It seems that part of what made this past 18 months so difficult is that so few people had capacity to absorb more trauma (direct or vicarious). We were all living in the center ring of the Ring Theory in some way. 1/ There were times when I felt that I was receiving everyone's worst moment/hardest death/biggest trauma and was running out of room/capacity. Maybe you did too? Learning how to create space to hold it all helped.

AND that's probably a lifetime's worth of work. 2/

My memories of my first month of internship in NYC are so vivid. The HIV ward, the Tagalog of night nurses, the endless paracentesis kits, the downward gaze of cryptococcal meningitis, the bat-wings of PCP Xrays in children. As well as things I couldn't see as clearly then. 1/ The HIV ward was a Staff ward. That meant uninsured and cared for by resident teams. The ID Attending would chart round in a backroom, tell stories, but wouldn't see the patients. It was a segregated and structurally racist practice. We, and the patients, were on our own. 2/

Maybe because I speak with vulnerability about everything from fetal loss to my own medical trauma to the huge psychological toll of this past year, I am often asked how I choose what to share. The cost of sharing so to speak. A thread 1/ My first and most essential rule for myself is that my wholeness cannot be contingent on how someone else may respond. If I am at risk of fracturing or my healing can be disrupted based on someone’s response then I am not ready to share. 2/

So many of us in medicine are deeply familiar with the normalization of abhorrent behavior in service of some perceived institutional gain (reputation, skill, productivity). There is a reason this feels so familiar to #MedTwitter
1/ And we are deeply familiar with the resistance we face when we elevate our voices and name it as a problem we are told by the enablers that “he didn’t mean it literally” we are “blowing it out of proportion.” The press faced this as well.
2/

Sometimes it feels like everyone is hurting. To feel of use, I spent part of my day being a book fairy. Delivered @withlovecleo Heart Talk and Journal to a friend who is doing hard work of boundary setting and self-construction. 1/ Delivered @maggiesmithpoet latest Keep Moving to a friend moving through grief after a tragic death, with a note reminding her that I love her. 2/

Some deceptively simple life advice I keep returning to these days. From patients, dead friends, wise family. A thread.

1. A problem you can solve with your own money, isn’t a problem. It’s an inconvenience. (A reminder that so much true suffering around us is so BIG). 2. Don’t pickle things. (A reminder not to preserve the good wine/china plates or expressions of love for a special occasion. Preserving things changes their character).

Creating art has been the key to my healing, first as a patient and then as a physician. And though it’s always been a private process, it seemed to need to breathe, so now it has a home. muchmoreart.com
There are journals for when a bird has crashed into your head 1/ Or this laptop sticker which pretty much exemplifies how it feels to be working during a pandemic when you mostly want to cry 2/

I know you all think I am good at things so I present this example as what I am like in spheres of normal life.

A thread on dropping off my car for repair.
Randy: Are you lost?
Me: No I am at the dealership.
Randy: I am here and I don’t see you. where are you?
1/ Me: the Audi dealer on Grand River
Randy: you haven’t had an Audi for six years. Remember you made me get you a new one when chipmunks moved in and ate the wires.
Me: oh right.
Randy: (gives me directions to meet him at the actual dealership)
2/

1/ Families #COVID19: @washingtonpost

With COVID our ICUs fell backwards in time. Consolidation of power within the medical team. Lack of visitation. It’s suppression of healing and it’s wrong.
Op-Ed Link: wapo.st/3ftwzBa
#medtwitter #pulmcc #meded @WesElyMD 2/ How do we bring patients and families (safely) into the very foreign world of the ICU with humility, integrity and purpose? How do we share the space?
#patientexp #MedTwitter

Current pandemic self-haircut brought to you by the confidence of a Zoom Cocktail Hour and maybe I’ll reverse the sequence of events next time. Husband came in to check how it was going and said “it’s fine, its not as if you have a job where you are known for your hair, so...” and I think he was trying to be pro-feminist so...

