Navigating emotional storms in the ER [PODCAST]

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Join Victoria Goodheart, an emergency physician. In this episode, we explore the intricate world of health care professionals, their emotional journeys, and the profound impact they make on the lives of patients and families. Victoria shares personal stories and insights, shedding light on the challenges, resilience, and humanity that define the frontlines of health care.

Victoria Goodheart is an emergency physician.

She discusses the KevinMD article, “A heartfelt plea: the power of emotions in health care.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at kevinmd.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Victoria Goodheart. She is an emergency physician. Today’s KevinMD article is “A heartfelt plea: the power of emotions in health care.” Victoria, welcome to the show.

Victoria Goodheart: Thank you so much. I’m excited to be on the podcast.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Victoria Goodheart: So I decided to be an ER doctor, I guess, as soon as I could speak, according to my parents. Not sure if it was fate, or I just watched Big Bird Goes to the ER a few too many times. And I tested it by becoming a firefighter and medic for several years, and then went to medical school, and now I’m an ER doctor. I was a traveler for the past 4 years and then finally decided to settle in a place and give that a try and work for my local community.

Kevin Pho: All right, so tell us about the current challenges, and rewards, for that matter, of being an emergency physician today.

Victoria Goodheart: Well, I think that could probably go on for a few hours as far as those specifics. I think the ones I’d kind of been focusing on lately, especially where I work currently, there are some issues kind of with politics, and there’s some public sentiment toward our hospital, about seeing us as a big corporation. Whereas working inside the ER, I just see the fellow doctors that I work with and my nurses and techs and RTs and everybody. And we’re not the big company. We’re just people there who want to do our best job and help the people who we see later on the streets and see in the grocery stores. We want to help the people in our community.

And so we kind of see it differently, and there’s the challenge of trying to impress that on people: We’re not in it with insurance, we’re not in it for your money; we’re here to actually help you. And then there’s dealing with all those challenges of their emotions, and realizing we’re all just kind of human beings trying to heal each other in this process.

And that’s the more exciting, I think, challenge that I’ve been dealing with. Obviously, all the other issues of overcrowding, boarding, lack of supplies, low staffing, and things like that are the more mundane challenges that I’ll let the administrators kind of focus on. But I think, on a shift-to-shift basis, I’m trying to focus more on those human connections and how we can better support our patients, but also support ourselves, and kind of communicate to our patients that we are just humans trying to help other humans.

Kevin Pho: So you bring up a great point about maintaining that humanity in medicine, especially in the emergency department setting. There are so many corporate invasions, right? You have a lot of emergency departments being bought and taken over by private equity. And of course, you have a lot of business elements in hospital administration. So how do you specifically maintain that human connection with patients when you have so many outside influences dictating and managing what you do or say?

Victoria Goodheart: I think one of my biggest things that I’ve learned over the years of being a doctor is that I try to look at my patients when I meet them as if that’s my friend’s dad or a family member. Because I feel like how we talk to patients in the emergency room versus how we talk to that friend of a friend who’s like, “Hey, I heard you were a doctor. Can I just run this by you?” is different. We give them that information in almost a more honest, genuine way when it’s out in the community versus when we’re on shift.

Out in the community, someone says, “I’ve had a cough for 3 weeks.” They go through their symptoms, no red flags for me. I say, “Honestly, I can send you in a prescription for some cough medication, but all the evidence says nothing commercially available works any better than a teaspoon of honey. Do you want to waste your money on that, or do you want to have some tea and honey?” And you’re kind of being really honest with those people. Whereas I feel like in the clinical practice setting, you’re more apt to be like, “Sure, I’ll send in a prescription for some Mucinex for you,” when you know it’s probably not going to really make a difference. And so it’s talking to people more genuinely, as if that’s a family member or friend asking you for your advice, and trying to be open and honest with them and not overestimate maybe what they’re looking for.

And I think I try to look at it as a challenge when I meet each patient: not just their diagnosis, not just their set of symptoms, but what are they actually here for? Are they here because they want an answer to the symptoms they’ve been feeling? Do they want a solution? Do they just want people to hear their frustration? Do they want a work excuse? Do they want to press pause on their life? Are they struggling with something else, and they’re here and need someone to listen to what’s going on with them? And so looking at that piece of the puzzle, I think, is even more interesting sometimes than the set of symptoms.

Kevin Pho: Now, your KevinMD article really focuses on that human element of medicine. It’s titled “A heartfelt plea: the power of emotions in health care.” Now, for those who didn’t get a chance to read your article, just tell us what it’s about.

