An emergency physician explains the importance of being fragile [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“I had been trained to be this way. No panic, just a calm journeyman’s approach to any affliction, like a mathematician working an equation. Years of preparation, acquiring a skill set, building up my vault, had readied me to stand in the lounge like a zebra.

And so, I stared at my hands to see if I was actually here, to see who I was. Maybe I was hoping to see something different. Anything, really. A tremble, a shake. But I saw nothing. Just my hands. Steady. Solid. Quiet.

The clock clicked, 8:21. It was one of those old-school clocks, like you’d see on the wall back in grade school. I had zoned out looking at a similar clock at my son’s last parent-teacher conference. The second hand was rigid and jerky, making a big move forward, then a small move back. Big forward, small back.

Everything fits together, like the pieces of a giant puzzle. The picture becomes clear only when the dark colors blend with the bright. The picture is revealed because of the unity of pieces. I felt the seconds ticking, moving forward from 8:21. Even though it didn’t look like it, deep down, the last thirty minutes had kicked my ass. From the outside I was calm, but somewhere inside, the hideous reality of death and suffering screamed and rattled in my well-guarded cage.”

Shannon Sovndal is an emergency physician and author of Fragile: Beauty in Chaos, Grace in Tragedy, and the Hope That Lives in Between.

He shares his story and discusses his KevinMD article, “Calm in the face of the hideous reality of death.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Shannon Sovndal. He’s an emergency physician. He’s the author of a new book, Fragile: Beauty in Chaos, Grace in Tragedy, and the Hope That Lives in Between. He’s also the host of the Match on a Fire: Medicine and More podcast. Shannon, welcome to the show.

Shannon Sovndal: Hey, thanks for having me. I appreciate it.

Kevin Pho: So, we’ll get into all of that in a bit. But first off, if you could share your story and your journey to where you are today with my audience, that’d be great.

Shannon Sovndal: Yeah, I definitely was not on track to be a physician when I started. I actually wanted to be a fighter pilot, and not just because I saw Top Gun. I was really motivated to be a fighter pilot. All through high school, I was trying to get into the academy, and I ended up going to the Air Force Academy. Then I lost my pilot qualifications when I was there. My vision wasn’t good enough, and at the time, you needed to have 20/20 vision to fly. I was devastated, and I ended up leaving.

That moment in my life really changed me forever. I was so devastated by not getting my goal, by the realization that you can’t always control everything, and then by quitting. It took years of honest reflection to say, “I actually quit.” I hated that feeling, and I said, “I’m never quitting again.” I will probably die before I quit again, because it felt so bad. So it was such a good learning experience for me.

Then I went to UC Davis, which is where my best friend and girlfriend went to school, just because I didn’t know where to go. I went there as an aeronautical engineer, but I switched to economics. I studied economics, and I was like, “I don’t think I’m going to do economics.”

Ultimately, what got me into medicine was bike riding. I started to race bikes, and my coach was a doctor. He was always talking about the physiology of the training we were doing, and I got very into that. At the same time, in the summer, I was working on an ambulance, just because I thought it was a good job. My roommates said, “Hey, you should be a doctor.” They were both going to be doctors, so they kind of led me to that, and here I was, going to med school. So that’s kind of how I got there.

Kevin Pho: Wonderful. And you’re board-certified in emergency medicine and EMS. How has the pandemic affected you and your practice?

Shannon Sovndal: Oh, well, when it started, we were overwhelmed. We saw what was happening in other countries, and we saw what was happening in New York, and we were kind of waiting for this wave to hit us and trying to get the EMS system ready for that. It just took a lot of time. I was super concerned about our people. I didn’t want them becoming infected and ultimately getting sick and potentially dying. So I was very stressed about that, and I spent a lot of hours trying to update our protocols, getting all the things in play on how to test our individuals, so that we could really stay in the fight, so to speak, and so that we wouldn’t lose our people when that started.

Then add to that that I still do shifts in the ER, and it definitely added stress, because we weren’t quite sure what this was all about, how effective it was, and what the risk was to me and my family. You’d go to work and wear the PPE all day and come home, and it was exhausting. I feel like right now I need a vacation.

