Episode 3: From Ruin to Remedy: Responding to the Haitian Earthquake

Health care is demanding and in the most challenging moments of illness, our community looks to us, the caregivers at Enloe Health, not just for treatment, but for hope and healing. 

Host Mehdi Sattari, M.D., Enloe Health’s Medical Director of Wellness, sits down with Kären Embrey-Edwards on the latest episode of the podcast to discuss her response to the 2010 Haitian earthquake.

Let us know how you feel about the podcast or share your ideas for wellness and mindfulness. Your input is essential.

Reach Mehdi Sattari, M.D., at mehdi.sattari@enloe.org. 

Transcript

SPEAKER_03 0:00

Okay, this person has survived five days or six days trapped under rubble. They have to have some sense of hope. Where is the humanity in denying the care to somebody who has suffered for five to seven days trapped under rubble, and now you're gonna turn them away, right? So, how do you manage that?

SPEAKER_01 0:31

Healthcare is demanding, and in the most challenging moments of illness, our community looks to us, the caregivers at Enlo Health, not only for treatment, but for hope and healing. Hello, I'm Maddie Sitari, Medical Director of Wellness. My role was created to strengthen resilience, support our medical staff, and help us rediscover joy in the practice of medicine. Today, we're joined by somebody who truly embodies the term multihyphenate. Karin Ambray Edwards. With a medical career rooted in emergency medicine, Karin has served as a trauma nurse specialist, a mobile intensive care nurse, and a nurse leader before becoming a CRNA. She practiced as a nurse anesthetist at LACUSC Medical Center while simultaneously serving as an instructor and later assistant professor of clinical anesthesiology at the Keck School of Medicine. During that time, she also earned her doctorate in education from UCLA. After relocating to Chico in 2019, she continued her academic work as a part-time faculty at Chico State. Her commitment to healing extends far beyond the hospital walls. Karin has a deep passion for international disaster relief, as we will hear shortly, and has served on surgical teams following the devastating earthquakes in Haiti in 2010 and Nepal in 2015. And outside the operating room or classroom, she continues to push her physical limits. She's a competitive cyclist, avid trail runner, and a master's national champion in cycling in the disciplines of road race and criterium in 2021. Also, a two-time Iron Man World Champion podium finisher, placing third in her age group in both 1997 and 2000. If that weren't enough, she's a gifted storyteller. Writing under the pen name Kat Edwards, she's authored two acclaimed novels, The Gritty Medical Thriller, Deep Trauma, and A Mystery, When the Smoke Clares, which explores the themes of generational trauma and resilience. I first got to know Karen through cycling, and as our friendship deepened, I came to appreciate the many dimensions of her life and career. I invited her to the podcast today to focus on her disaster relief work in Haiti, both to highlight the powerful role of service in wellness and to showcase a remarkable community member outside of Anlo Health. It's so valuable for us to truly know the depth and breadth of the people we serve. So please join me in welcoming Karin.

SPEAKER_03 3:07

Thanks for having me, Mary. I'm delighted to help you and participate in any way.

SPEAKER_01 3:12

So let's get right into it. If you can take us back to the moment when you first learned about the earthquake in Haiti, what did you see, feel, and think in those early hours?

SPEAKER_03 3:22

Sure. I remember the first exposure I had was probably this the exposure that the rest of the world had, and that was what the AP was reporting. The pictures and the video feed that was coming out of Haiti following that January earthquake in 2010 were absolutely riveting. I mean, you could not help but be moved by what you were seeing on the news. I mean, Haiti in and of itself has such a long storied history of trauma. Uh, it was at one point the richest colony on the planet. It was uh referred to as the Pearl of the Antilles during the slave trade when 40% of the world's coffee or sugar was coming out of there, 60% of the world's coffee was coming out of there. And it, you know, it's been fraught with trauma, warfare, and seismic activity ever since. So I had known a little bit about the history of the place. And when I saw those images, people who are living in abject poverty to begin with, I mean, 80% of the population in Haiti lives below the poverty line, and the infrastructure was very lacking, and I just knew there weren't a lot of resources there. And the pictures were just absolutely stunning. Just seeing the human suffering, the collapse of communities, and just knowing that there was so much devastation, it felt very frustrating to be seeing that and as a caregiver not being able to do something to impact it. I remember I was on a trail run actually thinking about how can I help, what can I do to help. And I went into the office that day, and one of my colleagues at USC said to me, Well, there's not really much we can do to help. Just give money, donate to the Red Cross or find a charity that you, you know, like to support and give. And while that felt okay to do, it didn't feel like enough. I felt like if I could do something hands-on, it would be more really in retrospect, it was more empowering to go jump into action than to stand back and be a voyeur or a a victim from afar, because I was impacted by it, as I'm sure the whole world was impacted. And so I decided I had to make a physical contribution. And what happened was if strangely, the very next day I went into work and it was amazing how I walked into an empty office, the phone was ringing and picked it up, and the person on the other end of the line asked me if I wanted to go to Haiti, they were putting together a team. That's right. It was absolutely serendipitous and synchronous, as Jung would put it. But the opportunity just opened itself up as soon as I put that thought out. And then the way our kind of journey unfolded from there could not have been written any better. Every single hour that we launched into our effort could not have unfolded more productively.

SPEAKER_01 6:29

I love those moments when you deeply and genuinely in your core desire something.

SPEAKER_03 6:34

Yeah.

SPEAKER_01 6:34

And then the opportunity just opens itself.

