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“Recently, I realized that something needed to change in my family life. With three busy daughters at three different schools who participate in multiple activities along with my full-time job as an anesthesiologist, my life depended on accurate and concise communication. However, this was the third time in a week that a ball had been dropped between my husband and me.
This time it resulted in my middle daughter, Laini, being left at practice, and the coach calling to figure out who was picking up this last straggler. It was enough to make me realize that something had to change.
The previous day, I had run a code in the GI suite at the hospital where I work. Everything had gone smoothly with team members, all understanding each other perfectly. If I could communicate effectively with a team of five health care members, why couldn’t I use these strategies to communicate with my own husband more effectively?”
Maria Michaelis is a pediatric anesthesiologist.
She shares her story and discusses her KevinMD article, “Closed-loop communications: Good for codes and for marriage.”
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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 Maria Michaelis. She’s a pediatric anesthesiologist and a KevinMD contributor. She wrote two articles recently for my site: the first, “Closed-loop communications: Good for codes and for marriage,” and second, “Can patients see my smile behind all of this PPE?” So first off, tell me your story and your journey to where you are today.
Maria Michaelis: Well, I’m a practicing anesthesiologist, and like you mentioned, I do pediatric anesthesia about 50 percent of the time and then general anesthesia the other 50 percent. We’re in an urban practice center where we do a mixed caseload, and I’ve been practicing 15 years post-residency. I did my residency at Mayo Clinic in Rochester, Minnesota, and then came back to practice here, in my home state of Nebraska. I think one of the best-kept secrets is living in the Midwest, and Omaha specifically. I like it here.
I’ve got three kids. I had one during residency and two afterwards, so I’m kind of a multitasking mom, trying to figure out how to balance it all, which, I figured out, is not possible. Then I started doing pediatric anesthesia about six years ago, when our practice asked for a few volunteers to get board-certified in pediatric anesthesia, and I decided that was an interest I had. So I’ve been doing about 50 percent kids for the last six years.
Kevin Pho: Wonderful. And how has the pandemic affected you and your practice so far?
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Maria Michaelis: Well, as everybody would say, it’s changed everything. We had to implement, at the beginning of this, intubation and extubation teams before we had universal testing. Now, luckily, our hospital has universal testing for every operative patient, and now every admission gets tested, so we know what we’re dealing with going in, and there’s no longer a need for the intubation and extubation team.
During that first month or six weeks, when we had the intubation and extubation team, we weren’t able to do full caseloads. We were just doing emergent and urgent types of cases. They had a staging system that our hospital implemented, and we’d only do those cases. It was very tedious, because you would be assigned to the intubation team or extubation team for the day, and all you would do is go from room to room to room, not meeting anyone ahead of time until you got in there with your full, we call them the PAPR, the full getup on. So they really couldn’t see you, and they barely could hear you, and all of a sudden you’re saying, “OK, trust me to intubate you.”
Then we’d sit there for 10 minutes afterwards, or 15, until the air recirculated in our operating room, while we wiped everything down and stayed with the patient and monitored the patient. Then everybody could come back in, and then we’d come back and do it all over for extubations. So it took a lot of coordinating to know which rooms to go to, and it just took the personal touch of anesthesia out for me. It was not my favorite thing to do, but it was a necessary thing at the time. Like I said, I’m so glad that we now have universal testing, and things are getting back to my old style of practice, which I enjoy.
Kevin Pho: And if there’s something that you know now that you wish you knew before the pandemic started, what would that be?
Maria Michaelis: Oh, I would say how important it is to have those interactions in pre-op, I mean, for me anyway, and I’m sure other physicians in different specialties know that meeting your patient, having that whole ability to have a conversation with full eye contact and expressions, is important. I didn’t realize how important it was until I was wearing a mask every day, which we still are in our facility, and I’m sure we will have the universal masking for quite some time.
But I’ve tried to convey more things with my voice tone and just talking things through a little bit more with patients, and then I do kind of utilize a brief time with your mask down while we do our airway exam, to kind of, you know, ease their fears and let them see my face too. But yeah, I think at the beginning of this, it would have been nice to know how important that really is.
Kevin Pho: Sure. You know how it is: When things are taken away, then you appreciate them.
Maria Michaelis: Absolutely.
Kevin Pho: So you wrote a KevinMD article, “Closed-loop communications: Good for codes and for marriage,” and I know that during the pandemic, a lot of families are going through stressful times right now. So tell me the story behind that article and why you decided to write it.
Maria Michaelis: Sure. My husband, Mark, and I have three daughters, and as you know, I know you have children too, we are always going in different directions with work and kids, driving them here to there, and we missed things so much in the last five years, where one kid wouldn’t have a bag, one kid wouldn’t get picked up. I would be at work late, my husband wouldn’t know, and I’d say, “No, I told you that,” and he wouldn’t remember. So we thought, OK, when I do codes at work, this stuff doesn’t get dropped, because you repeat back to me what you say.
So I talked to him about closed-loop communication. He’s not a medical person, so I just kind of told him the basics of it, and he latched on to it right away, because he’s kind of a no-nonsense, black-and-white type of individual. So we started doing the closed loop, where even if it was on text message, you’d have to repeat it back and say in your own words what you understood: who’s going to take this to there. We found out we had a lot fewer misunderstandings and, frankly, a lot less fighting, because we would bicker about who made the mistake. You know, you always kind of want to place the blame on your spouse, and we’d fight about that, and this closed-loop communication cut down on our bickering, and it made things more pleasant for our communications.