Kevin Pho: And if there was one tip that you could share with either your EMS or your emergency physician colleagues, what would that one tip be?

Shannon Sovndal: I mean, I think it’s always just focusing on basics and premise, like you have a premise. You get complex decisions that you have to make, and what I always try to do is set up pillars of importance. What are the things that I’m trying to accomplish here as I make my decision? That helps guide you in the decision-making process.

So really, there were three things for me in the pandemic. The first was, how do I keep my people safe? How do I keep the EMS providers from not getting sick? Number two, how do I limit the number of providers who are being exposed to the disease? And then number three, how do we provide our EMS care? How do we actually do our job? When we were shaping our protocols and how we would approach this, everything would always be brought back to those simple premises. I think when you have simple pillars that everyone agrees on, it makes buy-in easier, and it actually makes that decision-making process more streamlined.

Kevin Pho: So, the country is opening up, and we’re having more gatherings. How are you preparing your emergency room and your EMS services going forward? And what do you anticipate in the next few months?

Shannon Sovndal: Well, certainly a lot of physicians are concerned that we’re going to have another bump, another spike. That’s because of the natural progression of an infectious disease. You have the initial onslaught, then we kind of curtail it, then it opens up again, and there are going to be new cases. So I think we’re getting ready for that next wave a little bit. We certainly learned a lot in the first wave: How do we even move people through the emergency department safely? What are our policies for that? How do we work in our PPE? How do we take care of COVID patients? What are the best treatment options? And obviously, we’re learning that every day. That’s just being updated.

Kevin Pho: Sure. So, let’s shift gears. Let’s talk about your new book. You wrote an excerpt for KevinMD, and I want to read you a short portion of that excerpt. So, you write, “Everything fits together like the pieces of a giant puzzle. The picture becomes clear only when the dark colors blend with the bright. The picture revealed because of the unity of pieces. I felt the seconds ticking, moving forward from 8:21. Even though it didn’t look like it, deep down the last 30 minutes had kicked my ass. From the outside I was calm, but somewhere inside the hideous reality of death and suffering screamed and rattled in my well-guarded cage.” Now, tell me the story behind that article, and if you could, share the reasons why you wrote the book.

Shannon Sovndal: Yeah, that really kind of sums up the feeling I was having that made me write Fragile. I think a lot of doctors, ER doctors, like the excitement. We want to be the hero: “Who will answer the call? I’ll answer the call. I’ll step into the fray and take care of these people.” I really had this kind of superhero mindset.

What you realize very quickly when you get into medicine is that you can’t control everything. You can’t always control the outcome for your patients, and you’re going to experience devastation. You’re going to see it firsthand on a regular basis. We’re invited in as physicians to be with families through these terrible moments, and so you really have a feeling and a sense of it. I think it can be scary, because it starts to pull you in, and it can make you dark. Certainly, we know there are high levels of depression, PTSD, and anxiety in care providers. That really was the focus of it for me: I was feeling sucked into this. How could I function when I knew that at any moment these terrible things can happen, and the devastation that happens afterward is unreal?

The book started when I had an experience, as ER doctors do, right? We see kids and adults, and there’s no limitation to who you’re going to see who’s significantly hurt. I had a young child who died in my ER. The mother was there, and I had to deal with this. It really affected me deeply, and I decided to write about it. I wasn’t setting out to write Fragile. I was just feeling like I needed to get my brain around this a little bit, and that’s really what the first chapter in the book was. This prologue that I’m talking about is the feeling right after that, with that kid in room 11 just dying.

And then, for an ER doctor, the ER is open, and we’re a single-coverage ER, meaning there’s one doc there. So you don’t get a timeout. You don’t say, “Hey, I want to have an after-action report and go home.” The nurse is calling you for the patient in room 12 and room 17 and room two. So there was this feeling of, how do I deal with this emotion? I’m not really allowed to deal with the emotion at the moment. I have to keep working. And then how does that affect my home life? That’s really what brought Fragile out.

