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A trauma surgeon spent two decades on call for the worst nights of other people’s lives. Then he ran his hospital’s pandemic response. Then he could not function. Jeremy Heffner is a trauma surgeon, speaker, and author. This episode is based on his article “Why frontline health care workers get no mental support,” published on KevinMD. You will hear how compartmentalizing one case after another works until it does not, and why he was told the system had nothing for him until he was in acute crisis. He describes what he learned about how a board treats a physician who asks for help voluntarily, and the therapy that finally let him talk about a case he had blocked out for years. He explains why untreated trauma often shows up as anger that colleagues read as a character problem. Press play for a direct account of what frontline exposure did to one surgeon, and what he thinks health care owes the people working its front line.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Jeremy Heffner. He’s a trauma surgeon, speaker, and author. Today’s KevinMD article is “Why frontline health care workers get no mental support.” Jeremy, welcome to the show.
Jeremy Heffner: Hey, thank you so much. I’m glad to be on here and glad to talk about this subject. It’s obviously been part of my recent journey, so thank you.
Kevin Pho: All right. So before talking about the article, let’s have you briefly share your story, and then talk about why you decided to share this particular piece on KevinMD.
Jeremy Heffner: I’ve been in the trauma world for about two decades now. I started off in engineering, then went to medical school like the rest of us, and ended up doing trauma surgery. Over that period of time, I found myself becoming more and more emotionally detached from what was going on, and more psychologically affected by it, until about two years ago I really just collapsed. I had been on the front line. I had actually managed my entire hospital’s COVID response. Coming out of that, it got difficult, and I got to a point where I couldn’t function. It had become difficult, and I didn’t understand why.
Part of it was obviously that I didn’t know how to face the emotions themselves. I don’t know if that was a male thing or whatever, but part of it was just that our systems weren’t designed to help explain what was going on, what was happening to me from these years of dealing with frontline trauma exposure. Eventually I was put in a facility for about a month. I got diagnosed with severe PTSD and had to figure out how to put my life back together.
As I went through this, I had also built what’s called SurgeOn, which is the largest social media company for surgeons, with two of my partners, Mark and Mario. I started to reach out and do interviews with other surgeons, and in those conversations, I found that I was not the only one facing this.
Kevin Pho: So that was a very brief encapsulation of your story. I’m curious, when you felt what you now know as PTSD, give us a description, some characteristics of what exactly you were feeling but at the time couldn’t really describe.
Jeremy Heffner: I recently released a book, Proof of the Impossible, and I get into it in the book. The way I describe it in the book is the mental mason. I go way back to the first experience I had in medical school. I’m sure we’ve all experienced this. I was a third-year medical student, and I got called to do chest compressions on a patient I didn’t even know. I can remember that day, seeing the face of that patient. I went to my friend’s bar that night, and I couldn’t get it out of my head. I didn’t know why it was bothering me. My ability to logic through situations said that obviously this was a known thing. It’s not my fault this guy died, so why do I care about this? But I still couldn’t get past it.
As I described in the book, that was the first time I realized that I was facing emotions I didn’t know how to face. My mind and my body just compartmentalized, and a day or two after that, it locked it away. Over the course of the years, it got better at it. I would see some really bad things, and the children, my pediatric traumas, became really difficult. My wife said that within 48 hours, I would just stop talking about it. It never came up again, and I wouldn’t face it at all.
This led to the point where, by around 2019, I was seeing a therapist. I was dealing with what I refer to as the black hole. Any emotion I had would all go back to this black hole, and I couldn’t put my finger on what the black hole was. I just knew that if I was happy, I would all of a sudden want to cry. If I was sad, I’d want to cry. If I was mad, I’d want to cry. And I couldn’t. On top of all that, I got to a point where I physically couldn’t do it. I had so blocked the emotional outlet that when I would attempt to process it or go through the feelings of it, I was physically incapable. I would just shut it down, and then I would stop talking. It led to a complete lack of control over any sort of emotional wisdom, knowledge, or understanding. I just had none of that.
