got anaphylaxis before the case started 00:06:10.529 --> 00:06:16.350 uh plenty of nightmare cardiac cases um a severe 00:06:16.350 --> 00:06:18.709 pulmonary hypertension patient getting a c -section 00:06:18.709 --> 00:06:21.790 that crashed onto ecmo anticipated we'd plan 00:06:21.790 --> 00:06:27.180 but still it's a wide variety You've done so 00:06:27.180 --> 00:06:29.600 many of these dumpster fire cases that you actually 00:06:29.600 --> 00:06:32.000 have stickers. Is that correct? Correct. Tell 00:06:32.000 --> 00:06:34.899 me about the stickers. So this actually started 00:06:34.899 --> 00:06:37.500 on a very slow OB day, which is not common for 00:06:37.500 --> 00:06:41.420 me. When me and the current OB fellow, or previous, 00:06:41.500 --> 00:06:42.819 I guess, OB fellow current at the time, were 00:06:42.819 --> 00:06:46.620 talking about just the shenanigans. that i tend 00:06:46.620 --> 00:06:49.180 to get into and we were actually talking about 00:06:49.180 --> 00:06:51.720 tavers and so she had actually brought up the 00:06:51.720 --> 00:06:54.120 idea of that she had seen some dumpster fire 00:06:54.120 --> 00:06:56.939 stickers on etsy and we should hand those out 00:06:56.939 --> 00:07:00.819 for taver cases um that we were in but those 00:07:00.819 --> 00:07:05.920 don't always go that crazily um and so we got 00:07:05.920 --> 00:07:08.519 a sheet of these stickers and i started handing 00:07:08.519 --> 00:07:11.519 them out to page to the residents And some attendings 00:07:11.519 --> 00:07:14.540 who have survived these dumpster fire cases with 00:07:14.540 --> 00:07:16.519 me at the end. So we debrief, we talk about all 00:07:16.519 --> 00:07:19.120 the things. And then they get to pick their color 00:07:19.120 --> 00:07:20.819 of dumpster fire sticker because I think there's 00:07:20.819 --> 00:07:24.600 like nine of them. Excellent. And the first two 00:07:24.600 --> 00:07:26.660 residents really thought it was kind of fun. 00:07:27.959 --> 00:07:30.300 It's some kind of a badge of honor. Like, I don't 00:07:30.300 --> 00:07:32.139 want to have to be here, but if I am, this is 00:07:32.139 --> 00:07:33.480 kind of cool. And so they started wearing them 00:07:33.480 --> 00:07:36.490 on their badges. And I had two residents that 00:07:36.490 --> 00:07:38.370 every time we were paired together, shenanigans 00:07:38.370 --> 00:07:41.329 ensued. So we were the dark cloud duos, essentially. 00:07:42.230 --> 00:07:44.870 And so as they were collecting these dumpster 00:07:44.870 --> 00:07:48.670 fire stickers, they had gotten four or five at 00:07:48.670 --> 00:07:50.870 the time. And so I was like, OK, if you get five 00:07:50.870 --> 00:07:52.730 dumpster fire stickers, you're going to graduate 00:07:52.730 --> 00:07:56.069 to a dumpster phoenix. And so I presented them 00:07:56.069 --> 00:08:01.199 with a. uniquely made dumpster phoenix lapel 00:08:01.199 --> 00:08:03.899 pin at graduation, which they thought was hilarious. 00:08:04.139 --> 00:08:05.660 And we've continued to do so. And I now have 00:08:05.660 --> 00:08:07.480 three dumpster phoenixes that I have mentored. 00:08:07.879 --> 00:08:12.220 That is fantastic. Do you have their names? Do 00:08:12.220 --> 00:08:14.139 you know who the dumpster phoenixes are? Can 00:08:14.139 --> 00:08:16.240 you tell us? Cameron Harmon, who was an oral 00:08:16.240 --> 00:08:17.980 prior resident. Sean Nguyen, who's currently 00:08:17.980 --> 00:08:20.680 one of our faculty now. And then Jamie McGrath, 00:08:20.699 --> 00:08:22.420 who's doing a cardiac fellowship. Yeah, yeah, 00:08:22.480 --> 00:08:25.139 that certainly tracks. I can certainly imagine 00:08:25.139 --> 00:08:30.519 all three of them being dumpster phoenixes. You 00:08:30.519 --> 00:08:34.279 basically graduated during my first year of being 00:08:34.279 --> 00:08:37.220 an attending. And then you did your cardiac fellowship 00:08:37.220 --> 00:08:39.720 during my second year of being an attending. 00:08:40.200 --> 00:08:43.379 And right after that, you won the Golden Apple 00:08:43.379 --> 00:08:46.559 Teaching Award your first year out. And you've 00:08:46.559 --> 00:08:48.539 been involved in the residency ever since. And 00:08:48.539 --> 00:08:51.480 also you took over the clinical competency committee 00:08:51.480 --> 00:08:54.980 for me. With all the time that you've spent teaching 00:08:54.980 --> 00:08:58.070 and helping residents. through these disaster 00:08:58.070 --> 00:09:01.830 situations, how do you stay calm in those moments? 00:09:02.929 --> 00:09:07.509 I think a lot of that goes way, way back to when 00:09:07.509 --> 00:09:09.210 I was a kid and how we got interested in medicine, 00:09:09.350 --> 00:09:12.490 which is a little bit of a different story. But 00:09:12.490 --> 00:09:16.029 my grandmother used to basically say like, look, 00:09:16.090 --> 00:09:18.470 you have to stay calm in these situations. Like 00:09:18.470 --> 00:09:20.309 calm may save you, panic is going to kill everybody. 00:09:23.389 --> 00:09:25.889 What kind of situations were you in when you 00:09:25.889 --> 00:09:28.529 were a kid that calm was going to save everybody? 00:09:29.250 --> 00:09:32.309 My Nana lived on a dirt road in the middle of 00:09:32.309 --> 00:09:35.149 nowhere. The closest hospital was about a 45 00:09:35.149 --> 00:09:38.590 -minute ambulance call away. And in the summer, 00:09:38.590 --> 00:09:40.570 people would come careening off this dirt road 00:09:40.570 --> 00:09:43.330 into her yard. We were living with her at the 00:09:43.330 --> 00:09:45.509 time. I was about seven. And so we would go out 00:09:45.509 --> 00:09:47.250 and pull people out of these cars, out of the 00:09:47.250 --> 00:09:49.929 ditch, and basically triage them until the ambulance 00:09:49.929 --> 00:09:54.210 would get there. We're holding pressure on lacerations. 00:09:54.210 --> 00:09:56.070 People are bleeding everywhere. People are screaming. 00:09:57.669 --> 00:10:02.149 I'm seven. We're trying to help. Right. And it 00:10:02.149 --> 00:10:03.830 didn't happen like a ton of time, but it happened 00:10:03.830 --> 00:10:06.389 enough. That was where my initial interest in 00:10:06.389 --> 00:10:08.309 medicine started, too. But it was like, you got 00:10:08.309 --> 00:10:10.669 to stay calm. Was it like a weekly thing that 00:10:10.669 --> 00:10:12.669 there was a. Big disaster outside your house? 00:10:12.870 --> 00:10:15.009 At least once or twice a month in the summer. 00:10:15.649 --> 00:10:18.769 I feel like that's a pretty good gauge. This 00:10:18.769 --> 00:10:21.909 seems like a failure of civic engineering. It 00:10:21.909 --> 00:10:24.610 was. And they eventually just totally bypassed 00:10:24.610 --> 00:10:26.830 that. So now it's a dead end road. And they paved 00:10:26.830 --> 00:10:29.509 over and did a highway nearby. That's probably 00:10:29.509 --> 00:10:33.129 better. Yes. But it took a while. And so I think 00:10:33.129 --> 00:10:35.169 just from then, it was almost like a switch would 00:10:35.169 --> 00:10:37.789 flip. And so I just try to take out any emotional 00:10:37.789 --> 00:10:41.899 investment and just think. And I feel like that 00:10:41.899 --> 00:10:45.960 helps. And then going through med school and 00:10:45.960 --> 00:10:48.539 like rotations and seeing the other anesthesiologists 00:10:48.539 --> 00:10:50.200 when I was doing those rotations, you know, things 00:10:50.200 --> 00:10:52.899 hit the fan and everybody's panicking. I feel 00:10:52.899 --> 00:10:55.100 like everybody in the OR looks to the anesthesiologist 00:10:55.100 --> 00:10:59.379 to be the calm one. And my mentors and the people 00:10:59.379 --> 00:11:01.440 I really respected were always just like super 00:11:01.440 --> 00:11:05.019 calm. And so I think trying to prepare for things 00:11:05.019 --> 00:11:07.120 and being pretty confident in my training helps 00:11:07.120 --> 00:11:09.519 me at least outwardly. model calm because if 00:11:09.519 --> 00:11:12.259 you are also outwardly panicking uh everybody 00:11:12.259 --> 00:11:15.039 else maybe too that makes a lot of sense and 00:11:15.039 --> 00:11:17.320 i've talked to a lot of other anesthesiologists 00:11:17.320 --> 00:11:22.259 on style points about maintaining that outward 00:11:22.259 --> 00:11:25.659 sense of calm even though maybe inside it might 00:11:25.659 --> 00:11:31.080 not be maybe the same um do you find that over 00:11:31.080 --> 00:11:34.820 time you have more of a sense of calm than you 00:11:34.820 --> 00:11:38.710 used to or 100 I think for the vast majority 00:11:38.710 --> 00:11:43.029 of situations. Legit, actually calmer internally 00:11:43.029 --> 00:11:46.169 than when I first started. And some of that's 00:11:46.169 --> 00:11:49.049 just experiencing things and seeing things before 00:11:49.049 --> 00:11:51.129 and kind of knowing what to do and having a wider 00:11:51.129 --> 00:11:54.289 differential and things like that. So how do 00:11:54.289 --> 00:11:59.769 you teach other residents how to prepare for 00:11:59.769 --> 00:12:02.409 these type of situations? I think the first thing 00:12:02.409 --> 00:12:06.320 is to think about. the possibility of getting 00:12:06.320 --> 00:12:09.620 into these situations. I know, like, as a resident, 00:12:09.759 --> 00:12:13.100 soon after I was dubbed the Black Cloud and bad 00:12:13.100 --> 00:12:14.899 things just kept happening, every case I would 00:12:14.899 --> 00:12:16.360 go into, I'm like, okay, what is the nightmare 00:12:16.360 --> 00:12:17.820 scenario that could happen out of this case? 00:12:18.120 --> 00:12:20.500 Like, I know it's a lap appy, but, like, air 00:12:20.500 --> 00:12:23.039 embolus, right? Like, that could happen. And 00:12:23.039 --> 00:12:24.860 so that would be part of the stuff I would focus 00:12:24.860 --> 00:12:27.080 my reading on for that day of, like, I can't 00:12:27.080 --> 00:12:28.620 prevent the disasters, but how can I prepare 00:12:28.620 --> 00:12:31.159 for them? And so talking to the residents about 00:12:31.159 --> 00:12:34.649 even if it's, you know, a basic lap appy, Try 00:12:34.649 --> 00:12:36.470 to think about what could go wrong. I mean, there's 00:12:36.470 --> 00:12:37.809 always the anesthesia things, right? Difficult 00:12:37.809 --> 00:12:39.669 airway, malignant hyperthermia, crazy things 00:12:39.669 --> 00:12:42.549 that we don't expect to see. But what are the 00:12:42.549 --> 00:12:44.389 things that just from a surgical standpoint could 00:12:44.389 --> 00:12:48.029 also go wrong and preparing for that? And having 00:12:48.029 --> 00:12:50.309 read about it or thought about it before, I think 00:12:50.309 --> 00:12:53.070 just in itself lends to a little more feeling 00:12:53.070 --> 00:12:55.169 of I know what's going on and a little less tendency 00:12:55.169 --> 00:12:56.970 to panic and be like, oh, my God, what's happening? 