WEBVTT 1 00:00:00.600 --> 00:00:03.680 Welcome to the Trauma Therapists podcast. My name is Gaming Person. 2 00:00:04.240 --> 00:00:07.839 I interview incredible people who've dedicated their lives to helping 3 00:00:07.879 --> 00:00:11.000 those who've been impacted by trauma. A big thank you 4 00:00:11.080 --> 00:00:14.439 to our sponsors and our guests who are supporting this show. 5 00:00:15.080 --> 00:00:19.199 So vive for Grade too and one our folks book 6 00:00:19.239 --> 00:00:22.199 back to the podcast. Very excited to have as my 7 00:00:22.239 --> 00:00:26.199 guest today, Doctor Jim Jackson. Jim Welcome, Thanks guys. 8 00:00:26.199 --> 00:00:28.000 It's really good to be with you today and I'm 9 00:00:28.039 --> 00:00:30.399 excited to talk to you today and to your listeners 10 00:00:30.440 --> 00:00:32.079 about medical trauma. 11 00:00:32.200 --> 00:00:36.000 All right. Jim is a clinical psychologist, researcher, and award 12 00:00:36.119 --> 00:00:40.759 winning author specializing in trauma, PTSD, and the psychological impact 13 00:00:40.799 --> 00:00:44.039 of critical illness. He serves on the faculty at Vanderbilt 14 00:00:44.159 --> 00:00:48.359 University Medical Center, where his work focuses on ICU survivors 15 00:00:48.560 --> 00:00:51.920 and the long term effects of medical trauma. Doctor Jackson 16 00:00:52.200 --> 00:00:55.119 is the author of Clearance, as well as Reclaiming Your 17 00:00:55.119 --> 00:00:58.359 Life from Medical Trauma, his latest book offering a practical, 18 00:00:58.479 --> 00:01:03.119 compassionate roadmap for survivors of serious illness and ICU stays. 19 00:01:03.600 --> 00:01:07.319 Drawing on clinical experience and patient stories, the book helps 20 00:01:07.359 --> 00:01:11.799 readers understand post intensive care syndrome process trauma, and we 21 00:01:11.840 --> 00:01:15.439 build a sense of meaning and identity after medical crises. 22 00:01:15.879 --> 00:01:17.920 All right, Jim, obviously, just a little bit about you 23 00:01:18.159 --> 00:01:22.079 share with the listeners where you're from originally and where 24 00:01:22.120 --> 00:01:23.280 you are currently. 25 00:01:23.640 --> 00:01:27.359 Yeah, sure, thank you, Yeah, thank you. I'm from southwestern Michigan. 26 00:01:27.519 --> 00:01:30.680 I don't know how many listeners you have from Michigan, 27 00:01:30.719 --> 00:01:33.200 but I'm from right outside of Kalamazoo, a little town 28 00:01:33.239 --> 00:01:37.799 called Portage. And I love Michigan, but when I moved 29 00:01:37.799 --> 00:01:41.000 to a warmer locale, living there seemed a little bit 30 00:01:41.079 --> 00:01:44.400 less good. And I now live in a place where 31 00:01:45.040 --> 00:01:47.680 they don't have six months of winter, and that is 32 00:01:47.719 --> 00:01:51.079 in Nashville, Tennessee. I've been here for about twenty five years. 33 00:01:51.439 --> 00:01:54.480 Awesome, all right, so we're going to get into the book. 34 00:01:55.040 --> 00:02:00.319 I'm really curious how you started out, how you got 35 00:02:00.319 --> 00:02:02.879 pulled into this field in the first place, and then 36 00:02:02.920 --> 00:02:08.599 more specifically trauma and the effects of critical illness and 37 00:02:08.680 --> 00:02:12.039 chronic illness secondarily. But how did it all begin for you. 38 00:02:12.400 --> 00:02:15.280 It's a really good question, you know. I have Vanderbilt 39 00:02:15.400 --> 00:02:18.879 undergraduates who are in our lab here at Vanderbilt, and 40 00:02:19.199 --> 00:02:23.080 often they asked me for career advice, and I wish 41 00:02:23.199 --> 00:02:26.560 that I could tell them that it's a linear process, 42 00:02:26.639 --> 00:02:29.120 right like you set out down a straight path and 43 00:02:30.360 --> 00:02:32.879 you know how it's going to work. In my life, 44 00:02:33.000 --> 00:02:36.360 that rarely has been how it happens. I came to 45 00:02:36.439 --> 00:02:40.800 Vanderbilt to do a psychology residency at a place called 46 00:02:40.800 --> 00:02:46.759 the Vanderbilt VA Consortium. And during those days in two thousand, 47 00:02:46.840 --> 00:02:50.479 there was a critical care researcher named Wes Elee who 48 00:02:50.520 --> 00:02:54.479 was just starting a program focused on outcomes and ic 49 00:02:54.639 --> 00:02:58.319 you survivors, mental health outcomes, and he needed a psychologist 50 00:02:58.719 --> 00:03:01.960 and I happened to be one, and we had a 51 00:03:02.000 --> 00:03:04.719 baby on the way, and I needed a job. And 52 00:03:05.639 --> 00:03:07.719 it was really that simple, you know. I dipped my 53 00:03:07.759 --> 00:03:10.400 toe in the water. It felt fine, and then I 54 00:03:10.479 --> 00:03:14.319 jumped into the deep end and began to study specifically 55 00:03:14.400 --> 00:03:17.800 individuals who had been on a ventilator, on a respirator. 