Kevin Pho: So you mentioned that you did get treatment, and after that you went back into medicine again. Tell us exactly what changed, and tell us about the tools and skills you developed to understand and manage these emotions.
Jeremy Heffner: I think, realistically, I almost have to take a step back from there and say that first I had to recognize that I had lost the ability. It was me. I had a problem. That is something I see in colleagues and in others as we talk about burnout, or just managing the current medical establishment and walking through it as a doctor. We want to believe that we control this, that we have complete control over our emotional state, and that it’s not affecting us day to day.
But once I started to see it in myself, I’d look around at my partners, and it’s like, I see the alcohol problem over here, I see the problems with a wife over here or a husband over there. You realize that it’s a manifestation of what was going on in their mind from that case they had six months ago that they just hadn’t been able to deal with. You could start to see the trend since the moment that patient died on the table, or they had that trauma that was just horrible. Nobody talked about it. Everybody acted like it didn’t happen. But the effects were there. The aftershocks of that whole thing continued along that line.
It wasn’t just me. I was recognizing that we were all hiding some aspect because we were afraid we were the only ones who couldn’t manage it. Maybe I’m just the one who couldn’t deal with it. Is it really that, or is it something else in my life that I’m just not accepting? No, the reality was that I had a problem, I wasn’t facing it, and I needed to recognize that. That’s when I would eventually go to my therapist, and she said, “You need to go in. You need to really get managed and get help.” I had to open my belief system up to the reality that I needed somebody to help me.
Kevin Pho: Your article is titled “Why frontline health care workers get no mental support.” So tell us more about that article for those who didn’t get a chance to read it yet.
Jeremy Heffner: After all this, as I said, I spent roughly two decades on the front line of trauma, getting up at 2:00 in the morning or 4:00 in the morning and handling the worst that humanity had to offer. Following that, I ended up on the front line of COVID. I was on the front line for probably six months, until they reopened the operating rooms, managing the ICU with one other partner. Both of us are critical care certified, and I got to be the person who was managing all of this.
But the moment I broke, the moment I couldn’t take another step, when all of this had finally reached its pinnacle and I found myself needing help, the system basically said, “You’re on your own. We don’t see this as a problem, because you don’t have a gun in your mouth. You literally aren’t suicidal at this moment. Therefore, this is not our problem.” And it wasn’t just my hospital system. It was the insurance companies. When I talked to people at the facility, they said this is basically standard: Until you are willing to say you’re going to kill yourself, with a plan, today, they’re not going to care about what you’ve done.
So I recognized at that point that it wasn’t about the health care worker. You might have been the one who was there for everybody else, but the system doesn’t really care about you. I don’t think that’s the intent, and I don’t think other doctors and surgeons would see it that way, but I want them to realize that that’s how the external system is going to see them if they ever find themselves there.
On top of that, I think there’s the bigger question that we’re all afraid to face: What does this do to your liability? What does this do to your boards and your licensing? What does this do to all the other aspects of being this kind of person? I think we’re all facing some level of this mental trauma, especially depending on which specialty you’re in and what you’re seeing more often, and yet we’re afraid of it, because nobody has told us it’s OK to actually go get treated for it.
Kevin Pho: So what needs to be done, and what are the answers to those questions? I’m sure a lot of doctors are wondering, if they show that vulnerability and look to get help, how does that affect them professionally, from an insurance standpoint and from a credentialing standpoint? What are the answers to those questions?
Jeremy Heffner: It depends on the state. There is potentially going to be a problem depending on the state, so I’m not going to speak for every board. In my experience, I chose to go get help, and because I voluntarily went there myself and asked for help, that was protected, because you are actively making an attempt and showing that you accept that you need assistance. The board did not punish me for that. Had your actions because of this led to something that was discovered, then you would be liable, and the board would probably come after you.
So it is something to realize if you’re seeing this affect your day-to-day, potentially affecting your ability to make decisions. To put it in perspective, when I was in the facility, I had other surgeons there. There was one surgeon who was there because he couldn’t make decisions anymore. It had basically broken him, and he couldn’t make those difficult calls. If you’re willing to say, “Look, I need help,” it’s OK. There are other professionals.