SPEAKER_03 6:37

Yeah. There's a little hurdle you have to go over to get to that point because generally it's in a place of discomfort or fear. And once you bridge that, it was pretty much amazing to me how things just opened up and fell into place.

SPEAKER_01 6:52

That's awesome. Yeah. Yeah, like a little activation energy.

SPEAKER_03 6:56

It was.

SPEAKER_01 6:56

You rub the match on the edge of the box.

SPEAKER_03 6:59

It was. That's creates friction and goes right over. Great analogy because it just took this one little spark.

SPEAKER_01 7:04

That's cool. Yeah. So now you got an opportunity. You guys did the, you know, all the prep work and everything. Yeah. And you guys lend. And what was it like arriving in Haiti, integrating into what I understand was a military medical unit?

SPEAKER_03 7:18

Yeah.

SPEAKER_01 7:19

In such a chaotic environment.

SPEAKER_03 7:21

Okay, so yeah, it was a little bit more complex before that happened. So as I said, things fell into place. Somebody volunteered a $4.5 million private jet for to fly us over there. So we and we landed in Miami first. We went and got a whole bunch of MREs and supplies to keep ourselves taken care of in that environment. And then we were the very first plane allowed to land in Haiti that was not a government-sponsored plane. We weren't even sure they would allow us to land. We were literally circling over Haiti, waiting for approval for us to be able to land as the first private incoming jet. It was pretty amazing. And when we landed, even the airport had sustained significant damage. Toulouse Lobature Airport is their main airport there, and the building was all crumbling. And there were lots of C-3s, great big giant storage airplanes unloading supplies. And we landed there and we were told we were not supposed to be leaving the airport. Our sending body, which was the University of Southern California, who, which was working in conjunction with the University of Miami, had said to us, Well, don't worry, it's a very unsafe environment over there. There's people are shooting themselves or shooting each other for water. There's a it's an absolute disaster. I mean, just to understand the scope of the disaster to begin with, I mean, there were over a quarter million people killed immediately.

SPEAKER_01 8:47

Which is incredible.

SPEAKER_03 8:48

It's just absolutely incredible. A million people left how homeless, three million people left stranded. So the, you know, that what we were walking into or landing on was an absolute disaster zone where there had been very little infrastructure in the first place. And the UN was actually running the country because of their political instability. So but the UN building had collapsed with 108 employees in it because this was like mid-afternoon when the quake happened. So now the entire infrastructure for the UN was devastated. So we were supposed to follow these um orders that we weren't leaving the airport enclosure itself. We would be in a safe environment. But the first thing we did was leave the airport. Uh, we had a gentleman show up in a sprinter van who was a tetraplegic, believe it or not, who brought his security detail with him and his driver.

SPEAKER_02 9:43

Wow.