56 00:03:17.840 --> 00:03:21.199 Often they'd had a condition called sepsis or something called ards. 57 00:03:21.240 --> 00:03:24.520 They were the sickest of the sick, and in dealing 58 00:03:24.560 --> 00:03:27.439 with them, what I noted, again this is almost a 59 00:03:27.520 --> 00:03:30.000 quarter of a century ago, what I noted was that 60 00:03:30.120 --> 00:03:34.439 often they had recovered physically very well, but now because 61 00:03:34.479 --> 00:03:38.919 of the difficulties of being in the ICU, they had 62 00:03:38.960 --> 00:03:41.919 brand new problems they didn't have before. And often those 63 00:03:41.960 --> 00:03:45.680 problems were of a cognitive nature, that is, they had 64 00:03:45.719 --> 00:03:48.800 brain injuries. But very often those problems were of a 65 00:03:48.879 --> 00:03:52.199 mental health nature. They had symptoms of PTSD, they had 66 00:03:52.199 --> 00:03:56.560 symptoms of anxiety, They were worried about their health, they 67 00:03:56.560 --> 00:03:59.960 were bewildered by the brand new chronic illnesses that they 68 00:04:00.080 --> 00:04:04.439 were now experiencing. And as I began to engage with 69 00:04:04.520 --> 00:04:07.680 those patients in research studies and later in the clinic, 70 00:04:08.439 --> 00:04:12.280 as I pulled the thread, the story started to kind 71 00:04:12.319 --> 00:04:15.159 of unravel, and that was it was a story in 72 00:04:15.240 --> 00:04:19.519 which medical trauma. I didn't have that term. Then, you know, 73 00:04:19.560 --> 00:04:22.040 people have since started using it. It was a story 74 00:04:22.040 --> 00:04:25.600 in which medical trauma played a central role. These were 75 00:04:25.600 --> 00:04:30.040 not veterans of combat. These were not survivors of other 76 00:04:30.160 --> 00:04:33.519 things that we think of causing trauma, like sexual assault. 77 00:04:34.240 --> 00:04:37.720 These were not survivors of auto accidents. They were survivors, though, 78 00:04:38.040 --> 00:04:41.480 of a different kind of trauma, medical trauma. And even 79 00:04:41.519 --> 00:04:45.079 as those other conditions left to Mark, I began to 80 00:04:45.160 --> 00:04:49.040 learn that these life threatening medical conditions left to Mark, 81 00:04:49.399 --> 00:04:52.639 and as my work at Vanderbilt evolved, I moved from 82 00:04:52.680 --> 00:04:57.040 working with survivors of critical illness to people with chronic illness, 83 00:04:57.120 --> 00:05:01.600 to people after complicated surgeries, total populations of all kinds, 84 00:05:01.959 --> 00:05:07.600 and the same truth held, and that is, medical trauma 85 00:05:07.720 --> 00:05:09.959 was central to their story. It wasn't the only problem 86 00:05:10.000 --> 00:05:12.639 that they had for many it wasn't the prime problem, 87 00:05:12.800 --> 00:05:15.519 but it was a key problem. And I decided that 88 00:05:15.600 --> 00:05:18.120 someone needed to shine a light on this problem, which 89 00:05:18.199 --> 00:05:19.439 was really underappreciated. 90 00:05:20.000 --> 00:05:22.519 All right, let me pause you right there, so we're 91 00:05:22.519 --> 00:05:25.360 gonna get dive into that. I want to take a 92 00:05:25.399 --> 00:05:29.439 step back. How the heck did you get into psychology 93 00:05:29.519 --> 00:05:30.240 in the first place. 94 00:05:30.639 --> 00:05:33.519 It's great question. I wanted to be a sportscaster. That 95 00:05:33.680 --> 00:05:34.759 was my passion. 96 00:05:34.839 --> 00:05:36.000 I could see that with you. 97 00:05:36.199 --> 00:05:39.439 That was my passion. And I was pretty good, I 98 00:05:39.480 --> 00:05:44.199 will say I was pretty good on air. But all 99 00:05:44.279 --> 00:05:47.360 the technical things that editing back in the day, and 100 00:05:47.399 --> 00:05:51.199 the splicing of film and learning to work a camera, 101 00:05:51.560 --> 00:05:54.040 that was very intimidating to me. And I wasn't really patient. 