Stories from the World of Medicine
Season
3
Episode
11
|
Dec 8, 2020
Just Five Minutes
Pediatric critical care physician Cathy Humikowski tells the story of having a cardiac arrest the day she gave birth to her daughter.
This story was originally told live at The Nocturnists event on the theme of Transitions which took place at the Blue Shield of California Theater at YBCA on January 16, 2020.
0:00/1:34
Illustration by Lindsay Mound
Stories from the World of Medicine
Season
3
Episode
11
|
Dec 8, 2020
Just Five Minutes
Pediatric critical care physician Cathy Humikowski tells the story of having a cardiac arrest the day she gave birth to her daughter.
This story was originally told live at The Nocturnists event on the theme of Transitions which took place at the Blue Shield of California Theater at YBCA on January 16, 2020.
0:00/1:34
Illustration by Lindsay Mound
Stories from the World of Medicine
Season
3
Episode
11
|
12/8/20
Just Five Minutes
Pediatric critical care physician Cathy Humikowski tells the story of having a cardiac arrest the day she gave birth to her daughter.
This story was originally told live at The Nocturnists event on the theme of Transitions which took place at the Blue Shield of California Theater at YBCA on January 16, 2020.
0:00/1:34
Illustration by Lindsay Mound
About Our Guest
Cathy Humikowski earned her AB and MD from The University of Chicago, then trained in pediatrics and critical care medicine at Boston Children's Hospital. She was an Assistant Professor of Pediatrics at The University of Chicago until 2017 when she took a break from academics to spend more time with her family and write a book. She joined the faculty at Lurie Children's Hospital in 2020 and continues to write and speak about wellness and burnout in medicine.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
About Our Guest
Cathy Humikowski earned her AB and MD from The University of Chicago, then trained in pediatrics and critical care medicine at Boston Children's Hospital. She was an Assistant Professor of Pediatrics at The University of Chicago until 2017 when she took a break from academics to spend more time with her family and write a book. She joined the faculty at Lurie Children's Hospital in 2020 and continues to write and speak about wellness and burnout in medicine.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
About Our Guest
Cathy Humikowski earned her AB and MD from The University of Chicago, then trained in pediatrics and critical care medicine at Boston Children's Hospital. She was an Assistant Professor of Pediatrics at The University of Chicago until 2017 when she took a break from academics to spend more time with her family and write a book. She joined the faculty at Lurie Children's Hospital in 2020 and continues to write and speak about wellness and burnout in medicine.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
This season of The Nocturnists was made possible by the California Medical Association, the Gordon and Betty Moore Foundation, and people like you who have donated through our website and Patreon page.
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
ICU doctor Cathy Humikowski got a second chance at life after her cardiac arrest. It was an experience that changed her perspective on medicine, the brain, and truth. This is The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. In this episode, Cathy tells the story of how she died and came back to life. Afterward, Cathy and I talked more about her brief death experience and how it opened her up to new ways of thinking.
Cathy Humikowski
I'm a very grounded, empirical person. And this is something for which I have no real explanation.
Emily Silverman
Here's Cathy.
Cathy Humikowski
I'm in a coma. And the first thing I notice as I begin to wake up is a pain in my chest. The last thing I remember about my chest is it's where my healthy baby lay after a totally normal delivery. Why should it hurt me now? Why should I be tethered to a ventilator in a coma at all? I reach for the source of discomfort and I feel the edge of a defibrillator pad. Now, I'm a pediatric intensive care physician, so even in a coma, I knew what that meant.
My chest hurt because I had received CPR. I had chest compressions there when my heart stopped. Why would that have happened? My husband didn't yet know the answer either. All he was told at that point is that I had survived and that I might still have brain damage. So, as he waited for me to wake up fully, along my bedside with some of our closest friends who were also physicians, they speculated out loud. You know, “What could cause a cardiac arrest in an otherwise healthy young person?” And so, when I woke up fully, among the first things I said, and this is totally verifiable and almost verbatim, I said something like, "Well, of course, I had a PEA arrest. If you were hemorrhaging red cells, being resuscitated with crystalloid, what do you think what happened to your myocardial oxygen supply?"
So, he knew I was okay.
Even before we learned the name of what had happened, we were told later, I had something called an amniotic fluid embolism, which is a rare complication of childbirth that's often fatal. Somebody here knows what that is. So, in the weeks that followed we didn't talk much more about my resuscitation. We were just grateful to be alive in the world together with our healthy baby. Even simple things, like taking a shower, I would weep with joy that I could wash myself.
You know, there wasn't room inside of our home to talk about the physiology. But I'm an intensivist. So that's like my jam, you know. So, when I was getting ready to go back to work for the first time, after maternity leave, that's what I was actually really excited to talk about, you know? Just really explore my resuscitation with my colleagues and kind of nerd out about it in like, a super geeky way. And so, I got dressed up for work. I didn't have a clinical shift for a couple of weeks, I was just going in for a meeting. But still, I was excited.
And I squeezed into this abdominal binder that was meant to protect the scar running down my belly, but also served like a girdle a little bit so I could get into some of my better pre-pregnancy work clothes. And for some reason, I wore heels because you know, why not? My core had been totally destabilized. And I had to carry my work bag and my breast pump and my baby's bag and like, my actual baby. But I managed not to faceplant on the way to daycare and I got to work on time, even a little bit early.
And I ran into my department chairman between the parking lot and the hospital and he was so happy to see me. He put his arm out and he gave me this like, sideways bro-hug. And he said, "It's wonderful to see you here. How are you?" And I said, "I'm great. I'm as good as new. It's like nothing ever happened." He said, "Fantastic. Welcome back," and like, slapped me on the shoulder and sent me on my way. And as I waited for the elevator, I realized I just told the greatest lie of my life. "Like nothing ever happened." Everything in my life is different since that day.
Even now, six years later when I braid my daughter's hair, I wonder, “Who would do it if I couldn't?” Why would I say that? Anyway, I went up to the ICU and the conference room where the meeting was to take place was still empty. So, I went into this little workroom next door. It's this tiny little room where the on-service fellow and attending do their work. But it's also where everybody else goes to just like gossip and chat. It's like the office water cooler, except if the water cooler were in a closet.
And so, when I walked into the workroom, it was already pretty crowded. And the group parted for me, like I was sort of like a celebrity and like, patted the seat on the only empty chair. Like, they were excited to talk about my story, too. I mean, I could have talked about it with my husband, he's a doctor too, but he's like a neurologist. It's not the same thing.
So, we talked about it the way intensivists talk about stuff, right? Like, we use data, and equations and numbers. So, we dove right in. We talked about, you know, how many units of blood had I received? And was that the best ratio of red cells to plasma, knowing what we know in the trauma literature? And, you know, given my lactate, my hemoglobin, what could we speculate about my oxygen carrying capacity? And as we batted these numbers around, the fellow in the room, super good guy named Ronnie, he pipes in to ask for one specific number that I hadn't mentioned yet.
He said, "How long were you down for?" What he meant, of course, was how long was the cardiac arrest? Everyone who practices resuscitation knows that's an important number. The longer the heart is stopped, the less likely it will restart. And the more likely there will be brain damage. But however important this number, it's not easy to know. You can't look it up in the chart, like a lab value. So, I had to speculate. I was told I had one round of CPR and maybe two doses of epinephrine. So, I thought my heart was stopped for about five minutes.
So, that's what I said, to which Ronnie replied, "Five minutes? That's not very long." And he turned away from my story circle to face like, the computer or something that was more interesting than my short cardiac arrest. And my colleagues were astonished. They were like, "What is with you? This is our partner. This is our colleague, someone whose life was restored by the very science that we practice. Like, where's your humanity, man?" But I kind of understood where he was coming from, on some level, right?
Like, I had just done the same thing. I had minimized it outside with my chairman. I had participated in resuscitations with Ronnie where he had rotated in and out of chest compressions on a child for the greater part of an hour. Why should my story be so amazing? The truth is, as physicians, I think we all go through a transition at some point where things that once astonished us, events that at some point in our lives would have been terrifying to even consider, let alone bear witness to...Events that can destroy or even end another person's life become so commonplace in our experience that they cease to astonish us, and they become mundane.
And that sounds terrible. But I couldn't blame Ronnie if he had gone through that transition, because so had I at almost the exact same stage in my training as Ronnie was then. I will never forget it. I was crossing the lobby of the hospital ride train as a second year critical care fellow. And a woman was like, gesticulating and waving and smiling at someone. And I didn't recognize her at all. So, I kind of looked around to see who she was waving at. And of course, it was me.
And so, I did what all self-respecting people do and faked like I knew her. And I was like, "Hey, totally, what are you doing here? Oh, my gosh." And you ask the questions that help you figure out who that person is without revealing your total ignorance. And in the course of our conversation, I realized that she was the parent of a little boy who had died in our ICU many months before when I was the fellow on service. And when we parted, I was just crushed with guilt that I hadn't remembered her. I felt so bad about it.
I went home that night, and I wrote in my journal––it was this little green notebook I'd kept since I was a first year medical student, where I'd write about things that really impacted me and they tended to be times that I made a mistake. And I wrote that night with a hand so heavy my pen nearly tore through the paper. I wrote, "How could you? Who do you think you are at this stage in your training, that you should forget the death of a child? That tore a hole in this family that will never be repaired and you just forgot about it.”
But as I tend to do when I write in my journal, I read through some of the preceding entries before I put it away. And in doing so, I discovered that I had cared for almost half a dozen other children who had died in our ICU in the time since I met that woman and her son. And so, I forgave myself a little. Because, I realized I couldn't possibly carry them all in my memory with the detail that their lives deserved and still do my job.
