On this Hope4Med Podcast episode, we had an eye-opening conversation with Respiratory Therapist Jim Damron. Not only did we discuss his journey into medicine and beyond, but also his mind-baffling experiences being part of an interdisciplinary medical team.
Connect with our guest, Jim Damron:
[00:00:00] Dr. JB: Ever wish for a safe place to have conversations that need to be had? A place where you could say the things that need to be said? Well, welcome to Hope4Med. This is Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med. This is Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med.
[00:00:38] Welcome everyone to the Hope4Med podcast with me, Dr. JB. Today’s featured guest is Jim Damron, he is a respiratory therapist with over 20 years of experience who transitioned out of that role to become an author, a speaker, a professional coach, and a burnout specialist. Welcome, Jim.
[00:00:59] RT Jim Damron: Thank you so much, Dr. JB, for having me on.
[00:01:03] Dr. JB: So Jim, , we’re going to go ahead and start from the beginning. So what made you decide to become a respiratory therapist in the first place?
[00:01:12] RT Jim Damron: Yeah, I lost a bet. No, I’m kidding. Uh, no, really what it was is, I, my first major career was scuba diving instructor, so I taught students of all kinds in the sport of scuba diving and I had a lot of doctors and nurses who were students. And one of those talked me into– I was always concerned and interested in, in medicine– and they talked me into looking into the pulmonary field, and so I did. And because there was a lot of factors that related to one another in terms of diving in the physics and the science behind it with respiratory, so I looked into it and I thought, yeah, this is, this is a way to get in the door. And it’s a, it’s a fairly quick way to get in the door ’cause I wasn’t convinced with medical school, even though I was technically pre-med in undergrad, I thought this just doesn’t seem right for me, but I still was interested in the, in the medical field, so I chose respiratory, jumped in, and the rest is pulmonary history, as they say, twenty-three years. I still do it part-time, a day or two a week, just to kind of keep my skills up and to keep my foot in the door as it were.
[00:02:25] Dr. JB: Okay. Perfect. And so what did you like about being a respiratory therapist?
[00:02:33] RT Jim Damron: I think the best part was it was a specialty, in that you didn’t– you were very specialized in one particular area, and I liked the idea because I am a jack-of-all-trades, master of none thing, and you always want what you don’t have, and that’s just the way it is, so I wanted to have something that I could, kind of, specialize in and respiratory was just this particular area of pulmonary and all about the respiratory system. And getting into it I realized, you know, I’m the expert or should be the expert in this particular area, whether it be mechanical ventilation or whatever area you want to choose, hyperbaric medicine or asthma, whatever it is, in that particular area, I would be the potential expert in that. And getting into it, and studying it, and practicing it, there was one– that element of being an expert in particular field– but also, to be quite honest, there lacked the heavy responsibility and the burden that, say, a physician would have, which is it all kind of rests, at least it all seems to go back to the physician, I am the one that ends up making the final decision. And there was a, a sense of release, of that– speaking of burnout and all that– there was a sense of, “I don’t have to take it to the ultimate end,” because it ultimately relies on a physician and I’m there to assist that in any way I can, so there was a little bit of a burden that was mitigated in that sense. That’s a couple of the reasons why I still like, and still enjoy, helping people in a particular area, but also I don’t have a lot of the stress that some other people in the medical professions do, as you can relate.
[00:04:27] Dr. JB: Yes. Yes, indeed. But despite that you experienced your own personal burnout.
[00:04:36] RT Jim Damron: Yeah. I was a very common statistic in that a lot of people that burn out, do that very early on in their career, and there’s multiple reasons for that. One of which is a lack of competence, even though you quote unquote know how to do something, you don’t have the experience to understand the ramifications of what you’re doing, and to deal with the loss, and all the things that you experience in the medical field, and, to over simplify it, I think the main reason why people burn out is unmet expectations. They have this idea of what’s expected, what’s going to come about when they join the medical field, whatever area it is they joined, and when I got into respiratory, I had this ideal of what it was going to be like. And when I got in, patients were dying, and there were chronic conditions, and there was nothing that I could do about it. So you get this sense of failure, that “I can’t fix this problem.”
