June 28, 2024
Preparing for the Worst
On this episode, Charles Wooley recounts a life-changing moment in his early career as a paramedic that involved a lifeless baby and a desperate mother.
He takes us through the panic of such an intense moment, describing how he and his partner navigated the overwhelming responsibility and emotional weight.
Join us as we also address the broader emotional challenges healthcare providers face, especially when dealing with sick children and patient deaths. This episode highlights the dedication and preparedness that are vital for making a meaningful impact in both acute and long-term care settings.
Chapters
00:00 - Memoirs in Medicine
11:58 - Coping With Trauma in Medicine
19:46 - Building Support and Compassion in Medicine
Transcript
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I absolutely remember the moment whenever complete panic set in and I remember this tiny baby on this massive cot and I could not remember how to do anything that I was supposed to do.
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Hi, I'm Dr John Oden.
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This is Memoirs in Medicine, a podcast featuring the personal stories of healthcare professionals.
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And I'm Dr David Spiro.
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On each episode, one healthcare worker will share a moment from their career that has profoundly affected them and provide one suggestion, no matter how big or small, for improving the practice of medicine.
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Through storytelling, we hope to highlight the humanity of healthcare and create a space for candid and respectful discussion.
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To protect patient privacy.
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Some details may have been changed, but the stories are real.
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Welcome to Memoirs in Medicine.
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Welcome everybody to our next installment of Memoirs in Medicine.
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I am John Oden, I'm a pediatric endocrinologist at Arkansas Children's Hospital and my partner in crime, David Spiro, is a pediatric emergency medicine doctor.
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We like to present some stories from various different providers in the medical field, kind of leaving behind the medical jargon that confuses a lot of people and just creating a clear picture of what our lives are like.
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And we all have stories to tell.
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And just so the audience knows, for the most part we don't know what the story is before the story is told.
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So, without further ado, I'd like to introduce Charles Woolley Charles.
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Hey guys, thanks for having me on.
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This is really cool.
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So my name is Charles Woolley and I'm an outreach coordinator now here in Arkansas and I'm a paramedic and registered nurse by trade.
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These days I do a whole lot of outreach stuff, but the story I want to share with you guys is from my paramedic days.
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Yeah, please do Working as a paramedic.
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I started out as an EMT and a firefighter in the 90s.
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So I have a lot of stories but there's one in particular that changed everything for me and I've replayed it.
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I've told it a hundred times because I recognized at some point that this is what did it.
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You know, I was probably.
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I felt like I had been a paramedic for two weeks.
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So I started out as an EMT and I started out as a firefighter and I spent a lot of time just working, driving an ambulance and being that support guy.
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And then I went to paramedic school and everything kind of shifted at that point where, if you guys are not familiar, when you're the paramedic on the scene, all medical responsibility kind of falls on your shoulders.
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You have a set of written protocols and you're supposed to know them inside and out and be able to operate kind of with that recipe in the back of your mind.
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And I had trained for that and prepared for that.
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I went to a really good paramedic program and felt prepared.
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Two weeks after I got my beautiful gold patch on my shoulder I got that first pediatric call and up until that point I had this kind of thing in the back of my mind that was I'll never get that call, I'll never have to use those skills.
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You know, we get very little training as a paramedic, very little training as an EMT to take care of kids, especially the really significantly hurt or sick kids.
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Not prepared is really the label that I should have worn.
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That day.
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It was after a 24-hour shift at the fire station.
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I was cleaning my ambulance and getting ready for the oncoming crew make sure that the next crew had a clean ambulance to start the shift.
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And the area I was working with is notorious for these large bugs.
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And so I was out there that morning cleaning the front of the ambulance, trying to get the bugs off the windshield, and we get this call tones come out and it's just pediatric emergency and they give us the address.
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That's all they gave us, jumped in the ambulance and start towards the other end of town.
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You know lights and sirens, the whole thing.
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And I remember turning the corner into this apartment complex and seeing this mom run out of this apartment complex with this lifeless child in her arms.
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And there was no doubt about it, the way the baby was flopping in her arms, the way she was carrying the baby, the way she was running, that there was no life.
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As soon as the ambulance came to a stop, I remember my boots hitting the ground and this mom giving me this baby as fast as she could and screaming save my baby, save my baby, save my baby.