I suppose it was a form of protection. I know it was protection that I reached for that day, outside the hospital when I saw my chairman, in my abdominal binder and my heels, trying to look like my old self. I was about to cross the threshold into the hospital where I had practiced for most of my career––back into that environment of racing gurneys, and dinging alarm bells and code alarms. Only this time, I was a survivor of critical illness. And more than that, I was a parent. And I didn't know if I could do it.
I suppose you could imagine that maybe that experience would make me better at my work by putting me closer to it. But I worried then, and I still worry now, that maybe it put me too close, so that all the defenses I'd built up over the years would be too thin to protect me. So in that moment, it had to be true that I was as good as new, that it was like nothing ever happened, so that I could even walk through the door.
A couple of weeks later, when I was back at work for my first clinical shift, I found Ronnie in that same little workroom where this had all gone down. Now in the meanwhile, he'd become a little bit famous in our department for his comments. He was known as like, “Just Five Minutes Ronnie.” But we were okay. And before I could say anything to him, he rolled his head around and he said, "You know, I'm really glad you didn't die." Which, I don't know, is maybe a form of atonement, but I took it as like a weird kind of compliment. So I just said, "Thank you. Me too. I'm going to grab a cup of coffee. Can I get you something?" He said, "No, I've been on call all night. I'm really tired. I just want to get out of here. I don't want to wait around." I said, "Don't worry. I'll be back in five minutes.” We agreed––that wasn't very long.
Emily Silverman
So, I am sitting here with Catherine Humikowski. Catherine, thanks so much for coming in to speak with me today.
Cathy Humikowski
Thanks for having me.
Emily Silverman
So, I wanted to ask you a bit about your path to critical care.
Cathy Humikowski
You know, I joined critical care actually, in some ways, because I thought it would be easier than my original career path, which is that I set out to become a pediatric oncologist. When I was very young, I had childhood cancer. And that was the reason I became a physician. And then over time, I realized that my own experience with cancer might put me too close, you know, to that profession. And I will never forget my rotation on my oncology service. As a resident, I was physically sick for like a week, because I brought back so much just like, visceral memory of that time. I was like, “Um, maybe I'll pick something else,” you know? So, I oddly picked critical care, because I somehow thought it would be easier, which is weird. It's not, by the way. But it's, you know, it's hard now, because I've also had an experience to put me really close to critical care. And so, that same sort of intimacy with my profession is there in a way that I never anticipated.
Emily Silverman
Before we dive into the experience of being a critical care doctor, having been critically ill yourself, I would love to explore a bit about what that was like––the actual process of having this cardiac arrest and everything that you went through. Can you tell us a little bit about how that played out for you?
Cathy Humikowski
Yeah, I was actually thinking about that today because I think that my experience was very easy compared to the people in my family. We don't talk about it a lot, actually. I've almost never talked about it with my husband. My experience was, I had a really beautiful, easy delivery. And I remember a lot of the details of being wheeled into the OR. I remember feeling, I think already this deep peace that comes along with experiences near death. Which, it freaks me out to realize that I had like, the features of a near death experience.
But so, there's this indelible peace and this calm, and I remember it permeating everything. And so, even when I'm in the OR, and they're pinning down my arms for art lines, and I can see the monitor and I remember saying, "Oh, you know, my blood pressure always runs low, don't worry." You know, it's like 70 on 30 I'm like, just about to go down. And I was totally fine. I was like, “It's gonna be fine.” I never had a drop of fear. I just knew with every fiber in my being, that I was going to be fine.
And then when I woke up, and it started piece by piece to come through from family members what had happened...you know, little by little I'm realizing, “Oh, this thing in my face that's preventing me from talking is actually a breathing tube. Okay, that's weird.” And, you know, “This ache in my chest. Wow, that's because I had CPR. That's weird.” And eventually my sister, I think, was the first to tell me that I had to have an emergency hysterectomy, and processing that and...But I was still in this like, shroud of peace, and the whole thing just felt very victorious.
Even, you know, meeting my anesthesiologist and hearing from their perspective, that to them, it was also this like, good save, it was this great victory. But, my family had moments where they didn't think I would survive. My husband thought he would raise our daughter alone. My sister–– we had just lost my mom two years before and we're the only family each other––she thought she was gonna lose everyone in her circle of life within a few years of one another. And so for them, I think that experience was much more traumatic than it was for me.
And I think, you know, relating that to my work now, thinking about the extended family of a critically ill person, obviously, in pediatrics, we do that a lot anyway, because we're always dealing with parents and, I think that's a little bit different than in adult medicine. But, just the idea that there's this ripple effect for everyone involved around trauma like that. And so, I think for me, that's been the piece that I really still have yet to explore is what that felt like for my family.
For me, it was like, “Woo-hoo, look at me, I'm okay.” And that didn't stay that way. Months later, I think, after trauma people...that feeling of "Oh my God, we made it," turns into "Oh my God, we almost didn't make it," right? So there, you know, there was anxiety, and a period of time where I met with a therapist and things like that. But in general, my memory of those experiences is very positive, which is weird, because it was the scariest moments of my closest families’ lives, which is...It's just a disconnect, I think, in that experience.
Emily Silverman
There was one thing you said that I just like, cannot resist asking more about, just because I'm so curious about it, which is this peaceful feeling that you had. This concept of a near death experience, or one might argue in your case, was a death experience and then brought back. Because, I've read a little bit about people experiencing this feeling of oneness, and wholeness, and unity, and connection, and peace, and comfort and...Almost the way that you hear people describe like, when they're tripping on LSD, or on mushrooms or something. And so, I just have to ask you to open that up a little bit for me, because it's just something you don't always get to ask someone.
Cathy Humikowski
Yeah, it was without a doubt, the most powerful feeling I've ever experienced. And it's actually really hard to put it into words. And I've read other accounts of people who've had actual death experiences and this pervasive peace is probably the most common of the features that people describe. And almost everyone says the same thing—like, there really are not words for it. And I found that experience to be so profound, that I was afraid I would lose it over time, that I wouldn't be able to tap into it.
And I still find that when I need to, I can, but I have to consciously do it. And I certainly have friends who you know, they study various Eastern religions or various forms of meditation, and their goal is very similar to, you know, what mine I suppose is, which is to tap into that peace and, and reach beyond kind of what we see with our typical senses. And really dive into if there is the sense of connectedness or consciousness. And the hard thing for me and what I struggle a lot with, is that I'm not a religious person.
I wouldn't say that means I'm not a spiritual person, but I'm a very grounded empirical person. And I think many of us in medicine are, right? We study science and physiology and, and we know mechanisms for things. And this is something for which I have no real explanation. So, my brain had no blood flow at that time. And I have very clear memories of the operating room. And when I think about certain aspects of it, aside from the peace, which I can very readily accept was extremely real, it was the most real thing I've ever experienced.
There are other pieces of it that fit into like, a near-death-experience-type description. Which I push away, because I don't have a good rational explanation for, right? So, one example is that the night I was waking up in the ICU, right after I was excavated, and everyone knew I was okay, my family finally went home for the night to rest. And I was closing my eyes to sleep, or try, because the anxiety in the ICU as the drugs are wearing off is very profound––I have a deeper respect for that now––I saw the after image on the back of my eyelids of a butterfly, which was my mother's kind of spirit animal. And it was burned into…and I woke up and I thought, “Oh my god, did I see the light? Was that light the light? Oh my God, that's crazy.” And of course, I thought, “No, no, no, it must have been that I was laying flat on my back with my eyes looking up at the aura lights. And that's just the after image of the aura lights.” I tried to explain it in a way based on what I know of an operating room, you know, set up.
And one of my good friends, who's also a surgeon, she was like, “Operating room lights come in threes, they don't come in fours. It was your mother. You know?” And I'm like, “They come in all different clusters. Like, there's not like, a one standard way that operating room lights are.” But it just rose to my mind that people will really hang on to what they believe in. Right? If you're a very religious or spiritual person, as this friend of mine was, then obviously that was the spirit of my mother.
And I'm sitting here trying to explain it away, because I don't want to possibly think that this really crazy, otherworldly thing happened to me. So, I struggle with that a little bit, and I don't talk about it a lot. It's a pretty isolating space to be, especially when all your friends are scientists. I mean, my husband's a neurologist. We were having dinner once with one of our close friends who's a neuroscience PhD. She's brilliant.
And, you know, when we were talking about the sense of peace, she was like, "Well, obviously, that's just because, you know, your brain didn't have anything else to worry about. Because, your cognition was shutting down, you know, all this, you know, extra things were…they just weren't gumming your brain power. So of course, that's where the peace came from."
And I'm like, "No, I was in touch with the universe," right? So, I don't know how to explain it. But it's a little isolating, because it's no…you don't run into people who've had this experience every day. So, I still struggle with how to reconcile those experiences.
Emily Silverman
I definitely love science, and love data, and love evidence and love empiricism. And over the last year or two, I have noticed myself opening up to mystery a little bit more. And I think there's a variety of reasons why that is. But, just really feeling humble about what we know and what we don't know. And you know, the universe consisting of all sorts of different things that the antenna of our brain may or may not be picking up on. And like, really interrogating this idea of a collective consciousness and of the ego, and what does it mean when the ego dissolves? I, too, struggle with how to talk about that as a physician and as somebody who is so science loving, but also trying to open myself up to these other explanations.