102 00:05:55.160 --> 00:05:57.920 I'm not actually patient now, but I very much wasn't patient. 103 00:05:58.399 --> 00:06:00.959 I really didn't want to be a sports caster if 104 00:06:00.959 --> 00:06:03.959 I had to do a lot other than talk, which 105 00:06:04.000 --> 00:06:07.399 seemed at the time to be my singular gift. So 106 00:06:07.759 --> 00:06:11.079 I changed majors three or four or five times, graduated 107 00:06:11.120 --> 00:06:14.839 from college honestly in five years. By the skin of 108 00:06:14.839 --> 00:06:18.560 my teeth. I wasn't hugely focused in the nineteen eighties, 109 00:06:18.600 --> 00:06:21.720 but I had taken a psychology class or two and 110 00:06:21.800 --> 00:06:25.720 I had really enjoyed it, and after running around the 111 00:06:25.720 --> 00:06:29.800 barn a few times, it felt like helping people might 112 00:06:29.879 --> 00:06:32.480 really be my calling. So I got into a master's 113 00:06:32.519 --> 00:06:36.839 program in clinical psychology, a program in Atlanta, Georgia, really 114 00:06:36.879 --> 00:06:40.079 by the skin of my teeth. And while I was there, 115 00:06:40.240 --> 00:06:42.759 I met the woman that would become my wife, and 116 00:06:42.920 --> 00:06:45.120 she has been a great influence on me. She has 117 00:06:45.199 --> 00:06:48.040 focused me a lot, she has pushed me, she's empowered me, 118 00:06:48.600 --> 00:06:53.360 and with her belief in me, I quickly realized, I 119 00:06:53.360 --> 00:06:55.279 think I can do this, and I don't need to 120 00:06:55.279 --> 00:06:57.000 stop at a master's I think I'm going to get 121 00:06:57.000 --> 00:06:59.759 a doctorate. And before I knew it, I was in California, 122 00:07:00.079 --> 00:07:03.720 suing one and that's how it unfolded. I was discouraged 123 00:07:03.720 --> 00:07:07.720 at various times, as people are, and honestly This is 124 00:07:07.720 --> 00:07:10.439 a strange story, but a true one. Michelle and I 125 00:07:10.519 --> 00:07:13.240 were at a Chinese restaurant one day called August Moon, 126 00:07:13.879 --> 00:07:17.720 and I got a fortune cookie, still have it somewhere, 127 00:07:18.079 --> 00:07:21.319 and it said the fortune said you will prosper in 128 00:07:21.360 --> 00:07:24.879 the field of medical research. And I thought, how random 129 00:07:24.920 --> 00:07:28.319 is that? Right? Like, wow, very different than you'll find 130 00:07:28.360 --> 00:07:32.759 your true love or you know whatever generic fortune cookie 131 00:07:32.759 --> 00:07:34.879 say you will prosper in the field of medical research. 132 00:07:34.959 --> 00:07:38.759 And really candidly, I did take that as a sign, 133 00:07:39.199 --> 00:07:42.759 and I'm happy to say with humility that I have 134 00:07:42.800 --> 00:07:44.879 been able to prosper in the field of medical research. 135 00:07:47.000 --> 00:07:52.079 What a great story that is. So all right, you 136 00:07:52.160 --> 00:07:58.639 talked about the opportunity you had initially. I think when 137 00:07:58.639 --> 00:08:01.160 you when you were studying, you said you dip your toe, 138 00:08:01.240 --> 00:08:06.319 and then you said you dove in. What about working 139 00:08:06.480 --> 00:08:10.959 with these individuals who were experiencing medical trauma? Obviously that 140 00:08:11.040 --> 00:08:15.120 wasn't the term at the time, But what about those 141 00:08:15.120 --> 00:08:18.439 individuals or that experience drew you or pulled you. 142 00:08:19.079 --> 00:08:22.079 Yeah, it's a great question. So in the early days 143 00:08:22.120 --> 00:08:24.959 of my work two thousand and one, two thousand and 144 00:08:24.959 --> 00:08:30.279 two and three, we were enrolling patients and studies at Vanderbilt. 145 00:08:30.319 --> 00:08:33.480 But when we were following them up, and I was really, 146 00:08:33.480 --> 00:08:35.639 in those days, the only person that followed them up. 147 00:08:36.039 --> 00:08:38.200 I was following them up in their home. So I 148 00:08:38.240 --> 00:08:41.799 was driving all over the southeastern United States. I was 149 00:08:41.840 --> 00:08:48.000 going to Georgia, Mississippi, Kentucky, obviously, Tennessee, occasionally other places, 150 00:08:48.120 --> 00:08:51.120 all the time, multiple times a week. And as I 151 00:08:51.320 --> 00:08:55.000 was sitting across the table from these patients, these survivors 152 00:08:55.039 --> 00:08:58.279 of intensive care, eating cast or rolls at their dinner table, 153 00:08:58.480 --> 00:09:01.240 you know, sitting on the porch after we'd finished an assessment, 154 00:09:01.279 --> 00:09:05.039 really getting to know them, I was deeply moved by 155 00:09:05.080 --> 00:09:10.320 how derailed their lives were after these illnesses they had experienced. 