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Can we just stop there for a second, absolutely In that moment, first pediatric call for you as a paramedic, and it sounds like it's a dead baby.
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What's going through your mind in that moment, from what you can remember Like what are you thinking?
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Oh, I absolutely remember the moment whenever complete panic set in, and it was right after that.
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I was in the back of the unit and I remember this tiny baby on this massive cot Right, I remember that being a thing in my mind this little, this little babies on this massive cot, and I could not remember how to do anything that I was supposed to do.
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A lot of things happened right there.
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I had a baby at home at the time.
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It was emotionally just complete, blank and horror.
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You know, just absolutely felt terrible.
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I remember remembering that I needed to do encircling hands and I remember wrapping my hands around this lifeless child and thinking, ok, what do I do next?
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What do I do next?
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And then, once I got my composure which I don't know how long it took, but it sure felt like a long time Once I regained my composure, I was able to work through OK, I need to do CPR and I looked for help.
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I was able to work through okay, I need to do CPR and I looked for help.
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I remember looking up in the captain's chair, at the head of the bed, and there was a firefighter that was my MT partner and he was bawling.
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We both were young, we both had kids and we were both a mess.
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And he's like we got to get this together.
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We got to go, we got to go.
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You know, there was a lack of knowledge because I had been complacent in school.
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There was a lack of preparedness.
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Whenever I became a paramedic, they literally gave me the keys to the narcotic box, like that was my introduction to being a paramedic.
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I didn't ride with another paramedic and get you know.
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They just said here you go, you're the paramedic, you're up, let's go Right.
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And I got after it and I learned a lot of things that way, but this was not one of those things that I should have learned.
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The fallout from that, I think, is where the big life lesson.
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I think there's a paramedic probably every paramedic has that story, a very similar story.
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I went to my fire chief the next day, the next shift, and I came back after my 48 off and went straight to his office and I sat down and said I don't want to be a paramedic anymore.
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I want to pull hoses into burning buildings.
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Can I just ride the fire truck?
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I really just want to be a firefighter.
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And he's like we spent a lot of money on your career.
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We really want you to get on that ambulance, so I'll give you one shift off.
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So, charles, there's a lot to unpack here, but did this baby die?
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Yes, this baby didn't have a pulse, the heart wasn't beating and you all did a number of things, I'm sure in the ambulance CPR breathing for the baby, I'm sure in the ambulance, cpr breathing for the baby, maybe try to start an IV, and all that kind of stuff.
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And then you brought the baby to the hospital.
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And then when did you find out that the baby didn't make it, or did you stay and they declared the baby dead at the hospital?
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So we attempted a number of things on the way, but it was not the way we do things now.
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By the time that we got into the back of the ambulance, I feel like another firefighter had gotten into the front and we were going.
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We weren't far from the hospital.
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I remember trying to bag.
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I remember trying to intubate unsuccessfully.
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I remember trying to get IV unsuccessfully.
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I remember trying to get IV, unsuccessfully.
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I do remember that this child appeared to have been down for a really really long time and was found in a infants.
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Unless you have that interest and I remember having interest in NICU and the NICU and getting it and even though I was in the NICU as a resident for about three months for my training, which was more than the rest of my colleagues I was pretty good at intubating, but it still is a skill.
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That is not, I mean, it's not something you just kind of pick up a tube and go there it goes.
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It's a hard thing to do and that starting an IV in an infant, that's sick, that's hard to do.
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So I mean my hat's off to you for responding, that's a whole thing.
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You call 911 when something like this happens, but are we prepared to take care of these emergencies as paramedics?
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Are we prepared?
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Are we set up for success?
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That has been a driving thing for me for a long time.
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Before I dive into that, that's my purpose, that's my why.
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That's what drives me on a regular basis is that feeling of being unprepared.
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I really really want to share what I've learned since then with every paramedic, with every EMT, with every person in a hospital that just takes care of adults primarily.
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That knowledge that I've been able to gather from that scare, from feeling unprepared, absolutely drives me every day.
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But I also feel like there's another part of this that should have been handled differently.
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Nobody really talked about this.
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We left there that day, we gave each other a hug the firefighter and I that were on that truck and it was never brought up again.
