“Perinatal Trauma, Part 2” – with Dr. Katherine Jorda

Welcome back to Part 2 of covering Prenatal Trauma. In this episode of Healthful Woman, Dr. Nathan Fox meets with one of his former residents, Dr. Katherine Jorda. Dr. Jorda is an OBGYN in Oregon and will be discussing perinatal trauma.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I am your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.

All right, I want to welcome back Dr. Katherine Jorda. Kathy, thank you for coming back on the podcast. I really appreciate it.

Dr. Jorda: Thank you.

Dr. Fox: Yeah. Oh, my God, this is amazing. Last week we were talking about you, your background, how you got into sort of this trauma aspect of OBGYN, and we were talking… Where we left off last week, after talking about where you’re from, how you got into this, what you’re doing in your special clinic in Oregon, OHSU, Oregon Health and Science University, and we were talking about the three things that patients themselves can do to try to mitigate trauma, meaning whatever event they had, to not have the experience be traumatic, right? We talked about the event, the experience, and the effect, right? The event is what happened, and the experience is sort of how you experience that event, which we’re talking about is really the portion that leads to trauma much more so than the event itself, and the goal is to try to prevent or mitigate or reduce the effects.

And what you were talking about last week was you mentioned… I asked you, you know, what can patients do to try to, like, minimize that experience, and you said there’s three things, there’s education, communication, expectations, and we sort of wrapped up talking about education. And… Was that a good review? I think I just did it. Good. All right.

And I wanted to move on to communication, right? So you were talking about the communication aspect with your provider, and I was commenting, or I was about to comment that it’s really fascinating, because there’s this idea now in medicine that you don’t need a relationship with your provider, your doctor, midwife, whoever, that there’s sort of… You know, you can have these very large integrated groups, or you could have people you don’t know take care of you. But is that true? Meaning do you find that the communication piece, is it just simply how someone talks to someone at the time? Or is having a relationship, like a known relationship with your provider in advance, sort of a good way to prevent communication breakdowns?

Dr. Jorda: Oof, that is a tough question. I am a huge…

Dr. Fox: This is not a fluff podcast, my friend. We’re throwing…

Dr. Jorda: I know.

Dr. Fox: You know, this is “60 Minutes.” We’re throwing 100 miles an hour at you here.

Dr. Jorda: Yes. I am a huge fan of continuity of care, and continuing that relationship with a provider, because I do think it allows you to have almost that shorthand communication.

So say you talked about OB emergencies and operative vaginal delivery with your patient in the clinic, and then you’re in the midst of a deceleration during the second stage of labor when someone is pushing, you can almost do that shorthand, like hey, remember when we talked at your 36-week visit about emergencies? You know, we’re not quite in that scenario yet, but we are approaching that, and I don’t want to get into a situation where we only have a couple minutes to intervene…and then quickly go over operative vaginal delivery again, the risks, benefits, and alternatives. And if I think that is at all approaching, I will mention that, and it really makes that conversation easier, because you’ve already had it in a non-stressful situation.

Now, does it have to be you personally as the provider every time? No. I’ve had other patients that I’ve counseled in clinic end up delivering at a different time, when I wasn’t available, or when I wasn’t on call, and this patient had an emergency cesarean section, and she said, you know, I remembered exactly what you told me, that this could happen, and I stayed calm with the team that was with me, right?

And so I do think it can go both ways. My preference is that relationship, because knowing someone for eight-plus months, that is huge. And for the patient, I think that deepens your relationship and trust with your care team. And so I think if at all that’s a possibility, I absolutely prefer that, but I know that’s not always possible. And so if I’ve done a good enough job with education in advance in the clinic, I do think that can be a good intermediary.

Dr. Fox: Yeah, I mean, I have mixed feelings about it as well. On the one hand, I do think there’s such value to having the relationship with the person who’s taking care of you, who’s delivering you, and I think that this is, like, a global issue in medicine, that sort of medicine used to be like, one patient, one doctor, pretty much for your whole life.