156 00:09:10.360 --> 00:09:12.960 You know, their lives were turned upside down. They were 157 00:09:13.000 --> 00:09:17.120 often afraid to go to the er because they were 158 00:09:17.159 --> 00:09:20.000 worried that they would be sent back to the ICU. 159 00:09:20.480 --> 00:09:24.559 They were reacting to every single noise that they heard 160 00:09:24.840 --> 00:09:27.000 because it sounded like a noise in the hospital. You know, 161 00:09:27.039 --> 00:09:31.039 they were clearly hypervigilant. And as I got to know them, 162 00:09:31.080 --> 00:09:34.720 many of them quite well, I was touched. I was 163 00:09:34.840 --> 00:09:37.759 touched by the severity of their problems. I was touched 164 00:09:37.799 --> 00:09:40.159 by the fact that they didn't feel like they had 165 00:09:40.159 --> 00:09:43.879 any resources or anywhere to turn. And when that happened, 166 00:09:44.360 --> 00:09:47.000 I thought, you know, the least I can do is 167 00:09:47.039 --> 00:09:49.840 not dip my toe in, but jump in the deep 168 00:09:49.919 --> 00:09:52.360 end of the pool and really figure out how we 169 00:09:52.440 --> 00:09:55.200 can help those people. And that led to a lot 170 00:09:55.240 --> 00:09:58.279 of developments. One thing it led to was to the 171 00:09:58.399 --> 00:10:02.279 creation of a clinic for ICU survivors that I co 172 00:10:02.360 --> 00:10:05.679 founded with my friend and colleague, doctor Carlo Stephen. It's 173 00:10:05.720 --> 00:10:09.080 called the ICU Recovery Center at Vanderbilt, and that clinic 174 00:10:09.120 --> 00:10:13.360 has been going for about thirteen years now, and it's 175 00:10:13.399 --> 00:10:18.039 been dedicated to ice YOU survivors, and not only them, 176 00:10:18.159 --> 00:10:21.440 but to people with life threatening illnesses of all kinds 177 00:10:21.759 --> 00:10:26.080 who have complicated problems cognitive and mental health and physically 178 00:10:26.960 --> 00:10:29.440 physically driven problems. And people have come to us in 179 00:10:29.440 --> 00:10:31.879 the clinic really from all over the United States, from 180 00:10:32.120 --> 00:10:35.799 probably thirty different states, and it's been a privilege to 181 00:10:35.919 --> 00:10:39.039 try to address these challenges they have. And a recurring 182 00:10:39.159 --> 00:10:42.600 theme that I hear from them is when I talk 183 00:10:42.679 --> 00:10:45.200 to my PCP, when I talk to my counselor when 184 00:10:45.200 --> 00:10:49.000 I talk to my subspecialist about these problems, I'm having. 185 00:10:50.320 --> 00:10:53.320 They don't know what to do with me. They've never 186 00:10:53.399 --> 00:10:55.679 heard the term medical trauma. They don't know what post 187 00:10:55.759 --> 00:10:58.600 intensive care syndrome is, and on and on and on 188 00:10:58.679 --> 00:10:59.480 it goes, So. 189 00:11:02.039 --> 00:11:08.120 Me, okay, so clarify this if you can. What the 190 00:11:08.120 --> 00:11:10.440 hell are we talking about here? So these people go 191 00:11:10.519 --> 00:11:15.440 into the ICU, what do they When you think ic you, 192 00:11:15.679 --> 00:11:17.840 When I think ic you, you think a high level 193 00:11:17.840 --> 00:11:23.440 of care, a high level of amazing care. But a 194 00:11:23.480 --> 00:11:27.080 percentage of people are experiencing what we're calling medical trouble. 195 00:11:27.159 --> 00:11:28.440 What are they experiencing? 