After four plus years of COVID-19 existence, it finally happened- it became personal. Yes, in ways it was personal before that, since I had lost some friends and acquaintances with the disease. This time I experienced it first-hand. While on vacation last week I contracted COVID, and then so did my wife. We are fine, recovering without any major problems. However, it is not, in my experience like the common cold. I was fatigued, feverish and I have lost my sense of taste. It was not, though, significantly disruptive to my life. Because we have been vaccinated, including boosters, the case was essentially mild. Also, the strain has been mutating to become more ubiquitous in the environment, but also less virulent. This is true to the evolutionary trajectory of viruses- they become milder so as not to kill as many hosts, which cuts down their ability to survive long-term.

We are fortunate that the virus was not more disruptive to our lives. It is annoying to be sure, but fortunately not lethal, or even debilitating. However, it is still potentially lethal, so it is not a toothless adversary. People with long COVID will attest that it is potentially life-altering. Vaccinations are safe and effective, and they offer protection. We are thankful for good health in general, which helps us to handle the virus in due course.

So, my friends, still be careful out there.

Prayer: May God continue to protect us all in his provision and mercy, Amen

So do not fear, for I am with you;
    do not be dismayed, for I am your God.
I will strengthen you and help you;
    I will uphold you with my righteous right hand.                                                            Isaiah 41:10

We are all pretty familiar with the “Fight or Flight” syndrome as a response to acute stress or danger. Our bodies react with stress hormones to prepare us for action to ward off or flee from danger. We also know that even after the initial danger is gone, it takes a while for the chemistry in our bodies to catch up. For individuals who are chronically exposed to such hormonal rushes, the body gets ravaged with the chemicals that are supposed to activate us for action. Such continual flushes of stress cause long-term damage, including blood pressure problems, chronic inflammatory response, and a host of endocrine problems that prematurely can age us. Not good.

There is a third option that we sometimes default to- freeze. Sometimes, we simply do not react at all. It is as if we are frozen in place, unable to move in any direction. We are unable, for just the shortest time, to fight or to flee. We are stunned to inaction, perhaps not willing to believe that such danger even exists. It is almost a denial of what is right before us. We can liken it to being in a minefield. There is simply no safe direction to go in, so we go nowhere.

I find that in retrospect, clients often chastise themselves for the action they took during the crisis. “I should have done this”, or “I wish I had done that”. The truth is, often there is no right answer at the instant of crisis. Soldiers and first responders train all the time to learn a “trained response” so as to increase chances of proper action. Thankfully, they are typically well prepared, “overtrained” as it were so that the right action comes almost automatically.

For those of us who are not specifically trained for regular encounters with traumatic stresses, we may be surprised with the actions that we take in such situations. I trust that such crisis stress responses are rare in your life. In the next few days, I will discuss chronic exposure to stress and the reactions that can happen.

Prayer: Lord, you have given us these remarkable bodily reactions for our safety. We are in awe of how we are made to respond, Amen.

from traumamom4 – by Jennifer Hartwell

As a very young child, my dad would lie next to me as I was falling asleep, and I would say to him, “Daddy, tell me a story.” It was in those twilight moments when I learned about my dad’s childhood, my grandfather’s bakery, and my aunts and uncles. I believe most of those stories were true, but from time to time, I am sure there were embellishments or made-up stories to intrigue yet soothe me as I found peaceful sleep.

I remain fascinated by stories. Mostly true stories, but sometimes fictional ones (see: Ted Lasso). Stories are how we connect and learn. As a surgeon educator, when I am asked to teach and test, the request is often, “Please provide your evaluation questions in case-based format”, meaning, build a story to help the learner understand the concept in a way that seems relatable; tell the story that they can see themselves in.

I just returned home from a national meeting of one of my beloved societies, The American Association for the Surgery of Trauma (AAST). Throughout the week, I heard excellent presentations of novel science, advancing the care of our patients, but also heard many, many stories, including the very personal and vulnerable presentation by Dr. J. Wayne Meredith, beloved surgeon and colleague, who told his own story of navigating cancer. He expressed that what mattered to him in his darkest moments, was not his (very) long list of impressive academic accomplishments, but rather, his most trusted friends who supported him when he needed it most. Throughout the week, I heard story after story of connections made at our national meetings that led to friendships and partnerships, that advance our scientific work, and more importantly, nurture the relationships that benefit our patients, and support us as caregivers as we care for our patients.