Dr. Jorda: Yes.

Dr. Fox: And there’s some real beauty to that, and there’s real deep connections there, and the communication, I think that not having that has led to a lot of communication breakdowns. But also, it is very impractical to do that because people aren’t available 24/7, and there are different specialties, and medicine is more complex in that sense, and you may need different people to take care of you, you know? So it’s not practical to just say, all right, I’m going to find one doctor, and see that person, you know, my whole life, my whole pregnancy, whatever it is, but I think there is…you know, there are some, like, lessons that are learned from that kind of relationship. It’s just this idea that it’s not…I don’t think it’s ideal to have this, like, sterile non-relationship between the two parties involved, right, the patient and the doctor, whatever it is, and to have, like, this wall between them.

Like, I do think it is okay to talk back and forth on a little more personal level. And even if you’re meeting them for the first time on labor and delivery, you know, to ask like, do you have any questions? Do you have any…you know, is there anything that you specifically want for your birth, or something you don’t want, you know? Just to sort of get into that, as opposed to just I’m here to take care of you, I’m here to deliver your baby, I’m here to make sure that, you know, you and your baby are well, and that’s my job, and I’m going to get out of here. That may be very…you may be proficient, but if you don’t have that rapport, or you can’t develop any form of rapport, it is going to affect communication when things start happening, potentially.

Dr. Jorda: Absolutely.

Dr. Fox: Yeah. It’s not easy. I mean, it’s not easy for doctors, and it’s not easy for patients, I mean, the system we have now is definitely stacked against close relationships, but I do think it’s something that we need to consider in all the systems we set up, how do we either create that, or attempt to create something like it to mimic it, at least, in some capacity? And it’s a challenge. I don’t have an answer to it. I really don’t. I mean, in our own practice, we have a big practice, and we do our very best, but it’s one of the downsides to a big practice, obviously. There are upsides, but that is one of the downsides. And so I think that we do our… We try very hard to always be communicating, to try to combat this idea that, you know, we’re a big group, and I think we’re usually successful, but I assume we’re sometimes not, and it’s unfortunate in that sense.

But I mean, you obviously must work in a big group of other doctors, right? It can’t just be a couple of you.

Dr. Jorda: Yes, I do. I do work in a big group. For the patients that we take care of who’ve had a traumatic delivery, we absolutely try to be there for their deliveries for that reason, right? We’ve developed this relationship, this patient has shared their history of a traumatic delivery, they’ve shared a lot with us, and we want to honor that relationship, and try to be there.

But I will say there is a patient that I took care of her whole pregnancy, and she had transferred over to our group because she wanted to have that relationship, and know that person taking care of her because that was not present for her last delivery, which was traumatic. And I will have to say, that weekend she went into labor, I got sick, and it was the first time I’d gotten sick in a year, and I literally couldn’t get out of bed. And I felt so awful, right, because we had seen her for the whole prenatal care, and the whole point of her transfer into our group was that we were going to do our best to be there for her delivery. And I called her and I said I feel terrible, but I can’t get out of bed.

And you know, it wasn’t really an option for me to do that because I was so sick, but I could tell…I could see if I had some other conflict, or something where I wasn’t sick in bed, I might try to come in for that delivery, right, because I wanted to be there for that patient. But I also have to know that, gosh, have I done enough education in the outpatient setting? Have I set up a plan that other people can follow? And for this patient, she completely understood, and she had a wonderful delivery with the on-call team, following all of the principles that we had laid out together, and her plan.

And so, you know, for me it wasn’t ideal, but we know that we can still develop really good plans that other people can follow.

Dr. Fox: And then also, I think that, you know, the fact that you just reached out to her, you know, and she found out from you, like, hey, I’m sick, you don’t want me puking on your baby.

Dr. Jorda: Yeah.