Victoria Goodheart: Yeah, so it’s an article that I kind of wrote for my colleagues in medicine. I kind of went through three different situations that I’ve been through in clinical practice. Basically, one that kind of highlights it: I had a patient who was there for some minor post-operative pain, kind of the man flu situation, but he was very upset that he could hear laughter from some nurses in the hallway. It was nothing to do with him. They were not laughing about him. They were kind of around the Pyxis, laughing about something in their personal lives. And he was so irate that he could hear laughter when he was trying to recover, and he wanted them fired and written up and things like that.

And it made me so sad, because I saw those nurses, and we had had a really bad case that morning with a young child having died, and they were so upset. One had to go outside and excuse herself and have a moment, and they were so tearful. And then an hour later, they were able to laugh a little bit. And these are nurses fresh out of nursing school. They’re just little baby humans.

And for them, they’re humans. They’re dealing with all these crazy emotions and things that we have to see and deal with. If they can take a couple moments of laughter that’s not at the expense of a patient, certainly, I feel like that should be allowed and OK. And I wish people would understand more that there’s professionalism, certainly, but then we are still just humans. We have emotions. We’re going to have good days and bad days. And as long as it’s not jeopardizing patient care, we need to be allowed to have emotions in the moment sometimes.

Because I think we do too much stuffing that down. As you’ve heard a lot of ER doctors specifically say, we put those feelings in the black box in our brain. If we just keep stuffing them down and not feeling them, that’s when we get burnout and other mental health disorders. But if we’re allowed to just be human in the moment and say, “I just saw something horrible. Let me feel that for a minute. Let me grieve with you.” And maybe our patients realizing that: Do you think we don’t feel things with you? We’re celebrating when I get to tell you that your tumor has shrunk. I’m grieving when I have to tell you that your grandmother died. I want to feel all these emotions with you, and I want you to let me, to a certain degree, and see us as humans as well.

Kevin Pho: Absolutely. And that’s one of the goals that I have, of course, on my site and on this podcast, is that a lot of people don’t see those of us in health care as humans. And we each have stories. We each have emotions, and it’s tremendously important for all of us to have that space to express that, and not everyone may be aware of that. How important is it for you to write about these anecdotes and just let others know about what goes on behind the scenes of the emergency department?

Victoria Goodheart: It’s very important. I started writing a lot more in general in the past year and sharing it with people I know, but it’s almost more therapeutic just to start getting that out there. And this was actually the first essay I’ve really shared with more people. But it feels like an homage to the people that I work with, to say that you are heard, you’re seen. Maybe we can write it in such a way that other people read it, and they can feel and really empathize with our situation. And again, as you were saying earlier, with the layering in of politics, insurance, staffing shortages, and all these logistics, they really take away from the magic of the fact that we are just a species trying to heal itself.

People see a video online of one elephant helping another, and we’re like, “Oh my gosh, that’s so adorable.” And to some degree, we are doing that. We are just one species that tries to pick the other one up, tries to help fix the wounds of another human. We could be much more hedonistic than we are, but instead we choose to try to help each other, develop cures, and all that kind of stuff. And so if we try to step back and remember that magic of it, I think it’s better for everybody.

Kevin Pho: So tell us another anecdote that you shared in this piece that really showcases the emotion that you yourself go through as an emergency physician.

Victoria Goodheart: Yeah, I had two others. One was, a young girl had just died of a horrible traumatic injury, and her mother was, rightfully so, just wailing in the hallway and screaming, because her child had died. And there were some nurses with tears on their faces. I was in seeing another pediatric patient, and the respiratory therapist came in, and he brought in his nebulizer supplies, but he was kind of trying to quickly wipe some tears off of his face. The mother of my patient could hear the screaming in the hallway. She could see that we all looked dejected. She could see the tears on his face, and she was absolutely irate. She told us to make that woman stop screaming, and that she didn’t want to see us tearful because it was upsetting her.

And I do understand that, certainly, you’re allowed to have your own emotions about a situation. I understand that that was upsetting to her. But at the same time, we were in a horrible situation, and my staff had done a heroic job during this attempt at resuscitation, and they were feeling things in the moment, and this grieving mother is feeling things in the moment. And I think we need to allow other people to have those emotions.