And then also, at night, I didn’t put this in the article, I don’t think, we implemented a 20-minute sit-down time when our three kids are in bed, and we talk about the next day and if there are questions, concerns, or anything. That’s kind of what they do in the debrief on codes as well. So it helped our marriage, and especially in this pandemic time, when we were in close quarters, we found that our communication skills being at optimal levels cut down on bickering. Not to say that, you know, we didn’t get on each other’s nerves, because we did, because he wasn’t used to me being around as much, and vice versa, and our kids were there, doing classes in different rooms. But it did help that we had some of these communication things that we had figured out ahead of time.
Kevin Pho: Yeah, that’s funny, that whatever we learned in medicine and medical training kind of seeps into our family life. I have two young daughters as well. My oldest is a freshman in high school, and one of the things that I implement is the sign-out list, just like we do during change of shifts. Whenever she’s about to start her homework, we always kind of run the list, and whenever she’s finished, we always run the list, just to kind of make sure that everything gets done. So it’s funny how our training kind of seeps into what we do every day.
Maria Michaelis: Right, and our kids aren’t always on board with it, but once they figure out that it’s helpful, we try to get them that way. What I did find out is that our three girls were really appreciative of having that communication and not getting left at places, you know, knowing who was going to pick them up ahead of time, and then just knowing that we weren’t going to drop the ball. But now we have a new thing, which is that our 16-year-old, our oldest, is learning to drive, so we’re going to try to incorporate that into our communication, and I think that she’s going to be a part of our closed-loop communication debriefs at night.
Kevin Pho: So during the pandemic, a lot of us are staying in. The kids are staying in, they’re learning from home, there’s a lot of family time, and that could certainly increase the stress in any family. So do you have any advice, or anything that you’ve learned over the past few months, that you would want to share with the audience?
Maria Michaelis: Well, I found out that we have three daughters with three different personalities, and I’m sure your daughters have different personalities, so different things would work for them. Our middle daughter needed time alone, and that’s kind of like me: If I’m getting irritated by everything, I just need time alone. So there were times I would just go sit in my master closet, and she would go sit in her room, just to take time apart. And then my oldest and my youngest just like to have music playing, so they would go into their own area and play music.
But we did notice that we each had to kind of recognize that we were on each other’s nerves for whatever reason and try to just separate yourself from it, whether that’s even going on a walk. My husband would spend some time in the garage when he got irritated. But yeah, I think it’s important to be cognizant of your own feelings, and when you’re starting to get irritated about the close proximity of siblings or a spouse, that you take some time and just try not to offend them, and say, “I just need a little alone time right now.”
Kevin Pho: Now, over the past few months, has anything surprised you about yourself or your relationship with your family?
Maria Michaelis: I found out that, like I said, we had some good communication backbone there; there were things we could improve on. Our middle daughter especially, who is pre-adolescent, was going through some of those mood changes, and it was helpful for her to vocalize her issues to us. And then also, we started having her see just a counselor, a voice, because she was having only us around. She didn’t have her friends around anymore, she didn’t have her grandparents or anybody else to talk to. It was just her dad and I and her siblings. So we did Zoom calls with a counselor once a month for her, just to have a third party that she could go and talk to, somebody, without us eavesdropping and being around, and that helped her immensely.
So I would say, like I said, everybody’s a little different with their personalities, and you need to kind of see what works for your own personality. So I did learn that everybody’s a little different, even in our own household.
Kevin Pho: Sure. So let’s take a step back. Tell me something that you’ve been curious about or something that you’ve been passionate about recently.
Maria Michaelis: I would say figuring out your niche, like trying to figure out where you fit after 15 years in practice. Especially with this pandemic, we’ve had a lot of downtime in our department, at least, and it has given us some time at home to think about academic endeavors and think about all the things that I’ve done through the years. The one thing that I’ve done in the last couple of years is become involved in our Nebraska Board of Medicine and Surgery. I’m on the licensure committee, which hears complaints about other physicians in our state, and I’ve become more passionate about that and even decided to be on the national committee. I’m starting on the low rung, I’m just on the editorial committee, but I thought that would be a good opportunity to move my way up.
That’s where I feel like my passion has led me, to licensure and to board certification, things like that. But five years ago, I would have said three different things. It’s just that you have to try different things to see what really interests you, and I don’t think you should be ashamed to say, “Well, 10 years ago, I was really interested in this, but now I have zero interest in that,” because that’s part of life. Variety is the spice of life. But I’d say right now, I’m really interested in my position on the Nebraska Board of Medicine and Surgery and just licensure issues and board certification.
Kevin Pho: Sure. We’re talking to Maria Michaelis. She’s a pediatric anesthesiologist. She wrote the KevinMD article “Closed-loop communications: Good for codes and for marriage.” Maria, what’s your take-home message for the KevinMD audience?
Maria Michaelis: Well, I think this is probably one that’s been universal right now, but especially in our houses: Just be kind to each other, and not to try to tear anyone down right now. My middle daughter, again, is getting on the cusp of social media, and she was distressed last night about a post that she had put up on social media that had a negative comment on it. I listed all these positives that were listed with it, all these positive comments, but it was the one negative one that stuck out. I think that’s the way human nature is: You get 10 compliments to one complaint, and you’re always going to remember that one negative comment.
So it’s important to really think about what you’re saying, especially on social media, and to others in this time. Have some compassion and empathy, and try to keep the positive comments coming, and maybe the negative ones, really weigh whether they’re necessary to help anything, you know. So I think that’s what I told her last night, and that’s my take-home right now: Be empathetic and compassionate with others.
Kevin Pho: Thank you so much for sharing your stories, insight, and wisdom. Maria, thank you for being on the show.
Maria Michaelis: Thank you.
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