[00:05:40] And not only that, sometimes you, you can’t help the pain and the grief, and then on top of that, you had people that were just not listening and doing, you know, what you– “here’s, here’s the recipe to fix your problem, you know, don’t smoke and don’t do all of these things that you’re doing that cause this condition, or at least exacerbate this condition,” but yet they do it anyway, and they come back and you go, “what happened?” “Well, I, I smoked 15 packs yesterday.” Well, that’s, that’s part of the problem why you can’t breathe, and they’re not going to do that, and it becomes frustrating. And in the first two years, I was two years in, I started to have these feelings of going from, transitioning from, the idea that “I can’t do this today” because I’m too stressed to, “I can’t do this anymore.” And there’s a big shift there in terms of how you’re viewing what you’re doing, because when you get to the point where you think “I can’t do this anymore,” it’s too late because the candle has burned out. So year three, I quit. I quit respiratory, just walked away from it. I had an opportunity, they were laying off people, and, uh, I actually had seniority at the place I was working and I actually took the pink slip, let someone else stay and said, I can’t, I can’t do this anymore. Quit, walked away from it for six months, and a lot of people ask, “yeah, and then you missed it, you had to come running back?” And to be honest, no, uh, actually it was, uh, it was a great six months. I had no stress, I was teaching, I was tutoring students, and I thought it was great. And then six months rolled by and then I started to think maybe I should ease myself back into it. And that’s what I did very slowly.
[00:07:30] Dr. JB: Okay. So what did that easing look like?
[00:07:34] RT Jim Damron: It started out working PRN. So instead of just jumping back into the deep end– to keep that scuba metaphor– jumping back in, putting on your tank, and emerging yourself in the deep end of the ocean, I just went back two, three days a month, maybe, and then probably three to six months down the road, started to get to part-time and just taking more hours on. And that really helped me, instead of just flipping the switch and jumping right back in, I eased myself back in, and I think that time off did a couple of things. One, it helped me to realize what it was about medicine that I really wanted to be a part of. And it’s, it’s often only after you have time to stop and reflect on a situation that the significance of it becomes clear, and it, part of that time off, I did stop and think, what, what do I want to do with, why did I want to get into medicine? And remembering the “why” that you got into it and holding on to that helped me face the problems that occurred as soon as you walked in, because the problems didn’t go away, just the way I handled it was better.
[00:08:56] Dr. JB: And when you sat down to reflect after taking some time away, what was your answer to that “why?”
[00:09:03] RT Jim Damron: Couple of things. One was, I looked at the expectations and some of it was perspective, in that, you know, as you grow older, you get a couple of gray hairs, you realize the world doesn’t revolve around you. And I know that’s a shock to some people, and it was a big shock to me, “wait a minute? Why isn’t everything about me?” And, you know, as you get older, you realize through experience, because there’s no substitute for experience, there’s no substitute for– we all face this, especially if you train others, you know? Yes, when you, you learn this in school and there’s a difference between, “I know you read that in the book,” but there’s a difference between, “okay, now in the real world, as we say, we do this.” And there’s no substitute for actually experiencing that, and going through that, and you have to go through that mud, and that turmoil, and that process of losing patients and realizing that it isn’t a loss, you can reframe it. And a lot of it was reframing, I learned a lot of that in seminary and counseling classes, how to reframe a situation and to look at the positive, and what is the benefit of what you’re doing?
[00:10:18] I actually walked through this process with somebody. So instead of them being alone, instead of them, you know, grieving as, as much as they probably could, I can actually walk through it with them, and that actually helped me in the process. So it was all those little perspective changes that can only happen, again, with experience that really helped change at least the way I looked at it, but also how I experienced burnout.