Remembering my first call as an intern on the HIV ward at BIMC in NYC. 9 Linsky. Seven admissions, three LPs for PCP, 2 paras (HCV coinfection), and 2 lines for patients who went to the unit. Staff/uninsured service so attending did chart rounds only. It was hard. 1/ #MedTwitter In the morning the attending was hyper-critical. Berated us for not performing rectal exams in every patient. Nurses told us, “I’ve done enough IVs and blood draws, it’s your turn now,” and they laughed. We transported patients for tests that we had to beg for. 2/

I found my 2020 planner in a purse I abandoned mid-pandemic. Stops short on March 10th. Michigan had two confirmed cases. We all dropped everything. Any plans we had, any known future stopped short. On March 10th. 1/#MedTwitter We couldn’t have imagined what would follow. That didn’t stop us from dreading our imagined versions but they also fell short. We couldn’t have known. There was so much lost. 2/

We’ve called it burnout until it lost all meaning, and I’ve heard plenty of talk about compassion fatigue, but it may be more true in pandemic epicenters to say we are experiencing vicarious trauma. Cumulative and transformative. #MedTwitter 1/ We’re actively engaging in the hard work of healing through peer processing and *so much talking* about and working through the experience but I can’t help worry that our healing won’t be complete before the next wave hits. 2/

I’ve been thinking about power in systems. In medicine. In police forces. Government. Why there haven’t been mass defections. Why do we stay when the system harms? 1/ The System is made of people. We comprise It. Without us, it ceases to be. Strikes me as a kind of delusion that we don’t denounce and leave even when The System blatantly exploits and harms. 2/

"Between a high, solid wall and an egg that breaks against it, I will always stand on the side of the egg.
Someone else will have to decide what is right and what is wrong; perhaps time or history will decide. Each of us is, more or less, an egg. 1/ Each of us is a unique, irreplaceable soul enclosed in a fragile shell. And each of us, to a greater or lesser degree, is confronting a high, solid wall. The wall has a name: It is The System. 2/

The truth about being a physician and a mom is that’s incredibly difficult and I don’t know a single woman who hasn’t struggled to be both. Things I have learned, that I wish younger me knew. A #MothersDay #medtwitter thread...1/ You kid will sometimes express anger, hurt, sadness at you being away. This is hard to see because it triggers an instinct to fix it. You can’t unsad them by compromising YOU. Trust they are learning important lessons of self-sacrifice and self-sufficiency. 2/

A thread. If you want to know all the varied ways you are failing your child during a pandemic, schedule a zoom interview with a thoughtful reporter and eavesdrop on their conversation. #COVID19 #MedTwitter 1/ 9yo does his own research” online and could cite mortality statistics by age, including my age group, his grandmother’s age group, and his own. Didn’t look up his dad’s because his dad stays home. 2/

Each day I make wellness rounds on every inpatient unit caring for #COVID19 patients.
I ask,
Do you have everything you need to be safe?
Do you have a strategy to protect your family?
What’s hardest about this right now?
What concerns you most?
How are you holding up? 1/ I learn our people are feeling protected and cared for.
They feel valued and are being fed by the community.
Their heart breaks for patients dying alone.
They are acutely aware of national shortages.
They wish they knew when this would end. 2/

With my limited energy at the end of the day, I’ve chosen to share what I love with my kid.
(Not math)
We’ve been doing #visualthinkingstrategies and #narrativemedicine. This is our first exercise. I showed 9yo “The Subway” by George Tooker. A thread 1/ We talked about
1. What he thought was happening in the painting?
2. What he saw that made him say that?
3. What more could he see?
And then he wrote a few sentences in the voice of one of the characters.
He saw the themes of “aloneness even together when they are close.” 2/

Pro tip. During Q&A, after the speaker has presented, probably best not to begin your question with, “I am sure it isn’t easy to present to a crowd who wasn’t that interested in hearing your message.”

*whispers* it’s just not super welcoming. Also, I can hear you. It was very odd. Following that she was very complimentary so perhaps she had a skewed notion of what the talk would be?

One of the fun parts of having a book translated is how other countries “share” the book on social media and BY FAR my favorite has been the Polish Instagramming of In Shock. Behold the highlights.

Kitten tea pot and a bow? And pie? Did you read it? Like these little men are doing what exactly?