SPEAKER_03 9:43

He picked us up and immediately we left the airport because he knew where help was needed. Took us to the UN building, what was left of that area, and we saw how not to be effective as soon as we arrived there. The place had a major influx of people who were trying to provide care. They had triaged walking wounded into valuable resources, as in the hospital beds that were available in the tent. And there was no running water, there was no septic system, no toilets, uh, no food available. So anybody coming to help in that area was just bringing another victim to the scene of an accident. And we did not want to have anything to do with being in a situation where we were going to tax the resources that were available and not be able to do something effective. There were surgeries going on there with ketamine, a lot of surgeries, a lot of amputations, traumatic amputations with uh revisions of traumatic amputations with ketamine and nitrous or whatever else they had available to them. So we got there, and as part of the serendipity that followed us throughout this entire journey, we were walking down an alleyway when we saw uh an officer from the IDF, the Israeli Defense Forces, walking towards us, looking for surgeons to come and help and their team. And they were also looking for an anesthesia provider, and that's what I was able to provide for them. And we had I had two trauma surgeons and an orthopedic surgeon, as well as uh ER nurse, ICU intensivist. We had a really nice, good-sized team that was able to be effective and offer some resources. So just as it happened, this officer came across us and invited us to come to their camp. And the Israelis were in the air within 48 hours of the crack of the earthquake. They, the flight was a nine-hour flight for them. I no, it was a 16 to 15-hour flight, during which time they set up all their planned for their infrastructure and how they were going to lay out their camp. They set up their camp in a football field, immediately put up a security perimeter all the way around the football field, and put in place a phenomenal structure for triaging patients, as well as surgical tents, ICU beds. They were supposed to be set up for a total of 60 beds. We ended up having 72 beds, four ICU beds, one of them, which we used as a recovery room bed for all of the surgical procedures that needed recovery services. And then we were on a one-to-one basis, nobody got admitted to the field hospital without somebody being triaged out. And so that meant we had to be very, very efficient. And they were very efficient. That body, the IDF, is geared towards constant intervention. And that's basically they were so set up. And they also had two university hospitals that were had come over with the IDF. So it was kind of like a mixture of uh civilian population as well as the infrastructure and the organization and the security that the army could provide us. And it was very, very regimented. You know, mealtimes instant coffee in the morning, uh, triage was, you know, the gates were closed at night. We didn't admit anybody at night unless it was a dire emergency, but people would line up in the alleyway to be seen. And so, because they were so organized, it was easier for us to plug in and be more effective. And so, really to answer your question, when you have such chaos, how do you bring structure to that, to that chaos? And so some of the things that you absolutely have to have in place is the resources that you that you need to provide care. So the supplies, or you have to be able to employ nonlinear thinking. Uh, because we come from a linear thinking background. All of us who are in healthcare, I mean, we follow guidelines, we look for diagnoses, we follow testing uh regimens to get to the next step of evaluation. And so when you're in a situation that is so chaotic and you have multiple patient streams coming at you from different directions, it takes nonlinear approach, which you cannot have without expertise. So because the team itself was experienced practitioners, it's not the place for a novice. It's certainly not the place for an unguided novice. Otherwise, you're bringing another victim to the scene of the accident again. You know, even the fire department says, you know, chuck for down power lines before you get out of the fire truck, right? So because we were able to bring that to the table, and because that's what they were bringing to the table, all their organization, we were able to plug in and quantitatively take care of what we could manage. As far as the ethical kind of, those conundrums didn't go away. And we had to address those because the triage process became a matter of who can we take care of? Everyone's used to taking care of everybody, and that was not a possibility. You couldn't take care of everybody, so you had to be selective. Well, do we have number one, do we have the resources to provide for this particular pathophysiology? Number two, are they going to survive? Number three, if we take them, do they draw so many resources away from maybe five or ten other potential patients? So it was very complicated that way. And thank goodness they had the foresight to have that structure in place. Morning briefings happened every morning. Anytime there was an ethical case, a case that needed specific ethical consideration. Especially the patients who came with like crush injuries. You know, if you have a major crush injury and we can save your life, but we can't deal with your rhabdomyolysis and your renal failure because we don't have dialysis capabilities. There are no dial there never have been dialysis capabilities on Haiti to begin with. So we certainly, the field hospital certainly didn't bring them and they were not in place in the first place. So that's the kind of conundrum that you are dealing with was okay, what can we do? Who can we do it for? And if we, you know, take this patient, are we taking away from the care of multiple other patients? On the flip side of that, okay, this person has survived five days or six days trapped under rubble, they have to have some sense of hope. Where is the humanity in denying the care to somebody who has suffered for five to seven days trapped under rubble, and now you're going to turn them away, right? So, how do you manage that? And so anytime a physician had to make a life or death decision, that was passed on to three of his seniors. Wow. Who made the decision for that provider. So that no one person was calling a life or death sentence on anybody. But it was so it's very complex. Productive in as much as I said, the numbers, we were certainly triaging 150 patients a day easily. I mean, I think their 10-day camp, they triaged 1,100 patients, or they treated 1,100 patients, not triage. 1,10 days. Yeah. It was amazingly effective. And so, yeah, there was uh it was very intense. You know, more resources came in with each day. And then as far as the ethical considerations go, I mean, we can go I could talk for a week about that, but making sure there were follow-up visits for some of the patients that we take care of. There's only so much you can do. If you want somebody out of the hospital within 24 hours and you've done an X fix using nails that you went and got from a collapsed supply store in town and then sterilized, which is what was happening, then you need to provide some follow-up care for those people when you can. And they did have clinics that came back and set up clinic. You know, we were able to give Ivy antibiotics while they were in the hospital, where we could send patients out with orals for the next few days or whatever would tide them over. That's what was done. But very limited resources and very rigorous selection process and painfully rigorous selection process.

SPEAKER_01 18:34

Wow. Just off top of my head, I mean, I I hadn't heard any of this stuff before. But if you're thinking about 1,100 people in 10 days with a 70 bed capacity, you at least have several people, like 30 to 40 people a day that are just being brought in and discharged that day.

SPEAKER_03 18:53

Yeah, or triaged elsewhere. Right. And now there were a couple hospitals, but they were in very bad shape. And we mostly focused on orthopedic injuries. Where you will see, and this we also saw in Nepal, an earthquake, you typically will see longbone fractures in adults. And so it's typically though fortunately, we were able to do so many X fixes of femurs. It's long bones in adults, and in kids, unfortunately, it's head and spinal and cord injuries. And so that's a little bit more limiting as to what you can do. We had no CT scanner, and we had, as I said, very limited capacity for ICU beds. And maybe in X-ray machines? We had X-ray machines, we did, and actually they had a phenomenal triage like list. When people came in, we immediately took a photograph of them. They got a wristband on. It was amazing for a disaster zone. We were able to take the lessons we learned there in the Israeli Defense Hospital to the second location that we went to at a place called uh Quad de la De la Bokeh, where there was a little NGO setup, and we were able to institute, there was so much chaos there. We were able to institute some of the structure we had picked up in the prior setting that made operations smoother. And one of the things I would say, we had the perfect opportunity because we were working with a governmental organization. The second best tier of engagement would be with an NGO, a well-established NGO. So you really need someone who's on the inside that has, you know, historically been providing care or having connections in the community that can allow you then to plug yourself in as a disaster relief worker and function effectively rather than contribute to the chaos again.

SPEAKER_01 20:44

That is phenomenal. And and also just the expertise and the it sounds like that the IDF team was well honed in many respects.

