Prepare for the Unthinkable

The Doctor's Mentor® Show: Ideal Medical Practice | Business of Medicine | Entrepreneurship | Exit Strategies | Docgitimacy™

"The heart, mediastinum, pulmonary vascularity, pleural spaces, and bones appear normal."

[phone rings]

"New paragraph."

[phone rings]

[Telephone receiver is picked up.]

“Hello?”

“Is this Dr. Lori Barr?”

“Yes.”

“This is the nurse practitioner in the Eliza Coffee Memorial Hospital Emergency Room. Your parents have been in a motor vehicle accident. I have your mother here and she is experiencing amnesia but she knew enough to tell me to call you and had your phone number in her purse. I don’t know about your father’s condition. He was life-flighted to Huntsville from the accident scene.”

[introduction]

"There is only one other time in my life that I felt like I dropped into a Twilight Zone episode. That was the time I woke up alone in the dark in the middle of the night in a big house to something calling my name from the foot of my bed. That’s a story for another episode, or perhaps another podcast. It is good to be back, offering you as my protege tips to maximize your practice satisfaction and your opportunity for a rich full life with those you love. This episode is designed to leave you with five vital steps to help you prepare for the unthinkable. Preparation allows you to gain the most from this kind of growth opportunity rather than just by being devastated by overwelm.

You see the morning I received that call it was New Year’s Eve and I was sitting at Dell Childrens Medical Center in Austin, Texas, in my office reading X-rays because I was on call. And that call wasn’t the first on-call call I was expecting that morning. Usually, it would be one of our assistants letting me know that there was a stat read on a neonatal study from a hospital other than the one I was sitting at or perhaps one of the pediatric hospitalists or ER docs needing an emergency upper GI to evaluate a patient for malrotation and midgut volvulus. That call from the Eliza Coffee Memorial Hospital nurse practitioner changed our lives forever.

Thank goodness I’d had a number of mentors over the years who assisted me in being prepared for my family’s moment of crisis. Here is what I learned from them: 5 VITAL steps for being prepared for the unthinkable.

The “V” in vital is for Verify: Verify that your family members are totally prepared for a brush with or actual death. This means actually investing in a meeting with an estate planner and making sure that you have a will at a minimum and a full-blown estate plan if you or your family’s holdings are sufficient to justify the cost. This also means thinking about what you want to happen if you or a loved one is at a crossroads where there is a question about continuing life support or not. It is one thing to start thinking about this and another thing to put it in writing. Follow through so your family doesn’t feel like you left them with no guidance. Cremation or burial. Viewing or not. Is there a burial or cremation policy? Has a resting place been purchased? How do you access these things? In my case, I am an only child raised by a United States Coast Guard Officer, Sonny Barr, and his wife, Lee Barr, a world-renowned speech pathologist and audiologist. My father had planned for disaster since he first enlisted in the Coast Guard. My mother learned the drill as soon as they wed. Both were happy as independent successful humans who enjoyed times they shared and times of solitude. They thought of almost everything when it came to a brush with death, except a scenario that compromised them both at the exact same time. They were great mentors to me in this and so many other aspects of my life.

The “I” in Vital is for Identify. Identify any weaknesses in your emergency scaffolding. By this I mean take a look at the people around you, your workplace environment, and your pooled resources. Are you on sure footing in your practice or workplace where you know for certain you could provide a family member with the same level of love and support you give to your patients if an emergency calls you away on short notice? Do you have at least one practice partner who absolutely has your back no matter what and you have theirs in return? Do you understand who to contact if you need to leave your responsibilities unannounced in the hands of another provider? Is your practice or employer equipped with a mechanism that allows you to use family leave if necessary? You need to understand how family leave actually works in your setting. In some cases you may be considered “essential personnel” and thus your employer may not have to consider you for family leave. Your training may cause your injured or sick family member’s doctor to make medical decisions based on your availability and if you are then not available, that can lead to problems. For example, a loved one suffers a head injury and is deemed to have a concussion. Under average circumstances, they might be observed for 24 hours in a hospital or acute care environment to ensure no deterioration of neurological status occurs yet since you are a doctor, their provider decides it will be even better for the patient to go home with you where they can get more rest and you can still do the neurology checks in a kinder, gentler and less expensive way. That’s all great until you have to go to work during that same 24-hour period. In my case, as soon as I got off the phone with the nurse practitioner from the ER, I called my practice partner who I knew would know exactly what to do in this scenario. I told her what I knew and I said, “What do I do now?” She said, “You book a plane ticket to leave as soon as possible and I take a shower and come to the hospital.” Honestly, until you’ve experienced something like this, you really don’t know how much it means to know someone has your back. I am forever grateful to all of my practice partners at Austin Radiological Association who assisted me by taking my call, selling me their vacation, switching shifts, and bending over backward to make sure I could take care of my folks. In my case, I had both an extremely favorable practice setting and people who had my back. Now let’s talk about resources. Do you and your family have enough insurance coverage and emergency funds set aside to deal with disability or death? How accessible is it and what is the process? You will need cash and you might need credit. You may need legal assistance. I was glad I had listened to my mentor, Mike Koenigs, who years ago suggested that I determine my Fiscally Unfettered number, or as he said, F. U. number. The amount of money you need to accumulate to have the freedom to leave any work or practice situation that is no longer serving you. Depending upon the emergency, you might actually have to give notice to your current practice or employer. Are you fiscally ready for that? Are you emotionally ready for that? We who practice the arts as physicians, nurses, chiropractors, lawyers and other credentialed professionals tend to overly identify with our titles and roles. That can lead to unnecessary stress if a job change is required to maximize your support as your family faces a crisis. The FU number may change during different points in your career so be prepared to revisit this as time passes.