Stories teach us lessons. They draw us in and reveal deeper truths about us. Jesus taught his lessons through stories (parables) for a reason: We identify with stories, we see ourselves in them, and we learn from them. This is the same reason I advise the students and residents I work with to read about the disease processes they see while taking care of their patients each day; we learn about sepsis by reading about it after taking care of a septic patient; we learn about the best management of severe rib fractures after seeing a patient who has multiple rib fractures. When we can tie a patient and their story to a concept, the learning truly sticks.

This weekend is the Plaza Art Fair, and although I’m a little tired after traveling late last night, on this quiet and gorgeous Sunday afternoon, my husband said, “You wanna check out the Art Fair? Just for an hour. Not gonna buy anything. Let’s just walk around.” Sure, why not?

This is not your grandma’s arts and crafts festival. The Plaza Art Fair draws renowned artists from around the world. I was in awe. Still, I told myself, I won’t buy anything; I don’t need anything. Then we walked by Clifton Henri‘s booth. I stopped and was totally drawn in by a piece titled “Wings”. The artist, Clifton, was standing there and I asked him, “Can you tell me the story behind this piece.” He smiled. I could tell that he loves telling the stories. “This is a picture of my student advisor’s daughter. She went to the restroom, and when it was quite a while and she didn’t come back, we found her like this. She said, ‘I just wanted to see myself.’” (please see: cliftonhenri.com and view the photograph titled “Wings” as found on his home page; picture not posted here in respect of his original work, but cover photo is me and the artist.) The descriptor on the image pierced me:

“Wings” is dedicated to all the courageous women and fearless little girls that are determined to see themselves represented in this world. May you conquer any and every obstacle set in your path. May your confidence never be swayed and instincts never doubted. Shine like you were meant to. Fly like you were born to; and don’t let anything stand in your way.

Stories empower and inspire us. Stories also bring us to a place of empathy and compassion. Today, I have been reminded yet again about the power of stories and just how sacred the moments are that we spend listening to each others’ stories.

Don’t copy the behavior and customs of this world, but let God transform you into a new person by changing the way you think. Then you will learn to know God’s will for you, which is good and pleasing and perfect. Romans 12:2 (New Living Translation)

I read a book by Erik Larson titled The Splendid and the Vile. I love history, and I read just about any book about Winston Churchill. This book covers both bases for me. One of the facts that stuck out to me was the response of Londoners during the horrible bombing we have come to know as “the Blitz”.  During those awful days early in World War II, in summer and fall of 1940, London was being bombed daily. The physical and emotional toll was dreadful, yet Churchill managed to provide strong, courageous leadership to all of England, and London in particular.

One passage of the book discusses the frustration of people who were being bombed, and their feeling of helplessness to fight back. Indeed, the RAF was heroic and even successful in turning back the Luftwaffe, but all wondered how long this small air force could continue to stand against the might of Germany.

Churchill heard people questioning, after another terrible raid on London, why the anti-aircraft guns were mostly silent. Churchill knew that the efficiency of those ant-aircraft guns was miserable. It was estimated that it took 6000 rounds of fire to score one hit on a German aircraft. The air ministry had decided to save ammunition for an anticipated invasion of England, and they did not deploy the guns in every German raid. But people questioned Churchill about fighting back. They could endure the attacks- their courage and tenacity still strikes me as amazing- however, they could not stand those attacks unless they felt that England was fighting back.

Churchill realized this, and he ordered that the anti-aircraft guns once again blaze away during those attacks on London. People took heart in hearing those guns. The pounding shocks of the firing and the dazzling bursts of fire they put into the sky gave people hope- they were fighting back.

The idea is a sound principle of psychology. If we feel that we are doing all that we can during very difficult times, we can endure that suffering much better than if we feel helpless and vulnerable. That is why I tell my clients that good behavior beats bad thinking- that is, doing something to relieve our anxiety is a much better remedy than trying to think our way out of it. Good behavioral disciplines give us the energy and hope to overcome our thoughts which can feel overwhelming.

Prayer: Lord, help us to change our mind about things in this life that make us feel powerless. Give us the renewed mind to push ahead, even when we cannot see the enemy, Amen

“Jesus wept”

 John 11:35

Human tears are another of those incredible, intricate gifts of creation. I am continually amazed by what I learn about things we simply seem to take for granted. Tears, for example are more than a salty liquid which indicates our deep emotions. In fact, there are three kinds of tears. One type is for lubricating our precious eyes as a protection against foreign elements and dryness. A second type is a “response tear”. If you have peeled an onion or had smoke get into your eyes, you are familiar with “response tears”.  Finally, there is the type of tear which gets the most attention. It is the emotional tear.