SPEAKER_03 20:53

Many respects. And I was really impressed. I mean, they're human, you know, and I saw how the expressions on the faces of the most seasoned physicians could not hide what they were seeing, could not hide the distress that they were feeling. You know, I can remember standing around, we did grand rounds in the morning, we would round on all the tents in the hospitals, uh the t various hospital tents. And I can remember rounding on the pediatric ward, the pediatric tents, and there was a little girl in there, couldn't have been, but maybe five or six years old, and she couldn't see or hear and speak. And nobody knew what was wrong with her. In the long run, we ended up finding out that it was just a shock response. It was just a trauma response where she became almost catatonic. But I remember the looks on the faces of the seasoned physicians standing around her looking at her injuries, and their faces betrayed what that child could not see with her own eyes. It was hard to see. But you saw the the humanity. I saw the humanity on every level, from people who had nothing to give, who were coming barefoot to pushing a wheelbarrow, pushing somebody else in a wheelbarrow, that had people who hadn't eaten in seven days, hadn't had food or water in days, were bringing uh bringing other patients to the hospital. And I saw IDF soldiers hugging people. I saw we had this one gentleman who came in the middle of the night and he had lost 11 members of his family in his house that had collapsed. He was the only survivor. And he came with one family member who passed away at the hospital. And I was, I just seeing the soldiers hugging this man was eye-opening to me. Yeah. It was. I actually um reviewed some of my videotapes, CDs, and pictures in order to talk to you. And it was very difficult for me to go through those because now I'm processing it it post event. When you're in the event, as you know in the ER, as we are when we're providing care to people in need, we're stuffing those feelings. We're not addressing our own feelings at that time. And when they surface, they sure surface with a bite.

SPEAKER_01 23:21

That is so on point. And I think it I just first of all need to express my gratitude in you taking the time to go through them. I remember we were on a bike ride, and you know, it was at the end of the ride, and you mentioned this trip. And I remember asking you, and I remember it, you know, you had to really consider whether you wanted to share it and actually open the book.

SPEAKER_03 23:43

Yeah. It wasn't so much as that I was afraid to open the book, it's that the older I get, the more I realize the less I know. And so I'm never sure that I have any wisdom to share because I think that's it's also very personal to each one of us, what we consider growth. And so what might be growth for me might not be growth for somebody else.

SPEAKER_01 24:08

I think just if if we were to end this talk right now, I think what you've described is something that anybody in medicine can relate to.

SPEAKER_02 24:18

Yeah.

SPEAKER_01 24:19

But also at a different scale because of the the dramatic nature of that tragedy, and also in a different environment that was that is so brutal. I mean, just the concept of showing up to a hardware store, grabbing a bunch of nails, yeah, and then going back and putting them in the autoclave and and then fixing people is pretty, pretty mind-blowing.

SPEAKER_03 24:41

Yeah, it is. And in retrospect, when I look back at it, because I obviously gave a few talks at the university and to my professional organization, I actually did a TED talk on the subject. So I did have time to sort of go back and reflect with sort of an academic bent on what happens. And I was able to see that what we consider cultural competence is really a misnomer. Because when you go to a an environment, even any environment, even the ER, when you're working with your local patient population, we are taught that we're supposed to be culturally competent. And really what we need is cultural humility, not cultural competence, because each individual has an experience and a being that doesn't fit anybody's template. You know, there is no template. You go to, you know, go to Nepal and you realize there are some social norms there. You know, the first son is the financial provider for the family of origin. The third son is the caregiver of the family of origin, and the second son goes off to the monastery and spends some time becoming a monk. So you, I mean, there are some, you know, general social norms that you learn about when you're in the environment. But each and every individual has their own story, their own background, their own history, their own wants. And so it was kind of an interesting that these experiences have taught me that it doesn't matter whether you're in your in Chico and coming across a unhoused person lying on the bike path, or you're halfway across the world taking care of someone that just came out of a disaster, that each each individual has to be considered as an individual. And it's we cannot take what we think we believe to be their needs to the situation.

SPEAKER_01 26:40

Yeah, that makes a lot of sense in terms of the humility and then just stepping in with the intent to be of service as the avenue.

SPEAKER_03 26:48

Yeah, with the intent to be of service, but not falling into the trap of paternalism.

SPEAKER_01 26:53

Right. Yeah. And and I mean anything that's that makes a lot of sense. I mean, you really talked about the next question that I had, which was like in an environment where there's suffering, it was everywhere. You know, how did how did compassion show up in your daily work? I mean, you you were talking about how the physicians were seasoned military officers and physicians were really feeling it.

SPEAKER_03 27:15

Yeah, they were. And the trick is to stay on task. And I mean, I think action, when we employ action, we override the paralysis of being a collateral damage in a situation. So because we have the gift of being able to use our hands to stay in on task and take care of people and meet those immediate needs as you do every day in the emergency room, you defer that really painful insight that you have into the suffering of somebody else until you deal with it at a later point. You know, and it it takes dealing with at a later point. Whether that's, you know, some people have to go and get counseling after going to a disaster situation. If you don't uh deal with your own trauma, then it's going to surface at some point in the future. It always comes back to bite you. That's just like anybody going to warfare. So I think just in the moment, staying on task and using those wonderful gifts that we have to manage a wound or an outcome with the skill that we bring is that bridge that gets you across. And then you can have your downtime when it's not important. When I was in the field hospital, I was working very long hours. I was basically getting two hours of sleep a night. I would sleep from about four in the morning. Morning rounds were at seven, so I'd be up off, you know, within a couple hours, two and a half hours probably, I'd be up. But I do remember walking around the camp in the middle of the night when it's pitch black, no lights in some of the areas, just thinking and processing what I had been seeing and what was going on in this environment and trying to unpack it. And I remember coming across just cruising around the perimeter of the camp, and I suddenly found myself in an area where I knew I was in the morgue. I did not see I was in the morgue, but I felt it on a visceral level. This very animalistic sort of a real visceral response, and I thought, oh my gosh, I am in the morgue and I can feel it. So I don't know whether this was the sleep deprivation or the just the processing of everything that was going on, but your senses were very heightened, very heightened under the under that situation. Some of the other things that I know when I was just remembering sort of come back as flashbacks, seeing the helicopters flying over uh the camp all day long, back and forth, back it was really like being in the middle of the a war zone. Right. You know, the old MASH movies you used to watch was just like that, and seeing the big black clouds of smoke coming from town where you knew they were burning the bodies because there were so many bodies. And so being observant, I was just observing all these things on a visceral level, even on a you know, cerebral level, but I was not processing them because I could not allow myself to process them.