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Nobody ever said, hey, let's take a moment out and let's talk about what happened, let's debrief.
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There was no such thing as debriefing back then, right, and it was kind of one of those things.
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As a firefighter, as a paramedic, you look a little weak, right.
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If you came back to the station the next day, feel upset about it.
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You got over, it kept going or you didn't, right?
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Yeah, I had.
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I had a very similar experience in um, in residency, when I was in the PICU and there was a little girl that didn't make it and it it affected me profoundly and it surprised me and, um, you know, one of the things that I I probably was adversely affected was my.
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You know, one of the things that I probably was adversely affected was my you know outgoing nature to find out the truth and I wanted to understand in an appropriate way what happened to that kid.
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Was it something I did?
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Was it something a surgeon did?
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Was it something the ICU did?
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And I will tell you, I had the exact same experience.
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It was, if you made a wave right, you were weak and they laughed at you or they didn't talk to you much anymore.
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They took away a special privilege that you wanted.
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I completely feel what you're saying and that's absolutely true.
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And you had brought something else up.
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There are a few things I want to talk about.
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So first of all, thank you for sharing and being vulnerable, charles, you know, not just sharing the story but also the idea that things may have gone imperfectly is brave, and I appreciate that.
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And also things have changed a lot in 20 years and some things haven't changed that much.
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But one of the things that you mentioned early on and all of us here on this call are parents and we all have children that are older so we've gone through all of the developmental stages of early, middle and late childhood as parents, and then we've also taken care of sick kids and we continue to take care of sick kids at all the developmental ages kids and we continue to take care of sick kids at all the developmental ages.
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And I think something that's not talked about a lot is it's very common to personalize a child.
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At the time you're seeing them with the child that you go home to and it's really hard.
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It's even especially hard.
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You're dealing with the death.
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But then you come home and you have a child that age that's just been born, that's not dead, and all sorts of feelings can come up Guilt, worry that this could happen to your child.
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And, john, I don't know if that's happened to you or Charles, if you can relate, but one time I took care of a child with horrible leukemia and I went home and I actually examined one of my kids who was roughly the same age and he had lymph nodes, and then I brought him in to see my friend the oncologist, to say, is my son okay?
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And so I just am curious have both of you had these experiences before, john?
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Can you relate to that?
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Of course, I mean, I have type 1 diabetes, and anytime one of my kids drank a cup extra water, we were checking blood sugars and checking urine for ketones and sugar.
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So yeah, absolutely.
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Yeah, and when I worked in the emergency department, everything like that, you know you could go home and but, on that same note, nothing heals you quicker or better than going home and loving on those babies that are at home.
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But you brought something else up that maybe you didn't debrief and you came home and there was macho and no one wanted to talk about it.
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Days later we do a debrief now after almost every death, but then we don't talk about it, charles, there's no day later or two days later.
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Maybe we talk about it at a conference if the case comes up.
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But we all, as physicians and nurses and paramedics, experience trauma as providers, and I don't know what the right answer is.
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But what I do know is what we're doing now is inadequate because there's the moment and then there's what happens afterwards and I think it's cumulative.
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It's almost like a little PTSD to some degree, and I don't know what it's like in endocrine clinic.
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I know sometimes in the ED we see bad things.
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But, john, you've shared in other podcasts you give bad news to people.
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You know there's challenging situations that you have and I'm just curious like what do the two of you do when you have a bad case and you have to come home to that?
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Charles, I'll let you go first.
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I was first last time.
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Well, I asked the same question and I can't wait to hear you two.
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I want to hear your answers because I think we should ask this of anybody who's been doing this for any period of time at all, because you have to be successful at dealing with these things to have longevity in your career, right?
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I mean?
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Is that true?
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Is that the marker we're looking for?
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For me, I'm lucky to have a wife that I can go home and and talk to, because she's in health care and she gets it.
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She's been there, she's seen these things before, and so we're each other's sounding board.
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But if I didn't have that, I don't know.
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I don't know where I would start.
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Yeah, I think to have an enjoyable, happy career and, I will be honest, I have had times when I'm ready to be done, absolutely.
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It's been a tough day, tough week, tough month, whatever it was, and you hit some bad news or you forget to order the right lab and you're like, okay, that's just a sign.
