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