SPEAKER_01 30:31

That makes perfect sense. You know, one of the things you mentioned was that, you know, you have these set of skills. And in that moment, if you stay on task, it gets your buy. And it's also sort of a gift that we have that people took the time and the resources to train each and every one of us to have that gift. And if you know one of us medical providers of any sort are put into a disaster situation, we can do more so we have this gift of dealing with the moment with tasks and not feeling in the same way. But as you mentioned, that there is this, it doesn't negate the fact that afterwards you have to go back and process it in some way.

SPEAKER_02 31:11

Yes.

SPEAKER_01 31:11

At some point. And the failure to do so can result in all kinds of troubles. And it's you know, each person has to find a path and also access that that packet of information that you stored away in the hard drive at a later time, unpack it and do something, some form of ceremony.

SPEAKER_03 31:32

Yeah, ex some form of ceremony or some form of self help in the way I think that a lot of us use our sports that way. I know that certainly I use my sports that way, and we'll get to that. But I think we, you know, as Bessel Vandercock would say, the body keeps the score, right? Yes. And so you cannot be exposed to the trauma without it manifesting somewhere unless you address it.

SPEAKER_01 31:55

Absolutely. And when I say ceremony, I mean it could be church, it could be therapy. Absolutely. It could be athletics. It could be just a moment of remembrance in the wild, like in nature, however, you know, your calling is. But no, it's it's so important. What are the things you guys did at the time or afterwards that sort of helped process the emotional weight?

SPEAKER_03 32:20

Funny you should mention that because uh the second location we went to where we arrived, and uh there was a little bit of a power struggle, believe it or not, which was kind of an eye-opening thing to me to see in a disaster zone when uh other NGOs are in place and they sort of feel a territorial imperative, if you will, that hey, this is the place where we usually volunteer. These are usually the facilities that we use. You're not really welcome here, but we we're not here for you're welcoming. We're here for the population that needs our help. And so we arrived at our second destination and sort of ran into that situation. And we said, okay, so there's no beds available for us to sleep. We don't mind sleeping on the floor in the rat-infested, flea-infested, mosquito-infested classrooms of the school that are on the same property. We'll sleep on that floor at a hundred and some degrees with no air conditioning, no problem. But why are the operating rooms empty now? It's midnight and there's nobody in the operating room.

SPEAKER_02 33:22

Why is that?

SPEAKER_03 33:23

So, what we did was we ran the operating rooms at night and then triaged and did clinics during the day when they were occupying the operating rooms. This again is an example of the sort of nonlinear thinking, plugging yourself in, making use of any resource that you can possibly make use of. Now, the caveat being that the the operating room I had, the anesthesia machine probably hadn't been checked in years. So I had to run through a whole anesthesia check myself on this machine, which was sadly lacking, and I was able to get somebody to do a little bit of um maintenance on it for us. But we had a nitrous oxide leak in the room. So we actually laughed a lot one night and we didn't realize, we thought maybe it was sleep deprivation. We were in the operating room and somebody got the giggles, and the next thing we all had the giggles in the operating room. In retrospect, I am really thinking we had a nitrous oxide leak in our room because we had a nitrous tank in there and one of the tanks was leaking. We couldn't really determine which tank it was. There was profound devastation and profound sadness just outside of our doors. But somewhere in there, we found a little giggle time. And I felt so guilty about that. And I was so worried that anybody might hear us giggling that thought we might be taking this terrible situation too lightheartedly or not seriously enough. One of our teammates, an ER nurse who was working the recovery room night shift, came back to us. We'd had a major aftershock. We had just left the operating room, which was underground, actually, was a subterranean operating room. Scary. We had just left the operating room and there was a major aftershock. And we did experience like multiple aftershocks that were between five and five point nine, pretty good sized aftershocks. The earthquake had started, and all of these patients in the recovery room that had one leg tried to get up off of their beds to get out of the building. And she was relaying this horrific story to us. And it was very hard to deal with that on a visceral level, uh, an emotional level, and also not see the humor in all these people trying to get out of the building. And she was trying to explain this. And somehow, you see what I'm saying? I felt very bad that we could find some shred of humor in this absolutely tragic situation. So we didn't manage our we didn't manage it well. You know, we didn't have a other than doing presentations to share the information that we learned once we came back home and channeling all of our experiences into, okay, someone else is going to follow us in this into this disaster zone. We can create a checklist of what they need to take with them, how they need to be better prepared, what supplies are still lacking, uh, what they can do for communications, those types of pieces of information that we could then take our experience and turn it into teaching. And so again, we're giving in a different way, was really the only unpacking we did, the only mental unpacking we did. There was no emotional unpacking other than presenting to other bodies that information and then rethinking it, reprocessing and putting it from an emotional state into something that could cognitively be shared. I don't know if that answered your question.

SPEAKER_01 36:58

No, that's really helpful. And just to get a context, you know, you guys arrive in day five of the earthquake, right?

SPEAKER_03 37:04

I think that was probably about right because I think the growth quake was that on the 12th. I think it was on the 12th, and I think we got there uh, yeah, on the 17th.

SPEAKER_01 37:12

And then the day when you're talking about the aftershock is now how many days out?