I think the insurance side is the bigger issue. They’re not there to help you. What I would look at is to push Congress or somebody. There needs to be more of a push for frontline workers, and it’s not just doctors. Frontline nurses, frontline EMTs, and paramedics are all seeing these things. They’re all facing the realities of the human condition. I think they should be protected, so that if you need help at that level, you get coverage from whatever your insurance policies are. I think it should be covered as much as gynecologic care or cancer care or anything else, especially for frontline workers.
Kevin Pho: So tell us what options physicians have if they find themselves in the position you were in, with what you now know as PTSD. What are the various resources you would recommend for them?
Jeremy Heffner: For me, I’ll be honest: The first thing is to find a therapist, psychologist, or psychiatrist, whoever you trust, and start having that conversation. You need to recognize that every human, unless you’re a psychopath, will be emotionally affected if you’re dealing with enough of this kind of pain and suffering.
Part of my problem was that I’m a six-foot-six guy. I’m an ex-rugby player. I was a bouncer. I’ve kicked NFL players out of bars. I thought I was too tough and too smart. And I grew up in a family of firemen, and the whole thing was, you know, throw some dirt on it, rub it, and get on with it. That’s just not going to hold. So when you start to feel these things, realize there is an emotional undercurrent that you probably aren’t recognizing, or if you do recognize it, that getting help is OK. It’s OK to not be perfect in our world, and others are dealing with it. As I said, I’ve talked to plenty of other surgeons, and if you get them behind closed doors having this conversation, they’re all feeling some version of it. They’ve experienced something like it. So it’s OK. Reach out to a person you can talk to.
From my standpoint, I found that another therapy, called EMDR, was actually the only thing that really did me a lot of good. It’s not quite hypnosis, but it opens up the mind in a way that lets you go in there and really disconnect the emotions from the events themselves. Before that, I couldn’t have any of these conversations. I would simply break down and then shut down.
It was amazing, because the first time I went through it, I had a case from back when I was in residency where four children, a mother, and a grandmother died in a massive arson. A kid firebombed the house over a cell phone that got stolen, and the kid he was firebombing the house to punish wasn’t even in there. It’s like 10:00 in the morning on a random day. I go in, and there are four miniature bodies, just burned, rolling past us. Then the mother, and then the grandmother. I ended up taking care of the grandmother. She was burned pitch black, head to toe. She didn’t survive more than about 15 minutes after we got hold of her.
That story, I wasn’t even able to tell. I had actually blocked most of it out. I didn’t realize how much of it I just couldn’t see. The reason I make a big deal of it is that when I did the EMDR, the images came back. All of a sudden, I could remember the events. I could remember the whole thing step by step. Any one of us obviously reached our positions because we had good memories and good intellect. That’s how you get here. Somehow, I not only didn’t remember, I didn’t question why I couldn’t remember it. I just ignored it.
When I told my wife, I said, “Look, all of a sudden I can remember this. Is this real? Is this what actually happened?” She said, “No, you told that story,” for about 48 hours, and then I stopped. The second time we went through it, I could smell it. It was all there, and that was the amazing part. It was all there. I had just completely blocked it out. My mind just wouldn’t let me face it. And there was story after story like that. If you’re not actually facing them, you’re never going to really be able to work through them.
I think a lot of us, when they say “processing emotion,” don’t even know what that means. I didn’t. Maybe the rest of the world got that. Maybe all the other doctors got it, and I’m the one who just didn’t get the memo, but I didn’t know what that meant until I had to do it.
Kevin Pho: In your article, you wrote that police and firefighters get a review and a debrief whenever there’s a traumatic event, but there’s really nothing like that in medicine. My question is, should there be some type of formal debriefing session after some of the traumatic things that physicians see every day?
