Whos caring for the people who are caring for us

penny and her husband were my last

patients for the day

penny was this amazing preschool teacher

and she had this passion for taking care

of autistic children

her only concern around having surgery

was how long was she going to be out of

the classroom how long would it take to

get back to those kids

we were all hopeful surgery would go

well we’d get her right back to the

classroom where she belonged

her day of surgery came her operation

went well and she went to the floor

later that night though she had a couple

problems and by morning

it was evident that something was very

wrong i rushed penny back to the

operating room in the operating room i

found that penny had a hole in her colon

she was very sick we washed her out we

closed the hole

took her back to the icu she’s now on a

ventilator she’s on medicine to keep her

blood pressure up

and i went to explain to her husband

what we found i told him we found a hole

in her intestine

it was the result of a mistake that i

had made a surgical heir

she was now very sick but i was hopeful

she was going to survive

throughout the day unfortunately though

penny got progressively worse

by evening time she was now on high

doses

of numerous medications to keep her

blood pressure up

i went to the icu late that night and i

stood at the foot of her bed

i watched her laying there barely

hanging on to life

i was trying to replay the operation in

my head trying to figure out where i

made my mistake

when i realized that her husband was

sitting off in the corner in the dark

he got up he came and he stood next to

me we both watched his wife

lying in bed tubes and machines

everywhere

keeping her alive

i held it together long enough to tell

him

i don’t know if she’s going to survive

this i am

so sorry

i didn’t know how he’d react i don’t

know if he would yell at me i don’t know

if he would call me names

but he didn’t he put his hand on my

shoulder and he said to me

it’s okay i know you did your best

are you kidding me it’s okay i know you

did your best

i was supposed to be the one that was

saving her life but instead the mistake

that i made

was taking her away from him

he didn’t blame me he gave me grace

grace that i desperately needed but

never thought

that i would get

this special man had a gift to see that

i was struggling

and he set his grief aside

to help me now this is not where we

would expect to be getting support at

this time

from the husband of my dying patient

we’d expect to get that help

from more traditional channels from our

families

from our close friends maybe even our

co-workers

those people that know us best and have

the best insight into our personal

struggles that’s where we should get

that support

unfortunately no one person knows us

completely

no one has a complete 360 degree view of

our lives

and this lack of a circumferential view

creates

safety gaps that put us at risk

now many of those gaps occur in the

workplace

as many of those stressors are work

related and as a leader

it’s our responsibility to identify

those gaps

this comes natural to many leaders but

all leaders should feel comfortable

checking on their team members

and all team members should feel

comfortable being checked on by their

leaders

that’s how our system works that’s how

it’s worked for years

but unfortunately that system is failing

and it’s failing some of our key team

members

it’s failing our leaders who’s checking

on our leaders

some highly functional organizations may

do that well but most

do not and why

well early in my career i had the

opportunity to serve in the military and

had the honor to care for our soldiers

and their families

i’d been in the air force for about two

years i was a young major and i had the

opportunity to care for the wife of one

of the highest ranking military officers

i would ever meet

shortly after caring for her i diagnosed

her with an advanced stage of cancer

after making that diagnosis i had a rare

moment where i was with her husband

alone

and i felt the need to check in on him

to see if there was anything that he

needed or that i could do for him

during this stressful time i don’t

really remember exactly what he said to

me

but i certainly remember the shame that

i felt by crossing that line and asking

him

his message to me do you not know who i

am

do you not see the stars on my shoulder

do you think that i don’t handle my

emotions and i need your help

how dare you ask me that question the

lesson i learned from that was

leaders are strong they know how to

handle their emotions

they don’t need help especially from

somebody they lead

don’t check in again now in the course

of preparing for this talk

i had the opportunity to interview

leaders from across organizations and

industries

and i asked them all during the course

of your career

how often has somebody that you led

reached up to check in with you they

almost all told me

almost never one leader tells a story

where during the pandemic

she had pulled her team together to talk

about the struggles of living through

the pandemic

and the social unrest of the last year

during that meeting she

had revealed that she was struggling too

only after she revealed that she was

struggling

did someone on her team reach up to

check in with her

everyone was feeling the stress but

everyone assumed

that the leader was not

now i want to note i use the term

leaders i’m not using the term bosses

and i’m not using the term

executives this is not a problem

isolated to the c-suite and this is not

a problem isolated to large corporations

this affects leaders up and down an org

chart

this affects small and medium-sized

businesses this affects male and female

leaders

specs black white and asian leaders this

affects leaders have been doing this for

six months

and those been doing this for 50 years

if this problem is so pervasive why are

we afraid to talk about it

well there’s this universal perception

that leaders are immune to the stress of

the world

they are strong and resilient they have

their act together they do not need to

be checked on

even if we suspect they are struggling

we do not check in

it violates our chain of command it

doesn’t feel right

but we can make it right by simply

checking

in now a few years ago

i was called in in the middle of the

night to take care of a young boy that

had been in a severe car accident

i was in the trauma room when the child

rolls in as he rolls in i realize he’s

just a couple years younger than my

youngest daughter at the time

we start to resuscitate the child

placing a breathing tube starting ivs

giving him medicine fluids

taking x-rays we soon realize that he

really doesn’t have any significant

injuries

other than a devastating brain injury

his brain injury is so severe that we do

not expect him to be alive for more than

a few hours

we take him to the icu and by morning it

was clearly evident that the child was