SPEAKER_03 37:16

Oh, there were aftershocks continuously.

SPEAKER_01 37:18

But the one you just spoke about.

SPEAKER_03 37:19

Oh, that was probably five days out.

SPEAKER_01 37:22

Gotcha. Yeah. Yeah. So just uh, you know, I'm also just thinking like five days of an experience like that consistently has its own toll.

SPEAKER_03 37:30

Yeah, it it does. It does. When you come back, you know if you ever saw the movie The Hurt Locker, it's about a a war veteran coming back from an active zone and just not being able to plug back into the into life as normal.

SPEAKER_01 37:45

No, I didn't see that.

SPEAKER_03 37:46

And when I came back, it's like the whole world has slowed down. Because you're uh you're coming from a situation where there are multiple streams of dynamic input coming at you with urgency at all times. And then you come to normalcy, quiet environment, and it's almost unmanageable. It's like a manic high coming down to a the norm is a depressed is a depressed state. Yeah. Like managing any big trauma case in the ER, you know, when you're fully in sheet set me high would call f the flow state. Yes. When you're dealing with everything and ever you you're you're managing all these different this all this different input, but it's coming together nicely for you and you're calm with it. And then when it's over, how do you manage that? Now, how do you unpack what just hit you like a cyclone, but you managed.

SPEAKER_01 38:39

Absolutely. And it's interesting too how you know you go to a mall, right? You don't you just don't even know if somebody just landed from some war zone as a s in service. Or if you think about just bringing the focus back to Chico of all the disasters we've had around our area, what it's like. But it's interesting, you're you're absolutely right. That transition back is odd as well. It is odd.

SPEAKER_00 39:04

Yeah.

SPEAKER_01 39:05

Yeah. And then how does it change you as a human being? It's that's there's so many layers to that.

SPEAKER_03 39:13

Yeah, I mean, I think it the changing is in the unpacking of it. When you do process it and you do, I think for me, when I came back, a lot of people asked me what impacted you the most. And I can remember saying to someone after a presentation, I realized on some level that there is some force that's in charge of everything. And it's not me. Just because we had such amazing serendipitous luck and such amazing opportunities that happened one after the other after the other. I came away from that thinking we couldn't have possibly planned a single hour of our experience any better than it unfolded. And so that really did shift something in me because I basically didn't grow up with the religion. I mean, I was I went to British Commonwealth schools, so I had Church of England stuff every single day, but I wasn't raised in a religious household. I wasn't raised with religion, and I don't tend to lean on it. I think of myself more as a spiritual person than a religious person. But that experience was so impactful. I've never ex I think it's probably the highlight of my entire life. Wow. Just being able to have plugged myself into something that made a little difference. I would honestly say, of all the experiences in my life, and I've lived in on three continents, and I went to 13 different schools in my 12 years of schooling, and I've had a child and I've had all kinds of other experiences in life. That experience to me was the most impactful experience I have ever had.

SPEAKER_01 41:05

I could see what you mean.

SPEAKER_03 41:07

Yeah.

SPEAKER_01 41:07

And you know, you mentioned something really interesting that I also struggle with. You know, I don't follow any specific religion, but there's been some time when for many years now I do a daily practice and it involves prayer. But it's uh it's also just, and you talked earlier about humility and and first of all, to know that you've made a choice to be of service, and then you feel the energy or the positivity of the higher power guiding you and protecting you and putting you in touch, putting you in touch with the idea of camp and all the resources you guys got. But then thereafter, one of the things that has been really helpful for me is that when I find those really big lumps of unprocessed trauma or history or like a certain patient or something, the idea of putting that also before the same higher power.

SPEAKER_00 41:58

Yes.

SPEAKER_01 41:58

The humility of saying, look, you know, you put me there and I did what I had to do, and here I'm dealing with it. And it's interesting how how powerful that has been. Like sometimes I'll come across this really tough thing and I just put it before the higher power. However, you phrase that or contextualize it.

SPEAKER_03 42:17

Yeah. Yeah. I mean, I think you can't give from an empty basket, and so you have to be kind to yourself. And this is a lesson that a lot of us in healthcare have trouble with.

SPEAKER_01 42:28

Yes.

SPEAKER_03 42:29

We probably a good portion of us are codependent, let's be honest about it. Right. We are programmed to take care of others, right? Right. And a lot of times that comes at at the expense of taking care of ourselves, even if it's missing a meal, missing a bathroom break, or whatever you need to do in order to make some sure somebody else's needs are met. And I think if we are very hard on ourselves, we don't come out of it okay. And when you are putting this dilemma in front of the higher power to manage that for you, I think you're unloading some of that responsibility from yourself, which is a kindness that we need to show ourselves.

SPEAKER_01 43:10

Absolutely. And it also I think the other thing that I think it does is we try to fix problems from the past with, you know, pro problems with things we've learned from the past, right? But in a way, also just the act of putting something like that in front of the higher power opens up your preconceived notions and allows you to to maybe receive help where you didn't expect it.

SPEAKER_00 43:34

Yeah.

SPEAKER_01 43:34

Or you where you weren't gonna look for it or take it or what have you.