00:12:58.269 --> 00:13:01.230 When you're in some of these critical dumpster 00:13:01.230 --> 00:13:05.080 fire scenarios. One of the things that residents 00:13:05.080 --> 00:13:08.100 say that you'll do is you are still teaching 00:13:08.100 --> 00:13:12.600 even in those moments. How do you get into that 00:13:12.600 --> 00:13:16.279 mindset of teaching and still modeling calmness 00:13:16.279 --> 00:13:19.240 for the team? I just talk out loud. Everything 00:13:19.240 --> 00:13:23.080 that's going through my head, clinically, not 00:13:23.080 --> 00:13:24.820 the emotional side, but everything clinically 00:13:24.820 --> 00:13:27.779 is going through my head. Here's what's happening 00:13:27.779 --> 00:13:30.000 now. You know, I think, you know, here's my differential 00:13:30.000 --> 00:13:31.759 of eight things that could be going on. Here's 00:13:31.759 --> 00:13:33.039 what we need to be thinking about. Here's what 00:13:33.039 --> 00:13:37.519 we need to be doing. Or just here's what I'm 00:13:37.519 --> 00:13:39.139 doing. We'll talk about it in a minute as to 00:13:39.139 --> 00:13:40.980 why, if, you know, time is really of the essence. 00:13:41.120 --> 00:13:43.580 But a lot of it is just going through my thought 00:13:43.580 --> 00:13:48.720 process out loud. And they just tend to be bystanders 00:13:48.720 --> 00:13:51.559 who are benefiting from that. Yeah, that's fair. 00:13:52.559 --> 00:13:55.279 Sometimes residents will be. trying to do things 00:13:55.279 --> 00:13:57.840 to help, but they might be struggling a little 00:13:57.840 --> 00:14:00.039 bit, whether it's putting in a line or with an 00:14:00.039 --> 00:14:03.820 airway. How do you determine where the line is 00:14:03.820 --> 00:14:05.740 for when you need to step in and do something 00:14:05.740 --> 00:14:08.399 versus letting them maybe struggle a little bit, 00:14:08.539 --> 00:14:12.059 making sure that they are getting a good learning 00:14:12.059 --> 00:14:14.360 opportunity from it? I think that's a really 00:14:14.360 --> 00:14:17.399 hard thing to balance sometimes. And that's one 00:14:17.399 --> 00:14:19.519 of the trickier things, I think, for switching 00:14:19.519 --> 00:14:21.720 from like being a resident and becoming an attending 00:14:21.720 --> 00:14:24.669 is knowing where that line is. And I was much 00:14:24.669 --> 00:14:28.269 quicker to jump in earlier than I am now. And 00:14:28.269 --> 00:14:29.769 now I think the biggest thing is patient safety 00:14:29.769 --> 00:14:32.029 or at least patient tolerance, because like we 00:14:32.029 --> 00:14:35.690 do Neuraxial up on OB. Obviously, if the patient's 00:14:35.690 --> 00:14:39.509 not tolerating it well, this is no longer a good 00:14:39.509 --> 00:14:41.129 learning opportunity. Like we need to get this 00:14:41.129 --> 00:14:44.070 in and get this done. So patient safety does 00:14:44.070 --> 00:14:46.929 come first. And I don't want to I will not let 00:14:46.929 --> 00:14:48.570 it get to a point where I don't think I can rescue 00:14:48.570 --> 00:14:52.210 the situation. So if I know they have. low reserve, 00:14:52.389 --> 00:14:54.470 and they're going to desaturate, you know, pretty 00:14:54.470 --> 00:14:56.710 quickly, like you get one shot. If they're an 00:14:56.710 --> 00:14:59.909 easy airway, easy mask, I have no concerns. Sure, 00:14:59.970 --> 00:15:01.850 take two or three as long as we're not damaging 00:15:01.850 --> 00:15:04.490 the airway. Same thing with lines. If you have 00:15:04.490 --> 00:15:06.429 good technique and it's just a struggle with 00:15:06.429 --> 00:15:08.230 getting a wire in or something like that, I'll 00:15:08.230 --> 00:15:09.809 let you keep going. If you can't keep your needle 00:15:09.809 --> 00:15:11.990 in view or you've caused a hematoma or only have 00:15:11.990 --> 00:15:15.769 one or two shots, maybe I step in earlier. That 00:15:15.769 --> 00:15:20.220 makes a lot of sense. You are the chair of the 00:15:20.220 --> 00:15:22.080 Clinical Competency Committee here. That means 00:15:22.080 --> 00:15:26.820 that you are ultimately responsible for checking 00:15:26.820 --> 00:15:30.299 residents off, making sure that they are competent 00:15:30.299 --> 00:15:32.980 clinically across a wide variety of domains. 00:15:34.159 --> 00:15:37.059 But, you know, sometimes residents can struggle. 00:15:37.159 --> 00:15:40.759 You are known, though, for having good conversations 00:15:40.759 --> 00:15:42.799 with residents when they are struggling, and 00:15:42.799 --> 00:15:45.539 you've been a mentor to a lot of people. How 00:15:45.539 --> 00:15:48.059 do you approach... Some of these conversations 00:15:48.059 --> 00:15:51.059 with residents that might be struggling with 00:15:51.059 --> 00:15:54.460 something or who are beating themselves up about 00:15:54.460 --> 00:15:57.500 a situation that didn't go well. Definitely on 00:15:57.500 --> 00:15:59.200 the beating yourself up, I can relate. There's 00:15:59.200 --> 00:16:01.360 a lot of imposter syndrome that I feel like does 00:16:01.360 --> 00:16:04.259 not get talked about very much in this specialty. 