So there was that one. And then my one other one is, I was going onto an elevator after a shift. I had a terrible shift. I was exhausted, sleep-deprived. And, as I think other women will relate, there was a man in the elevator trying to make small talk, trying to make me laugh and smile, and I was honestly so tired. I was really not even registering what was happening, and he became very upset at me for not smiling and not playing along. And it made me think about how I don’t think people see what doctors go through. Even my friends or family can’t imagine what I have seen before they’ve even gotten up in the morning. I had had to deliver a stillborn baby that morning that was in a horrible condition and tell the mother, and it was a horrible situation, and most people hadn’t even had their cup of coffee yet.

And I have a sister who’s a soldier. I have a sister who’s a police officer. And in their lines of work, I think it’s more acknowledged. They have a lot of training about PTSD, and everybody’s like, “Oh my gosh, what did you see on your deployments?” et cetera. There’s kind of all this anticipation that they’ve seen horrible things. And honestly, neither of my sisters has seen as much death, honestly, and trauma as I have in my job. And again, they do incredible jobs. But I do think that what’s less understood by laypeople is what a nurse sees in a shift, what a respiratory therapist sees in a shift. What a doctor sees in one shift is likely more trauma, more death than most people see in a lifetime, even in some occupations where that is more likely to happen. The level of trauma that we’re dealing with, and then to expect us to just pick up and be smiling and laughing with the next patient, sometimes is just impossible at that time.

Kevin Pho: In the emergency department, there’s such an extreme spectrum of emotion that, like you said, you see every day. How do you handle that? How do you deal with such an extreme contrast of emotion that can swing from case to case?

Victoria Goodheart: Certainly, a little piece of detachment, of course, has to be necessary to try to set some of those emotions aside for you to process later, and then having healthy outlets outside of work where you can talk to someone about it, have hobbies, and things to work through. So there is a detachment in the moment. But again, sometimes things are so overwhelming, I think it needs to be allowed to bubble over.

And then I think another thing is just trying to hold on to the really good moments and trying to let those feelings surge within you as much as you can. I had a moment in the past month or two where I had a really bad case, and then I went in to do just a simple laceration repair, the simplest thing of my shift, straightforward, certainly not lifesaving. But the wonderful couple that I met, we had chatted while I was suturing him about how I used to be a travel doctor and now I live here. And the wife said, “I just think you were brought here so you could help him in this moment.” And it was so beautiful.

To me, I was doing something so not profound medically, something none of us would think two times about when we went home later. But to her and her husband, a simple laceration repair meant the world to them. And it was such a little moment of, wow, even those little things that we do that maybe aren’t the huge victory to us, physiologically or medically, are still profound things to other people. And it’s just trying to hold on to those little moments and let them rise to the surface above all the rest of the debris.

Kevin Pho: You mentioned as part of your story that you wanted to go into emergency medicine ever since you were young. Has the reality met your expectations of the field?

Victoria Goodheart: I think, generally, yes. I’ve never been a particularly rose-colored glasses person, so I do think I went into it with a pretty reasonable expectation that this wasn’t going to be the hero lifestyle and everybody’s so grateful for the work you do. I think I went into that with realistic expectations, so I do think it met those. Obviously, I think sometimes the logistics and, again, those administrative things that bog us down, those hours of charting after our shifts, those loopholes where our hands are tied and we can’t help people as much as we want to, really skew our view of it.

But again, you try to remember those little moments of ways that you really did get to change someone’s day or change someone’s life, and look back at how many lives are changed by small things that we do but are big things that ripple out into the rest of someone’s life or the world, and just try to hold on to those things in the midst of the rest. So I think when you’re able to step back and look at that part of it, it definitely is as rewarding as I expected.

Kevin Pho: We’re talking to Victoria Goodheart. She’s an emergency physician. Today’s KevinMD article is “A heartfelt plea: the power of emotions in health care.” Victoria, let’s end with some of your take-home messages that you’d like to leave with the KevinMD audience.

Victoria Goodheart: Yeah, I would say, kind of referring to my article a little bit, I would say to remember that we are human. Let us remember that we are human. Let us be human. Try to let other people see that we are human. So don’t be afraid to have moments of grief. Don’t be afraid to feel that you want to rejoice with your patients. Let us help you rejoice in your victories together, and let us just all try to be humans together, feel every emotion that goes through our minds while we’re working a shift, and feel them. And let’s work together to create a more compassionate future.

Kevin Pho: Victoria, thank you so much for sharing your stories, time, and insight, and thanks again for coming on the show.

Victoria Goodheart: Thank you so much.

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