SPEAKER_03 43:37

Yeah. I think the other piece of that, the other side of that coin is knowing what a tremendous blessing it is that we are in a position to help. Where this came to roost for me was during the pandemic when I was not working. I had just retired before the pandemic. And And of course, I thought, oh my goodness, but this is before we had the vaccines or anything. What was happening in New York? What was happening in LA? And I said, Oh no, I've got to go back to work because there are young CRNAs who are taking care of patients, intubating patients in the ICU who have families at home. They've got little children to go home to, and I don't have that. You know, I felt like I had a responsibility then to plug myself back in. And as much as I tried to plug myself into the situation, it just never materialized. Right. Not only because my husband was like adam adamant that I couldn't go unless I could guarantee that I was coming back. But it made me realize how lucky all those other folks who were getting to help in a situation like that were.

SPEAKER_02 44:47

Right.

SPEAKER_03 44:47

And I would not have ever come to that epiphany if I hadn't, you know, hadn't been in a position where I couldn't do something to help. It was very frustrating. And I thought, I wonder how many people who are feeling exhausted know how also lucky they are that they can make a difference.

SPEAKER_01 45:08

Well said. And I think that's one of the biggest messages that I hope people you know hear in their own heart.

SPEAKER_02 45:16

Yeah.

SPEAKER_01 45:18

That as as tough as it is in those toughest moments, that you really are you have a very unique capability.

SPEAKER_02 45:26

Yeah.

SPEAKER_01 45:26

That's really amazing. And actually, you coming away from this experience, what do you think people in today's healthcare system, especially those struggling with burnout, need to hear the most? I mean, one of them is just that, right? That was my next question. You went right to it.

SPEAKER_03 45:41

Burnout. I think another way to phrase burnout is collateral damage. It kind of takes to me, though the term burnout has almost conferred a sense of responsibility on the burned-out person.

SPEAKER_02 45:57

Right.

SPEAKER_03 45:57

Because I was probably one of those people or was afraid of being one of those people who was, I'm sure that we've all had periods of quote unquote burnout in our careers. And I think once we reframe that into realizing that we have become collateral damage to the trauma that we're dealing with, seeing every day and processing or not processing, it then empowers us to do something about making ourselves not a victim anymore. And so there's voyeur, there's victim, and there's empowered person. And so I think for me, that looked like self-care. My sports, my exercising, my yoga practice, my meditation practice, my social time with friends, my social time unpacking with colleagues, things that happen at work. That's a big part of self-care where we are empowered to do something about it as opposed to be the recipient of that label.

SPEAKER_01 46:58

Makes sense. There is a need for action, right?

SPEAKER_03 47:01

Action is the undoing. Um when we have all this pent-up energy, whether it's negative energy from bad experiences or untapped energy, and we can direct it in some way. You know, I always say it's even, I mean, one person can make a big difference. One person can inspire other people to do more to help or to take care of themselves. I remember a particular patient we had in Haiti. I'll never forget her, and I I can use her name because she's been all over the news. Her name was Jeanette, and her husband, Roger, spent six days trying to dig her out from underneath the building where she worked. Whoa. She was a bank manager, and she was trapped in the bank with two of her security detail. The building had collapsed on them, and she had been trapped under a beam with her hands outstretched in front of her, and she was literally just pinned by her fingers under feet of rubble. And Roger had been digging for six days on that site to try to get her out, and he wouldn't give up. Six days. Six days he spent digging. And a search and rescue team from LA County, who actually some of the guys I knew came across Roger and they helped him. They dug her out and they brought her to my operating room tent at like three in the morning or something. And I was able to provide some anesthesia services for her so that we could amputate digits three through five on one hand. And I don't think we took any fingers off the other, but they looked pretty gangrenous, but she was doing well. I did, I think, an axillary block on this side, and we actually discharged her the next morning. But because Roger would not give up, one person didn't give up. His wife made it. That team from LA County was able to do something productive. We at our tent and our hospital were able to do something productive. And guess what? The whole world heard that story. And all the news agencies put it out there, and it gave the world hope that there were other people that were still salvageable.

SPEAKER_00 49:17

So day six. Day six.

SPEAKER_03 49:20

Yeah, I mean, surely if she had had a more uh, you know, central injury from cr uh from crushed wound, she would not have survived. We had cases in uh in Nepal where patients were trapped for days, you know, with heavy beams on them, and there was no way they're gonna make it the minute you relieve the pressure, you know, the rhabdo is there, and they had that release of all those inflammatory mediators and they don't make it. But this one person who wouldn't give up, the one person that was saved, and the impact that that had around the globe was phenomenal. So I say whatever you can do, whether it's giving blood at the blood bank, stopping at that unhoused person you see laying on the sidewalk, or impacting someone that you come across in a disaster zone, the one person can make a difference, right?

SPEAKER_01 50:11

Yeah, the the experience of you spend an hour doing something, spend two hours doing something, and then you're talking six days.

SPEAKER_03 50:18

Yeah. Um, yeah, and it was, as I said, you never feel more alive. You know, sleep deprivation does something very positive for you. Did you know that? It makes you manicky.

SPEAKER_01 50:28

Yeah, it does.

SPEAKER_03 50:29

It does make you manicky, which keeps you active. Yeah. So you are productive to some extent. It's a bell-shaped curve like anything. And at some point you're not going to be functioning on all cylinders and you don't want to be doing anything unsafe.

SPEAKER_01 50:43

I mean, this is somewhat switching gears, but it it's somewhat related to that. But I would love to hear but you you talked about pushing yourself to the limits. And so one of the things that you know, you're an endurance athlete who's complete on a high national level. And how do you integrate that medical practice and how did it change or even help your work?

SPEAKER_03 51:02

It's it's funny because I could draw analogies between different sports and the way that we conduct ourselves in our practice. I always used to draw analogies between learning a new skill and mountain biking.

SPEAKER_00 51:16

Okay.