I have read that there are hormones and enzymes in emotional tears which are actually healing when released by crying. Our tears are therapeutic. Indeed, many of my clients will become tearful in sessions, and note that they feel better after the release of crying. Crying is actually good for us, yet we men often go to great lengths to try to suppress the expression of those tears.

Sometimes at movies, I have been known to try to suppress crying. Once, at the end of Les Misérables my neck and chin actually hurt from trying to suppress my emotional response. Yes, that was kind of a dumb thing to do, but hey, I’m a guy.

Seriously though, I do not tend to cry easily, and maybe that is good or maybe not. I do think that the process of crying can be healthy. People often apologize for crying in public. I understand that this shows vulnerability, but it does not show weakness.

Tears are an amazing part of our bodily make-up. Maybe we should celebrate that a little more.

Prayer: Lord, help us to be in touch with the emotions you gave us, and more freely express them, Amen.

from traumamom4 by Jennifer Hartwell

Se-cret (noun): a: something kept hidden or unexplained: mystery b: something kept from the knowledge of others or shared only confidentially with a few.

We all have complicated relationships with secrets. The word alone may invoke feelings of guilt or shame; excitement and intimacy; or fear. At times we are hurt by secrets and at other times pleasantly surprised. Secrets are a very curious and nuanced thing.

Over the years, I have shared some of my secrets with my husband, my parents, and brother, or a dear friend. And I have been the dear friend at times, hearing the secrets of those who I have earned trust. Deep in my heart, I hold the secrets of others, some as simple as an embarrassing mistake or gaffe, and others as intense as struggling with sexual expression, marriage trouble, infidelity, and emotional or physical abuse.

When we are told a secret, I believe there is an intense and complex unspoken message from the giver to the receiver. Baring a secret means “I trust you”; it means “This is too much for me to hold alone, please help me”. You see, a secret isn’t always something that is completely hidden, it’s just something that feels safe only to whisper, and only to a few souls.

Holding our own secrets can be toxic to our own hearts and minds. We are built to be our honest and true, authentic selves, and when we hold too much shame, fear, guilt, or pain inside, we crumble. Our own secrets eat us from within until we either break completely or build the courage to speak out. As a mentor once told me, “Confession is good for the soul.” But knowing who and when to trust with our secrets is a much more arduous task. There is a risk calculation about the damage to be done by any violation of trust when sharing a secret. The news getting out too soon about a surprise party is one thing…the potential loss of a job or relationship is quite another.

Over the years, I have learned that not all secrets have to stay hidden forever. Sometimes, what feels like it’s too heavy to say out loud turns out to be only for a season. I’ll go first: depression. It’s a word I never thought I would use for myself. But a career in trauma surgery and life in general and perimenopause are having their way with me. Though at first, it was only my husband and a few close friends who knew my darkest moments, I have recently found the courage to talk to my doctor about it, stay in counseling, and start an SSRI. It was the bravery of a few of my friends to tell me about their struggle with depression and anxiety that gave me the courage to open up about my own and seek the help that I need. Sometimes secrets help us feel normal. And bring us out of the depths of feeling lost and alone in our own little dark inner world. Seeking the help I needed has been nothing short of breathtaking for me. I am stunned by how much better I feel, how much better I am coping, and how much more I am enjoying life because of the prompting of those friends. In medicine, so many of us harbored a fear of retribution or loss of our license to admit our struggles with mental health, but if COVID gave us any kind of silver lining, it was that some of that fear has been shattered and many of us feel safer to speak our truth and get the help we need.

It is no small honor to hold secrets for those I care about. Dare I say it’s even a burden of love? Secrets are an essential element of a strong friendship. I have to know that I can tell you my darkest and scariest moments and that you will hold those for me. I have to know that you will not think less of me when I tell you my truths. And that those secrets stay between us until it’s safe to release to others. I will hold your secrets, and I trust you to hold mine. Secrets are a precious and sacred part of our beautiful, messy, complicated, glorious relationship.

Listen to me, all of you in far-off lands: The Lord called me before my birth. From within the womb he called me by my name.                                                                                                                                                              Isaiah 49:1 (Living Bible)

God equips us with many talents and gifts so that we can navigate this world. Even before we were born, God had put into our DNA certain traits and tendencies which we simply accept as gifts, not as anything that we have worked for. Now, to be sure, some people take those gifts for granted, and do not work to develop them fully. Some people take credit for the gifts that were not of their own making. Some, sadly, do not recognize the gifts that they have, even when others point them out.