Cathy Humikowski
Yeah, I think you have to—we have to be honest about a gap in our knowledge, right? So it's very frustrating that it's either, we have a scientific explanation for it, or we leave it to the realm of religion, spirituality, otherworldly mumbo jumbo, and there's nothing in between. And the truth is, we don't really know, right? So, all the theories that have been put forth about why people who have had similar experiences at the edge of death, right, whether it be a light or a tunnel, or all of these things... You know, was it hypoxia? Was it, you know, whatever these mechanistic explanations are? They've never really been tested or proven, right? And it's an especially palpable gap, I think, for physicians, because we do navigate that spiritual space and that humanistic space so much. And yet, it's very neglected, I think, in our training. And I think that's a big, big gap that I'm hopeful that the sort of next generation of physicians will start to help close the gap.
Emily Silverman
One thing that came up for me as you were talking, was about how as physicians, we are trained to enter into a stressful situation. And so, our adrenaline is pumping, and our cortisol is pumping, and then we suppress. And we like, keep all of that anxiety down, and we maintain this kind of calm, analytic “Okay, what are we going to do next?” mindset. And that's certainly how I was trained in residency. And I notice that now, in my ordinary life, I don't really feel my stress that much.
And, you know, I'll say to my husband, like, "I actually don't feel that stressed about this, but why is my ear ringing?" Or like, "I actually don't really feel that anxious or feel that stressed, but like, why are my muscles clenching up in this way?" And how, like, cognitively we override it. And then, the idea that it's like, the body that takes the beating, and how the body knows.
Or as the famous psychiatrist Bessel van der Kolk says––the title of his book, which is all about PTSD, is The Body Keeps The Score. And I was wondering if you thought at all about that. Like how, as physicians, if we're constantly overriding this stress, do we think about our own bodies?
Cathy Humikowski
That's such an interesting question. I mean, I've two anecdotes about that. One is that when I was starting medical school, and everybody was like, "Aren't you stressed?" I was like, "No, it's gonna be fine." It's like, "I've wanted to do this my whole life." But meanwhile, I had like, bloody diarrhea and hives the week before medical school. I'm like, "No, I'm not stressed at all. What do you….Hand me my Benadryl."
And then, the other is just recently. I…and I don't feel stressed right now. At least, I don't think so. I'm in a pretty good place with a balance between you know, my family at home and the way that I work now. And I went and saw the dentist, and he's like, "You're cracking your teeth from all the grinding that you're doing at night." And I like, had to have my teeth filed down because I was chipping into them at night, and my whole neck and shoulders were tense.
And after my cardiac arrest, for months I slept with my shoulders and my neck all tightened, because at night is when I processed that trauma. So, there is this very real way that we abuse our bodies without even realizing it. I mean sure, physicians are notorious for not sleeping enough, not drinking enough water, drinking too much caffeine, you know, all the things that are unhealthy…having a granola bar as your only meal all day. That is, if you're on the healthy side, versus people who either don't eat at all, or get french fries at the cafeteria, or what have you. So, we don't care for our bodies.
And then as you said, the stress has to get processed somehow. And it's not at work. And we certainly don't want to take it home with us. And so, we do it in ways that we don't even realize. And when I started doing some counseling with the same therapist who ended up speaking with me after my cardiac arrest—I had originally met her after my mom died. And I was doing grief counseling—what I thought was grief counseling—with her. And she was like, “Let's back up and talk about your job.”
I was like, "Oh, my job doesn't have anything to do with this. Like, I love my job. I mean, I think anyone in the world who knows what's good for them would want to be a pediatric ICU doctor. It's the best job in the world." But, as I'm describing to her what I do, she's like, "You realize that you process trauma every single day––that your job is a trauma." And I was like, mind-blown by hearing this, like I couldn't...And I think of myself as a pretty insightful person, and pretty self aware and pretty introspective.
And I was like, "Whoa, that's right. I mean, I see children die. I see…and this is, you know, at the time, I was practicing at the University of Chicago in the Southside of Chicago—lots of penetrating trauma, lots of diseases, of social injustice, lots of poverty, neglect, gang violence, like, very bad things happen to children. And we see it every day. It's just part of our normal. And so, to hear her frame it as trauma, that I didn't even know it…Where's that going? Right? It's not just going nowhere. It's being processed somehow, in my body, in my sleep, in, you know, in just the dreams that you have at night. It's got to go somewhere, right? And so, I think the most effective people are people who recognize that and then find places to put it. Whether that's, you know, the crazy surgeons I know who get up—even if it means they have to get up at three o'clock in the morning—so that they can run 10 miles a week somehow, and just get that energy out somewhere.
And it's different things for different people. But the people I know who find time to paint, or they find time to cook, or they find time to just burn off energy in some way—I think those are probably the healthiest, most balanced people that I know in medicine.
Emily Silverman
I wanted to loop back on what you said about this revelation in therapy. That, "Oh yeah, my job is actually just like, chronic daily trauma." Because, that's something that I've come to realize a lot, both regarding my exposure to the suffering of others, but also just the trauma of sleep deprivation and kind of what we put ourselves through as a medical community. And as I mentioned, I've been diving a little bit into the PTSD literature, and I'm by no means an expert in PTSD. But, listening to this interview with the author of the book, The Body Keeps the Score, he talks not just about the body, but also about actually storytelling and narrative, and how that can be used to help us process trauma. And in this recent interview, I heard with him, Dr. van der Kolk, on Krista Tippett's On Being, he was saying that if you take a group of men who were off at war, and you look at who has PTSD, and who does not, the men who don't have PTSD are the ones who have been able to integrate the war experience into their life story in a way that feels constructive and feels productive. Like, you know, “Obviously, it was terrible, but I made great friends, and it was a growth experience and I traveled,” and things like that. Whereas, the people who have PTSD are not able to integrate it into their life story in that way. And that they remember it more as like, very visceral fragments.
He gave the example of children who have been dealing with sexual assaults at a young age like, will often remember the wallpaper in the room when they were being molested. And, just these very kind of snapshot sensory details, and it stays like that over years, and they're not able to integrate it into a story and kind of weave it into their life.
And so I was wondering, as physicians, if we're going to call our jobs trauma––which I don't want to overuse that word or throw it around in an irresponsible way. But, I think there is a case to be made that as physicians, we do have secondary trauma in our job. Like, how do we then integrate that into our own lives in a way that's adaptive? And not get kind of stuck or hung up on these...How do we just be less stressed about it all?
Cathy Humikowski
Yeah. I think, you know, one of the ways, as you said, in terms of telling stories—one of the ways that I'd always processed my traumas at work without realizing they were traumas, was by talking about them, often with my sister, who's always been my sounding board. But, people don't like to hear about really sick kids, right? It's really hard for other people to digest.
And, you know, she's always been very generous with listening to me, but there'll be times where she'll be like, "Listen, I can't talk to you about work right now, because neither of my boys are within eyesight or earshot of me. I don't know that they're okay right now. So, I can't actually hear this for you," right? And so, I think that some physicians probably process their stories at home, with their partners, with their loved ones.
Hopefully, people pick many people in their lives to process with, because one person can't always be that receptacle, right? I think it's, you know, turning it off entirely, right? And this idea that we have to compartmentalize work and life, and that you shut the door of the hospital and you don't take anything with you. Based on what you're saying, it seems likely that those would be the people who would bottle it up, and it would come out in other ways.
And whether that's in physical ailments, as we talked about, or struggling marriages, or you know, substance use or depression, you know? Our profession has a terrible, terrible track record in terms of mental health and acceptance of that. And the suicide rate in physicians is unacceptably high. So yeah, we have to process that and incorporate that into our own story. But how do we do that without, you know, again, ceding that stress into others?
Emily Silverman
I agree with you. And I think the idea that perhaps some of this could be worked out, not necessarily through talk therapy, but through more physical means, whether that's running, or massage or exercise...just really, kind of viewing the body as a possible vector through which to process, that is wordless. Because some of it, you really can't describe.
As you said, the very beginning of the conversation, that some of these experiences, there really just aren't words for. And it has to be processed through the body, and what does that look like? So, I think that's really a great note to end on, and certainly gives me a lot to think about moving forward. Thank you so much, Catherine, for coming in and speaking with me today.
Cathy Humikowski
Thanks, Emily.
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
ICU doctor Cathy Humikowski got a second chance at life after her cardiac arrest. It was an experience that changed her perspective on medicine, the brain, and truth. This is The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. In this episode, Cathy tells the story of how she died and came back to life. Afterward, Cathy and I talked more about her brief death experience and how it opened her up to new ways of thinking.
Cathy Humikowski
I'm a very grounded, empirical person. And this is something for which I have no real explanation.
Emily Silverman
Here's Cathy.
Cathy Humikowski
I'm in a coma. And the first thing I notice as I begin to wake up is a pain in my chest. The last thing I remember about my chest is it's where my healthy baby lay after a totally normal delivery. Why should it hurt me now? Why should I be tethered to a ventilator in a coma at all? I reach for the source of discomfort and I feel the edge of a defibrillator pad. Now, I'm a pediatric intensive care physician, so even in a coma, I knew what that meant.
My chest hurt because I had received CPR. I had chest compressions there when my heart stopped. Why would that have happened? My husband didn't yet know the answer either. All he was told at that point is that I had survived and that I might still have brain damage. So, as he waited for me to wake up fully, along my bedside with some of our closest friends who were also physicians, they speculated out loud. You know, “What could cause a cardiac arrest in an otherwise healthy young person?” And so, when I woke up fully, among the first things I said, and this is totally verifiable and almost verbatim, I said something like, "Well, of course, I had a PEA arrest. If you were hemorrhaging red cells, being resuscitated with crystalloid, what do you think what happened to your myocardial oxygen supply?"
So, he knew I was okay.
Even before we learned the name of what had happened, we were told later, I had something called an amniotic fluid embolism, which is a rare complication of childbirth that's often fatal. Somebody here knows what that is. So, in the weeks that followed we didn't talk much more about my resuscitation. We were just grateful to be alive in the world together with our healthy baby. Even simple things, like taking a shower, I would weep with joy that I could wash myself.
You know, there wasn't room inside of our home to talk about the physiology. But I'm an intensivist. So that's like my jam, you know. So, when I was getting ready to go back to work for the first time, after maternity leave, that's what I was actually really excited to talk about, you know? Just really explore my resuscitation with my colleagues and kind of nerd out about it in like, a super geeky way. And so, I got dressed up for work. I didn't have a clinical shift for a couple of weeks, I was just going in for a meeting. But still, I was excited.
And I squeezed into this abdominal binder that was meant to protect the scar running down my belly, but also served like a girdle a little bit so I could get into some of my better pre-pregnancy work clothes. And for some reason, I wore heels because you know, why not? My core had been totally destabilized. And I had to carry my work bag and my breast pump and my baby's bag and like, my actual baby. But I managed not to faceplant on the way to daycare and I got to work on time, even a little bit early.
And I ran into my department chairman between the parking lot and the hospital and he was so happy to see me. He put his arm out and he gave me this like, sideways bro-hug. And he said, "It's wonderful to see you here. How are you?" And I said, "I'm great. I'm as good as new. It's like nothing ever happened." He said, "Fantastic. Welcome back," and like, slapped me on the shoulder and sent me on my way. And as I waited for the elevator, I realized I just told the greatest lie of my life. "Like nothing ever happened." Everything in my life is different since that day.
Even now, six years later when I braid my daughter's hair, I wonder, “Who would do it if I couldn't?” Why would I say that? Anyway, I went up to the ICU and the conference room where the meeting was to take place was still empty. So, I went into this little workroom next door. It's this tiny little room where the on-service fellow and attending do their work. But it's also where everybody else goes to just like gossip and chat. It's like the office water cooler, except if the water cooler were in a closet.
And so, when I walked into the workroom, it was already pretty crowded. And the group parted for me, like I was sort of like a celebrity and like, patted the seat on the only empty chair. Like, they were excited to talk about my story, too. I mean, I could have talked about it with my husband, he's a doctor too, but he's like a neurologist. It's not the same thing.
So, we talked about it the way intensivists talk about stuff, right? Like, we use data, and equations and numbers. So, we dove right in. We talked about, you know, how many units of blood had I received? And was that the best ratio of red cells to plasma, knowing what we know in the trauma literature? And, you know, given my lactate, my hemoglobin, what could we speculate about my oxygen carrying capacity? And as we batted these numbers around, the fellow in the room, super good guy named Ronnie, he pipes in to ask for one specific number that I hadn't mentioned yet.
He said, "How long were you down for?" What he meant, of course, was how long was the cardiac arrest? Everyone who practices resuscitation knows that's an important number. The longer the heart is stopped, the less likely it will restart. And the more likely there will be brain damage. But however important this number, it's not easy to know. You can't look it up in the chart, like a lab value. So, I had to speculate. I was told I had one round of CPR and maybe two doses of epinephrine. So, I thought my heart was stopped for about five minutes.
So, that's what I said, to which Ronnie replied, "Five minutes? That's not very long." And he turned away from my story circle to face like, the computer or something that was more interesting than my short cardiac arrest. And my colleagues were astonished. They were like, "What is with you? This is our partner. This is our colleague, someone whose life was restored by the very science that we practice. Like, where's your humanity, man?" But I kind of understood where he was coming from, on some level, right?
Like, I had just done the same thing. I had minimized it outside with my chairman. I had participated in resuscitations with Ronnie where he had rotated in and out of chest compressions on a child for the greater part of an hour. Why should my story be so amazing? The truth is, as physicians, I think we all go through a transition at some point where things that once astonished us, events that at some point in our lives would have been terrifying to even consider, let alone bear witness to...Events that can destroy or even end another person's life become so commonplace in our experience that they cease to astonish us, and they become mundane.
And that sounds terrible. But I couldn't blame Ronnie if he had gone through that transition, because so had I at almost the exact same stage in my training as Ronnie was then. I will never forget it. I was crossing the lobby of the hospital ride train as a second year critical care fellow. And a woman was like, gesticulating and waving and smiling at someone. And I didn't recognize her at all. So, I kind of looked around to see who she was waving at. And of course, it was me.
And so, I did what all self-respecting people do and faked like I knew her. And I was like, "Hey, totally, what are you doing here? Oh, my gosh." And you ask the questions that help you figure out who that person is without revealing your total ignorance. And in the course of our conversation, I realized that she was the parent of a little boy who had died in our ICU many months before when I was the fellow on service. And when we parted, I was just crushed with guilt that I hadn't remembered her. I felt so bad about it.
I went home that night, and I wrote in my journal––it was this little green notebook I'd kept since I was a first year medical student, where I'd write about things that really impacted me and they tended to be times that I made a mistake. And I wrote that night with a hand so heavy my pen nearly tore through the paper. I wrote, "How could you? Who do you think you are at this stage in your training, that you should forget the death of a child? That tore a hole in this family that will never be repaired and you just forgot about it.”
But as I tend to do when I write in my journal, I read through some of the preceding entries before I put it away. And in doing so, I discovered that I had cared for almost half a dozen other children who had died in our ICU in the time since I met that woman and her son. And so, I forgave myself a little. Because, I realized I couldn't possibly carry them all in my memory with the detail that their lives deserved and still do my job.
I suppose it was a form of protection. I know it was protection that I reached for that day, outside the hospital when I saw my chairman, in my abdominal binder and my heels, trying to look like my old self. I was about to cross the threshold into the hospital where I had practiced for most of my career––back into that environment of racing gurneys, and dinging alarm bells and code alarms. Only this time, I was a survivor of critical illness. And more than that, I was a parent. And I didn't know if I could do it.
I suppose you could imagine that maybe that experience would make me better at my work by putting me closer to it. But I worried then, and I still worry now, that maybe it put me too close, so that all the defenses I'd built up over the years would be too thin to protect me. So in that moment, it had to be true that I was as good as new, that it was like nothing ever happened, so that I could even walk through the door.
A couple of weeks later, when I was back at work for my first clinical shift, I found Ronnie in that same little workroom where this had all gone down. Now in the meanwhile, he'd become a little bit famous in our department for his comments. He was known as like, “Just Five Minutes Ronnie.” But we were okay. And before I could say anything to him, he rolled his head around and he said, "You know, I'm really glad you didn't die." Which, I don't know, is maybe a form of atonement, but I took it as like a weird kind of compliment. So I just said, "Thank you. Me too. I'm going to grab a cup of coffee. Can I get you something?" He said, "No, I've been on call all night. I'm really tired. I just want to get out of here. I don't want to wait around." I said, "Don't worry. I'll be back in five minutes.” We agreed––that wasn't very long.
Emily Silverman
So, I am sitting here with Catherine Humikowski. Catherine, thanks so much for coming in to speak with me today.
Cathy Humikowski
Thanks for having me.
Emily Silverman
So, I wanted to ask you a bit about your path to critical care.
Cathy Humikowski
You know, I joined critical care actually, in some ways, because I thought it would be easier than my original career path, which is that I set out to become a pediatric oncologist. When I was very young, I had childhood cancer. And that was the reason I became a physician. And then over time, I realized that my own experience with cancer might put me too close, you know, to that profession. And I will never forget my rotation on my oncology service. As a resident, I was physically sick for like a week, because I brought back so much just like, visceral memory of that time. I was like, “Um, maybe I'll pick something else,” you know? So, I oddly picked critical care, because I somehow thought it would be easier, which is weird. It's not, by the way. But it's, you know, it's hard now, because I've also had an experience to put me really close to critical care. And so, that same sort of intimacy with my profession is there in a way that I never anticipated.
Emily Silverman
Before we dive into the experience of being a critical care doctor, having been critically ill yourself, I would love to explore a bit about what that was like––the actual process of having this cardiac arrest and everything that you went through. Can you tell us a little bit about how that played out for you?
Cathy Humikowski
Yeah, I was actually thinking about that today because I think that my experience was very easy compared to the people in my family. We don't talk about it a lot, actually. I've almost never talked about it with my husband. My experience was, I had a really beautiful, easy delivery. And I remember a lot of the details of being wheeled into the OR. I remember feeling, I think already this deep peace that comes along with experiences near death. Which, it freaks me out to realize that I had like, the features of a near death experience.
But so, there's this indelible peace and this calm, and I remember it permeating everything. And so, even when I'm in the OR, and they're pinning down my arms for art lines, and I can see the monitor and I remember saying, "Oh, you know, my blood pressure always runs low, don't worry." You know, it's like 70 on 30 I'm like, just about to go down. And I was totally fine. I was like, “It's gonna be fine.” I never had a drop of fear. I just knew with every fiber in my being, that I was going to be fine.
And then when I woke up, and it started piece by piece to come through from family members what had happened...you know, little by little I'm realizing, “Oh, this thing in my face that's preventing me from talking is actually a breathing tube. Okay, that's weird.” And, you know, “This ache in my chest. Wow, that's because I had CPR. That's weird.” And eventually my sister, I think, was the first to tell me that I had to have an emergency hysterectomy, and processing that and...But I was still in this like, shroud of peace, and the whole thing just felt very victorious.