00:16:04.460 --> 00:16:06.659 And I think when things don't go well, especially 00:16:06.659 --> 00:16:08.299 with residency and training, your first thought 00:16:08.299 --> 00:16:10.559 is, what did I do wrong or what could I have 00:16:10.559 --> 00:16:13.960 done better? As far as, you know, stuff that 00:16:13.960 --> 00:16:15.440 comes up in clinical competence committee, a 00:16:15.440 --> 00:16:17.259 lot of times I'll go back and try to talk to 00:16:17.259 --> 00:16:20.220 whoever put in evaluations or whoever talked 00:16:20.220 --> 00:16:22.019 to me that would suggest somebody is struggling 00:16:22.019 --> 00:16:25.059 to get their background first. And then I really 00:16:25.059 --> 00:16:26.919 like to do these as sit down things. So I'll 00:16:26.919 --> 00:16:29.659 try to pull the resident aside when we have time 00:16:29.659 --> 00:16:32.639 and we're not, you know, dealing with clinical 00:16:32.639 --> 00:16:34.580 constraints or, you know, in the OR taking care 00:16:34.580 --> 00:16:35.879 of a patient and trying to have an emotionally 00:16:35.879 --> 00:16:39.139 charged conversation. Starbucks is often involved. 00:16:40.539 --> 00:16:43.659 And just sit there and talk like, hey, you know, 00:16:43.659 --> 00:16:46.500 either I heard this or like, you know, I was 00:16:46.500 --> 00:16:47.679 made aware that maybe you're having a little 00:16:47.679 --> 00:16:50.720 bit of a rough time. Like, can we talk about 00:16:50.720 --> 00:16:53.379 this? How do you feel things have been going? 00:16:53.879 --> 00:16:55.340 And then kind of trying to interweave it from 00:16:55.340 --> 00:16:58.799 there to try to get their view on it before just 00:16:58.799 --> 00:17:00.480 jumping in and being like, well, I've heard X, 00:17:00.539 --> 00:17:04.680 Y, Z. That makes a lot of sense. A lot of times 00:17:04.680 --> 00:17:09.140 I find that context is really. with a lot of 00:17:09.140 --> 00:17:12.500 the things that we discuss with the residents, 00:17:12.619 --> 00:17:15.500 making sure that we're on the same page as them, 00:17:15.660 --> 00:17:19.539 making sure that we understand the whole situation 00:17:19.539 --> 00:17:22.140 because often there can be a little bit more 00:17:22.140 --> 00:17:25.119 than meets the eye about any one evaluation or 00:17:25.119 --> 00:17:30.420 situation. So one of the things that I remember 00:17:30.420 --> 00:17:33.660 that we've talked about in the past just in passing 00:17:33.660 --> 00:17:36.220 is sort of your pathway towards medicine. And 00:17:36.220 --> 00:17:37.619 I've always thought it was very interesting. 00:17:38.119 --> 00:17:41.759 I wonder if you'd be willing to share maybe the 00:17:41.759 --> 00:17:44.579 time after you saved all the traumas that showed 00:17:44.579 --> 00:17:47.880 up at your front door and before you made it 00:17:47.880 --> 00:17:52.180 all the way to anesthesia residency. Sure. So 00:17:52.180 --> 00:17:54.740 yeah, so pulling people out of my nana's yard 00:17:54.740 --> 00:17:56.599 was kind of the beginning. She was always very 00:17:56.599 --> 00:17:59.730 interested in medicine, but did not. I had the 00:17:59.730 --> 00:18:01.950 opportunity to even finish, I think, even middle 00:18:01.950 --> 00:18:05.410 school. And nobody in my family had ever gone 00:18:05.410 --> 00:18:07.990 to college, so, of course, med school was a pipe 00:18:07.990 --> 00:18:10.009 dream. But she would watch all these medical 00:18:10.009 --> 00:18:11.630 documentaries, and I always thought it was, like, 00:18:11.630 --> 00:18:15.569 super cool. Got through high school. I went to 00:18:15.569 --> 00:18:18.069 a very small high school. Your career path was 00:18:18.069 --> 00:18:20.029 essentially you could work at the prison, the 00:18:20.029 --> 00:18:22.869 boot camp, or the barge on the river. They really 00:18:22.869 --> 00:18:25.970 didn't talk to you about college. I happened 00:18:25.970 --> 00:18:29.140 to get... An opportunity to participate in a 00:18:29.140 --> 00:18:32.960 scholarship competition from a neighboring county 00:18:32.960 --> 00:18:35.700 college for like underprivileged kids, essentially. 00:18:37.200 --> 00:18:39.420 And so I did that and it was like an interview 00:18:39.420 --> 00:18:41.759 and an essay competition that you had to write 00:18:41.759 --> 00:18:45.920 there and actually won, which was incredible 00:18:45.920 --> 00:18:48.019 because I had previously gone through MEPS and 00:18:48.019 --> 00:18:51.240 was going to join the Air Force to get to college. 