Volume 34

May - 2022

Cover: Peony

I always found dotwork really satisfying to work with because of the time it takes to finish a piece. It's my first time trying to incorporate watercolor to my art and I like the life it brings to the artwork. Art was always a way of meditation for me. Just to sit down and be in my own bubble has been a good way to reset after few days at work.

Letter from the Editors:

Welcome to Art of Emergency Medicine, an online blog featuring amazing works of art created by your Emergency Medicine colleagues, along with their own stories of wellness and inspiration. Each month we try to focus on a new topic within wellness, and this month we’re talking about second victim syndrome, and learning to cope and be available for your coworkers.

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First however, we have some amazing news to share with you! We were honored to be selected amongst multiple participants to give a presentation on our educational and wellness intervention over the past two years at the FOAMed Showcase for 2022 at that Society of Academic Emergency Medicine in New Orleans. We were shocked when we found out that our little website won both the Judges vote on the day of and community vote via Twitter poll. We could never have reached these milestones without your help and we are excited to continue to grow this community we have developed. Thank you all tremendously for the support!

Speaking of growing our community, this month you will see the start of what we hope will be a useful tool for all emergency medicine providers. We will be creating short succinct infographic summaries of our monthly pieces (see the end of this volume) that you may download and utilize on shift or share with others! Let us know what you think and how it can be best improved.

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This month we’re covering Second Victim Syndrome (SVS), and it is not an easy topic to cover. Initially coined by Dr. Albert Wu from Johns Hopkins, it has progressively been defined as any healthcare provider who is involved in an unanticipated adverse patient event, medical error, or patient related injury and becomes victimized, in the sense that they are experiencing trauma from the event. 

Unfortunately, this seems all too common in emergency medicine (83% experience some form of SVS during their career) where we are expected to make snap decisions with extremely limited information available. Thus, we are at higher risk for experiencing SVS and the guilt, anxiety, burnout, moral injury, and reduced job satisfaction that comes with it. Similar to previous mental health crises, this has only been exacerbated with the pandemic due to problems with resource allocation and an inability to help. 

To understand the syndrome, it is important to realize how it presents in a physician. Think of an acute stress response to a poor patient outcome:

• Physicians may experience anxiety and grief regarding their decisions

• Sleep disturbances are common with reliving of the event

• May ultimately change the way one practices medicine

• Experience of moral injury

It is important to realize that the course of SVS can expand over six different stages, but these are not necessarily linear, and often the first three occur simultaneously- 

• Chaos and Accident Response: The provider is easily distracted, often found to be thinking on other topics than the task at hand. May lead to self-isolation.

• Intrusive Reflections: Ongoing reenactments of the event, development of feelings of internal inadequacy

• Restoring Personal Integrity: Seeking support and discussion with trusted individuals, discussing the event, utilizing external validation to compete with the sense of internal inadequacy. 

• Enduring the Inquisition: Focusing on concerns of being labeled as incompetent, fearing repercussions or losing respect during a lawsuit. 

• Obtaining Emotional First Aid: Caring for yourself, seeking support with therapists or focused hospital groups aimed towards improving mental health.

• Moving On:

  • Thriving: Taking the knowledge skills learned through the previous 5 steps and utilizing them to better yourself and interactions with patients. Using these learned experiences to create better outcomes in the future with an improved sense of wellbeing.

  • Surviving: Making it through the last five steps with some scars, but ultimately being able to recover and continuing working in your practice with a renewed sense of meaning.

  • Dropping Out: Unfortunately, moving on is not always successful and there are a portion of people who end up leaving medicine entirely depending on the severity of what they are experiencing. 

It is clear that moving on is not always positive, so the goal is to strive to become one of those members who ends up thriving at the end. But how can we get there and how can we help others to get there if we notice a colleague experiencing SVS?

• Open conversations with our colleagues

  • Frequent check-ins both individually or with others will allow you to evaluate your stress levels, and if there is significant change, realize when you need to seek additional help.

• Coordinate your resources

  • Discuss with hospital administration, EMS supervisors, or residency coordinators what resources look like for mental health support. 

• Listen to others

  • Be empathetic in your listening. All of us have experienced difficult patient encounters, or the death of patients. Be there as a sounding board for your colleagues and offer advice free of both judgment and blame. 

• Connect with others

  • One big part of SVS is the isolation that providers either place themselves into or feel following the adverse outcome. Do your best to prevent this by seeking social support, friend groups, or support groups. Remember that you’re not alone. 

• Normalize the response

  • As we said before, up to 83% of EM providers experience SVS at some point in their career, so realize that this isn’t an anomaly. Instead of focusing on mistakes or outcomes, seek what knowledge may come from the encounter and how you can better patient care.