Dr. Fox: I mean, like, it’s…you know, but I think people do appreciate that. I mean, they appreciate that because, you know, I mean, you’re human, I mean, you can’t…you know, you’re not a robot, obviously, and people get sick, or people…you know, they’re out of town, or whatever it might be. But the fact that you took the time to reach out to her shows that you care, and it also shows that you’re probably going to reach out to her, the team taking care of her, to make sure that everyone’s on the same page, and that’s probably why it worked out so well.

Dr. Jorda: Yep. Oh, definitely, I had conversations with the care team… It wasn’t just me calling the patient, right?

Dr. Fox: Yeah.

Dr. Jorda: I am 100% rooting for her to have a good outcome, so I need to kind of do things, to put things in place, and that involves making that call, and I can make that call from my bed, right? Like, that doesn’t mean I have to be physically there for every aspect.

Dr. Fox: Yeah. The third thing you were talking about, which is the expectation, right, education, communication, expectation, it’s really interesting that you were linking sort of expectations to guilt. Meaning it’s not… You know, there’s obviously the idea of being disappointed, right? If you have an expectation of A, and you get B, right, you may have a disappointment, right? I wanted this, and I got something else. But that’s… You know, disappointment is a kind of low-level, you know, type of feeling but guilt, that’s like…you know, that’s like the penthouse of feelings, you know, in this.

Dr. Jorda: Mm-hmm.

Dr. Fox: And I have also found the same thing. And it’s so unfortunate because it’s so unwarranted. Which is what guilt is, right? It’s not something you choose to have, it’s something you just have, you know, people feel so much guilt over something bad that happened to them. Like, they didn’t do anything, something happened. It’s like, you know, it’s like feeling guilty that you got hit by a bus, right? It’s just so… It makes no sense, obviously.

Dr. Jorda: Yes.

Dr. Fox: But it’s so real. And it’s interesting that you link it to expectations, and I think that’s very true, that if you expect something and you get something else, you sort of feel like it’s my fault that this didn’t happen. That is hard. And have you found that if people have different expectations, they just don’t have the same amounts of guilt?

Dr. Jorda: Oh, gosh. You know, I feel when patients are blindsided by an outcome, that that is the most challenging, right? Because that didn’t even enter their mind as a possibility. But sometimes, why would a bad outcome necessarily enter their mind? But I think if we message, as a society, that obstetrics is always 100% happy, yes, the vast majority of the time it’s happy and wonderful, but when it’s not, it can be downright devastating. And if you are coping with that on your own, isolated, ashamed, worried about something, that is not helpful either.

And so I do think being able to process with a clinician who has seen bad outcomes, right, we are able to give that perspective of, gosh, I know you probably feel like you’re the only person this has ever happened to, but you’re not, right? And that opens that door a little bit. And are there peer support groups we can get you connected with? Are there others that you can reach out to? That can be incredibly healing.

Dr. Fox: Yeah. And I think that it’s also one of these things that there’s, number one, there’s a balance with expectations, and number two, it’s different for every person. Meaning it’s probably not appropriate to tell…you know, to give someone the message, you know, like you said earlier, in the last week’s podcast, you know, all births are great, your body can do anything, nothing bad is going to happen to you, because that’s…A, it’s false, and B, the expectation is if that doesn’t happen, it’s going to lead to, potentially, some really serious trauma or guilt from it.

On the other hand, it’s not great to sit someone down and say, all right, here’s the 100 horrible things that could happen to you and your baby, starting with number 100, and we’re working up to number 1.

Dr. Jorda: Right?

Dr. Fox: Like, that’s also probably not a great way to go either. And that takes a little bit of finesse, I would say, on the the doctor end of it, you know, to sort of be able to get the messaging that, you know, you’re healthy, we expect everything to go well, you know, but sort of talk about these are things that, you know, might come up, or you might hear about, and you know, how to do that well is hard, and also it’s probably going to differ for every person. Because like you said, some people want more information about adverse outcomes in advance, and other people just don’t. And you know, like, I get it, you know, but I don’t need to hear about it right now. And I think that that takes a lot of, you know, EQ on the level of, you know, the provider, more so than IQ.