00:18:51.440 --> 00:18:55.200 And so they got I got the call that I won in 00:18:55.200 --> 00:18:59.910 March. I guess it was 2006, maybe. Do you remember 00:18:59.910 --> 00:19:03.630 what your essay was about? It was something about 00:19:03.630 --> 00:19:06.250 Martin Luther King. Like Martin Luther King said 00:19:06.250 --> 00:19:09.849 something about, you know, it's a true, a man's 00:19:09.849 --> 00:19:11.690 true character is not revealed in times of peace, 00:19:11.789 --> 00:19:15.130 but like in times of strife. That's definitely 00:19:15.130 --> 00:19:18.069 paraphrasing. But like. We'll accept that. Pick 00:19:18.069 --> 00:19:21.450 three, give three examples of people that you 00:19:21.450 --> 00:19:23.769 think meet this criteria or, you know, fit the 00:19:23.769 --> 00:19:28.420 situation. And so I chose Abe Lincoln, Martin 00:19:28.420 --> 00:19:29.940 Luther King himself, and then one of my personal 00:19:29.940 --> 00:19:32.839 friends as like a historical. Here's why he said 00:19:32.839 --> 00:19:35.140 this. And here's like how we relate this to like 00:19:35.140 --> 00:19:38.220 the common person. And so they thought that was 00:19:38.220 --> 00:19:42.480 good. So, yes, I got that. They said it was going 00:19:42.480 --> 00:19:44.359 to be a Fulbright scholarship. That was super 00:19:44.359 --> 00:19:45.839 exciting. Couldn't believe it. Thought they were 00:19:45.839 --> 00:19:48.319 kidding. Called my mom in tears, I'm pretty sure. 00:19:48.759 --> 00:19:52.980 And I was very excited. Talked to my recruiter. 00:19:53.019 --> 00:19:55.299 He was like. Cool. You haven't gone to boot camp 00:19:55.299 --> 00:20:00.039 yet. Like, you're out. Went to college. Signed 00:20:00.039 --> 00:20:02.059 a contract saying I would do four years or owe 00:20:02.059 --> 00:20:04.900 them money back. Reasonable. Then found out they'd 00:20:04.900 --> 00:20:07.039 never put anybody into med school. They had a 00:20:07.039 --> 00:20:09.259 very successful nursing program, which, great. 00:20:09.380 --> 00:20:13.180 Not what I wanted to do. So I figured out what 00:20:13.180 --> 00:20:16.140 classes I needed to take the MCAT. Took a little 00:20:16.140 --> 00:20:18.079 finagling. Had some professors that really jumped 00:20:18.079 --> 00:20:20.619 in and helped. Had to take physics one and physics 00:20:20.619 --> 00:20:24.960 two at the same time. calculus advanced level 00:20:24.960 --> 00:20:26.700 by myself because they didn't actually teach 00:20:26.700 --> 00:20:28.380 that because we didn't have enough people to 00:20:28.380 --> 00:20:32.740 be in the class. Fun times. Took the MCAT. Didn't 00:20:32.740 --> 00:20:36.099 do so hot. Didn't even apply that year. Took 00:20:36.099 --> 00:20:39.099 a summer off. Taught myself the rest of the organic 00:20:39.099 --> 00:20:42.299 chemistry book and worked construction and built 00:20:42.299 --> 00:20:47.779 cars during that time to pay for things. Managed 00:20:47.779 --> 00:20:51.720 to Get an interview at University of Tennessee 00:20:51.720 --> 00:20:53.619 Health Science Center. I did not know you're 00:20:53.619 --> 00:20:55.779 supposed to apply to like 30 med schools. I think 00:20:55.779 --> 00:20:59.880 I applied to three. Got that interview, went, 00:21:00.140 --> 00:21:02.700 had to do a program during their summer that 00:21:02.700 --> 00:21:05.920 was incredible. That was basically like, we're 00:21:05.920 --> 00:21:08.000 glad you graduated top of your class of college. 00:21:08.039 --> 00:21:09.980 But for all we know, you colored inside the lines 00:21:09.980 --> 00:21:13.220 because they don't have a track record. So basically, 00:21:13.259 --> 00:21:15.480 if you can hack it for this pretend med school 00:21:15.480 --> 00:21:17.759 course in the summer, then we'll let you in. 00:21:17.880 --> 00:21:20.619 And so I did that and that went well. Got to 00:21:20.619 --> 00:21:27.839 med school. Yay. Wow. That that is pretty incredible. 00:21:27.920 --> 00:21:31.019 And as one of the associate program directors, 00:21:31.259 --> 00:21:34.539 I I read personal statements all the time. And 00:21:34.539 --> 00:21:40.940 I I was I wouldn't have been in the. program 00:21:40.940 --> 00:21:42.420 director's office at that time when you were 00:21:42.420 --> 00:21:44.240 applying, but I would have loved to see a personal 00:21:44.240 --> 00:21:48.140 statement like that. I bet that was a really 00:21:48.140 --> 00:21:51.220 good one. I like to think so. I got asked to 00:21:51.220 --> 00:21:53.279 talk about the road, and one of the people interviewing 00:21:53.279 --> 00:21:55.180 asked me to comment on the cabinets they were 00:21:55.180 --> 00:21:58.940 building for their kids' room. I was like, you 00:21:58.940 --> 00:22:00.519 know what? That's fair. Like, it's not everyday. 00:22:00.640 --> 00:22:02.359 You see, I work construction for three summers. 00:22:02.700 --> 00:22:04.519 And maybe you could fix my car, too, while you're 00:22:04.519 --> 00:22:06.339 on it. Potentially. I'm really good at YouTube. 00:22:08.000 --> 00:22:10.779 That is something that I... tell a lot of my 00:22:10.779 --> 00:22:13.299 patients before they go off to sleep is that 00:22:13.299 --> 00:22:15.640 I looked up how to do anesthesia on YouTube right 00:22:15.640 --> 00:22:18.140 before, so they should feel comfortable and confident 00:22:18.140 --> 00:22:22.759 with their anesthesia care. How do you think 00:22:22.759 --> 00:22:24.920 your background has really influenced the way 00:22:24.920 --> 00:22:28.640 that you connect with both trainees and with 00:22:28.640 --> 00:22:31.700 your patients? I think it makes me more relatable. 