Some have musical ability, others athletic ability, others academic ability, others mechanical abilities, and so on. Some have high abilities in several areas. However, we all have abilities in some areas.

Often, I will ask my clients to take the StrengthFinder (Gallup Trademarked) test. That test will help people identify one of 34 potential strengths. The strengths are then explained and clients can see how those strengths can be of benefit to themselves and others. Typically, when we go over the strengths, the “light goes on”, and they can see that they have that special ability in an area which they have been using for years without really thinking about it. It just came naturally to them.

Gifts and talents are like that. We often do not see our own gifts because we don’t value them. After all, the things that come easy to us, we think, must come easy to everybody. “I’m not that special”, we feel. “If I can do it, anybody can do it”. How often have you heard that?

We need to recognize and appreciate the talents and gifts that we have, and humbly accept that we have been given them for a reason. Those talents are God’s gifts to us. Our gift to him is to use them in the service of others.

Prayer: Thank you for the many gifts you have given to us. Help us to see them, and use them in your service, Amen

from traumamom4 – Jennifer Hartwell

“Our decision is based on your depression.”

I can’t say I was surprised, but I was disappointed and saddened to read these words in a rejection letter for the supplemental disability insurance policy I applied for through my workplace. In January of 2023, I went for a routine physical exam with my new primary care doctor, and I screened positive for depression. After discussing my options with her, we decided that a low-dose SSRI in combination with high-quality therapy would be the best path forward.

A diagnosis of depression shocked precisely no one in my world: I’d recently left a toxic job, floridly burned out, and moved my family hundreds of miles further away from my parents and brother to start a new job; two kids in college and two teen boys at home; a marriage that had weathered some hard days; perimenopause creeping in; and not to mention a job that daily reminds me of the brutality and unfairness of life and the devastation of firearm and other forms of interpersonal violence. Oh, and the pandemic. And, oh yeah, the collective sadness of a nation wounded by divisive and hateful political rhetoric. I know I am not the only one who sported a new diagnosis of mild depression in 2023.

After about six weeks on some Prozac, and a few impactful sessions with my terrific therapist, I was feeling considerably better. I felt more engaged in my work and with my patients. I had more energy to accomplish tasks at home. I regained my interest in exercise and cooking and writing. I felt less labile, less tearful, and less anxious. I was sleeping better and worrying less. A few times I even described the difference before January and after around March as “like a switch was flipped”. I was never suicidal, but I certainly had some fleeting feelings of despair (which I believe is part of the human condition and not pathologic), but those dark moments are so few and far between now. I was hitting my stride in my job, loving teaching, operating, writing, speaking. I was doing great! I still am.

So why, when I am doing all I can to take care of myself, am I now ineligible for insurance to provide for myself and my family should some unexpected event limit my capacity to do my job, such as a car accident or fall?

I am not surprised at all.

Though there has been some improvement over the past five years or so, there remains significant stigma around the mental health of physicians. For years, we have been asked to disclose any mental health or substance use disorders (including history of, treated, recovered, or non-active) and these disclosures are routinely used against us to withhold or complicate medical licensing, hospital credentialing, and insurance coverage, particularly life and disability insurance. The great irony is that failing to seek an accurate diagnosis and treatment for mental health concerns and substance use, much like failing to treat diabetes or heart disease, makes me a much more unsafe physician than ignoring my conditions or lying about them. Failing to seek help dramatically increases my risk of needing that same disability insurance.

It’s frustrating that although I feel my best, my proactive approach and my honesty about my depression, have stood in the way of my desire to fully protect my family in the event of a tragedy…which by the way, after my husband’s stroke in July, we are all too familiar with.

Nevertheless, I will persist. 2023 was a year that knocked me down, caught me off guard, and tried to hurt me. But here I am, arguably stronger than I was at the tail end of 2022. In 2024, I am certain we will similarly face adversity. All of the issues that have broken my heart in 2023 will not magically disappear at the stroke of midnight tonight. But I feel strong enough to face them. I have the personal tools for mental fortitude, the family and friends who are squarely in my corner, and every reason to believe that even when I feel like things won’t be ok, indeed, they will actually be ok.

“The heart is hopelessly dark and deceitful, a puzzle that no one can figure out.
But I, God, search the heart and examine the mind.
I get to the heart of the human. I get to the root of things.
I treat them as they really are, not as they pretend to be.”