Dr. Jorda: Yes.

Dr. Fox: And not everyone’s got the chops for that, unfortunately. Most doctors have a pretty high IQ, but EQ is, you know, maybe yes, maybe no. Not easy to pull it off. I mean, it’s hard. I mean, I do my very best with those things, to try to read the room, and read what they’re looking for, and like, I think I’m pretty good with people, but obviously, I’m sure I fail some with that. But it’s challenging.

Dr. Jorda: Yes, 100%. And no physician is immune to that, right? Like, we do our very darndest, but sometimes there’s a communication style that is just not working for a patient, right? I can absolutely share that, you know, I took care of a patient who had a neonatal demise in her last pregnancy from a listeria infection. And I took care of her in my clinic throughout the whole pregnancy, and she had a wonderful induction, and everything was going really well until that second stage of labor, and she was pushing for a good four hours. She was getting tired, and I told her, gosh, we probably should think about a forceps delivery, because I know you’re getting tired, baby’s looking like they’re showing a little fatigue too, and you could meet your baby sooner, and that would be safe, right? And she’s like, gosh, no, I’m not so sure about that…

And my counseling style is usually pretty collaborative, and I…you know, we kept pushing, I kept speaking with the patient, and giving her updates, and labor still kept going and I was like, you know what? I think we should really talk more seriously about a forceps delivery, and she said, no, no, I don’t want to do that. And finally I spoke to one of my colleagues who was on the obstetrics floor, and I said, “Gosh, you know, I don’t know if I’m getting too close to this situation, but I’m making this recommendation, and my patient is electing to continue pushing. Can you kind of review what I’ve been doing, and see if there’s anything that you would recommend differently?”

And so my colleague very graciously agreed to talk to review the case and talk to my patient, and the patient shared what was going on.S he’s like, “You know, I need to leave this hospital with an alive baby. It is really hard for me to make this decision. You know, if you think this is the recommended course, then I think that’s okay. But it’s really hard for me to make this decision.” And so I said, gosh, I’m so glad that information came out, right? And usually I’m a lot more collaborative, but then I much more enthusiastically made my recommendation, the patient agreed, right…

Dr. Fox: Yeah, the Mount Sinai came out in you, saying let’s do this…

Dr. Jorda: Yes.

Dr. Fox: You’re like, I’m going to suppress my Portland, and I’m going to bring back my New York.

Dr. Jorda: Yep, and I still got it. I still have it in there.

Dr. Fox: Like, all right, we’re doing this. Let’s go.

Dr. Jorda: Right? Exactly. And we did, and the baby came out great, and she got the outcome that she was hoping for. So I do think that nuance of communication style, that comes up a lot, and it’s okay to change up your style and ask for help. So for me as the clinician, I 100% wanted to a good outcome for this patient, but I needed some help. I needed some perspective in that moment, and I got it, and it was incredibly valuable information. And I don’t feel afraid or nervous about asking for help, and it’s again, that supportive relationships with colleagues. That’s important, right? If I didn’t have that supportive relationship, I could get into an event or an experience or an effect that isn’t good, right? And so supportive relationships for both patients, and the clinical care team, it’s huge.

Dr. Fox: Yeah, I mean, I was planning, and I mentioned this last podcast, I was going to ask you what can providers do for education, communication, and expectation? And we’ve been talking about it. It’s sort of been folded through this conversation, about what patients can do.

And I think with communication, we’re talking about a lot of really important themes that, you know, there are different styles, you know? On the one hand, like you said, there’s like, a very collaborative model, which is, you know, here are the options, you know, you have autonomy, you make your own choices for your health, I’m here to educate you and to help you and to guide you, which is great, and then the other model is, you know, I’m the doctor, I’m a professional, I’m going to tell you what’s best. And there is… Different people want different things. Different people need different things. There is sort of a balance between those two.