Even, you know, meeting my anesthesiologist and hearing from their perspective, that to them, it was also this like, good save, it was this great victory. But, my family had moments where they didn't think I would survive. My husband thought he would raise our daughter alone. My sister–– we had just lost my mom two years before and we're the only family each other––she thought she was gonna lose everyone in her circle of life within a few years of one another. And so for them, I think that experience was much more traumatic than it was for me.
And I think, you know, relating that to my work now, thinking about the extended family of a critically ill person, obviously, in pediatrics, we do that a lot anyway, because we're always dealing with parents and, I think that's a little bit different than in adult medicine. But, just the idea that there's this ripple effect for everyone involved around trauma like that. And so, I think for me, that's been the piece that I really still have yet to explore is what that felt like for my family.
For me, it was like, “Woo-hoo, look at me, I'm okay.” And that didn't stay that way. Months later, I think, after trauma people...that feeling of "Oh my God, we made it," turns into "Oh my God, we almost didn't make it," right? So there, you know, there was anxiety, and a period of time where I met with a therapist and things like that. But in general, my memory of those experiences is very positive, which is weird, because it was the scariest moments of my closest families’ lives, which is...It's just a disconnect, I think, in that experience.
Emily Silverman
There was one thing you said that I just like, cannot resist asking more about, just because I'm so curious about it, which is this peaceful feeling that you had. This concept of a near death experience, or one might argue in your case, was a death experience and then brought back. Because, I've read a little bit about people experiencing this feeling of oneness, and wholeness, and unity, and connection, and peace, and comfort and...Almost the way that you hear people describe like, when they're tripping on LSD, or on mushrooms or something. And so, I just have to ask you to open that up a little bit for me, because it's just something you don't always get to ask someone.
Cathy Humikowski
Yeah, it was without a doubt, the most powerful feeling I've ever experienced. And it's actually really hard to put it into words. And I've read other accounts of people who've had actual death experiences and this pervasive peace is probably the most common of the features that people describe. And almost everyone says the same thing—like, there really are not words for it. And I found that experience to be so profound, that I was afraid I would lose it over time, that I wouldn't be able to tap into it.
And I still find that when I need to, I can, but I have to consciously do it. And I certainly have friends who you know, they study various Eastern religions or various forms of meditation, and their goal is very similar to, you know, what mine I suppose is, which is to tap into that peace and, and reach beyond kind of what we see with our typical senses. And really dive into if there is the sense of connectedness or consciousness. And the hard thing for me and what I struggle a lot with, is that I'm not a religious person.
I wouldn't say that means I'm not a spiritual person, but I'm a very grounded empirical person. And I think many of us in medicine are, right? We study science and physiology and, and we know mechanisms for things. And this is something for which I have no real explanation. So, my brain had no blood flow at that time. And I have very clear memories of the operating room. And when I think about certain aspects of it, aside from the peace, which I can very readily accept was extremely real, it was the most real thing I've ever experienced.
There are other pieces of it that fit into like, a near-death-experience-type description. Which I push away, because I don't have a good rational explanation for, right? So, one example is that the night I was waking up in the ICU, right after I was excavated, and everyone knew I was okay, my family finally went home for the night to rest. And I was closing my eyes to sleep, or try, because the anxiety in the ICU as the drugs are wearing off is very profound––I have a deeper respect for that now––I saw the after image on the back of my eyelids of a butterfly, which was my mother's kind of spirit animal. And it was burned into…and I woke up and I thought, “Oh my god, did I see the light? Was that light the light? Oh my God, that's crazy.” And of course, I thought, “No, no, no, it must have been that I was laying flat on my back with my eyes looking up at the aura lights. And that's just the after image of the aura lights.” I tried to explain it in a way based on what I know of an operating room, you know, set up.
And one of my good friends, who's also a surgeon, she was like, “Operating room lights come in threes, they don't come in fours. It was your mother. You know?” And I'm like, “They come in all different clusters. Like, there's not like, a one standard way that operating room lights are.” But it just rose to my mind that people will really hang on to what they believe in. Right? If you're a very religious or spiritual person, as this friend of mine was, then obviously that was the spirit of my mother.
And I'm sitting here trying to explain it away, because I don't want to possibly think that this really crazy, otherworldly thing happened to me. So, I struggle with that a little bit, and I don't talk about it a lot. It's a pretty isolating space to be, especially when all your friends are scientists. I mean, my husband's a neurologist. We were having dinner once with one of our close friends who's a neuroscience PhD. She's brilliant.
And, you know, when we were talking about the sense of peace, she was like, "Well, obviously, that's just because, you know, your brain didn't have anything else to worry about. Because, your cognition was shutting down, you know, all this, you know, extra things were…they just weren't gumming your brain power. So of course, that's where the peace came from."
And I'm like, "No, I was in touch with the universe," right? So, I don't know how to explain it. But it's a little isolating, because it's no…you don't run into people who've had this experience every day. So, I still struggle with how to reconcile those experiences.
Emily Silverman
I definitely love science, and love data, and love evidence and love empiricism. And over the last year or two, I have noticed myself opening up to mystery a little bit more. And I think there's a variety of reasons why that is. But, just really feeling humble about what we know and what we don't know. And you know, the universe consisting of all sorts of different things that the antenna of our brain may or may not be picking up on. And like, really interrogating this idea of a collective consciousness and of the ego, and what does it mean when the ego dissolves? I, too, struggle with how to talk about that as a physician and as somebody who is so science loving, but also trying to open myself up to these other explanations.
Cathy Humikowski
Yeah, I think you have to—we have to be honest about a gap in our knowledge, right? So it's very frustrating that it's either, we have a scientific explanation for it, or we leave it to the realm of religion, spirituality, otherworldly mumbo jumbo, and there's nothing in between. And the truth is, we don't really know, right? So, all the theories that have been put forth about why people who have had similar experiences at the edge of death, right, whether it be a light or a tunnel, or all of these things... You know, was it hypoxia? Was it, you know, whatever these mechanistic explanations are? They've never really been tested or proven, right? And it's an especially palpable gap, I think, for physicians, because we do navigate that spiritual space and that humanistic space so much. And yet, it's very neglected, I think, in our training. And I think that's a big, big gap that I'm hopeful that the sort of next generation of physicians will start to help close the gap.
Emily Silverman
One thing that came up for me as you were talking, was about how as physicians, we are trained to enter into a stressful situation. And so, our adrenaline is pumping, and our cortisol is pumping, and then we suppress. And we like, keep all of that anxiety down, and we maintain this kind of calm, analytic “Okay, what are we going to do next?” mindset. And that's certainly how I was trained in residency. And I notice that now, in my ordinary life, I don't really feel my stress that much.
And, you know, I'll say to my husband, like, "I actually don't feel that stressed about this, but why is my ear ringing?" Or like, "I actually don't really feel that anxious or feel that stressed, but like, why are my muscles clenching up in this way?" And how, like, cognitively we override it. And then, the idea that it's like, the body that takes the beating, and how the body knows.
Or as the famous psychiatrist Bessel van der Kolk says––the title of his book, which is all about PTSD, is The Body Keeps The Score. And I was wondering if you thought at all about that. Like how, as physicians, if we're constantly overriding this stress, do we think about our own bodies?
Cathy Humikowski
That's such an interesting question. I mean, I've two anecdotes about that. One is that when I was starting medical school, and everybody was like, "Aren't you stressed?" I was like, "No, it's gonna be fine." It's like, "I've wanted to do this my whole life." But meanwhile, I had like, bloody diarrhea and hives the week before medical school. I'm like, "No, I'm not stressed at all. What do you….Hand me my Benadryl."
And then, the other is just recently. I…and I don't feel stressed right now. At least, I don't think so. I'm in a pretty good place with a balance between you know, my family at home and the way that I work now. And I went and saw the dentist, and he's like, "You're cracking your teeth from all the grinding that you're doing at night." And I like, had to have my teeth filed down because I was chipping into them at night, and my whole neck and shoulders were tense.
And after my cardiac arrest, for months I slept with my shoulders and my neck all tightened, because at night is when I processed that trauma. So, there is this very real way that we abuse our bodies without even realizing it. I mean sure, physicians are notorious for not sleeping enough, not drinking enough water, drinking too much caffeine, you know, all the things that are unhealthy…having a granola bar as your only meal all day. That is, if you're on the healthy side, versus people who either don't eat at all, or get french fries at the cafeteria, or what have you. So, we don't care for our bodies.
And then as you said, the stress has to get processed somehow. And it's not at work. And we certainly don't want to take it home with us. And so, we do it in ways that we don't even realize. And when I started doing some counseling with the same therapist who ended up speaking with me after my cardiac arrest—I had originally met her after my mom died. And I was doing grief counseling—what I thought was grief counseling—with her. And she was like, “Let's back up and talk about your job.”
I was like, "Oh, my job doesn't have anything to do with this. Like, I love my job. I mean, I think anyone in the world who knows what's good for them would want to be a pediatric ICU doctor. It's the best job in the world." But, as I'm describing to her what I do, she's like, "You realize that you process trauma every single day––that your job is a trauma." And I was like, mind-blown by hearing this, like I couldn't...And I think of myself as a pretty insightful person, and pretty self aware and pretty introspective.
And I was like, "Whoa, that's right. I mean, I see children die. I see…and this is, you know, at the time, I was practicing at the University of Chicago in the Southside of Chicago—lots of penetrating trauma, lots of diseases, of social injustice, lots of poverty, neglect, gang violence, like, very bad things happen to children. And we see it every day. It's just part of our normal. And so, to hear her frame it as trauma, that I didn't even know it…Where's that going? Right? It's not just going nowhere. It's being processed somehow, in my body, in my sleep, in, you know, in just the dreams that you have at night. It's got to go somewhere, right? And so, I think the most effective people are people who recognize that and then find places to put it. Whether that's, you know, the crazy surgeons I know who get up—even if it means they have to get up at three o'clock in the morning—so that they can run 10 miles a week somehow, and just get that energy out somewhere.
