October 27, 2015
For Dr. Julia Trahey, a shattering encounter 20 years back with one troubled young man carved a lasting division in both her life and medical career.
The experience also instilled in her a deep understanding of the burden that healthcare providers can feel after a patient is harmed. That's a special empathy the native Newfoundlander brings to her work every day as a general internal medicine specialist in St. John's.
"When I think about why I do what I do now, I go back to an episode that happened very early in my career, because there is a before and after of my career from that point," Trahey says. "It was a patient, a young man who was only a few years older than I was at the time, who had come in with a suicide attempt and had been transferred to the hospital I was working at for care because of respiratory difficulties that he had as a result of that."
After successfully reviving the man and working to stabilize his medical condition, Trahey remembers shuttling back and forth to emergency throughout a typically long and busy shift at the hospital. The patient seemed to be doing well.
But then she received a call at about one in the morning saying the man had again attempted suicide while under care at the hospital. For the second time in 24 hours, Trahey was called in to attempt resuscitation on the same individual. This time it was a completed suicide.
"I continued on call and was called in a few hours later to try another resuscitation of another patient who had been found dead at home, and then there were other patients throughout that night that I was dealing with. It was myself and the junior intern who was with me, and we were meeting with some of the family members, and it was a very, very traumatic event for the hospital, for the nursing staff, for the emergency physicians. Trying to deal with that and then going on with the rest of the work that had to be done throughout the night — you go into a state of kind of suspended not-feeling-anything. Work to do, just keep going, don't think about it."
Soon enough, though, the emotional trauma hit home.
"I know the next morning when I was coming off call, and I knew that there were going to further meetings about this, but I didn't know what to feel. I remember driving away from the hospital and ordinarily I would go to my mother and talk to her about this, but my mom and dad were out of town that particular day, so I went to my eldest sister's house. And I remember running a red light on the way there. And I just realized it after I went through, because I was just so — I don't even know how to put it into words. I didn't know what to think, it was just a jumble of thoughts, a jumble of thoughts and a lack of feeling because I didn't know what to feel."
She just needed someone to talk to. She'd needed someone to talk to back at the hospital, of course, but Trahey had wanted to be steadfast for her intern and besides, her other fellow physicians had seemed more matter of fact about her experience. A part of her also felt that, as a female, if she became too emotional it might be seen as somehow less professional on her part.
Still, an encounter with healthcare-associated harm can be an intrinsic hit to who you are as a health care professional, Trahey says, and also how you see yourself as an individual.
"I think certainly for those physicians of my generation and older, we were trained to feel that what we did and the outcomes for our patients reflected on some level how good we were as a person," she says. "Our professional role and our personal roles were so intertwined that when things go wrong there was little defense against feeling that somehow you failed as a human being, and not just in your professional role."
That view is changing and Trahey has been doing her part over the years to aid that shift in thinking. She's clinical head of patient safety at her organization and she's worked to ensure patient safety is a priority in the training of the next generation of Canada's health professionals. Ask her if there's one thing she would change about her experience with that patient years ago, and she responds quickly:
"If there is one thing I would change it's actually what I have chosen to change, and that is introducing patient safety into the undergraduate curriculum at our university" Trahey says.
"As part of that I have spoken about the need for a peer support network and that there should be no shame or apprehension about talking about errors, and that the likelihood of making errors is pretty much a given. Now they may not be errors that have catastrophic outcomes, but they need to be comfortable and accepted as normal as part of doing a high-risk business and also normal to talk about it. So, I've been encouraging them, and teaching them, that that's part of being a doctor."
The young man's death that day exposed collaborative flaws in the way that particular hospital dealt with patients with psychiatric and medical illness. In its aftermath, a new psychiatric liaison service was created to give all patients real-time access to psychiatric treatment. To this day, Trahey views that service as a tremendous positive for both patients and their physicians that arose from something that was otherwise so terribly negative.
That one life achieved a service that has helped hundreds of patients in the intervening years, she says.
"I think about the English language and how we use certain words — sorrow, grief, stoic — and I've seen that. I've been there in the room when it's been manifest, when people have been stoic in the face of horrible news, I've seen what sorrow is because it fills the room. I've seen and felt grief because you're there with people who have had really bad things happen.
"With that particular patient I did not have a long relationship. This was a very short duration experience, but it marked my career from before and after because of how I felt things could have been done differently that may have made a difference. That's how it's impacted me, then, now and why I try to do the work I do in the way that I do it."
If sharing her experience helps reduce the burden of emotional trauma for some health care providers out there, all the better, Trahey says.
"I'm at an interesting point in my career. I'm heading into the final phase. I'm not a junior doctor, I'm a senior doctor and I think it's important for other physicians and students to appreciate that these are the journeys that some people have taken through the course of their career. It can make you, I was going to say a better physician but it's not a better physician, it's a more aware physician. They will have their patients too that will change how they do business, and to embrace that as a learning experience and do something good with it. And I hope they get the support that they need from their peers."