The “T” in Vital is for Talk. Talk before an emergency like this happens so the action plan is easier to implement. Talk even more after something like this happens. Effective closed-loop communication is essential in preparation for an untimely emergency and assures your loved one gets the care they need. It is worth your time to talk to your family about what you would do if there is a local disaster or if someone is seriously injured. Have a written action plan with the five W’s: Who, What, Where, When, and Why. Make sure the plan and important information like medication lists and insurance cards are readily available. My favorite tool for this is Evernote. It is readily available on all mobile devices and on laptop computers and desktops. It is easy to create and upload notes, take notes, and to share notes. We have a family Library that we share. The OCR reader is excellent so that even if your notes are handwritten or there is a word or number embedded in a picture, the search tool will find that note. It is pretty amazing. In our case, the paramedics on the scene did an incredible job keeping each of my parents’ possessions with them so they had what they needed when they needed it in each of the two hospitals they were in roughly seventy miles apart. I was able to notify my aunt and cousin who assisted my mother in one town and another cousin who assisted my father until I could arrive about seven hours later.

The “A” in Vital is for Allow. Allow your training as a health care provider to assist you as you order your immediate action steps. You’ve been trained to take your own pulse first when there is a healthcare emergency, and the same serves you in this instance. The hospital is like Disneyland. You wouldn’t dream of letting a small child go to Disneyland by themselves. Consider the same with a hospital or convalescent care facility. Both are busy places and while the care teams want the best for their patients, there is a difference between what the customer experiences and what the employees live day after day to make the magic happen. As a health professional, you most likely understand this more than your siblings who have other professions. A simple tip like, “ Wear warm clothes and bring an extra blanket, hospitals are usually cold,” can make a difference. Your insider knowledge can be instrumental in improving the outcome for your loved one. For example, you may understand how different care teams make rounds and at what time. You can prepare a list of questions or have whoever is at the bedside call you when the care team arrives for rounds. This is how errors are prevented and tests get done without falling through the cracks.

The “L” in Vital is for love. Love those who are ailing and yourself with every fiber and vibration that is your being. Any unexpected challenge like this is an opportunity to reflect on the question, “For what have I exchanged my short life?” You may find yourself too devoted to your profession or inwardly focused on a challenge in your own life. Nothing like a family emergency to shift your focus outward on the needs of those who mean the most to you in this world. This is an opportunity to realign yourself with the real reason you are here on Earth right now. Remember, in a situation like this, everyone is ailing, and everyone is doing the best they can to cope using the coping mechanisms they currently have so everyone needs to be cut some slack. That includes you. Cut yourself some slack if you feel guilty about how you left a relationship that is now forever changed. You may feel sad for your loss and scared or confused by the unknown. Usually, you feel all of these emotions and more. This is where loving habits you’ve created prior to the emergency can really comfort you. In my case, our habit of reading the Bible together every night as a family continued throughout my parents’ convalescence. We used an iPad so that we could all be together for this and for prayer even though my parents remained 70 miles apart for several weeks.

VITAL, Verify, Identify, Talk, Allow and Love. Five simple preparation steps that I, as your mentor, suggest you take before an emergency so that you and your family grow closer through the experience with less distress. Let’s continue our journey together toward a different type of professional life. One that gives you maximum satisfaction as you care for your patients and clients and maximum opportunity for a rich full life with those you love.

I am Dr. Lori Barr, the Doctors Mentor. One idea is all it takes to change your world.

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