Review of “Critical Crash”

The power of listening closely, the importance of respecting the humanity before us, no matter how broken or seemingly hopeless, and the power of our words as health caring professionals is the explicit message in a story T. Dixon, MD, tells on the MOTH Radio Hour about one of her patients. The story articulates the fundamental skill of narrative medicine, close reading, which is manifested by listening carefully, and watching closely in caring for patients.

Dixon was a second-year surgical resident at Johns Hopkins when she was called to care for a young woman who had a terrible accident on her sixteenth birthday – thrown from her car which then landed on her. She suffered life threatening injuries to her head, both lungs, liver, spleen, and pelvis. Dixon said, “I mean, this girl was broken. I guess we both were at that point in time.”

During the initial stabilization, Dixon created a minute to speak to this young woman’s parents. She reflected, on her way to the consultation room, on how she could explain the bleak situation without squashing “any hope they might have, because that doesn’t help anybody.” Dixon pointed out that the patient’s youth and good health gave her the best chance to come through. Yet, Dixon still carried doubt about the outcome.

Dixon learned that her patient’s name was Savannah, and the mother found reassurance that “Savannah” is written across her scrubs, announcing the name of the institution where Dixon had previously studied.

Dixon cared for Savannah for five months, three on the trauma service, and two while on vascular surgery. She encountered daily battles to keep her patient alive. These months were filled with painful procedures and Dixon had the habit of talking to Savannah, explaining the procedures and the potential for pain. “I tried to warn her anytime I did anything to her,” Dixon said.  When Dixon finally rotated off service, she lost track of her patient.

Dixon brought her story to a dramatic conclusion. “About a year after Savannah’s accident, I was back in the unit talking to a nurse when a young woman approaches and announces, ‘It’s me, Savannah!'”  Dixon was excited to hear Savannah tell of her current life at home and school, and her upcoming graduation. Then Dixon stopped her and asked, “How do you know who I am? You never met me. You were unconscious.”  Savannah said, “Oh, I recognized your voice! You were the one who talked to me.”

Dixons voice cracked as she continued, “So all those times I would say, ‘Savannah this is going to hurt, but I am going to do everything I can to try to make it as painless as possible, but this is going to hurt a little bit,’ she had heard me, and she remembered it.”

Dixon’s voice cracked again, “And so I knew that treating people like a human being, it does matter, and it does make a difference, and for me that is when I finally realized that all that sacrifice, and all that blood sweat and tears, it was worth it.”

What I haven’t told you is that right from the beginning of the story, Dixon sprinkled this account of heroic care with the struggles she faced training to become the physician she yearned to be.  She told of the “sacrifice and time to get all that training done.”  She was depressed while caring for Savannah. She called it a dark time. She talked about the toll of the mental stress of surgery. She worried about her patients, “I took my work home with me… I felt like I was just limping along.”  Despite the struggles, Dixon eventually completed a fellowship in trauma, critical care and burns.

Close reading and listening requires that we ask, “Why did Dixon include her personal challenges as she told this remarkable story?” The answer lies in knowing the rest of the surgeon’s story. After graduation from fellowship, Dixon completed two tours of duty in Iraq. When she returned, she suffered severely from PTSD and depression. She never returned to the OR. She now devotes her life to advocating for military survivors who struggle with PTSD.

In telling her story, Dixon illustrates another principle of narrative medicine, the power of witness. By telling her story over and over, she enlists many witnesses who contribute to her recovery. She understands the importance and power of the witness. Just as she bore witness to Savannah’s survival and recovery, those of us who attend to her story bear witness to Dixon’s.

It takes courage for Dixon to share her wounds in this story. The wounds she bore as a trauma survivor were terribly difficult to overcome. She told an interviewer that she was an “embarrassment to herself, her family, and the Army.” Through her recovery, she overcame that sense of shame so that her wounds could become a source of healing.

This is an important message for all health caring professionals – we all have our woundedness, and our own story is important in the context of providing care to our patients. These stories and wounds operate in the background of our consciousness and we must recognize and manage them. When we manage our woundedness we will then, like Dixon, assume the role of what Henri Nouwen calls, “The Wounded Healer.”

Nobody escapes being wounded. We all are wounded people, whether physically, emotionally, mentally, or spiritually. The main question is not “How can we hide our wounds?” so we don’t have to be embarrassed, but “How can we put our woundedness in the service of others?” When our wounds cease to be a source of shame, and become a source of healing, we have become wounded healers.

~ Henri Nouwen, “The Wounded Healer”

 

“I have my scars, but I am not my scars.”  ~ Dr. Dixon