196 00:11:28.639 --> 00:11:32.000 It's a great question. Uh, And I should clarify. I mean, 197 00:11:32.039 --> 00:11:34.840 I agree with you. I work in the ICU a 198 00:11:34.879 --> 00:11:37.919 day or two a week at Vanderbilt, and at Vanderbilt 199 00:11:37.919 --> 00:11:41.360 and elsewhere, people get an amazing level of care. And 200 00:11:41.480 --> 00:11:46.600 yet that experience of being delirious and having episodes that 201 00:11:46.679 --> 00:11:51.679 are you know, essentially episodes of psychosis where people hear 202 00:11:51.720 --> 00:11:54.000 things and see things that they think are there but 203 00:11:54.279 --> 00:11:56.919 are not really there. Right Like, That's a common phenomenon, 204 00:11:57.200 --> 00:12:01.080 and it's very traumatic being on a ventilange and being 205 00:12:01.159 --> 00:12:04.960 mindful of the fact that you very well may die. 206 00:12:05.240 --> 00:12:08.840 It's hugely traumatic. The nature of the critical illness, which 207 00:12:08.919 --> 00:12:14.000 is often Hey, it's Wednesday, and on Monday I was fine, right, like, 208 00:12:14.039 --> 00:12:16.440 I was living my best life and I got infection 209 00:12:17.080 --> 00:12:20.000 and Wednesday I wake up with a tube down my throat. 210 00:12:20.399 --> 00:12:22.360 I have no idea where I am. I have no 211 00:12:22.399 --> 00:12:25.440 idea how I got there. Those are the sorts of 212 00:12:26.080 --> 00:12:33.039 traumatic experiences that people have and they are left to 213 00:12:33.120 --> 00:12:36.879 try to make sense of what has happened. And that's 214 00:12:36.960 --> 00:12:40.279 even in the context of the best care. You know, 215 00:12:40.320 --> 00:12:43.120 there are some situations where we can do the very 216 00:12:43.120 --> 00:12:46.240 best we can and it's still really hard, and critical 217 00:12:46.279 --> 00:12:48.480 illness is one of those. Cancer would be another one. 218 00:12:48.519 --> 00:12:48.799 I think. 219 00:12:49.879 --> 00:12:57.000 So is this something that has been left out of 220 00:12:57.240 --> 00:13:01.200 the treatment and care that I see you as delivering. 221 00:13:01.919 --> 00:13:07.639 Is this kind of not really frontline care? Is it 222 00:13:07.840 --> 00:13:10.320 just are they just thinking, well, we're just dealing with 223 00:13:10.440 --> 00:13:13.919 we've got to deal with and I'm sorry, but I 224 00:13:14.000 --> 00:13:16.360 mean to be blunt like that, but yeah, people are 225 00:13:16.360 --> 00:13:17.360 going to get traumatized. 226 00:13:17.679 --> 00:13:20.360 Yeah, I think I think there is a recognition that 227 00:13:20.399 --> 00:13:23.840 people will get traumatized and that we shouldn't be fine 228 00:13:23.840 --> 00:13:26.279 with that, right, Like, we emphatically should not be okay 229 00:13:26.320 --> 00:13:31.679 with that, and that despite our best efforts. There are 230 00:13:31.720 --> 00:13:36.919 going to be some emotional injuries, and those injuries are 231 00:13:36.960 --> 00:13:40.720 injuries that I think we can attend to thoughtfully in 232 00:13:40.799 --> 00:13:44.559 the ICU if we have the resources to do it. 233 00:13:44.639 --> 00:13:47.480 You know, for instance, when I see people in the ICU, 234 00:13:47.679 --> 00:13:51.840 I'm trying to set expectations. I'm trying to help them 235 00:13:51.879 --> 00:13:54.600 brace for what is coming. I'm trying to help them 236 00:13:54.600 --> 00:13:58.879 manage their anxiety. We're talking to families about more effective 237 00:13:58.879 --> 00:14:01.639 and less effective ways to provide support. So I think 238 00:14:01.720 --> 00:14:04.080 all of those things make a difference. Things that you 239 00:14:04.159 --> 00:14:08.200 might broadly call trauma informed care interventions, those make a difference. 240 00:14:09.240 --> 00:14:11.759 But it's really hard. You know, the nature of the 241 00:14:11.799 --> 00:14:16.240 critical illness is hugely hard. And as a consequence of 242 00:14:16.279 --> 00:14:21.639 it being hugely hard, you know, the science varies a bit, 243 00:14:22.120 --> 00:14:25.840 but you can find studies, many studies of PTSD, in 244 00:14:25.919 --> 00:14:29.519 particular in ICU survivors, that would say that it occurs 245 00:14:29.639 --> 00:14:33.480 in up to one in five people. You know, there's 246 00:14:33.480 --> 00:14:36.080 some studies that would say it occurs in even many 247 00:14:36.120 --> 00:14:40.279 more than that. You know, depression and anxiety is common. 248 00:14:40.559 --> 00:14:42.720 I think you hit on it. You alluded to this 249 00:14:42.840 --> 00:14:45.279 minute ago, and I think you're quite right. For a 250 00:14:45.320 --> 00:14:48.960 long time. The paradigm in so much of healthcare has 251 00:14:49.039 --> 00:14:53.440 been we are trying to help you. Let's talk about oncology. 252 00:14:53.639 --> 00:14:56.799 We're trying to help you survive your battle with cancer. Right. 253 00:14:56.879 --> 00:14:59.120 We want you to survive. We want you to survive 254 00:14:59.200 --> 00:15:03.080 the ICU, and very often there's a well meaning, but 255 00:15:03.159 --> 00:15:08.159 I think misguided dynamic, which is you survived. That's a 256 00:15:08.200 --> 00:15:12.000 great outcome. My job is done, yeah, exactly. And often 257 00:15:12.039 --> 00:15:14.879 in the ICU patients they don't come back and talk 258 00:15:14.960 --> 00:15:17.799 to the doctors who who treated them because they were 259 00:15:17.840 --> 00:15:20.399 life flighted from, you know, five hundred miles away. So 260 00:15:20.440 --> 00:15:24.360 it's easy to imagine, Wow, they left the ICU, they 261 00:15:24.360 --> 00:15:27.039 were pretty happy. I think they must be fine, right, 262 00:15:27.080 --> 00:15:29.759 And then when you interact with them, they often say, 263 00:15:30.440 --> 00:15:34.519 oh my gosh, like if I knew what would have happened, 264 00:15:34.879 --> 00:15:36.879 if I knew what my new life would be like, 265 00:15:37.919 --> 00:15:40.279 I'm not sure I would want to have survived. I mean, 266 00:15:40.279 --> 00:15:42.159 we don't hear them, but we hear it occasionally. 267 00:15:42.960 --> 00:15:46.159 All right, let me just remind everyone I'm speaking with 268 00:15:48.200 --> 00:15:52.320 doctor Jim Jackson. He's a clinical psychologist, and we're talking 269 00:15:52.399 --> 00:15:55.679 about his book, Reclaiming Your Life from Medical Trauma. So 270 00:15:56.200 --> 00:15:57.919 let's get into this book here, and I want to 271 00:15:57.960 --> 00:16:03.440 hear some stories. Why did you write this book? First off? 272 00:16:04.240 --> 00:16:08.000 Yeah, so I had written a book about long COVID 273 00:16:08.720 --> 00:16:14.600 about three years ago now, and the feedback I got 274 00:16:14.600 --> 00:16:17.360 from many people, many patients, was it was helpful. It 275 00:16:17.399 --> 00:16:21.399 was really empowering. And it occurred to me that these 276 00:16:21.480 --> 00:16:24.440 medical trauma survivors that I had been dealing with, and 277 00:16:24.440 --> 00:16:26.840 that many of us in the field are increasingly dealing with, 278 00:16:27.399 --> 00:16:31.440 that they didn't really have a solid patient facing resource. 279 00:16:31.519 --> 00:16:33.919 There was a book or two written for clinicians, but 280 00:16:34.320 --> 00:16:38.559 nothing for patients. And frequently I would get emails and 281 00:16:38.639 --> 00:16:40.759 other people in the field. I would get emails from 282 00:16:40.799 --> 00:16:43.679 people who would say, I think what I've got is 283 00:16:43.720 --> 00:16:48.320 medical trauma, but I don't exactly know, and I need 284 00:16:48.360 --> 00:16:50.600 a guide, you know, I need a resource. Can you 285 00:16:50.639 --> 00:16:53.399 help me? And occasionally it would come to Vanderbilt, but 286 00:16:53.440 --> 00:16:56.440 often that wasn't practical, you know, for whatever reason. And 287 00:16:57.480 --> 00:17:01.240 I really felt like there were useful things to say 288 00:17:01.240 --> 00:17:05.079 to these patients and their families and that it would 289 00:17:05.160 --> 00:17:07.720 be be a loving thing, really, it would be a 290 00:17:07.799 --> 00:17:12.319 kind thing to develop a guide for them, And that's 291 00:17:12.359 --> 00:17:14.839 really why I wrote the book Reclaiming Your Life for 292 00:17:14.960 --> 00:17:18.640 Medical traumas dedicated to patients, as dedicated to patients and 293 00:17:18.680 --> 00:17:23.599 families who I experience as so resilient and so brave, 294 00:17:24.720 --> 00:17:29.039 often in the face of really difficult things. And you know, 295 00:17:29.200 --> 00:17:35.519 I think you mentioned practical in the introduction. The book 296 00:17:35.599 --> 00:17:39.759 is designed to be very practical. Often in academics, you know, 297 00:17:39.799 --> 00:17:42.839 I'm in my office here at Vanderbilt. Often in academics 298 00:17:42.880 --> 00:17:48.920 we talk in abstractions, We talk very esoterically about complicated things, 299 00:17:49.359 --> 00:17:53.039 and I find that often unhelpful from the point of 300 00:17:53.119 --> 00:17:56.319 view