And it's different things for different people. But the people I know who find time to paint, or they find time to cook, or they find time to just burn off energy in some way—I think those are probably the healthiest, most balanced people that I know in medicine.
Emily Silverman
I wanted to loop back on what you said about this revelation in therapy. That, "Oh yeah, my job is actually just like, chronic daily trauma." Because, that's something that I've come to realize a lot, both regarding my exposure to the suffering of others, but also just the trauma of sleep deprivation and kind of what we put ourselves through as a medical community. And as I mentioned, I've been diving a little bit into the PTSD literature, and I'm by no means an expert in PTSD. But, listening to this interview with the author of the book, The Body Keeps the Score, he talks not just about the body, but also about actually storytelling and narrative, and how that can be used to help us process trauma. And in this recent interview, I heard with him, Dr. van der Kolk, on Krista Tippett's On Being, he was saying that if you take a group of men who were off at war, and you look at who has PTSD, and who does not, the men who don't have PTSD are the ones who have been able to integrate the war experience into their life story in a way that feels constructive and feels productive. Like, you know, “Obviously, it was terrible, but I made great friends, and it was a growth experience and I traveled,” and things like that. Whereas, the people who have PTSD are not able to integrate it into their life story in that way. And that they remember it more as like, very visceral fragments.
He gave the example of children who have been dealing with sexual assaults at a young age like, will often remember the wallpaper in the room when they were being molested. And, just these very kind of snapshot sensory details, and it stays like that over years, and they're not able to integrate it into a story and kind of weave it into their life.
And so I was wondering, as physicians, if we're going to call our jobs trauma––which I don't want to overuse that word or throw it around in an irresponsible way. But, I think there is a case to be made that as physicians, we do have secondary trauma in our job. Like, how do we then integrate that into our own lives in a way that's adaptive? And not get kind of stuck or hung up on these...How do we just be less stressed about it all?
Cathy Humikowski
Yeah. I think, you know, one of the ways, as you said, in terms of telling stories—one of the ways that I'd always processed my traumas at work without realizing they were traumas, was by talking about them, often with my sister, who's always been my sounding board. But, people don't like to hear about really sick kids, right? It's really hard for other people to digest.
And, you know, she's always been very generous with listening to me, but there'll be times where she'll be like, "Listen, I can't talk to you about work right now, because neither of my boys are within eyesight or earshot of me. I don't know that they're okay right now. So, I can't actually hear this for you," right? And so, I think that some physicians probably process their stories at home, with their partners, with their loved ones.
Hopefully, people pick many people in their lives to process with, because one person can't always be that receptacle, right? I think it's, you know, turning it off entirely, right? And this idea that we have to compartmentalize work and life, and that you shut the door of the hospital and you don't take anything with you. Based on what you're saying, it seems likely that those would be the people who would bottle it up, and it would come out in other ways.
And whether that's in physical ailments, as we talked about, or struggling marriages, or you know, substance use or depression, you know? Our profession has a terrible, terrible track record in terms of mental health and acceptance of that. And the suicide rate in physicians is unacceptably high. So yeah, we have to process that and incorporate that into our own story. But how do we do that without, you know, again, ceding that stress into others?
Emily Silverman
I agree with you. And I think the idea that perhaps some of this could be worked out, not necessarily through talk therapy, but through more physical means, whether that's running, or massage or exercise...just really, kind of viewing the body as a possible vector through which to process, that is wordless. Because some of it, you really can't describe.
As you said, the very beginning of the conversation, that some of these experiences, there really just aren't words for. And it has to be processed through the body, and what does that look like? So, I think that's really a great note to end on, and certainly gives me a lot to think about moving forward. Thank you so much, Catherine, for coming in and speaking with me today.
Cathy Humikowski
Thanks, Emily.
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
ICU doctor Cathy Humikowski got a second chance at life after her cardiac arrest. It was an experience that changed her perspective on medicine, the brain, and truth. This is The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. In this episode, Cathy tells the story of how she died and came back to life. Afterward, Cathy and I talked more about her brief death experience and how it opened her up to new ways of thinking.
Cathy Humikowski
I'm a very grounded, empirical person. And this is something for which I have no real explanation.
Emily Silverman
Here's Cathy.
Cathy Humikowski
I'm in a coma. And the first thing I notice as I begin to wake up is a pain in my chest. The last thing I remember about my chest is it's where my healthy baby lay after a totally normal delivery. Why should it hurt me now? Why should I be tethered to a ventilator in a coma at all? I reach for the source of discomfort and I feel the edge of a defibrillator pad. Now, I'm a pediatric intensive care physician, so even in a coma, I knew what that meant.
My chest hurt because I had received CPR. I had chest compressions there when my heart stopped. Why would that have happened? My husband didn't yet know the answer either. All he was told at that point is that I had survived and that I might still have brain damage. So, as he waited for me to wake up fully, along my bedside with some of our closest friends who were also physicians, they speculated out loud. You know, “What could cause a cardiac arrest in an otherwise healthy young person?” And so, when I woke up fully, among the first things I said, and this is totally verifiable and almost verbatim, I said something like, "Well, of course, I had a PEA arrest. If you were hemorrhaging red cells, being resuscitated with crystalloid, what do you think what happened to your myocardial oxygen supply?"
So, he knew I was okay.
Even before we learned the name of what had happened, we were told later, I had something called an amniotic fluid embolism, which is a rare complication of childbirth that's often fatal. Somebody here knows what that is. So, in the weeks that followed we didn't talk much more about my resuscitation. We were just grateful to be alive in the world together with our healthy baby. Even simple things, like taking a shower, I would weep with joy that I could wash myself.
You know, there wasn't room inside of our home to talk about the physiology. But I'm an intensivist. So that's like my jam, you know. So, when I was getting ready to go back to work for the first time, after maternity leave, that's what I was actually really excited to talk about, you know? Just really explore my resuscitation with my colleagues and kind of nerd out about it in like, a super geeky way. And so, I got dressed up for work. I didn't have a clinical shift for a couple of weeks, I was just going in for a meeting. But still, I was excited.
And I squeezed into this abdominal binder that was meant to protect the scar running down my belly, but also served like a girdle a little bit so I could get into some of my better pre-pregnancy work clothes. And for some reason, I wore heels because you know, why not? My core had been totally destabilized. And I had to carry my work bag and my breast pump and my baby's bag and like, my actual baby. But I managed not to faceplant on the way to daycare and I got to work on time, even a little bit early.
And I ran into my department chairman between the parking lot and the hospital and he was so happy to see me. He put his arm out and he gave me this like, sideways bro-hug. And he said, "It's wonderful to see you here. How are you?" And I said, "I'm great. I'm as good as new. It's like nothing ever happened." He said, "Fantastic. Welcome back," and like, slapped me on the shoulder and sent me on my way. And as I waited for the elevator, I realized I just told the greatest lie of my life. "Like nothing ever happened." Everything in my life is different since that day.
Even now, six years later when I braid my daughter's hair, I wonder, “Who would do it if I couldn't?” Why would I say that? Anyway, I went up to the ICU and the conference room where the meeting was to take place was still empty. So, I went into this little workroom next door. It's this tiny little room where the on-service fellow and attending do their work. But it's also where everybody else goes to just like gossip and chat. It's like the office water cooler, except if the water cooler were in a closet.
And so, when I walked into the workroom, it was already pretty crowded. And the group parted for me, like I was sort of like a celebrity and like, patted the seat on the only empty chair. Like, they were excited to talk about my story, too. I mean, I could have talked about it with my husband, he's a doctor too, but he's like a neurologist. It's not the same thing.
So, we talked about it the way intensivists talk about stuff, right? Like, we use data, and equations and numbers. So, we dove right in. We talked about, you know, how many units of blood had I received? And was that the best ratio of red cells to plasma, knowing what we know in the trauma literature? And, you know, given my lactate, my hemoglobin, what could we speculate about my oxygen carrying capacity? And as we batted these numbers around, the fellow in the room, super good guy named Ronnie, he pipes in to ask for one specific number that I hadn't mentioned yet.
He said, "How long were you down for?" What he meant, of course, was how long was the cardiac arrest? Everyone who practices resuscitation knows that's an important number. The longer the heart is stopped, the less likely it will restart. And the more likely there will be brain damage. But however important this number, it's not easy to know. You can't look it up in the chart, like a lab value. So, I had to speculate. I was told I had one round of CPR and maybe two doses of epinephrine. So, I thought my heart was stopped for about five minutes.
So, that's what I said, to which Ronnie replied, "Five minutes? That's not very long." And he turned away from my story circle to face like, the computer or something that was more interesting than my short cardiac arrest. And my colleagues were astonished. They were like, "What is with you? This is our partner. This is our colleague, someone whose life was restored by the very science that we practice. Like, where's your humanity, man?" But I kind of understood where he was coming from, on some level, right?
Like, I had just done the same thing. I had minimized it outside with my chairman. I had participated in resuscitations with Ronnie where he had rotated in and out of chest compressions on a child for the greater part of an hour. Why should my story be so amazing? The truth is, as physicians, I think we all go through a transition at some point where things that once astonished us, events that at some point in our lives would have been terrifying to even consider, let alone bear witness to...Events that can destroy or even end another person's life become so commonplace in our experience that they cease to astonish us, and they become mundane.