00:22:31.799 --> 00:22:36.420 I try to hold on to that. I think a lot of Stuff 00:22:36.420 --> 00:22:38.400 gets lost in communication. I remember, like, 00:22:38.460 --> 00:22:41.819 my nana had to be, had to have a bunch of surgical 00:22:41.819 --> 00:22:43.960 procedures and, you know, stuff like that and 00:22:43.960 --> 00:22:46.579 hearing them talk about, well, I don't know what 00:22:46.579 --> 00:22:48.079 the doctor said. They said a bunch of big words 00:22:48.079 --> 00:22:49.859 or, you know, being there and hearing a bunch 00:22:49.859 --> 00:22:51.259 of big words that nobody knows what they mean. 00:22:52.140 --> 00:22:54.119 And then even seeing it on this side when you're, 00:22:54.119 --> 00:22:56.559 you know, anesthesia is a very team sport, but 00:22:56.559 --> 00:22:59.460 we often operate in isolation. And so I remember 00:22:59.460 --> 00:23:01.779 being on call with one of my co -residents talking 00:23:01.779 --> 00:23:04.259 to someone who had a history of IV drug use and 00:23:04.259 --> 00:23:06.339 was in the burn unit and having a lot of pain. 00:23:06.880 --> 00:23:09.420 And this co -resident launched into a discussion 00:23:09.420 --> 00:23:12.539 about opioid receptors and down regulation and 00:23:12.539 --> 00:23:14.839 why this wasn't going to work. And I'm just sitting 00:23:14.839 --> 00:23:16.720 there thinking, prior to med school, I would 00:23:16.720 --> 00:23:18.980 have had no idea what that means. My mom, if 00:23:18.980 --> 00:23:20.640 you're talking to her, has no idea what that 00:23:20.640 --> 00:23:22.779 means. And it was kind of funny because after 00:23:22.779 --> 00:23:25.240 they got done talking, she's like, can you tell 00:23:25.240 --> 00:23:26.559 me what he just said? Because none of that makes 00:23:26.559 --> 00:23:28.059 sense. I'm like, nothing we give you is going 00:23:28.059 --> 00:23:29.759 to be as good as what you were using. Right. 00:23:30.099 --> 00:23:32.559 And so I think finding a way to break it down 00:23:32.559 --> 00:23:35.799 to very simple terms for anything, whether it's 00:23:35.799 --> 00:23:38.720 clinical stuff or just, you know, the hard discussions. 00:23:39.599 --> 00:23:42.859 Here's what I'm seeing is really relatable. And 00:23:42.859 --> 00:23:45.000 I really try to hold on to the experiences that 00:23:45.000 --> 00:23:47.160 I had as a resident and put myself in their shoes 00:23:47.160 --> 00:23:49.220 because I feel like people tend to forget what 00:23:49.220 --> 00:23:53.309 that's like. And I hear often, like, I'm so happy 00:23:53.309 --> 00:23:54.650 that you remember what that's like or that you 00:23:54.650 --> 00:23:57.369 can put yourself back there. And then if I'm 00:23:57.369 --> 00:23:58.890 explaining anything, I pretend I'm explaining 00:23:58.890 --> 00:24:01.690 it to my mom. Very simple. And I try to put things 00:24:01.690 --> 00:24:04.329 in simple terms of, you know, electrical things, 00:24:04.650 --> 00:24:09.089 plumbing, pipes, tubes, buckets. I feel like 00:24:09.089 --> 00:24:11.430 that helps. That's how you won your Golden Apple 00:24:11.430 --> 00:24:18.640 Teaching Award. Yes. Chaos is something that 00:24:18.640 --> 00:24:21.039 you're really good at managing at work, but you 00:24:21.039 --> 00:24:24.700 also have two little kids at home. Yeah. How 00:24:24.700 --> 00:24:30.140 do you manage your home life? Is it as much of 00:24:30.140 --> 00:24:32.960 a dumpster fire there trying to put your kids 00:24:32.960 --> 00:24:37.299 to bed versus maybe an aortic dissection? At 00:24:37.299 --> 00:24:39.359 times. At least at the aortic dissection, for 00:24:39.359 --> 00:24:42.380 the most part, the pathophysiology follows general 00:24:42.380 --> 00:24:45.220 rules. I have all of the tools at my disposal, 00:24:45.460 --> 00:24:49.440 and I know what to expect. Whereas bedtime with 00:24:49.440 --> 00:24:52.140 my three and a half year old, not always the 00:24:52.140 --> 00:24:55.119 case. He will straight up call you out. Not if 00:24:55.119 --> 00:24:57.279 you even skip a page while reading one of his 00:24:57.279 --> 00:24:59.880 five books that he not only demands but counts 00:24:59.880 --> 00:25:02.140 down. We'll call you out if you've skipped a 00:25:02.140 --> 00:25:07.880 word. Yeah. And, you know, God forbid you don't 00:25:07.880 --> 00:25:10.599 have the toast or the bagel that he requests 00:25:10.599 --> 00:25:15.140 at 852 because it's bedtime, you know. And he 00:25:15.140 --> 00:25:19.019 will say, you need to go to the store. Lovely 00:25:19.019 --> 00:25:22.259 input, child. But no, I manage the chaos at home. 00:25:22.900 --> 00:25:25.599 One, with the help of my husband who does work 00:25:25.599 --> 00:25:27.160 from home. The kids are in daycare, but he is 00:25:27.160 --> 00:25:29.059 phenomenal at doing the running and taking care 00:25:29.059 --> 00:25:31.299 of them and stepping in when I can't because 00:25:31.299 --> 00:25:36.019 I'm here. And bedtimes hit or miss. You know, 00:25:36.099 --> 00:25:39.660 my kids don't have as set of a routine with bedtime. 00:25:39.779 --> 00:25:41.940 There's not like a series of five books to read. 00:25:42.640 --> 00:25:46.680 But they will a lot of times pick out. a new 00:25:46.680 --> 00:25:49.220 or different book that they want to read. And, 00:25:49.319 --> 00:25:53.200 uh, with my four, almost five -year -old now, 00:25:53.319 --> 00:25:58.539 uh, she will sometimes pick books that are too 00:25:58.539 --> 00:26:02.920 long and we have no chance of getting through 00:26:02.920 --> 00:26:07.799 that before bedtime. So I, I will admit that 00:26:07.799 --> 00:26:11.079 I have skipped a page or two on occasion. We 00:26:11.079 --> 00:26:13.599 have removed some of the very, very long books. 