Valerie Sams: Handling Trauma and Saving Lives

What happens when a life hangs in the balance during a high-stakes NFL game? Join us as Air Force Colonel and Dr. Valerie Sams, a renowned general surgeon and trauma critical care expert, recounts her heroic efforts on the night Buffalo Bills safety Damar Hamlin suffered cardiac arrest. Dr. Sams sheds light on the often overlooked emotional and mental traumas that accompany physical injuries, emphasizing the importance of addressing these invisible wounds. Hear her unique perspective on the immense pressure and expectations that come with emergency surgery and learn how she stays grounded through it all.

Ever wondered how medical professionals handle the intense demands of their jobs without breaking? In this episode, we explore the vital skill of detachment in high-stress medical environments and how Dr. Sams teaches this to new trainees. Discover the delicate balance between rigorous training and providing emotional support to patients' families. Plus, we tackle the pervasive issue of imposter syndrome and share strategies for staying current with medical advancements to keep self-doubt at bay. For a touch of light-heartedness, listen to Dr. Sams discuss her proficiency in the board game Operation and her admiration for the character Hawkeye from MASH.

Finally, we take a journey through the evolution of combat surgery and the importance of continuous learning and truth-telling in leadership roles. Dr. Sams shares heartwarming stories of camaraderie among deployed medical professionals and clarifies common misconceptions about the roles of trauma surgeons and emergency medicine doctors. Hear her thoughts on the necessity of confidence in their field, and the critical role of teamwork in medical emergencies. Our conversation culminates in a reflection on the Damar Hamlin incident, underscoring the preparedness and crucial role of medical teams in saving lives. Tune in for a compelling discussion that celebrates excellence, kindness, and humility in the medical field.

Conversation:
Intro 00:00 Dr. Valerie Sams

When thinking about January 2023
0:216 Dr. Valerie Sams Well, you know, I had only been at the University of Cincinnati for a short time, after spending nearly a decade in San Antonio, and I just moved up here as a new job, doing my job on nights, on call. For those of us that do trauma, it doesn't matter what walks in the door. We're going to have the same standard of care, no matter who it is. But it does bring an extra level of eyes and ears when it's someone famous. And then on top of that, he reminded me so much of our soldiers and our airmen and our Marines that he's young, healthy athlete. He just overcame so much and it was just such an honor to take care of him  It was a crazy week, to say the least.

How society can heal invisible wounds
3:31 Dr. Valerie Sams I think first and foremost is recognize them. I think since that talk in April, I was at another meeting shortly after that and we heard a presentation from a group of medics that got injured in battle and to hear their perspective of how, I mean, we do amazing things in medicine, even in civilian medicine, military medicine, we do amazing things. We take people whose heart stops and we bring them back. And I want to credit the team on the field that night, which was the UC health team on the field at night, that really brought him back to life. So we do amazing things.

But then that's just kind of the beginning and when I talk about other soldiers and casualties and even civilian traumas that go through this as a society we have to recognize that's just the beginning of their journey is when we save their life now. Now the hard part starts, which is the trauma of what they've been through, the trauma of the rehabilitation. The psychological recovery that goes along with that we kind of gloss over. And you know hearing those medics talk about a week from injury and serious injuries, they're sitting in their living room going what just happened and there's some unseen injuries there that we've not dealt well with.

Advice for clearing one’s self of trauma taken on from others
4:51 Dr. Valerie Sams When we take care of civilian traumas, one of the things that I try to teach my residents, in particular my fellows, is that it's a job of honor in and of itself. It can be a little bit jading in the civilian world, because our patient population in the civilian world is not like the battlefield. We're not getting society's best of the best, but what I remind them is that you know every mother and father, son or daughter that gets in a car accident going to work did not ask for that and we're taking care of people on the worst day of their life and just trying to keep it all in perspective and stay humble about that.

Tips for handling pressure when expectations continue to rise
5:50 Dr. Valerie Sams For me the reason I was drawn to do emergency surgery and trauma critical care was exactly for that. I didn't want to be worried about what was coming through the door that night or that day. I wanted to be ready for whatever the world presented to me, and that meant that I had to be trained in that way. So I just fall back on my training and if I have the expectations of myself and my team members that we're going to do the very best we can every single time and sometimes we're not going to save everybody then that's all we can really ask of ourselves and we have to be okay with that. But it has to come from within.

When feeling overwhelmed or unfocused, or has lost focus temporarily, steps taken to get back into the zone
7:43 Dr. Valerie Sams Well, I know one of the things we practice in surgery is kind of like the time out, the eyes on me. We operate in an environment of kind of controlled chaos. In general, our trauma resuscitation room in the emergency department, the operating room it's all fairly chaotic when you're trying to save a life, so you get a little bit used to that. But then there does come a time when it tips over to chaos. That then gets in the way of saving the life. So I do practice the timeout and one of the quotes that I like to say when I'm trying to get the room under control is let's pretend like we've done this before.

Teaching skill of detachment
8:44 Dr. Valerie Sams I think for me, and probably what I try to role model for my trainees, is again, rely on your training in the moment, because the emotions can get high, the stress can get high. So just fall back on your training, be confident in your skills, do what you need to do, but then at the end don't be afraid to hug the family, hold a hand, cry, you know, and that's all okay and it's not a negative thing.