And that is again the sign of, you know, when people ask me, like, how do I know if my doctor is any good, I’ll tell them that they’re sort of not always one or the other, they sort of know when it’s the right time to sort of put out options on the table, and say here’s what I think about A, here’s I think about B, what do you think, you know, sort of in that model versus listen, you need this. Like, I’m telling you, like, I’m trained, like, this is what I know, and option A is really the one you need to do. And it’s not always one or the other, and that is a very…it’s not trained. Like, you can’t… It’s not something that we focus on a lot in training, although we should, when we, you know, train young doctors how to do this. But it is really critical that people have that ability to communicate in different ways, with different patients, at different times. That is really, really important stuff.

Dr. Jorda: Yes, absolutely.

Dr. Fox: The other thing is… One of the things that I do, like, overtly train students and residents is when emergencies happen, again, and the level of emergency is going to vary, but when something’s going on, we’re always…the training that we always do is, you know, you focus on what is happening, the pathophysiology, the solution, you know, like what’s the problem, why is it happening, how do I fix it, right? And so like a hemorrhage, you know, like why is she hemorrhaging, what do I need to do to stop it, and to, you know, stop her from bleeding, save her life, all very, very important.

But it’s not that hard at the same time to communicate, right? And just literally, just while you’re doing this, the difference between doing all that and saying nothing, versus doing all that and saying to her, hey, you’re bleeding a little more than expected, it’s a little more serious than I would like, we’re going to do A, B, and C, you’re going to be okay, right? We’re going to take care of you, you’re going to be okay. Like, that five seconds can change someone’s life, and how they experience a hemorrhage, and sometimes we forget to do that.

Dr. Jorda: Absolutely. You know, our hospital does emergency training drills, and the rule for the attending physician was literally communication. And when that training rolled out, some of my colleagues laughed. They were like, that’s ridiculous. That’s the only thing I’m supposed to do? I can do other things, right? I can help insert the Foley catheter, I can help connect the Bovie, I can take care of equipment… But actually, no, just the communication with the patient, or controlling the communication with the partner, right? A spouse might be outside, freaking out. It doesn’t take much, but you, as the leader of that team, can say to a nurse, hey, I need you to communicate with the partner, and let them know what’s going on. They haven’t had an update for a while, right? It’s so small, but enormous for the patient and their family.

Dr. Fox: Yeah, I mean it really is on the communication end, like, that is what we can do to try to make an event not lead to a bad experience. And really, it’s communication with the patient, right, what’s going on, it’s the family, and like you said, there’s also, there’s another level of communication you’re talking about between the care team, and that is, A, probably just going to lead to a better outcome. But I think B, when sort of the patients, they’re lying on the bed or the table, or their family’s watching, when they see the team working together efficiently, they’re like, all right, this is a group of people who are taking care of me, right? They are really…they’re functioning to take care of me, and that is very soothing. Versus when you see complete pandemonium out there, and you’re like, oh, my God, these people are going to kill me, right?

Dr. Jorda: Yeah. Yeah.

Dr. Fox: And it’s so critical to their view of what is happening to them, this communication when people are speaking. And again, it’s so odd because everyone knows how important it is, but we don’t… I mean, I’m glad during your drills you guys focus on it, it’s not focused on, because everyone’s focused on, all right, what do I need to do to stop the bleeding? Which obviously you need to do. Like, that’s critical. But you can do that, and the patient can be left with 30 years of trauma, or you can do it, and the patient can walk out and feel great that her life was saved. And the same thing happened to her, and it’s just really how you communicate it to her, and to each other at the time that’ll potentially make it go one road versus the other.