of patients. So this is intended a lot of 301 00:17:56.319 --> 00:17:58.640 my analogies have to do with food, so forgive me, 302 00:17:58.759 --> 00:18:02.319 but this is intend to put the cookies on the 303 00:18:02.319 --> 00:18:06.160 shelf where people can reach them, right, Like, this is accessible, 304 00:18:06.640 --> 00:18:12.200 and it's a story in the book. It's a story 305 00:18:10.960 --> 00:18:15.400 of realism and hope. And would I would hold those 306 00:18:15.519 --> 00:18:19.039 two things together, Like, reclaiming your life from medical trauma 307 00:18:20.200 --> 00:18:22.799 is no simple thing, right, as you know from interviewing 308 00:18:23.039 --> 00:18:27.720 countless people with expertise in trauma and PTSD, reclaiming your 309 00:18:27.759 --> 00:18:34.920 life is no simple thing, and making progress is indeed possible. 310 00:18:35.039 --> 00:18:37.839 So trying to hold both of those things together, that 311 00:18:38.279 --> 00:18:41.440 it's not about rainbows and unicorns. Right, It's not simple, 312 00:18:42.000 --> 00:18:46.759 and it's satisfying, and you can find a way to 313 00:18:46.839 --> 00:18:51.079 live a meaningful life even in the midst of difficult things, 314 00:18:51.200 --> 00:18:54.000 even in the midst of medical trauma. And I think 315 00:18:54.079 --> 00:18:58.200 that last idea is really a central theme, really one 316 00:18:58.200 --> 00:19:00.559 of the central themes of my life, as somebody who 317 00:19:00.599 --> 00:19:04.480 has a chronic illness. That is, in an ideal world, 318 00:19:04.599 --> 00:19:07.279 we could take a giant eraser and just make every 319 00:19:07.279 --> 00:19:09.960 symptom go away, right, we just erase it from a whiteboard. 320 00:19:09.960 --> 00:19:13.359 In the actual world, that's not how it works, and 321 00:19:14.599 --> 00:19:19.640 we should seek to reduce suffering, absolutely, But if we can't, 322 00:19:19.920 --> 00:19:22.119 there's still a way to live a meaningful life. That's 323 00:19:22.240 --> 00:19:23.279 that's the theme of the book. 324 00:19:24.599 --> 00:19:28.799 Share with us, Jim, if you can an individual who 325 00:19:29.279 --> 00:19:33.440 maybe stood out to you or inspired you, or maybe 326 00:19:33.960 --> 00:19:38.319 even solidified this idea of I need to I need 327 00:19:38.359 --> 00:19:39.720 to do this work. 328 00:19:40.400 --> 00:19:43.599 Some years ago. I appreciate the question, and I'll change 329 00:19:43.599 --> 00:19:45.400 the details a bit, as I do in my book 330 00:19:45.440 --> 00:19:48.559 to preserve confidentiality. But some years ago we had a 331 00:19:48.559 --> 00:19:52.519 patient at Vanderbilt, and I think about her a lot 332 00:19:52.559 --> 00:19:57.839 candidly and she had been in in in the Caribbean. 333 00:19:57.920 --> 00:20:01.000 She'd been in a place out side of the United States. 334 00:20:01.079 --> 00:20:06.480 She'd become rapidly ill young woman, and had been life 335 00:20:06.559 --> 00:20:11.799 lighted to Vanderbilt actually from hundreds and maybe thousands of 336 00:20:11.799 --> 00:20:15.400 miles away, and she had a profoundly severe critical illness, 337 00:20:15.599 --> 00:20:20.160 and among many other things, it resulted in the amputation 338 00:20:20.599 --> 00:20:23.839 of most of the toes on one of her feet. 339 00:20:24.000 --> 00:20:27.680 And she was young. What we know is that medical 340 00:20:27.720 --> 00:20:31.119 trauma can be particularly challenging for people who are young, 341 00:20:31.240 --> 00:20:34.480 because if you're ninety years old in the ICU, you 342 00:20:34.559 --> 00:20:36.720 kind of expect to be sick, right, But if you're 343 00:20:37.079 --> 00:20:39.440 twenty two years old, it's a different thing. So she'd 344 00:20:39.440 --> 00:20:41.440 been in the ICU, usually sick, lost most of the 345 00:20:41.440 --> 00:20:43.839 toes on her foot, and she was a big surfer, 346 00:20:44.000 --> 00:20:48.240 that was a passion of hers. And she struggled a 347 00:20:48.279 --> 00:20:53.759 lot with anxiety and depression PTSD as well, believing that 348 00:20:53.799 --> 00:20:57.039 she could never reclaim her life right, never return to 349 00:20:57.079 --> 00:21:00.680 a meaningful life. And I worked with her, other people 350 00:21:00.720 --> 00:21:03.599 worked with her to support her. She was