00:26:14.519 --> 00:26:16.440 Or we tell him that he's only getting one that 00:26:16.440 --> 00:26:18.480 night. My husband loves to read St. George and 00:26:18.480 --> 00:26:21.200 the Dragon to him. That is a long book. Buddy, 00:26:21.240 --> 00:26:23.660 you get one book tonight. Or you can have five 00:26:23.660 --> 00:26:27.039 books and we read more. Yeah, you have to think 00:26:27.039 --> 00:26:29.640 of system level solutions for these sorts of 00:26:29.640 --> 00:26:31.940 things. Just take it out of the options menu. 00:26:34.599 --> 00:26:37.660 How has being a parent changed how you approach 00:26:37.660 --> 00:26:40.339 crisis management at work? Or has it? I don't 00:26:40.339 --> 00:26:42.180 think it's approach crisis management. I think 00:26:42.180 --> 00:26:44.009 it's... or I don't think it's changed how I approach 00:26:44.009 --> 00:26:46.150 crisis management. I do think it's changed how 00:26:46.150 --> 00:26:49.309 I communicate with people. I think communication 00:26:49.309 --> 00:26:53.369 is very important anyway, but having to explain 00:26:53.369 --> 00:26:56.230 to a three -and -a -half -year -old how you do 00:26:56.230 --> 00:27:00.369 things really helps break it down. And it may 00:27:00.369 --> 00:27:02.130 be something as simple as, like, he loves to 00:27:02.130 --> 00:27:04.269 start the bottle washer. He knows you put in 00:27:04.269 --> 00:27:05.710 the tablet, you push this button, you hold for 00:27:05.710 --> 00:27:07.069 three seconds, you push the next button, you 00:27:07.069 --> 00:27:09.700 start the next button. He's got it. So definitely 00:27:09.700 --> 00:27:12.059 talking to, especially like the CA1s as they're 00:27:12.059 --> 00:27:14.180 starting procedures and things like that, I think 00:27:14.180 --> 00:27:15.900 about how do I explain this to my three and a 00:27:15.900 --> 00:27:17.839 half year old? Not, I don't have to dumb it down, 00:27:17.980 --> 00:27:22.039 but like really clarifying the steps. And maybe 00:27:22.039 --> 00:27:24.380 in a crisis situation, being a little more clear 00:27:24.380 --> 00:27:26.599 about what I want. You know, I think instead 00:27:26.599 --> 00:27:28.740 of saying like, we need bicarb, I want three 00:27:28.740 --> 00:27:32.559 amps of bicarb. I think that's help, maybe. Yeah, 00:27:32.660 --> 00:27:35.779 that makes a lot of sense. Clear, persistently 00:27:35.779 --> 00:27:38.579 clear communication is one of the... Things that 00:27:38.579 --> 00:27:44.619 often will come about when people are going over 00:27:44.619 --> 00:27:48.279 incidents that happened or when Sean Josephs 00:27:48.279 --> 00:27:50.240 is talking about things that went wrong during 00:27:50.240 --> 00:27:53.539 Grand Rounds. A lot of times it comes down to 00:27:53.539 --> 00:27:55.920 a communication issue. So that makes a lot of 00:27:55.920 --> 00:28:01.519 sense. So with all the things that happen in 00:28:01.519 --> 00:28:07.380 a given week for you, how do you recharge? Get 00:28:07.380 --> 00:28:09.460 back to feeling like yourself after a long week 00:28:09.460 --> 00:28:14.819 at the hospital and at home. Despite the fact 00:28:14.819 --> 00:28:17.079 that tiny humans are a lot of work, I love going 00:28:17.079 --> 00:28:19.859 home and playing with my son. My daughter's just 00:28:19.859 --> 00:28:21.880 turned eight months. She's fun. She's not super 00:28:21.880 --> 00:28:24.440 interactive. Sure. But, you know, seeing her 00:28:24.440 --> 00:28:27.019 smile and do her little velociraptor screeches 00:28:27.019 --> 00:28:28.519 when you're playing with her is always great. 00:28:28.619 --> 00:28:32.940 My son is a joy. I mean, he likes to. He's got 00:28:32.940 --> 00:28:35.279 a great imagination. So we go outside. We play. 00:28:35.980 --> 00:28:39.640 And we run around, hide from monsters, whatever. 00:28:39.759 --> 00:28:41.980 And then once the kids are finally in bed, even 00:28:41.980 --> 00:28:44.000 though that's, you know, fun to play with, like 00:28:44.000 --> 00:28:48.240 you need a break. So, you know, that's time for 00:28:48.240 --> 00:28:49.779 like me and my husband to kind of reconnect and 00:28:49.779 --> 00:28:53.819 recharge. We watch a lot of TV, a couple different 00:28:53.819 --> 00:28:56.500 types of series we got going on or play video 00:28:56.500 --> 00:28:58.980 games together. That's definitely a great way 00:28:58.980 --> 00:29:03.099 to connect. Can confirm. So. What advice would 00:29:03.099 --> 00:29:05.240 you give for residents who feel like a black 00:29:05.240 --> 00:29:08.059 cloud is following them or that they seem to 00:29:08.059 --> 00:29:10.079 find themselves in dumpster fires all the time? 00:29:10.420 --> 00:29:14.640 Yeah, I don't think I am ripping off a song or 00:29:14.640 --> 00:29:16.700 a movie lyric, but my own personal mantra is 00:29:16.700 --> 00:29:18.660 you cannot change the weather, but you can prepare 00:29:18.660 --> 00:29:21.440 for the storm, especially as it comes to, you 00:29:21.440 --> 00:29:25.420 know, black clouds. And that's really it. I feel 00:29:25.420 --> 00:29:27.500 like, you know, they've actually done studies 00:29:27.500 --> 00:29:30.819 looking at so -called black clouds in the ED. 00:29:31.949 --> 00:29:33.369 