• Build your confidence in address stress reactions

  • Learn from the experience and identify what your individualized stress reactions are. Once you are able to start noticing these, you will become progressively more able to intervene sooner and recover sooner from these acute stress reactions. 

Second Victim Syndrome is a complex topic, and by all means, this only begins to scratch the surface of the information that is out there, but we hope this helps you open up the conversation to support both yourself and colleagues at your institutions.

Sunset

I love [to see the] sunset. I love drawing as a hobby in addition [to] taking photos of anything beautiful since [I was] a small kid.

Small Change

A man with a mortality rate of one hundred percent
by our calculation, 
without a family or spouse. 

His emergency contact is Richard,
a friend he met when they were 
hospitalized together,
for injuries he doesn’t mention. 

Richard used to visit 
frequently, he says. Then COVID. 
And nothing. 

We wonder whether he will come now, 
a friend who lost touch,
to be with the man 
in the last intimate moments of his life.

But Richard would get on a train immediately.
Would gather quarters and print off directions
from the suburbs to the city
he hasn’t seen in years.
He would even make the painful decision 
to withdraw life support. 
From what he knew of his friend, 
he wouldn’t have wanted this. 

One relief, Richard tells us, 
is that despite his own debts,
he has a small amount of cash in savings 
to give his old friend 
a funeral.

I am just a speck
too tired and too ordinary 
to say anything that hasn’t already 
been said. 

It must be true, though, 
everything they say 
about love.

In a rare quiet moment, I wrote this from a hospital call room in the wee hours of the morning. I don't have any particular identity as an artist, but use writing and reading as a way to process the range of emotions we witness in our work.

Looking Up/Tuscan Sky

I painted this while on a trip to Italy with my family, which was a much needed escape from the department after several hard months this winter. As cheesy as it is, the act of "looking up" or finding beauty helps me regroup and find comfort when everything seems to be falling apart or I find myself on the brink of giving up.

Red River Gorge Series 2021

I don't care where you practice - none of us have ever been tried with anything in our line of work like the COVID-19 pandemic. We've all had to face it - we have all had to adapt to the unique sets of challenges it has presented us with and test ourselves. It has been, to say the least, great for my artwork - as I use painting as a therapeutic outlet. I've done more work and progressed as an artist than ever before.

Monthly Infographic:

Second Victim Syndrome

Do you want to see your art shared with the community? Don’t forget to submit today!

Finally, don’t forget to share Art of Emergency Medicine with your colleagues, friends, and family on Twitter or Instagram and like us on Facebook for all the latest news!

This Months Featured Artists:

Alaa Muhsin Humaidy, MD

I am an emergency medicine specialist [in Oman]. I love drawing as a hobby in addition of taking photos of anything beautiful since [I was] a small kid.

Alina Khurgel, MD

I'm an emergency medicine resident at Boston Medical Center. For as long as I can remember art has been part of my life. I took classes in photography as far back as high school, and then took up drawing and acrylic painting while in undergrad. More recently, and secondary to time and other constraints, I've been dabbling in watercolor and color pencil. I turn to my creative outlets to provide respite and release from life and work, and I love sharing the enjoyment of creating (and appreciating) art with my family. See more of her work on instagram.

Alison Vasa, MD

I am a first year emergency medicine intern at Cook County Hospital. I don't have any particular identity as an artist, but use writing and reading as a way to process the range of emotions we witness in our work. While not in the ED, I enjoy traveling, being outdoors, bird watching, running, and spending time with my dog, Nacho.

Haedan Eagar

I am a third year medical student with a lifelong dream of practicing EM. I starting painting during medical school as my mind often needed a break from thinking about science. My favorite thing is that art has no “rules” to follow. I have recently begun quilting and look forward to making my own patterns.

Jon Gaddis

My name is Jon. Prior to EKU's Emergency Medical Care program, I'd always taken an interest in fine arts. I currently work as a paramedic in the Emergency Department (I'm also a current student), and my sense of peace has always been tied to outdoor pursuits; those interests led me to volunteer as a Wilderness Paramedic for RedSTAR in Kentucky's Red River Gorge - which had been a source of inspiration for some of my more recent artwork. The experiences I've had over the years in emergency medicine and the lessons I take from it compliment all areas of my being; I am always learning and growing from them. My art (primarily traditional acrylic on canvas) and my interests across the many disciplines might capture some of the moments on my journey, or reflect upon them. I have found great joy in painting and it has translated positively in all areas of my own life - and hope you can find joy in your own art. See more of his work on instagram.

Paulina Malek

I have finished school a year ago and been working as a paramedic in the capital of Norway for a year now. Art was always a way of meditation for me. See more of her work on Instagram.

You can learn more about the artists featured in this and other volumes at our contributors page!