delightful, and 351 00:21:04.400 --> 00:21:08.799 she transitioned h away from Tennessee and and did what 352 00:21:08.880 --> 00:21:12.400 she did, and a year or so later, I got 353 00:21:13.119 --> 00:21:15.440 I got an email from her and it had a 354 00:21:15.640 --> 00:21:20.160 had a video attachment, and and I really cried when 355 00:21:20.200 --> 00:21:22.240 I when I opened it. It was a picture of 356 00:21:22.240 --> 00:21:24.839 her on a surfboard. She was surfing. She's surfing. It 357 00:21:24.920 --> 00:21:28.160 was so beautiful. And there was a comment in the 358 00:21:28.200 --> 00:21:33.839 email and it said basically, it said, you know, I'm 359 00:21:33.920 --> 00:21:38.079 proving that you don't have to just survive after a 360 00:21:38.240 --> 00:21:42.119 disruption like this, but you can actually thrive. And and 361 00:21:42.200 --> 00:21:45.160 I love that. And you know, if she was with 362 00:21:45.240 --> 00:21:47.839 us today, I think she would say that all the 363 00:21:47.880 --> 00:21:50.880 reconstituting and dealing with a new identity and dealing with 364 00:21:50.920 --> 00:21:55.640 the trauma was was gigantically hard, and that she had 365 00:21:55.680 --> 00:22:00.079 found a way to embrace this new life in a 366 00:22:00.079 --> 00:22:03.839 manner that reflected real beauty. And so I think of her, 367 00:22:04.240 --> 00:22:06.599 you know, honestly, probably not a month goes by that 368 00:22:06.640 --> 00:22:10.200 I don't think of her. And in some ways, she's 369 00:22:10.319 --> 00:22:13.640 one of many patients in writing this book that I 370 00:22:13.680 --> 00:22:18.319 have really wanted to honor. And her story isn't necessarily typical, 371 00:22:18.440 --> 00:22:22.039 like not everybody who loses their toes is back on 372 00:22:22.079 --> 00:22:24.839 a surfboard a year later, But I think her story 373 00:22:24.920 --> 00:22:29.079 is really potent because it shows what can happen, right, 374 00:22:29.160 --> 00:22:31.599 what can very hopeful, Yeah, super hopeful. 375 00:22:32.480 --> 00:22:36.440 So as I'm looking at this and thinking about this, 376 00:22:37.039 --> 00:22:41.759 we have the ICU where this incredible amount of care 377 00:22:41.960 --> 00:22:47.720 and depth of care is taking place, and oftentimes or 378 00:22:50.160 --> 00:22:55.240 even because of that, people are experiencing trauma. It's traumatic. 379 00:22:55.319 --> 00:22:57.519 Like you said, you give us examples of just the 380 00:22:57.559 --> 00:23:01.680 fact of being waking up with an imagine that happening, 381 00:23:01.720 --> 00:23:06.200 waking up with a tube down your throat. But is 382 00:23:06.240 --> 00:23:11.400 there a point at which the ball is being dropped 383 00:23:11.440 --> 00:23:16.759 in a sense, are they not providing enough psychological care 384 00:23:17.200 --> 00:23:18.039 in that moment? 385 00:23:18.559 --> 00:23:21.720 Yeah, I think that's right. I do think that's true. 386 00:23:21.799 --> 00:23:24.440 I mean we could we could count on a hand 387 00:23:24.519 --> 00:23:29.079 or to the excellent psychologists around the United States who 388 00:23:29.160 --> 00:23:31.880 work in an ic setting. My friend Megan Josey at 389 00:23:31.920 --> 00:23:35.599 Johns Hopkins, my friend Aaron Hall at Geisinger Medical Center. 390 00:23:35.799 --> 00:23:41.240 It's shortlist, though, and where mental health professionals are working, 391 00:23:41.799 --> 00:23:45.000 they're making a huge difference. But it's partly a resource problem. 392 00:23:45.000 --> 00:23:48.839 I think it's not necessarily a lack of will problem, 393 00:23:49.039 --> 00:23:53.480 but it's a resource problem. At academic medical centers there 394 00:23:53.519 --> 00:23:59.119 are often many psychologists around, but there are vast numbers 395 00:23:59.160 --> 00:24:02.720 of ICUs. The majority of ICUs are not at Vanderbilt 396 00:24:02.759 --> 00:24:05.880 Medical Center, They're not at Yale, they're not at MGH, right, 397 00:24:05.880 --> 00:24:09.599 they're not at Columbia. And many of the hospital systems 398 00:24:10.000 --> 00:24:13.640 that have ICUs don't have a single psychologist on the 399 00:24:13.640 --> 00:24:16.599 team at all or hardly any So we've got to 400 00:24:16.680 --> 00:24:19.720 find a way to bridge that gap. But I think 401 00:24:19.759 --> 00:24:23.319