And that sounds terrible. But I couldn't blame Ronnie if he had gone through that transition, because so had I at almost the exact same stage in my training as Ronnie was then. I will never forget it. I was crossing the lobby of the hospital ride train as a second year critical care fellow. And a woman was like, gesticulating and waving and smiling at someone. And I didn't recognize her at all. So, I kind of looked around to see who she was waving at. And of course, it was me.
And so, I did what all self-respecting people do and faked like I knew her. And I was like, "Hey, totally, what are you doing here? Oh, my gosh." And you ask the questions that help you figure out who that person is without revealing your total ignorance. And in the course of our conversation, I realized that she was the parent of a little boy who had died in our ICU many months before when I was the fellow on service. And when we parted, I was just crushed with guilt that I hadn't remembered her. I felt so bad about it.
I went home that night, and I wrote in my journal––it was this little green notebook I'd kept since I was a first year medical student, where I'd write about things that really impacted me and they tended to be times that I made a mistake. And I wrote that night with a hand so heavy my pen nearly tore through the paper. I wrote, "How could you? Who do you think you are at this stage in your training, that you should forget the death of a child? That tore a hole in this family that will never be repaired and you just forgot about it.”
But as I tend to do when I write in my journal, I read through some of the preceding entries before I put it away. And in doing so, I discovered that I had cared for almost half a dozen other children who had died in our ICU in the time since I met that woman and her son. And so, I forgave myself a little. Because, I realized I couldn't possibly carry them all in my memory with the detail that their lives deserved and still do my job.
I suppose it was a form of protection. I know it was protection that I reached for that day, outside the hospital when I saw my chairman, in my abdominal binder and my heels, trying to look like my old self. I was about to cross the threshold into the hospital where I had practiced for most of my career––back into that environment of racing gurneys, and dinging alarm bells and code alarms. Only this time, I was a survivor of critical illness. And more than that, I was a parent. And I didn't know if I could do it.
I suppose you could imagine that maybe that experience would make me better at my work by putting me closer to it. But I worried then, and I still worry now, that maybe it put me too close, so that all the defenses I'd built up over the years would be too thin to protect me. So in that moment, it had to be true that I was as good as new, that it was like nothing ever happened, so that I could even walk through the door.
A couple of weeks later, when I was back at work for my first clinical shift, I found Ronnie in that same little workroom where this had all gone down. Now in the meanwhile, he'd become a little bit famous in our department for his comments. He was known as like, “Just Five Minutes Ronnie.” But we were okay. And before I could say anything to him, he rolled his head around and he said, "You know, I'm really glad you didn't die." Which, I don't know, is maybe a form of atonement, but I took it as like a weird kind of compliment. So I just said, "Thank you. Me too. I'm going to grab a cup of coffee. Can I get you something?" He said, "No, I've been on call all night. I'm really tired. I just want to get out of here. I don't want to wait around." I said, "Don't worry. I'll be back in five minutes.” We agreed––that wasn't very long.
Emily Silverman
So, I am sitting here with Catherine Humikowski. Catherine, thanks so much for coming in to speak with me today.
Cathy Humikowski
Thanks for having me.
Emily Silverman
So, I wanted to ask you a bit about your path to critical care.
Cathy Humikowski
You know, I joined critical care actually, in some ways, because I thought it would be easier than my original career path, which is that I set out to become a pediatric oncologist. When I was very young, I had childhood cancer. And that was the reason I became a physician. And then over time, I realized that my own experience with cancer might put me too close, you know, to that profession. And I will never forget my rotation on my oncology service. As a resident, I was physically sick for like a week, because I brought back so much just like, visceral memory of that time. I was like, “Um, maybe I'll pick something else,” you know? So, I oddly picked critical care, because I somehow thought it would be easier, which is weird. It's not, by the way. But it's, you know, it's hard now, because I've also had an experience to put me really close to critical care. And so, that same sort of intimacy with my profession is there in a way that I never anticipated.
Emily Silverman
Before we dive into the experience of being a critical care doctor, having been critically ill yourself, I would love to explore a bit about what that was like––the actual process of having this cardiac arrest and everything that you went through. Can you tell us a little bit about how that played out for you?
Cathy Humikowski
Yeah, I was actually thinking about that today because I think that my experience was very easy compared to the people in my family. We don't talk about it a lot, actually. I've almost never talked about it with my husband. My experience was, I had a really beautiful, easy delivery. And I remember a lot of the details of being wheeled into the OR. I remember feeling, I think already this deep peace that comes along with experiences near death. Which, it freaks me out to realize that I had like, the features of a near death experience.
But so, there's this indelible peace and this calm, and I remember it permeating everything. And so, even when I'm in the OR, and they're pinning down my arms for art lines, and I can see the monitor and I remember saying, "Oh, you know, my blood pressure always runs low, don't worry." You know, it's like 70 on 30 I'm like, just about to go down. And I was totally fine. I was like, “It's gonna be fine.” I never had a drop of fear. I just knew with every fiber in my being, that I was going to be fine.
And then when I woke up, and it started piece by piece to come through from family members what had happened...you know, little by little I'm realizing, “Oh, this thing in my face that's preventing me from talking is actually a breathing tube. Okay, that's weird.” And, you know, “This ache in my chest. Wow, that's because I had CPR. That's weird.” And eventually my sister, I think, was the first to tell me that I had to have an emergency hysterectomy, and processing that and...But I was still in this like, shroud of peace, and the whole thing just felt very victorious.
Even, you know, meeting my anesthesiologist and hearing from their perspective, that to them, it was also this like, good save, it was this great victory. But, my family had moments where they didn't think I would survive. My husband thought he would raise our daughter alone. My sister–– we had just lost my mom two years before and we're the only family each other––she thought she was gonna lose everyone in her circle of life within a few years of one another. And so for them, I think that experience was much more traumatic than it was for me.
And I think, you know, relating that to my work now, thinking about the extended family of a critically ill person, obviously, in pediatrics, we do that a lot anyway, because we're always dealing with parents and, I think that's a little bit different than in adult medicine. But, just the idea that there's this ripple effect for everyone involved around trauma like that. And so, I think for me, that's been the piece that I really still have yet to explore is what that felt like for my family.
For me, it was like, “Woo-hoo, look at me, I'm okay.” And that didn't stay that way. Months later, I think, after trauma people...that feeling of "Oh my God, we made it," turns into "Oh my God, we almost didn't make it," right? So there, you know, there was anxiety, and a period of time where I met with a therapist and things like that. But in general, my memory of those experiences is very positive, which is weird, because it was the scariest moments of my closest families’ lives, which is...It's just a disconnect, I think, in that experience.
Emily Silverman
There was one thing you said that I just like, cannot resist asking more about, just because I'm so curious about it, which is this peaceful feeling that you had. This concept of a near death experience, or one might argue in your case, was a death experience and then brought back. Because, I've read a little bit about people experiencing this feeling of oneness, and wholeness, and unity, and connection, and peace, and comfort and...Almost the way that you hear people describe like, when they're tripping on LSD, or on mushrooms or something. And so, I just have to ask you to open that up a little bit for me, because it's just something you don't always get to ask someone.
Cathy Humikowski
Yeah, it was without a doubt, the most powerful feeling I've ever experienced. And it's actually really hard to put it into words. And I've read other accounts of people who've had actual death experiences and this pervasive peace is probably the most common of the features that people describe. And almost everyone says the same thing—like, there really are not words for it. And I found that experience to be so profound, that I was afraid I would lose it over time, that I wouldn't be able to tap into it.
And I still find that when I need to, I can, but I have to consciously do it. And I certainly have friends who you know, they study various Eastern religions or various forms of meditation, and their goal is very similar to, you know, what mine I suppose is, which is to tap into that peace and, and reach beyond kind of what we see with our typical senses. And really dive into if there is the sense of connectedness or consciousness. And the hard thing for me and what I struggle a lot with, is that I'm not a religious person.
I wouldn't say that means I'm not a spiritual person, but I'm a very grounded empirical person. And I think many of us in medicine are, right? We study science and physiology and, and we know mechanisms for things. And this is something for which I have no real explanation. So, my brain had no blood flow at that time. And I have very clear memories of the operating room. And when I think about certain aspects of it, aside from the peace, which I can very readily accept was extremely real, it was the most real thing I've ever experienced.
There are other pieces of it that fit into like, a near-death-experience-type description. Which I push away, because I don't have a good rational explanation for, right? So, one example is that the night I was waking up in the ICU, right after I was excavated, and everyone knew I was okay, my family finally went home for the night to rest. And I was closing my eyes to sleep, or try, because the anxiety in the ICU as the drugs are wearing off is very profound––I have a deeper respect for that now––I saw the after image on the back of my eyelids of a butterfly, which was my mother's kind of spirit animal. And it was burned into…and I woke up and I thought, “Oh my god, did I see the light? Was that light the light? Oh my God, that's crazy.” And of course, I thought, “No, no, no, it must have been that I was laying flat on my back with my eyes looking up at the aura lights. And that's just the after image of the aura lights.” I tried to explain it in a way based on what I know of an operating room, you know, set up.
And one of my good friends, who's also a surgeon, she was like, “Operating room lights come in threes, they don't come in fours. It was your mother. You know?” And I'm like, “They come in all different clusters. Like, there's not like, a one standard way that operating room lights are.” But it just rose to my mind that people will really hang on to what they believe in. Right? If you're a very religious or spiritual person, as this friend of mine was, then obviously that was the spirit of my mother.