brain dead

now to declare someone brain dead you

have to do a series of neurologic tests

and i had done this examination numerous

times in adults

but i had never done this in a child

and declaring the death of a child

is something that stays with you forever

now the only solace i had was that due

to his numerous uninjured organs

this child would be an ideal organ donor

and ironically

he would now be able to save the lives

of numerous children across the country

and answer the prayers of their families

we had this conversation with his family

we talked through that they agreed to

proceed

and so we began the complex process of

preparing for organ transplantation

that night i received a call from the

icu nurse

she said the families changed their mind

and they decided not to proceed with

donation

and they wanted him taken off the

ventilator immediately

and the child died shortly thereafter

without donation

i respected the family’s decision

because i couldn’t imagine the grief

they were feeling

but i was personally devastated it was

hard enough to have lost the life of

this little boy

but i also felt that we lost the lives

of all these other children

that had been waiting for a heart

transplant or a lung transplant

or a liver

obviously the situation was very tough

on everyone involved very emotional

so in order to make sure that my team

was able to talk through their grief

and grieve safely we brought in our

critical incident stress management team

to help them through that process a

couple days later i passed the lead

counselor in our hallway of the hospital

and i asked her

i said how’s everyone doing is there

anything that we need to do for them and

she thought that the team was doing okay

and they would be all right and not need

any more help and then she said you know

no one’s probably asked but

how are you

i explained it was tough it was kind of

emotional thing for me but but i was

doing

okay when i realized now

that i had tears rolling down my face

clearly my words and my emotions did not

match

and all she had done was check in

no one had checked in with me right but

i don’t need to be checked in on

right i’m a trauma surgeon i see death

all the time

i’m a chief medical officer i’m former

military

i have my act together and these things

don’t bother me

well maybe not fortunately this team

member took a risk

in reaching out to ask me

she didn’t know how i’d react would i

laugh and belittle her concern

would i get angry with her for

suggesting that i couldn’t do my job

or would i show unexpected emotion

in a hallway and she find herself now

talking me through my grief

as people are walking by

i was fortunate that she was able to

reach out and ask

because many are not so fortunate

prior to covid the higher the highest

incidence of suicide is among physicians

300 physicians a year take their own

lives

the incidence of depressive symptoms is

three times higher since the onset of

the pandemic in adults than it was prior

in the incidence of severe depression is

seven times higher

since the onset of the pandemic in march

leaders have been fighting to keep

businesses open

lights on and employees paid

and despite that we’ve asked them to

step it up numerous times

as we exited the first surge we

re-engaged

as we prepared our covet exit strategy

we had to step it up again and then a

second surge and we stepped it up again

and now as we’re leaving kovid we’re

asking them to step it up the last time

our leaders are exhausted they are

stressed they are out of gas

with our leaders and subsequently our

teams

at greatest risk now how do we support

them best

how do we create the environment where

they are supported from above and below

where we create that culture where we

can ask questions

professional or personal of each other

and of our leaders

sometimes this is an organizational

culture where we do not draw hard lines

in our hierarchical structure

but many times this is not an

organizational culture but it’s a

personal quality

am i able to be an effective leader and

an empathetic co-worker

that encourages my team members to be

able to ask questions of me

and to check in with me as the leader

absolutely

and i think those are some of our most

effective leaders

if we just check in does it have to be

an emotional soul emptying conversation

in a hallway

it doesn’t if we just check in

does it have to be a prolonged

counseling session it doesn’t

can it be yeah it may be

if we just check in it may just be a you

know i’m good

i so appreciate you checking in thank

you

the most important part is just checking

in

the mere act of checking in is

incredibly powerful for both people

for the team member it’s empowering as

they reach out of their comfort zone

to check in on somebody they wouldn’t

normally be checking in on

and for the leader to know that their

team is concerned about their personal

well-being

it’s not only comforting but reassuring

knowing that they are there to support

them

this sense of caring both up and down is

what solidifies teams

checking in initially though is

uncomfortable

it’s backwards it doesn’t feel right

but with time it gets easier and maybe

with time it doesn’t feel so weird

maybe ultimately it becomes the norm

and maybe it bleeds out of the workplace

to a place where we feel comfortable

checking in with somebody that we

wouldn’t normally be checking in on

a neighbor an old friend

maybe even a total stranger somebody

that may be struggling

they need to be checked on and they need

to know that we care

not the passing how you doing but an

intentional

how are you doing with the empathetic

intent and commitment

to be there if their answer is you know

i am not good

now i never finished the story about

penny by morning

penny had stabilized a bit and over the

next few days she got better

three weeks later she left the hospital

and three months later she returned back

to the preschool

where she worked before i had taken care

of penny

seen her numerous times during her

recovery

and about a year later shortly after

christmas she returned to my office

i went in to see her she had this huge

gift and a card for me

i opened the card up and the card was

written by her and her family

explaining to me how thankful they were

for me

i opened the gift and the gift was this

custom-made picture they had made for me

i think they thought it was something

cute that i would hang on my

shelf in my office i don’t think they

understood

the significance this would have for me

so this picture now hangs on the wall in

my office

and it serves for me as a daily reminder

of the significance of the work that i

get to do each day

of a day that i was given grace

and the impact that we can make by

simply checking in

on each other in the words

of c.s lewis

to save a man all it takes is to take a

step

and then to take another

so i need to ask you who do you need to

check on

thank you