Dr. Jorda: Yeah. And we, as obstetricians, we can do some of that team training, and do some of that communication. So I think most obstetricians feel really good with emergencies, right? Like, that’s our adrenaline rush, and being able to lead in an emergency is huge. But you can lead in a way that isn’t freaking people out, and you can lead in a way that is calm and reassuring. So sometimes I’ll say in an emergency, okay, can we bring the noise level down, right? Because yes, there might be a lot of side conversations, but people need to be able to clearly hear from the leader, which is typically the obstetrician in the room, what needs to be done. And that, and managing your emotions, as the obstetrician, that’s huge, right?

Dr. Fox: Right.

Dr. Jorda: You can be…right, I think back to that delivery way back when, when you were like, all right, let’s do those forceps delivery. My hands are shaking, I’m like, the metal’s clanging, right, that was early on in my training. But at this point, I’m like, you know what? I need to be a calm and sturdy presence for this whole team, and my patient.

Dr. Fox: Yeah, it’s amazing. I want to shift a little bit, and focus on the impact, potentially, of this trauma on the care providers, right? Because we were focusing a lot on trauma that the patients experience, but there’s also a level of trauma that comes up for the providers. And I know that you talk about that, and you focus on that as well, so let’s talk a little bit about that. What is your experience with that, or your understanding about the trauma that happens for the providers?

Dr. Jorda: Yes. So as obstetricians, again, a lot of the time, things are really, really great, and when there is a bad outcome, it can be devastating. And so we, as obstetricians, need to kind of figure out ways to cope, because we can, over time, see so many of those experiences, that it can negatively impact us. And again, I’m thinking about the supportive relationships. So for us, as healthcare workers, it may be reaching out to a fellow colleague when they have a bad outcome.

I’ll never forget when I had a bad outcome, my boss at the time came up to me and said, “You know, I reviewed the tracing, I wouldn’t have done anything differently.” And that was so helpful and healing for me, and my boss was very emotionally intelligent, and came up to me because they had heard of that outcome. And at the time I was more junior in that practice, so I wasn’t savvy enough to reach out to my fellow colleagues at the time, but again, my boss took that load off of me, and just came up to me, not at my request, and shared that, and that was incredibly helpful for me to be able to continue showing up for work the next couple days, right, and to heal from that experience.

Because like you said, nobody goes into medicine wanting a bad outcome for a patient. It is devastating for us, as providers.

Dr. Fox: Yeah, it’s so interesting, because you know, I trained back in the old days, and I can tell you, I think that this idea of trauma to the providers was always real, obviously, but it was just dealt with so differently when I was trained. I remember, I’ll tell this story, when I was…I think it was the first C-section I did, or maybe the second C-section I did. It was really, really early in my training. And it wasn’t a particularly complex situation, but during the C-section, she started to hemorrhage, and it was just me as the intern, and the attending, and I remember…literally she’s hemorrhaging, I don’t know what to do, right? I literally, I don’t know what’s going on.

He points at me, and he goes, “You cut her uterine artery,” right? Meaning, like, it’s my…and she’s filling with blood…so at the time, I’m like, well, that’s not good. So number one, he called in for the senior resident to scrub me out, and at the same time, I started getting very lightheaded, dizzy, and I basically, the second I walked out of the operating room, I passed out, right? So I’m lying on this stretcher in the hallway, and you know this hallway very well, right outside of the operating rooms in the [inaudible 00:29:13] labor floor. So I’m on the stretcher that was intended for this patient, just lying there, passed out, the chief is in there scrubbed with him, I think I just killed somebody, right? And so that’s my first C-section. Good job.

So after, you know, I sort of come to, Ray Sandlarsher came by, who was really nice to me. This was before he was the labor director. He was an attending then.

Dr. Jorda: He’s so nice, yes.