And I'm sitting here trying to explain it away, because I don't want to possibly think that this really crazy, otherworldly thing happened to me. So, I struggle with that a little bit, and I don't talk about it a lot. It's a pretty isolating space to be, especially when all your friends are scientists. I mean, my husband's a neurologist. We were having dinner once with one of our close friends who's a neuroscience PhD. She's brilliant.
And, you know, when we were talking about the sense of peace, she was like, "Well, obviously, that's just because, you know, your brain didn't have anything else to worry about. Because, your cognition was shutting down, you know, all this, you know, extra things were…they just weren't gumming your brain power. So of course, that's where the peace came from."
And I'm like, "No, I was in touch with the universe," right? So, I don't know how to explain it. But it's a little isolating, because it's no…you don't run into people who've had this experience every day. So, I still struggle with how to reconcile those experiences.
Emily Silverman
I definitely love science, and love data, and love evidence and love empiricism. And over the last year or two, I have noticed myself opening up to mystery a little bit more. And I think there's a variety of reasons why that is. But, just really feeling humble about what we know and what we don't know. And you know, the universe consisting of all sorts of different things that the antenna of our brain may or may not be picking up on. And like, really interrogating this idea of a collective consciousness and of the ego, and what does it mean when the ego dissolves? I, too, struggle with how to talk about that as a physician and as somebody who is so science loving, but also trying to open myself up to these other explanations.
Cathy Humikowski
Yeah, I think you have to—we have to be honest about a gap in our knowledge, right? So it's very frustrating that it's either, we have a scientific explanation for it, or we leave it to the realm of religion, spirituality, otherworldly mumbo jumbo, and there's nothing in between. And the truth is, we don't really know, right? So, all the theories that have been put forth about why people who have had similar experiences at the edge of death, right, whether it be a light or a tunnel, or all of these things... You know, was it hypoxia? Was it, you know, whatever these mechanistic explanations are? They've never really been tested or proven, right? And it's an especially palpable gap, I think, for physicians, because we do navigate that spiritual space and that humanistic space so much. And yet, it's very neglected, I think, in our training. And I think that's a big, big gap that I'm hopeful that the sort of next generation of physicians will start to help close the gap.
Emily Silverman
One thing that came up for me as you were talking, was about how as physicians, we are trained to enter into a stressful situation. And so, our adrenaline is pumping, and our cortisol is pumping, and then we suppress. And we like, keep all of that anxiety down, and we maintain this kind of calm, analytic “Okay, what are we going to do next?” mindset. And that's certainly how I was trained in residency. And I notice that now, in my ordinary life, I don't really feel my stress that much.
And, you know, I'll say to my husband, like, "I actually don't feel that stressed about this, but why is my ear ringing?" Or like, "I actually don't really feel that anxious or feel that stressed, but like, why are my muscles clenching up in this way?" And how, like, cognitively we override it. And then, the idea that it's like, the body that takes the beating, and how the body knows.
Or as the famous psychiatrist Bessel van der Kolk says––the title of his book, which is all about PTSD, is The Body Keeps The Score. And I was wondering if you thought at all about that. Like how, as physicians, if we're constantly overriding this stress, do we think about our own bodies?
Cathy Humikowski
That's such an interesting question. I mean, I've two anecdotes about that. One is that when I was starting medical school, and everybody was like, "Aren't you stressed?" I was like, "No, it's gonna be fine." It's like, "I've wanted to do this my whole life." But meanwhile, I had like, bloody diarrhea and hives the week before medical school. I'm like, "No, I'm not stressed at all. What do you….Hand me my Benadryl."
And then, the other is just recently. I…and I don't feel stressed right now. At least, I don't think so. I'm in a pretty good place with a balance between you know, my family at home and the way that I work now. And I went and saw the dentist, and he's like, "You're cracking your teeth from all the grinding that you're doing at night." And I like, had to have my teeth filed down because I was chipping into them at night, and my whole neck and shoulders were tense.
And after my cardiac arrest, for months I slept with my shoulders and my neck all tightened, because at night is when I processed that trauma. So, there is this very real way that we abuse our bodies without even realizing it. I mean sure, physicians are notorious for not sleeping enough, not drinking enough water, drinking too much caffeine, you know, all the things that are unhealthy…having a granola bar as your only meal all day. That is, if you're on the healthy side, versus people who either don't eat at all, or get french fries at the cafeteria, or what have you. So, we don't care for our bodies.
And then as you said, the stress has to get processed somehow. And it's not at work. And we certainly don't want to take it home with us. And so, we do it in ways that we don't even realize. And when I started doing some counseling with the same therapist who ended up speaking with me after my cardiac arrest—I had originally met her after my mom died. And I was doing grief counseling—what I thought was grief counseling—with her. And she was like, “Let's back up and talk about your job.”
I was like, "Oh, my job doesn't have anything to do with this. Like, I love my job. I mean, I think anyone in the world who knows what's good for them would want to be a pediatric ICU doctor. It's the best job in the world." But, as I'm describing to her what I do, she's like, "You realize that you process trauma every single day––that your job is a trauma." And I was like, mind-blown by hearing this, like I couldn't...And I think of myself as a pretty insightful person, and pretty self aware and pretty introspective.
And I was like, "Whoa, that's right. I mean, I see children die. I see…and this is, you know, at the time, I was practicing at the University of Chicago in the Southside of Chicago—lots of penetrating trauma, lots of diseases, of social injustice, lots of poverty, neglect, gang violence, like, very bad things happen to children. And we see it every day. It's just part of our normal. And so, to hear her frame it as trauma, that I didn't even know it…Where's that going? Right? It's not just going nowhere. It's being processed somehow, in my body, in my sleep, in, you know, in just the dreams that you have at night. It's got to go somewhere, right? And so, I think the most effective people are people who recognize that and then find places to put it. Whether that's, you know, the crazy surgeons I know who get up—even if it means they have to get up at three o'clock in the morning—so that they can run 10 miles a week somehow, and just get that energy out somewhere.
And it's different things for different people. But the people I know who find time to paint, or they find time to cook, or they find time to just burn off energy in some way—I think those are probably the healthiest, most balanced people that I know in medicine.
Emily Silverman
I wanted to loop back on what you said about this revelation in therapy. That, "Oh yeah, my job is actually just like, chronic daily trauma." Because, that's something that I've come to realize a lot, both regarding my exposure to the suffering of others, but also just the trauma of sleep deprivation and kind of what we put ourselves through as a medical community. And as I mentioned, I've been diving a little bit into the PTSD literature, and I'm by no means an expert in PTSD. But, listening to this interview with the author of the book, The Body Keeps the Score, he talks not just about the body, but also about actually storytelling and narrative, and how that can be used to help us process trauma. And in this recent interview, I heard with him, Dr. van der Kolk, on Krista Tippett's On Being, he was saying that if you take a group of men who were off at war, and you look at who has PTSD, and who does not, the men who don't have PTSD are the ones who have been able to integrate the war experience into their life story in a way that feels constructive and feels productive. Like, you know, “Obviously, it was terrible, but I made great friends, and it was a growth experience and I traveled,” and things like that. Whereas, the people who have PTSD are not able to integrate it into their life story in that way. And that they remember it more as like, very visceral fragments.
He gave the example of children who have been dealing with sexual assaults at a young age like, will often remember the wallpaper in the room when they were being molested. And, just these very kind of snapshot sensory details, and it stays like that over years, and they're not able to integrate it into a story and kind of weave it into their life.
And so I was wondering, as physicians, if we're going to call our jobs trauma––which I don't want to overuse that word or throw it around in an irresponsible way. But, I think there is a case to be made that as physicians, we do have secondary trauma in our job. Like, how do we then integrate that into our own lives in a way that's adaptive? And not get kind of stuck or hung up on these...How do we just be less stressed about it all?
Cathy Humikowski
Yeah. I think, you know, one of the ways, as you said, in terms of telling stories—one of the ways that I'd always processed my traumas at work without realizing they were traumas, was by talking about them, often with my sister, who's always been my sounding board. But, people don't like to hear about really sick kids, right? It's really hard for other people to digest.
And, you know, she's always been very generous with listening to me, but there'll be times where she'll be like, "Listen, I can't talk to you about work right now, because neither of my boys are within eyesight or earshot of me. I don't know that they're okay right now. So, I can't actually hear this for you," right? And so, I think that some physicians probably process their stories at home, with their partners, with their loved ones.
Hopefully, people pick many people in their lives to process with, because one person can't always be that receptacle, right? I think it's, you know, turning it off entirely, right? And this idea that we have to compartmentalize work and life, and that you shut the door of the hospital and you don't take anything with you. Based on what you're saying, it seems likely that those would be the people who would bottle it up, and it would come out in other ways.
And whether that's in physical ailments, as we talked about, or struggling marriages, or you know, substance use or depression, you know? Our profession has a terrible, terrible track record in terms of mental health and acceptance of that. And the suicide rate in physicians is unacceptably high. So yeah, we have to process that and incorporate that into our own story. But how do we do that without, you know, again, ceding that stress into others?
Emily Silverman
I agree with you. And I think the idea that perhaps some of this could be worked out, not necessarily through talk therapy, but through more physical means, whether that's running, or massage or exercise...just really, kind of viewing the body as a possible vector through which to process, that is wordless. Because some of it, you really can't describe.
As you said, the very beginning of the conversation, that some of these experiences, there really just aren't words for. And it has to be processed through the body, and what does that look like? So, I think that's really a great note to end on, and certainly gives me a lot to think about moving forward. Thank you so much, Catherine, for coming in and speaking with me today.
Cathy Humikowski
Thanks, Emily.
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