How this physician’s first experience with death affected her [PODCAST]

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“My sister called me. I answered. And, then, I lost it: ‘He died. He died,’ I repeated. ‘Our patient died. I literally did CPR on this guy. We tried to save his life, and he died,’ I repeated over and over. The tears streaming down my cheeks were cathartic. More than signifying a loss, the tears signified that I was still human, that I haven’t lost touch with reality. Residency hasn’t changed me. Death still affects me. I’m not numb. I’m human.

My tears were confirmation that I haven’t changed in that way. I was not calloused. He died. And I still felt it. I had a heart.”

Maseray S. Kamara is a general surgery resident and can be reached on Instagram @drkamara.

She shares her story and discusses her KevinMD article, “Death still affects me. I’m not numb. I’m human.”

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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 Maseray Kamara. She is a general surgery resident, and she wrote the KevinMD article “Death still affects me. I’m not numb. I’m human.” Maseray, welcome to the show.

Maseray S. Kamara: Thank you so much for having me. I’m excited to be here.

Kevin Pho: So we’ll get into your KevinMD article in a little bit, but first off, can you just share your story and your journey to where you are today?

Maseray S. Kamara: No problem. So again, my name is Maseray Kamara. I am a general surgery resident based in Detroit, Michigan. I was born and raised in Virginia, Northern Virginia to be exact. I’m a first-generation American; my family is originally from Sierra Leone, West Africa. I went to undergrad at Princeton University. My major was molecular biology, and I actually wrote my thesis on sickle cell disease in Sierra Leone. I went to medical school at Michigan State University College of Human Medicine, and then I stayed in Michigan for my residency. I’m now at Detroit Medical Center, and I am in my third of five years of general surgery residency.

Kevin Pho: From a general surgery standpoint, how has the pandemic affected what you’re seeing and your training?

Maseray S. Kamara: Especially during the first initial wave, it had a huge impact. We stopped doing all of our elective operations, and we went mostly toward doing all the emergent operations. Another major thing that happened was that our post-operative area actually became a full-fledged intensive care unit, or ICU, because we had that many patients who were very sick from the COVID virus, and they needed to be intubated and have more intense care.

The effect for our training meant that we weren’t getting as many elective cases and weren’t doing as many of the skills that we would hopefully want to train in at that time, but we got training in a different sense. The general surgery team covered one of the ICUs, but additionally, we were the tube and line service. So we would help, especially in the medical intensive care unit, with anybody who needed any chest tubes or central lines and arterial lines. I spent many of my calls during the height of the COVID pandemic in Michigan putting in chest tubes, replacing central lines, and putting in new lines. So that’s a lot of the things that happened there.

Kevin Pho: So we’re talking at the beginning of November, and we’re on the cusp of another surge of coronavirus cases. Now, from a general surgery standpoint, what do you anticipate the next one to two months will bring?

Maseray S. Kamara: Well, we shall see. Right now we’re just getting ready in case we have another surge. But if we are to have another surge, we have to make sure that we keep all of our patients, and the providers as well, as protected as possible. So we are continuing to have our discussions on PPE, and we are continuing to talk about what the surge plan will look like: which parts of our hospital will take an influx of patients, and how exactly the different residents, based on whatever specialty you are, will play a role. Whether you are an emergency medicine physician and right there seeing the patients as they first come in, or you’re in a more surgical subspecialty and will see them when they get to the floor, and we’re helping out with the ICU.

So I think one thing that is good this time around is that we have more plans that are set in place and ready to go. But I expect to do the same thing we did before, which is focus on protecting our providers but making sure we’re taking very good care of our patients. And funny enough, I’m actually the president of the Detroit Medical Center’s resident council. We just had an all-resident and fellow COVID call yesterday, and we met with graduate medical education and the leaders at our hospital. So we’re getting ready, and I think right now it’s about having plans for when and if it gets worse.

Kevin Pho: All right, let’s transition into your KevinMD article, “Death still affects me. I’m not numb. I’m human.” Now, for those who haven’t read that story, can you just share it with my audience now, and maybe share the story of why you decided to write it?

Maseray S. Kamara: No problem. So I am actually a writer at heart. I’ve been writing since I was young; I used to write a lot of poems and short stories. One thing that I do, and I think it’s a way that I just decompress and deal with everything that’s going on, is I will take out my phone and write in the notepad. This story, “Death still affects me,” I actually wrote in my intern year, while I was on the burn and ICU service. We had a patient who unfortunately coded, and we had to do CPR on this patient. This was the first time that I did CPR, and we didn’t get ROSC, or a return of spontaneous circulation, so the patient unfortunately passed away.