Dr. Fox: So he’s like, it’s okay…you know? He sort of did what your wonderful attending, he said it’s okay, don’t worry…you know? So I’m sitting up, sitting on bed, the chief comes out at the time, I won’t say her name, but she was old-school, and she said to me, “You all right,” and I said, “Yeah, I think I’m okay now.” She goes, “Get your shit together. You’re scrubbing on the next section.” That’s how we dealt with trauma back then.

Dr. Jorda: Yes. Yes.

Dr. Fox: So I was like, okay, so I got my shit together, and I scrubbed in on the next section, and it was all fine.

Dr. Jorda: Yes. Yes.

Dr. Fox: So I bring that story up, A, because I’ve always found it humorous, but I want to ask you a question, and this is a very sincere question. We’ve just described two very different paradigms for dealing with trauma, and the first paradigm is supportive communication, discussion, thought, you know, healing, and the second one is get your shit together, right?

Dr. Jorda: Yep.

Dr. Fox: And those are two very, very different ends of a spectrum for dealing with trauma. And my question to you is, in your experience doing this, is it always better to be on sort of the more touchy-feely side of it? Is it sometimes better to just say to someone, listen, you’ve just got to get over this? I mean, I’m just trying to get a sense, because no one really knows the right answer to that question, in a sense, you know? Because it worked for me, right? That was fine.

Dr. Jorda: Yeah.

Dr. Fox: Like, I don’t have any…I don’t feel any trauma from that event. I joke about it, I think it’s a great story, and I literally have nothing from it. But potentially, that could have been the worst thing she ever said to me.

Dr. Jorda: Mm-hmm.

Dr. Fox: And so, how do you sort through that, like, those different ways to deal with trauma, both for the provider, for the patient…right? Because I mean, sometimes, like, I’ll be speaking to a patient, and I’m pretty communicative, and I really…like, I want people to trust their feelings. Like, I’m sort of on that end of things. But every now and again I come across someone, and they’re talking about something, like oh, and you know, my discharge had to be delayed by a day, and I feel like it’s so traumatic to me…and I just want to say to them, like, get over it. Like, at a certain point, like, you know, like, you’re just… Like, this is too much.

Now, it doesn’t happen a lot. Most of the things we’re hearing about are a much different situation. But do you ever say that to somebody, like dude, this isn’t trauma, you’ve got to move on? Or is it like, is it just not helpful ever?

Dr. Jorda: Yeah. You know, that definition of trauma is defined by you, and your lens, right? And so I do think that would be challenging, to tell a patient, like, no, this is not trauma. Like, that’s not validating, right?

Dr. Fox: Right.

Dr. Jorda: But like, okay, if we are living in that space of, like, gosh, like, poor me, this thing happened to me, like, there is… You know, people who have had trauma are very resilient, right? And sometimes it’s a matter of reminding them, okay, you have had this experience. What can we do moving forward? Or what have you learned from that experience that you can bring upon some of your own resilience, right? And remind patients of their own agency, and that it’s not just, gosh, this thing happened to me. Like, yes, that happened to you, but what are we doing kind of moving forward, right? I do think that can be a productive way to kind of move that conversation along.

In terms of the providers, I mean, right, like, we deal with patients and their health all the time. So I think there are times when you’re like, yeah, it’s time to get your shit together, right? Like, I talked about a vaginal hysterectomy, right? Like, I have definitely cut a hole in someone’s bladder, and been like, okay, now I want to go cry, right?

Dr. Fox: Right.

Dr. Jorda: But like, that’s not going to happen, because you can’t operate while you’re crying, right? You can’t see…right? So that… I mean, we, as clinicians, are really good about, okay, now is not the time for that, right?

Dr. Fox: Right.

Dr. Jorda: Like, I have to get my shit together, I have to take care the patients in front of me, but at some point, I have to process that, right?

Dr. Fox: Right.