Shutting down internal doubt and negative self-chatter
9:24 Dr. Valerie Sams Yeah, every day, every day, and not to get on a whole other tangent with imposter syndrome, but it is something yeah, it is something that affects particularly physicians, I think, but probably other high stress career fields. Where you look around you're like I can't believe they're trusting me to do this

Who's watching over me and making sure I'm doing this right. But again, I think, just holding myself to a standard that if I'm not going to rest in the comfort of a mundane job, I'm going to do a job that requires me to stay up on the latest technology, the latest medicine, the latest science, and that's going to continue to push me to stay the best that I can be. So I think for me that's how I kind of push out the imposter syndrome when it starts to creep in.

Rating her skills at the board game operation
10:38 Dr. Valerie Sams Oh, terrible. I was terrible at the board game operation, but I'm also a trauma surgeon so I will say I don't wear the magnifying thing. You know a lot of surgeons that work on really intricate things wear the magnifying goggles. I haven't worn those since I was in training and I was actually deployed with a vascular surgeon one time that was a reservist, typically worked at the VA, I won't call him out, but was a great vascular surgeon but didn't do trauma routinely. So on our deployment we had a lot of vascular trauma and it doesn't look the same when you're doing it than when you're doing it electively. So he would ask me all the time he's like Valerie, how do you find these things in this mess? And I said because you just have to know where it's supposed to be. And so I'm a surgeon that operates a little bit by feel a lot by knowing where things are supposed to be.

Which character from MASH she most identifies with
11:30 Dr. Valerie Sams Oh, definitely Hawkeye because he was just great with morale, obviously, but he was also, I mean, I don't relate to any of them in terms of not wanting to be where they were, but I understood that I think he was just so dedicated to his craft and he was passionate about taking care of the patients.

Recommended books for anyone recovering from traumatic events
17:48 Dr. Valerie Sams I don't know that I have any specific recommendations, because I think trauma affects everybody a little bit differently and I'm never surprised at the differences I see in people when they've overcome something like this. Some people it's like a battery to them and for some people it just stops them in their tracks. So I don't know that I have a specific book, but I will say that however you respond to trauma, it's okay, because everybody responds a little bit different. There's no defined way of what you're going to feel like when you're on the other side of it, and that's okay. So don't shy away from it, don't not talk about it, don't seek out resources for it, et cetera, because even if you feel like it's motivating you, that motivation could be masking just you trying not to think about it.

Common misconceptions about ER and Trauma doctors
18:57 Dr. Valerie Sams Oh, yeah, they're separate. I'm glad you said that, yeah, they're separate. So we're not emergency medicine doctors. ER doctors are emergency medicine, which they're like our teammate essentially, but they are truly like the jack-of-all-trades because they have to treat the pneumonias, the COPD exacerbations, the diabetes. They still see all that in the emergency room and they have to be our partners when we have injured or surgically ill patients come in.

That we're a little bit arrogant, which my response to that is because it's not untrue. But you have to understand why. It's internally derived arrogance. It's not because people are out there stroking our egos. That's certainly not happening. I joke about when doctors during the holidays get gifts from their patients. You go into the surgical oncologist's office who's been treating cancer patients all year and there's like baskets and chocolates. And then you go to the trauma's office, there's nothing. But the arrogance comes from within because you think of what we have to do. I mean, we have these people that don't get a choice. They show up in our emergency room and they're putting their entire life in our hands. So it's just the sheer magnitude of the expectation that requires us to be a little bit confident in what we do. So there is a little bit of an arrogance about trauma surgeons in general, but I think they're misperceived sometimes, that it's really internally driven.

If there was a GIANT BILLBOARD that she could place anywhere in the world with her message on it for the world to see, where would the billboard be and what would the message say?
21:53 Dr. Valerie Sams I would say I don't even know where I would put it I would fly it over the United States periodically is probably what I would do.

I would just make sure it flew over any major event in the United States, and I think it would say pursue excellence, be kind and stay humble.

What she wants people to know about Damar Hamlin event
23:06 Dr. Valerie Sams I think the take-home message about that and thank you so much for asking there's a take-home message in terms of just medicine, and that is we had a team out on the field and that was their job was when bad things happened they were ready and fortunately, 99.9% of the time bad things don't happen, but that didn't mean they weren't ready. When it did that 0.1% of the time they had the worst thing happen, which was a cardiac arrest, and they sprung into action just like they had practiced and just like they were trained to do. It fell back on their training and resuscitated him right there on the field. So by the time he got to me in the emergency room his heart had restarted. Then everything from there when I took care of him, the rest of the week in the emergency room and in the critical care unit was all about my training and I've taken care of not just in COVID but before COVID, as a critical care doctor. You do a lot of management of people with lung failure and heart failure and those sorts of things.

So, again falling back on my training, the other take-home message here is that it is such a benefit to both the civilian health care system and the military health care system, that we have partnerships like we do. I'm an active duty trauma surgeon that works in a civilian trauma center to sustain my skills. All my partners that work there sustain their skills there because they do it every day and that way, when we're called to take care of the Damar Hamlin’s or the Ryan Davis or the Clint Trials of the world, we're ready and there is no substitute for that. You can't simulate your way through it, you can't read your way through it, you have to do it and you have to exercise that muscle memory. So it was just a full on example of what all that means.

Parting thoughts
24:57 Dr. Valerie Sams I just see a lot of people kind of resting on the laurels after COVID. Don't forget the lessons we learned from COVID, with pandemics and in bad situations. Don't forget that we just got out of a 20 year war that looks very different than what our future war may look like. We're hopeful that it never happens. But hope is not a plan and preparation is the only thing we can rely upon. So it's nice to have a little breather after 20 years of war. But let's not get complacent and let's remember why we do what we do.

Mentioned:
Damar Hamlin
Ryan Davis
Clint Trial

Quote:
“If you think you can do a thing or think you can’t do a thing, you’re right.”
- Henry Ford