Jeremy Heffner: I think there needs to be, actually, for a couple of reasons. One, we are seeing horrible things. As I said, you’re going to see the death of children, surprising deaths, some loved ones, or ones you may feel responsible for in some respect. Even if you didn’t do anything technically wrong, you want to believe you could have done something, or maybe you made some mistake, or in your mind you’re accepting some liability for it that’s not real. Those are going to affect you over time.
And I think what we’re seeing, in the way administrations function in the modern world, is the secondary emotional outburst, the anger and the frustration that these doctors and surgeons develop over time. Realistically, a lot of it is coming from this underlying, untapped emotional pain that nobody realizes is there, because we’re not processing it in real time as it’s happening. With the downstream loss of some of our colleagues to these problems, we’re actually misinterpreting what’s happening. We’re treating them as evil people, or mad, or as having anger management problems, or whatever it is they’re presenting as, when the reality is that we never faced the problem. They dealt with something that we were probably even there for. We probably reviewed that case six months ago and didn’t realize it. It’s still bothering them, and nobody’s ever asked them.
As a society, we know that it’s going to directly affect frontline workers. We know that if you’re a police officer and you accidentally shoot somebody, or have to shoot somebody, and you think you caused their death, even if you knew it was the right thing to do, it’s going to hurt you. It’s going to cause some psychological injury. Yet how is that affecting us? Why do we think we’re special? And that mistake is our ability to think that we are special.
Kevin Pho: Now, you mentioned earlier that you’re the co-founder of a social platform for surgeons. Why did you decide to do this? Give us a story or an example of why you think it’s helpful.
Jeremy Heffner: We built SurgeOn because when we looked at the major social media platforms, it’s not that it’s wrong that the public has such access to them, but we wanted to create a vetted platform where surgeons could have the conversations we’re not able to have in the real world. What I mean by that is, say you want to talk about a really difficult case. If you go on LinkedIn or Facebook and post it, and some patient gets in and sees it, they may not understand the nuance of the discussion, and it can paint the discussion in a negative light. The reality, as we all know, is that in medicine we’re traveling through dirty water. It’s a lot of tough decisions, and you’re trying to balance a lot of aspects of care that the general population really can’t fully comprehend. That’s not an attack on them. We just need a place to be able to have those conversations and discussions.
On top of that, there’s the hierarchy we’ve developed in our systems. I always tell people it’s hard to be a surgeon unless you’re a smart person. The dumb surgeon really doesn’t exist. The lazy surgeon, maybe, but even the lazy surgeon is working 55 or 60 hours a week. It’s a tough group. Someone might say that this one understands it better, and they might, but there are also lived experiences coming from the community surgeon over here, because they took a different path. We need to be able to hear all these voices and really get the full picture of how the field is developing, and of what’s going on in places we don’t necessarily see coming out in the papers, in the journals, or from the person giving the lecture on stage.
This gives us the opportunity to share those experiences, discuss what we’re seeing that’s different, and really develop game plans in a way that’s more granular than we’ve ever been able to before. That’s what we built the platform for. Now there are about 50,000 surgeons worldwide on it, so it’s a global platform. We do interviews with some of the top surgeons in the world, and I travel to do them. I was just back from Luxembourg a couple of weeks ago, talking to some of the top surgeons at a conference there. It’s really about sharing and creating a space that we’ve never had before.
Kevin Pho: We’re talking to Jeremy Heffner. He’s a trauma surgeon, speaker, and author. Today’s KevinMD article is “Why frontline health care workers get no mental support.” Jeremy, let’s end with your take-home messages to the KevinMD audience.
Jeremy Heffner: I think we need to break this mentality in the world of surgery, and in medicine in general, that we have some innate, special ability to not have to face the realities of dealing with the human condition. We do it on a front line in a way that the vast majority of the population doesn’t have to deal with. I think we need to start really looking at each other with empathy and compassion, and recognizing that we need to help create a safe space, and I hate to use that term, but a safe space where we can really start discussing the emotional pain that this causes us individually.
Kevin Pho: Jeremy, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.
Jeremy Heffner: Thank you.
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