Typically, and they found that there's actually 00:29:33.369 --> 00:29:36.230 not a difference in like call shifts or the amount 00:29:36.230 --> 00:29:38.730 of patients that like they have. It's just somehow 00:29:38.730 --> 00:29:41.490 they seem to get worse patients or things of 00:29:41.490 --> 00:29:44.789 that nature. So like if you if you feel like 00:29:44.789 --> 00:29:49.009 you have acquired said black cloud energy, prepare 00:29:49.009 --> 00:29:51.029 for it. Read about emergencies, the things that 00:29:51.029 --> 00:29:52.509 are rare, the things that you don't expect to 00:29:52.509 --> 00:29:54.410 happen and go into each case thinking what's 00:29:54.410 --> 00:29:59.450 the worst case scenario. So if you could go back 00:29:59.450 --> 00:30:04.240 and give yourself. Right around graduation, right 00:30:04.240 --> 00:30:07.420 before fellowship, a piece of advice for becoming 00:30:07.420 --> 00:30:10.279 a new attending, being a new graduate. What advice 00:30:10.279 --> 00:30:13.619 would you give yourself? Imposter syndrome is 00:30:13.619 --> 00:30:17.160 real and it's not your fault. I legit probably 00:30:17.160 --> 00:30:20.460 had an existential crisis thinking, am I really 00:30:20.460 --> 00:30:22.359 just this bad at my job that all these bad things 00:30:22.359 --> 00:30:25.319 keep happening? And it was nothing in my control. 00:30:26.160 --> 00:30:30.269 But it kind of feels like that. And don't be 00:30:30.269 --> 00:30:32.210 afraid to reach out for help, which I've never 00:30:32.210 --> 00:30:33.829 have been. I'm always quick to call for help 00:30:33.829 --> 00:30:36.630 if I feel like I'm in over my head. I have no 00:30:36.630 --> 00:30:39.130 shame in that. But I think reinforcing that because 00:30:39.130 --> 00:30:41.849 I do see that as a problem with people as they 00:30:41.849 --> 00:30:43.390 graduate. They feel like I'm the new attending. 00:30:43.509 --> 00:30:45.329 I have to prove myself. I shouldn't call for 00:30:45.329 --> 00:30:47.710 help. Don't be afraid to call for help. That 00:30:47.710 --> 00:30:49.690 is something that I've shared with a lot of our 00:30:49.690 --> 00:30:52.450 new attendings as well. And fortunately, I think 00:30:52.450 --> 00:30:55.170 that that's a really strong part of the culture 00:30:55.170 --> 00:30:58.720 here. calling each other, running things by each 00:30:58.720 --> 00:31:01.420 other. I have certainly run plenty of things 00:31:01.420 --> 00:31:08.339 by you. Lastly, what kind of style points, just 00:31:08.339 --> 00:31:10.819 backing up a little bit and not just talking 00:31:10.819 --> 00:31:12.880 about disasters, but what kind of style points 00:31:12.880 --> 00:31:17.039 or piece of advice would you have for residents, 00:31:17.319 --> 00:31:19.599 medical students, and anesthesiologists in general 00:31:19.599 --> 00:31:21.259 that have helped you with your life, with your 00:31:21.259 --> 00:31:26.100 career, and everything else? Organization. I 00:31:26.100 --> 00:31:29.500 still do like my resident write -up of my patients 00:31:29.500 --> 00:31:32.140 beforehand. It's not as detailed as it used to 00:31:32.140 --> 00:31:34.339 be, but I still have all my like basic concerns. 00:31:34.559 --> 00:31:36.299 And that's why I can, you know, if I'm running 00:31:36.299 --> 00:31:38.579 three rooms, I can take a quick peek. Oh, here's 00:31:38.579 --> 00:31:40.099 my risk factors. Here's what I'm worried about. 00:31:43.099 --> 00:31:46.480 You got to take care of yourself before you can 00:31:46.480 --> 00:31:48.220 take care of other people. It seems super cliche, 00:31:48.359 --> 00:31:50.619 but if you're totally burned out, like that's 00:31:50.619 --> 00:31:53.319 not going to help your patients. So put the oxygen 00:31:53.319 --> 00:31:56.630 mask. on yourself first when the plane starts 00:31:56.630 --> 00:32:00.809 to crash. Yeah, yeah. I don't know. I throw out 00:32:00.809 --> 00:32:03.109 so many tidbits in drop of just like little things 00:32:03.109 --> 00:32:04.490 that I'm like, oh, this will make your life easier. 00:32:04.630 --> 00:32:07.690 Like your stylet will actually fit in the back 00:32:07.690 --> 00:32:09.509 of the plumb pump and you can use that to make 00:32:09.509 --> 00:32:11.069 a hanger for your drugs when you don't have the 00:32:11.069 --> 00:32:15.250 metal piece. Absolutely. Yeah, there's a lot 00:32:15.250 --> 00:32:17.250 of little stuff like that that I really like 00:32:17.250 --> 00:32:21.769 showing people as well. Well, Kristen, thank 00:32:21.769 --> 00:32:23.779 you so much for joining us. I really enjoyed 00:32:23.779 --> 00:32:28.720 talking to you. Thanks for having me. Thanks 00:32:28.720 --> 00:32:31.160 for listening to another episode of Style Points. 00:32:31.599 --> 00:32:34.259 If you enjoyed the show, please consider leaving 00:32:34.259 --> 00:32:37.119 us a five -star rating or a quick review. It 00:32:37.119 --> 00:32:39.980 really helps other people find us. If you didn't 00:32:39.980 --> 00:32:42.500 enjoy the show, please put your feedback in the 00:32:42.500 --> 00:32:44.940 anesthetic record so that no one will ever read 00:32:44.940 --> 00:32:48.779 it. You can reach us anytime at stylepointspodcast 00:32:48.779 --> 00:32:52.819 .gmail .com. 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