SPEAKER_03 51:17

Because it's so fraught with danger, challenge, and fun, right? Depending on how you can navigate that pathway wisely and with the appropriate support. So I think sometimes stretching ourselves, putting ourselves in a situation that is not comfortable is really the only way you're going to grow. I mean, my doctorate is in educational psychology. And so we learn about the zone of proximal development, which is this little window that you enter into from where you've come with your knowledge base to where you want to be in the future. There's this zone of proximal development. It's a bridge area that you cannot traverse without the appropriate support and help.

SPEAKER_01 52:00

Got it.

SPEAKER_03 52:01

And the only way you get across that bridge is with uh some expertise interjected from a colleague or a mentor or however you avail yourself of that skill. But it also takes uh willingness on your part and you know, a little bit of bravery to venture into something that's uncomfortable. And so I've often drawn analogies between various sports, especially since I do some risk-taking sports. One of the things I absolutely love to do is race the criterion, which is a very high-speed endeavor surrounded by other people going very high speeds, and you have to have some level of trust in those around you, which what you do in a team, a care team. You have to have a vision of where you're going and some introspection that you're not causing an issue while you're while you're headed in that direction. It can be a lot of fun when you do it well.

SPEAKER_01 52:55

I bet. And for those of you who don't know, a criterium or a crit is a high-speed 30 to 90 minute bicycle race with a short, closed city circuit, usually one mile or less. Think of it as Formula One for bikes, packed with intense sharp corners, constant jockeying for position, and thrilling spectators with laps that pass every few minutes. And then they're really fun to watch for spectators because they're right there in front of everybody.

SPEAKER_03 53:22

Yeah, it's like a dynamic roller coaster. And it's uh it's somewhat terrifying if you don't know what you're doing, and it's a heck of a lot of fun if you know what you're doing. And you're around people that can be trusted.

SPEAKER_01 53:33

And you know, what I you know, you guys have taught me so much, you know, as one of the experienced members of our cycling team of how to manage it. It's kind of really cool. And like you said, there's that zone of proximal knowledge. Yeah, you you show up to bike and then you have people that actually teach you say, don't do this, do that. That's right. And you move forward. One thing that just popped into my head that I I really love about cycling or endurance sports is that, and it really carries to work, is that the more tired you get, the more taxed you get, the more you have to relax and go back to that good form.

SPEAKER_03 54:06

Yes, form is everything. You don't have to demand of yourself all the time. Sometimes a workout is just about form.

SPEAKER_01 54:14

Well said.

SPEAKER_03 54:15

Yeah. You don't have to pressure yourself. Sometimes it's just about form. And it's, you know, it's keeping moving forward. Anything you can do to keep moving forward uh is not only empowering, it's very necessary for that decompression. I used to get up at well, I when I was working in the operating room at LA County, I would be up at 3 50 in the morning and I'd be out for my run by about 4 30 in the morning. So I'd have to fit my before I went off to the operating room. And it was very important to me. If I got my workout in before I went to work, I sort of got my little, you know, we think about endorphins, but actually endorphins don't cross the blood brain barrier. It's it's it's endogenous cannabinoids, believe it or not, that cross the blood brain barrier. So you get you a little nice relaxation before you go off to work, and your day is a whole lot better because you know you took care of yourself before the birds were even up.

SPEAKER_01 55:08

So true. And I remember like when I first started cycling with you guys, I mean, you guys really I remember I was like, these guys don't look like they're hurting at all. Because their faces relax as I've gone along and I've gotten some coaching and everything. I realized like part of the reason you guys don't show because you don't want to even flex the muscles in your face because all the VO2 Max has to go to your legs. So it's just that relaxation, even in a state of discomfort, I think is I don't know, just such a powerful lesson.

SPEAKER_03 55:38

What's the messages we give ourselves? You know, we put on a face for other people, we have to put on a face for ourselves also. Right. And so, yeah, smiling and relaxing. I have a grimace that looks like a smile. So all my pictures that are taken by our photographer during Criterion Racing, I have look what's I look like I'm grinning from ear to ear, and that's the way I'm getting my oxygen.

SPEAKER_01 56:04

I just want to take a moment and again really thank you. You know, I love the work we do at Enlo, and I love the fact that we get to to sort of explore this. And I think not only I think this is an amazing body of information for people to gather or to to kind of avail themselves of, but it's also I I hope people appreciate really the amazing community that we have in Chico. Yeah, such as yourself. And I'm so glad you're here and spend the time with us to chat.

SPEAKER_03 56:33

Oh, thank you. That's so sweet of you to say. I feel very much the same way about you. Delighted to have met you and have you on our team and have you as a friend.

SPEAKER_01 56:41

Right back at you. Thank you.

SPEAKER_03 56:42

Thanks, Matty.

SPEAKER_01 56:43

As an aside for the local listeners, we're coming up on crit season here in Chico. Here's a fun family opportunity at the Chico Airport. There's going to be a weekly crit race every Tuesday starting at 6 p.m. You can watch the races, and it's a dedicated kids' race. It's a great way to watch fast-paced cycling and have your children get a taste of cycling that's really safe. Reach out to me for details. Let us know how you feel about this space and share your ideas for wellness and mindfulness. Your input is essential to shaping this journey. What's the best way to communicate with you? What format works best? Email, podcast, or something else? What ideas do you have to strengthen resilience and join practice? Send your feedback anytime via email at medi.setariat and low.org or by phone or text via my cell phone listed in the episode description. Together, let's work towards a healthier, more connected medical community.