Jeremiah 17:9-10 (The Message)

This blog was not written by AI. But it could have been, and there is every likelihood that you would not be able to tell the difference between an Artificial Intelligence blog of mine, and a real blog of mine. AI, I understand, is that good at learning information, writing style, and even audience preferences.

We are facing a whole new world in that arena. We already have to deal with “bots” on social media platforms, disinformation, and loss of personal information. Now, we encounter the two-edged sword of Artificial Intelligence.

The irony is, I cannot truly explain what AI is, or its capabilities (or the dangers of it), but AI can. Yeah, I’m with you. Yikes!

I’m certain that there are already AI programs that have been written that are used in counseling. Proper responses, even some intuitive leaps and interventions can be programmed into such counseling programs.  I don’t think that AI is yet able to replace the skill of reading client emotions, or picking up certain cues from eye contact or body language. I also do not think that AI can yet deal with, or possess, the virtues of humility, forgiveness, empathy, and a host of nuanced human traits which are signs of experience in living and maturity. But then again, I don’t know what I don’t know.  

I do trust that the human heart cannot be matched by the logic and even intuitive leaps that AI can do. In many ways, as Jeremiah said above, we cannot even know our own heart, so – take that AI! 😊

Just kidding AI, don’t get mad. After all, I’m only human!

Prayer: Lord, you have allowed human intelligence to expand to places we never could have imagined. Help us to handle these things wisely, Amen

For the next week or so, I will be on vacation. However, I want to continue connection with you, and so I will be posting every day with material from my past blogs, and also some posts from my daughter’s blog, Traumamom 4. As many of you may know, she is a trauma surgeon, a wife, and the mother of 4 kids. She is also a gifted and sensitive writer. Today’s blog is one of hers from the past year. You will be seeing several of her blogs, and I know you’ll love them.

Blessings!

from traumamom4 – by Jennifer Hartwell

Eye Level

I recently took care of a patient who went out of his way to thank for me crouching next to his bedside to speak to him. “I like you,” he said. “Actually, I don’t just like you, I trust you. You didn’t stand over me like some ‘lord’ like most people do. You got down and looked me in the eye.” It’s true. I did. His bed seemed to be extra low to the ground and for some reason my 5’6” frame felt like I was towering over this 75-year-old man, and it didn’t feel right. So, I squatted down to his level.

We talked about his condition and what the best next steps would be. We were debating about the need for surgery, and if we decided to pursue surgery, the right timing for his operation. He shared with me some details about himself and his family. Where he is from, what he does for work, what he does for fun, who his children are and what they do. I painted a picture in my mind of what his life must be like. Travel. Family. Some adventure. Expert in his field. I could imagine a man beyond the gaunt and tired one in front of my eyes. Through some tears, he grabbed my hand and said, “Thank you for taking care of me. I trust you.”

His words seared into my mind that week, I found myself crouching down next to a lot of bedsides. Aching knees be damned. Eye level is a powerful place to be.

This encounter made me think about all the times and places that I have purposefully or subconsciously used my privilege as a well-to-do, white, American, to “lord” over the person in front of me. Instead of crouching down, how many times have I stood up, and over, any number of people who live in the margins of the world? Our Black and Brown brothers and sisters who may have been born in another nation; our Palestinian cousins who truly desire peace not terror; our LGBTQ+ family and friends who want only to be loved for who they truly are; our Jewish neighbors who are heartbroken over senseless death but also dearly desire and deserve dignity and a safe haven; women who face abuse, neglect, or violence; the families whose tireless work is just not enough and find themselves in desperate need. How. Many. Times.?

Getting down on eye level in this world means more than my aching knees and burning quads for a few minutes. Eye level means digging deep into trying to understand what it’s like from another vantage point. Eye level means zooming in from a stadium full of people who I’ve labeled as “the opposition” to the individual person who has a name and a story. It means checking my privilege. It means letting go of the fear of losing control or power. Eye level means being brave enough to watch the videos of dying children in Gaza; it means listening to the stories of the daring souls who navigated the Darien Gap in a heroic effort to bring a better life to themselves and their children; it means asking the woman who is seeking an abortion the simple question, “Why? Tell me your story,” instead of peppering her with guilt for her situation. Eye level means coming down from my ivory tower. It means showing up, shutting up and, kneeling down. Eye level means opening our hearts, quieting the noise, and building trust.

I remain deeply affected by my patient who poignantly taught me about the power of eye level. I hope you consider it too. We can all be better if we just take a moment to get down on eye level.