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But I do what Charles does and I go home and I am HIPAA compliant.
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I'm going to say that for those who are going to be listening to this.
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I'm HIPAA compliant but I talked to, I talked to my wife as much as I can about how things are going and it is not uncommon to address the idea of PTSD, for my wife and I to discuss that case that I had in residency because it affected me so profoundly.
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It was just like one of these things where you're not prepared.
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For me, it's about talking to my partner or talking to my kids.
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I also incorporate a lot of self-care, like exercise and making sure I get sleep, and I have a therapist and I talk to my therapist.
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You know it's 2024.
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I think 10 years ago maybe I wouldn't share it with the world, but I have a therapist and I meet with a therapist once a week or every other week and it's incredibly helpful for me in the work that I do to have someone that's neutral to talk to and not just somebody who delivers the honesty that we're really looking for and the tools to to utilize that honesty in an effective way.
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I mean, one of the things that I have found in medicine when we're kind of debriefing ourselves, quote, unquote is it's very sterile.
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Well, you followed procedure, you followed X, y and Z, you did right.
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You may not have seen that, but not everybody would have seen that, and that's okay, don't worry about it.
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And then case closed.
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It's because we're scared of our feelings.
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We don't want to talk about our feelings because that would be vulnerable, right?
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That kind of goes back to why we have a therapist.
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I remember in residency I walked up to my mentor and he was an ICU attending.
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And I walked up to him and I looked at him and I opened the conversation with some weak like I can't remember what it was, but it was hey, what happened to that kid?
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And he looked at me like why do you care?
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And then that was the end of it and I left his office.
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I mean, honestly, there was absolutely no interest.
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I don't think he said exactly that, but that was his.
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You know.
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You could see it in his body language that he didn't want to talk to me and he didn't want to rehash it in his body language.
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And he didn't want to talk to me and he didn't want to rehash it.
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It was almost as if he was kind of I don't know.
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He was just not interested in doing that and I was out of his office in like two minutes.
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I didn't start following up on patients until I became a nurse.
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So for all the years that I worked as a paramedic, taking patients to the hospital, it was just not something we did and it was just not expected.
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It wasn't part of our culture.
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It was just not something we did and it was just not expected.
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It wasn't part of our culture.
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There was no follow-up.
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I have no idea what happened to these people good or bad, and that messes with your mind.
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Yeah, it leaves an open space, doesn't it?
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No closure.
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Well, I need to tell you guys, I need to take you back to July, probably July 1st-ish 1991.
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And I was an intern at Denver Children's Hospital.
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My first rotation was the NICU and I met an incredible woman, a teacher mentor, named Sharon Langendorfer, and she was a neonatologist and first day showed up.
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She said this is perfect.
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Three new interns showed up to be with her for the month.
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And I said what do you mean?
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And she said well, we have a dead baby in the room over there and this is the best situation for all of you on your first day.
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And I had no idea what she was talking about Dead baby.
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And it was a stillborn baby.
00:19:31.146 --> 00:19:37.123
And she said I'm going to teach you the most important thing that you're going to learn during your residency.
00:19:37.123 --> 00:19:40.031
And I was thinking what could this be?
00:19:40.031 --> 00:19:41.737
I came here to save lives.
00:19:41.737 --> 00:19:44.001
I came here to make a difference.
00:19:44.001 --> 00:19:46.086
This is really crazy.
00:19:46.547 --> 00:20:03.228
We spent the next 10 minutes her showing us how to make footprints to the mother, how to take care from the baby and put it in a special book, and then how to wrap the baby up and clean the baby up in a way to present the baby to the mother.
00:20:04.309 --> 00:20:28.813
And then we went and watched Dr Langendorfer engage with this mother with compassion and love I could use that word and my guess is that that mother is going to remember that moment for the rest of her life and the way that we prepared the baby without blood or all the different things that go along with death.
00:20:29.512 --> 00:20:47.586
And what it taught me was that in the code that you had, charles, and in many of the dead babies that we care for because a lot of babies come in and they're dead and I know we're not going to resuscitate them and ultimately what we do, we try to save the baby, but usually it's futile.
00:20:47.586 --> 00:21:18.375
When it is futile and it sounds like in this case it was futile the most important thing that we do is take care of the family and manage the family and support the family, and then the second most important thing we do after that is support each other and I think at that high level to me, that's one of the takeaways from this wonderful story that you're sharing is taking care of the family and taking care of each other when there's a situation.
00:21:18.375 --> 00:21:25.182
That's futile, because a lot of times in medicine we think we have control over things, but we really don't Right.
00:21:25.243 --> 00:21:25.483
Right.
00:21:25.483 --> 00:21:40.471
Can you imagine the outcome for me emotionally if the physician who called the code would have taken me with him to talk to the family and I could have connected, I could have been there with that family in that moment.
00:21:40.471 --> 00:21:44.934
It would have been hard, but that would have been a way to have closure, right?
00:21:45.394 --> 00:21:55.686
What happens is I got back on the truck and went back to the, you know, back to the station and went back in service, and that's what happens every time and it still happens here.
00:21:55.686 --> 00:21:58.099
You know, we have these debriefings, we have the family in there and we have we take care of the family.
00:21:58.099 --> 00:22:03.743
I'm saying we, the emergency department team, and a lot of times EMS is not in that loop.
00:22:04.263 --> 00:22:04.463
Yeah.
00:22:05.065 --> 00:22:22.617
So, john, in in the setting of a clinic and in the setting of times where you have to give people bad news, whether it's the diagnosis of type 1 or a new other kind of diagnosis that's lifelong, requiring treatment, do you have follow up with the family?
00:22:22.617 --> 00:22:24.181
Like what do you do?
00:22:24.181 --> 00:22:27.111
And you know when there is a difficult situation, like what happens.
00:22:27.799 --> 00:22:31.851
We always have follow up with our families that we provide a diagnosis for.
00:22:31.851 --> 00:22:32.141
I mean.
00:22:32.141 --> 00:22:41.690
Well, I'm going to say, not always Nothing in medicine is 100%, but you know kids that we find with type 1, that's a challenging diagnosis to make for some families.
00:22:41.690 --> 00:22:46.407
They go into a lot of denial but in general it was always in the back of their mind.
00:22:46.407 --> 00:22:48.287
They absorb it eventually.
00:22:48.287 --> 00:22:56.938
Diagnosis of things like thyroid cancer and some syndromes that we take care of is a little bit more challenging.
00:22:57.378 --> 00:23:08.038
Sometimes families have, you know, a history in their relative of cancer and they know exactly what that means, or they have a perception of what that means and that's a little bit more.
00:23:08.038 --> 00:23:13.990
But we follow those kids in perpetuity until they graduate out of our program when they're about 18 or 19.
00:23:13.990 --> 00:23:25.625
So I think in that regard it's different than an emergency or EMT kind of experience, because it's for you guys I can imagine it's basically one and done, moving on.
00:23:25.625 --> 00:23:46.153
But for us and a point that we make with our surgeon colleagues a lot once they get done with their treatment there, we follow them until they graduate and then somebody like me follows them until the end of time and so it helps in most matters.
00:23:46.153 --> 00:23:46.861
I think that way.
00:23:46.861 --> 00:23:48.483
Is that continuity of care?
00:23:49.266 --> 00:23:53.054
Well, I think so much teaching here, so much learning.
00:23:53.054 --> 00:24:07.909
You mentioned it at the beginning, but I think that, as we close here, tell us a little bit about the importance of your job being an outreach coordinator and why it's meaningful to you and how that relates to this story.
00:24:08.510 --> 00:24:11.380
Oh, absolutely, why it's meaningful to you and how that relates to this story.
00:24:11.380 --> 00:24:16.760
Oh, absolutely, I kind of touched on it.
00:24:16.760 --> 00:24:18.144
But that feeling of not being prepared really sets me up every day.
00:24:18.144 --> 00:24:18.624
For what I do Right now.
00:24:18.624 --> 00:24:27.344
I'm helping build these response teams in schools to take care of sudden cardiac arrest or really any medical emergency, and that's kind of how we look at it.
00:24:27.344 --> 00:24:31.903
They're life saving teams, emergency and that's kind of how we look at it.
00:24:31.923 --> 00:24:39.761
There are life-saving teams and just yesterday I was in a set of schools in the Ozark Mountains and their EMS response time on a good day is 45 minutes.
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