I basically write in this reflection about the impact. I would say that I’m a person who’s in touch with my emotions, but that day, nurses cried, my medical student cried, another one of my co-residents cried openly, and I didn’t feel anything. I felt like I wanted to make them feel better, and I comforted them, but I wasn’t sad myself. So then I was worried. I said, “Wow, residency. This is what they say: You see so many sick patients that you forget, or it doesn’t affect you. You just keep moving, because that’s what we’re expected to do.” We’re expected to remain stoic and make decisions without the emotion affecting us. So I thought, in my intern year, that day, that this is it. It happened.

But then when I went home, took a shower, and really thought about it, my sister called me, and then I started crying. I told her what happened. I kept on saying, “He died. He died. The patient died.” The tears felt good in a way, because it just showed me, “You still do. This affects you. You might have seen a lot of people, some with good outcomes, some with very poor outcomes, some with trauma, but you’re OK. You still feel this.” So that’s what the article is about. It’s about how we might be stoic at all times, but the emotion still affects us, even when we go from ICU room to ICU room.

Kevin Pho: Now, you wrote this story when you were an intern, and now you’re in your third year of residency training. Tell me how death affects you now, after seeing so many cases during your training, and I’m sure some of them may not have gone the way you thought they would.

Maseray S. Kamara: It’s the same thing. It’s something where now what I do is let myself take that pause. I think as an intern, sometimes you think, “I have to keep going. I have to go see the next patient. I have to do it quickly, and then I have to present to my chief resident so that we can talk to the attending.” You’re really just in this flow of trying to get things done quickly, and you don’t give yourself the moment. But now I tell myself, “It’s OK for me to just stop.” I discuss it with my team, and I say it’s really unfortunate, and we really digest a lot of the feelings that we’re having. And then you just keep going, because I have to keep going for the next patient. I think I just give myself more space now, and that’s what’s different as I’ve progressed in my training.

Kevin Pho: Now, on your team you have a lot of medical students and interns. If they’re going through this for the first time, what kind of lessons did you learn from this? What kind of advice can you give them?

Maseray S. Kamara: I would say welcome the emotions. One thing is, when people are, you know, you’re a surgeon, you’re supposed to be stoic, you’re supposed to have that straight face, and you’re always supposed to know the answer. But I think give yourself space to be human. Sometimes things happen where the outcome is not what we would have wanted, or not what we would like to explain, but I think it’s just to give yourself space to have these emotions, to process them, and then move forward.

Kevin Pho: Now, you have that stereotype of the surgeon, like you said, being stoic or being afraid to show emotion. Has anything changed over the years from that stereotype? How is surgery training now? Are people more encouraged to show emotions, especially in the surgical field?

Maseray S. Kamara: In the surgery field, yes. I think medicine in general is becoming more open to the idea of wellness. Right now, physician wellness, resident wellness, it’s a really sexy term; everyone’s talking about it. But I think it goes through all the specialties, and we’re realizing that while once being a physician meant that your life was all about that, 100, I think now that’s not the case, and we are departing from whatever the believed stereotype of each specialty should be. So I would say I have very open conversations with my attending physicians now, and we talk about these things, and they say, “Back in my training, we wouldn’t have discussed that,” or “We wouldn’t have sat down and really practiced that.” So I think medicine in general is moving in that direction. I think it’s a beautiful thing, because it’s just acknowledging more truth.

Kevin Pho: Now, when I was a resident 20 years ago, there wasn’t a lot of support when it came to talking after a case goes wrong, or even after a death. What’s it like now? What kind of support services are available if someone wanted to talk further about their emotions, or about themselves, or about wellness?

Maseray S. Kamara: From a more systematic standpoint, we always have morbidity and mortality conferences, where we can talk about things that went wrong and went right in a particular case where we had an unfortunate outcome. But from a more individual standpoint, now we have mentorship in place. I have a faculty mentor who I can text at any point in time and tell her, “Hi, I just wanted to talk about something that just happened.” So I feel like, number one, we’re being assigned more mentorship, whether it’s at the attending level or another co-resident. And then two, we also have services that are available if you would like to utilize them. My graduate medical education program does have opportunities for us to meet with a psychiatrist or a psychologist and basically go over some things, especially when you’re at the height of a lot of these difficult things to handle while you’re training. So I think it’s just more opportunities to talk, and people are open to talking, so it’s good.

Kevin Pho: We’re talking to Maseray Kamara. She is a general surgery resident, and she wrote the KevinMD article “Death still affects me. I’m not numb. I’m human.” Maseray, what’s the take-home message that you want to leave with the KevinMD audience?

Maseray S. Kamara: The take-home message would be: Be well. Find whatever it is for you that allows you to decompress and process everything that’s happening around you. For me, it’s writing; for others, it might be hiking or whatever. But find whatever it is and just be very diligent about doing that. You deserve to decompress. You deserve to process everything that’s happening. You’re not a robot; you’re human.

Kevin Pho: Maseray, thank you so much for sharing your story and insight, and thanks again for being on the show.

Maseray S. Kamara: Thanks for having me.

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