Dr. Jorda: And so, for your example, right, yeah, you got your shit together, but like, maybe you went home that day and talked to your family. Maybe you went to…right? Maybe you shared it at another time. And so I think when we, as clinicians, don’t find a way to process that on some other time, right, because there’s sometimes when you’re with patients, and you’re like, now’s not the time, right, but otherwise, if it doesn’t get processed, if you’re not addressing that, if you’re not reaching out to your supportive relationships, like, physicians have incredibly high rates, higher than the general population of suicide, alcohol abuse, drug abuse, right? And I don’t think it’s a surprise that it’s because we do a lot of hard things, and then if we don’t process that, and if we don’t do other ways to get through that, that it manifests in those things.

Dr. Fox: Wow, do I love your answer. That was awesome. I mean, I agree, first of all, with you 100%. I think with patients, I would never tell someone that, obviously. I just think that it’s not…it’s not helpful. Because like you said, the trauma’s the experience, it’s not the event. So even if I’m sort of like, internally like, why would that event lead to that trauma? It doesn’t make any sense to me. What’s the difference, right? Who cares, right? Who cares that I think? I’m not the one experiencing it. But I do think that, you know, always start with validation, like you said, like, this is traumatic to you, this is your experience, but part of the resolution could be, like you said, to say, all right, you know, let’s focus on what you can do, and sort of where your strength is, and how we can sort of put this in a different context, or whatever it might be. And again, this is hard to do, but it’s not sort of just telling… It’s not blowing them off, is essentially… You can’t just blow someone’s experience off, in that sense.

Dr. Jorda: Yeah.

Dr. Fox: Because it’s not… First of all, it’s mean, right? It’s just not nice to them. But also, it’s not helpful. It’s not gonna work, right? It’s just not productive, I guess is the best term.

But you know, with us, and like, with our trainees, yeah, there’s a time and a place for it. Like, if they can’t…you know, if they’re going to harm the next patient because they’re sitting and crying about the first patient, that’s bad, right? And so we just sort of train to compartmentalize certain things in our lives.

It’s the same thing if you’re having like a lot of stuff, let’s say, in your personal life or at home, of course it’s going to affect your job, and it’s horrible. But ultimately, if you’re at your job, you’ve got to take care of your patients, and sort of train yourself to sort of put that aside, and then hopefully find the time in the space to work through those things, again whether it’s from a past patient, or whether it’s from something at home. Because if you don’t, if you’re only compartmentalizing, that can lead to very bad things as well. And that’s also very tough to train on, A, how to compartmentalize, and B, how to sort of then remove those blocks, and actually address it at some point.

Dr. Jorda: Yeah. I mean, sometimes at work you feel a little bit like…you can feel like a little bit of an emotional robot, right?

Dr. Fox: Yeah.

Dr. Jorda: Like, ugh, this hard thing happened, but I can’t deal with that because I have to access all of this medical knowledge, and come up with a plan. But you don’t have to be that way all the time, right?

Dr. Fox: Right.

Dr. Jorda: And so there is a time and a place to be able to, like, gosh, that was really hard. And that might be when I call up a friend of mine from residency, or one of my class members, and we talk about this hard experience, right, and because that is a supportive relationship to me.

Dr. Fox: Wow. Kathy, thank you so much for taking so much time to come on the podcast two weeks in a row.

Dr. Jorda: Thank you.

Dr. Fox: I love what you’re doing. I think you’re awesome. I thought you were awesome before, and then you left us, but you’re still awesome out in Portland. And it’s just…it’s such an amazing thing you’re doing, and this is such an important topic. Because so many people have a form of trauma from their life, from their birth, from whatever it is, and I think the more that all of us, the providers and the patients can sort of be open about that, and talk about it, and try to improve upon it, it really, really can change someone’s life, and I just really appreciate that you’re doing your best on this. I just think it’s great, and thanks for educating all of us about it.

Dr. Jorda: Yes. Thank you so much for having me.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast, or any other topic you would like us to address, please feel free to email us at HW@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only, and does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health, and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.