Kevin Pho: And what kind of tips can you share with other physicians and clinicians who work in the emergency room? What are some of the lessons that you learned from the book that you could pass on to your colleagues?

Shannon Sovndal: Well, I think that initial premise of me thinking that I had control of the situation is not true, you know? You kind of have to let go a little bit. I’m going to do my best, and I’m going to do the interventions that I can do, but I can’t ultimately control the outcome. I can do my best medicine, but I shouldn’t take it personally that I can’t always change that outcome. I think coming to terms with that one was difficult.

Number two was coming to terms with how I had to be guarded and protected while at work. Because I have to keep working, I can’t be fully in or give a family member fully what they needed, and it made me feel bad. I try to be compassionate and sensitive, but ultimately, I don’t have much time, and I have to move on. Dealing with those feelings was rough. And ultimately, you come to the realization that we’re doing a job there that is a hard job, and you can’t control it necessarily.

Fragile sounds like it’s a downer or a sad thing, and really, my tip and my take-home from this is that it’s not. Life being fragile is really what opens everything up. If I didn’t have those fragile moments, if I didn’t embrace those moments, I wouldn’t love my life the way I do, or love my kids, or the sunset, or having a cup of coffee. All these little things are little gifts every day, every moment. I’ve really learned to appreciate those because life is fragile. We just have to say, “Hey, we’re going to take the ups and downs, because that’s life.” There’s no way to avoid the downs, right? There’s no way to avoid it. You are going to have some down moments. And really, it’s just saying, “How do I learn from that? How do I move forward from that?”

Kevin Pho: So, you clearly have a lot on your plate. You have the podcast, you have the book, you’re a full-time emergency physician, and you have a beautiful family. What’s something that you’ve been particularly curious about or passionate about in the last few months?

Shannon Sovndal: Well, I’ll kind of switch that a little bit. My real release is jiu-jitsu. For people who don’t do jiu-jitsu, it’s like a wrestling art. You get to essentially fight somebody without hurting them, right? You really have this super hard workout while you’re doing a chess match. You have to think it through while you’re working at the extreme. I found that it really relieves my tension, and it really is a nice outlet for me. So when I have all these stresses from work, I go to jiu-jitsu.

It’s funny, because I can get a sore neck and I can’t turn my head to the left, and I tell my wife I’m going to jiu-jitsu, and she’s like, “Are you crazy? Why would you go to jiu-jitsu when your neck hurts?” But after I go there, I feel better. It’s my tension that’s the problem.

What I’ve really noticed is that during the pandemic, which is obviously stressful, you can’t go to jiu-jitsu, right? That’s a sport that’s not conducive to a pandemic. So really, for me, I’ve had to focus on other things for an outlet, and I think it’s really important to focus on an outlet. One, I think you have to exercise regularly. And then two, I enjoy playing the piano and the guitar, and I’ve really focused more on that during the pandemic. I get my exercise out of the way, and then I try to release by doing those artistic things.

Kevin Pho: Wonderful. Thank you so much, Anthony, for sharing your story, insight, and wisdom. My final question: What’s your take-home message for the KevinMD audience?

Shannon Sovndal: Yeah, life’s fragile, and life being fragile is not a bad thing. That means that we are open to experience fully. You get the highs and the lows. We need it all, because that opens the spectrum of our lives. So again, embrace every moment that you have, because life is fragile, but that makes those moments so real and so awesome.

Kevin Pho: Thank you so much. On our show, we have Shannon Sovndal. He’s an emergency physician and the author of Fragile: Beauty in Chaos, Grace in Tragedy, and the Hope That Lives in Between. Shannon, how can people find you?

Shannon Sovndal: You can go to my website, drsovndal.com. That’s drsovndal.com. You can type in Match on a Fire, and it pops up, or Fragile: Beauty in Chaos, and the book will pop up. If you go to the website, I’d love to hear from you. So leave a message. Shoot me an email.

Kevin Pho: Fantastic. Thank you so much for being on the show.

Shannon Sovndal: Hey, thanks for having me.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes