Published 11/1/2017
Eeric Truumees, MD; Jeffrey M. Smith, MD

A Surgeon's Attitude Resilience is Critical When Responding to Constant Crises

Surgeons need to know how to process difficult, uncontrollable scenarios and outcomes
The last few months have offered us a host of calamities to add to the daily crises afflicting surgeons. To reflect our coverage of orthopaedic aspects tied to the recent hurricanes and the mass-casualty event in Las Vegas, this editor's message has gone through several last-minute modifications.

Originally, we intended to discuss attitude resilience as a mechanism to address the stressors common to orthopaedic daily practice. As we read accounts of those involved in the recent, devastating hurricanes and the senseless atrocity at the Route 91 Harvest Festival in Las Vegas, we realized the much broader application of resilience. As you will read in this issue, orthopaedic surgeons affected the outcomes of these events. At the same time, the events deeply affected the surgeons. We extend our sympathies to those who suffered inestimable losses.

Our original message was directed mainly at supporting orthopaedic surgeons. Yet, these events remind us to prepare to meet the nonmedical needs of our patients and their families as well. As caregivers, the more we are prepared, the better we can weather these storms ourselves and the more helpful we can be to those around us.

Often, that preparation involves logistics. In Las Vegas, the hospitals had run mass-casualty drills in the past. Effective triage and adequate anesthesia personnel allowed several ORs to run concurrently after hours. Professional caregivers stepped up and joined the larger effort. They stayed, often for days, until the job was done. Amidst the devastation, hundreds of civilians were prepared to risk their own lives treating and transporting hurricane and shooting victims.

This spirit was exemplified by Nebraska orthopaedic surgeon Barry Bohlen, MD, who rendered at-the-scene care to multiple gunshot victims. Interviews with Dr. Bohlen point out his experience in Iraq as a member of the U.S. Army Reserve. That experience is priceless and, as a profession, we have learned a great deal about high-energy musculoskeletal trauma and mass-casualty events from our military colleagues. But we were taken by the emotional toll these events had, not only on the victims, but also on the caregivers. Dr. Bohlen, for example, reports that he selected his current practice, in part, to get away from the trauma he saw during his residency and military deployments. Despite his experience, he reports difficulty processing what he saw in Las Vegas.

The truth is, mass-casualty events can occur anywhere. And, even outside of these "singular" events, most of us deal with smaller, more isolated traumas on a regular basis. These include uncomfortable scenarios from addressing a patient's dire prognosis, to dealing with an unsuccessful surgery and the ensuing complications, or preparing to give a patient's family in the waiting room the news they feared most.

As with those assisting in disasters, initially, we keep our heads down and do the work. Later, we ask ourselves difficult questions: Was there something more I should have done or something I should not have? In daily practice situations, we may ask: Should I have referred the case? Should I have operated sooner or later? Should I have asked for a partner's help? This post-processing goes on and on. It can be constructive or confidence-shattering.

Regardless of how frequently these events occur in your life or practice, every successful surgeon develops attitude resilience. Attitude resilience is the ability to not get discouraged, distracted, or defeated. It is the priceless ability to stay confident and strong even in the face of catastrophe. Where do we get this resilience? Unfortunately, most current resilience training leans heavily on the negative, shaming and blaming trainees for their mistakes or shortcomings.

That approach may cost us some promising young surgeons who drift away to less harsh environments. Even those survivors, with their resilience, may compartmentalize their emotions rather than process them. They may actively avoid accountability or take on too much responsibility. These unhealthy responses contribute to burn-out.

There are tools that allow us to maintain clear, progressive learning and rational thinking in life-and-death situations. Preparation starts with physical health to maintain the stamina required. Sufficient rest, a healthy diet, and proper exercise are crucial. To keep a balanced mindset and help process these tragic events, a trusted colleague to lend an ear is priceless. That person should be able to understand, listen without judgment, and support without going into problem-solving mode.

While the recent natural and man-made disasters are self-limited events, mental reset from the soul-crushing web of Electronic Health Record hassles, bureaucratic administrators, and the insurance company paperwork requires planning. Outside of vacations, engaging with friends and family, hobbies, volunteerism, medical missions, and mentoring provide great joy and refill the tank, emotionally speaking.

Even when their specific, hard-earned skill set was not required, our fellow orthopaedic surgeons stepped in with first aid, triage, transport, and resources. After these terrible events, it is hard not to be proud of them and our other fellow citizens. We welcome other accounts of these events and strategies that have helped responders and surgeons address calamities large and small. If you can contribute, please email AAOS Now Managing Editor Dennis Coyle at coyle@aaos.org.

Additional information can be found in the online version of this article, available at www.aaos.org/aaosnow/17012.

Orthopaedic Community Saddened by Loss
The shooting at the Route 91 Harvest Festival in Las Vegas claimed the lives of 59 victims, including Sonny Melton, the husband of Heather Gulish Melton, MD, and son-in-law to Eugene Gulish, MD—an AAOS Fellow and emeritus member, respectively.

Dr. Melton released a statement to WZTV in Nashville and said, "Sonny was the most kind-hearted, loving man I have ever met. He saved my life and lost his." In an interview on the Today Show, Dr. Melton said Sonny was protecting her as they ran for cover when he was shot.

Sonny was a registered nurse and worked with Dr. Melton at the Henry County Medical Center in Paris, Tenn.

The orthopaedic community mourns the loss of Sonny and extends thoughts and prayers to Dr. Melton and her family.
—Eeric Truumees, MD