[00:10:46] Dr. JB: So, part of these exaggerated expectations when coming into medicine was your view that when you got out of respiratory therapy schooling that you were going to enter into the hospital and you were going to be able to save every patient that you saw. Was that kind of your vision?
[00:11:06] RT Jim Damron: Yeah. I mean, you have this idyllic vision– and it’s not to blame any instructor or anything like that, or any guidance counselor, they didn’t give you the brochure that says you will save everybody– but you can’t help but think that “I’m going to go in, I’m going to– you can’t breathe? No problem. I’m going to tube you, put you on a ventilator, fix you, get you off, and you’re going to go home, and you’re going to thank me, and you’re going to hug me, and I’m going to get cards, and there might even be some confetti.” You know, whatever it’s going to be, “because you guys were the best.” Yes. Thank you very much, we handled it, we took care of it, and sometimes there’s no family. And sometimes you do everything for the patient and they yell at you. And you, and you go, well, wait a minute, this isn’t how it’s supposed to be, I just saved her life. “Well, why did you do that?” You’re complaining? And, “why did you break my rib?” Because your heart stopped! You know, and you have this unexpected reality that you couldn’t even begin to imagine going into this field.
[00:12:10] And I had this idyllic vision, but also on top of that, kind of had an idea that I can handle this, ’cause I didn’t go into it as a teenager. I mean, now this was a second or even third career for me, because I was teaching in a science museum, I did, I was the dive instructor, and then I thought, well, I’m not a child here, I’m, I was mid-twenties at the time– I can’t remember, probably, you know that’s what happens when you get more gray hair, you can’t remember the age– and I said, well, like, you know, I can handle this. I can handle the loss, I can handle what’s expected of me, and I’m a very laid back person as well, so I thought, well, this is no problem. And then when you start experiencing these feelings of, I don’t, I don’t want to do this anymore, and then when you’re two years in, you go, “what’s wrong with me that I want to quit?” “What’s wrong with me that I can’t handle this?” “Maybe I’m not as strong as I thought I was,” or “maybe this was a wrong choice.” “Wow, how did I make such a bad decision?” So you start to deconstruct yourself and think about all the mistakes you could possibly make instead of looking at this and saying, all right, what did I learn from this? What can I get from this moving forward? So that takes time and that takes growing,
[00:13:29] Dr. JB: Some people, well, not even some people, many of us, right? We go through this, I call it a roller coaster ride, where we have our highs, “oh yeah, I love what I’m doing, this is fantastic, what a great decision,” then we have our lows, “why am I here? Why’d I come back, you know, this is my last day.” And those highs and lows can vary in the various heights, until finally you get to the point where you’re like, “I’m done.” And so, in terms of determining the severity of your burnout, like how, how does one go about realizing, “you know, actually this is, I am actually experiencing burnout, and it’s pretty severe.”
[00:14:08] RT Jim Damron: That’s a great point, that we’re all going to have the highs and lows, I mean, you’re going to go into work, and how was work today? It was amazing. I mean, I did A, B, and C. And then some days are just horrible. And for me, it became a point where I wasn’t, there wasn’t any ebbs and flows anymore, it was all low and it was a continuous low. And there was no more roller coaster, it was just down and it just kept going down. I didn’t have good days, I just had bad days and worst days. And I said, you know, to myself, you can’t continue to do this. Because you start to feel and think– I mean, I noticed the change in my personality. I was getting more cynical, which is another, that’s part of the emotional exhaustion, the depersonalization. You start going, I don’t even want to be around other people. So, you know, burnout is characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. And any one of those is bad. Two of them, ooh, careful. I was all three! I was exhausted, I mean, I would get up in the morning, just my first thought was, ugh, I have to do this because I have to eat. And then it was, if no one could talk to me, I could just go in and do my work and leave, it would be a good day. And I thought, well, that’s horrible to want to think and feel that way. And then, probably what did it for me was I got to the point where I thought, no matter what I did, it doesn’t even matter.
[00:15:43] And I’ll share a quick story for it with you. I was doing– this is actually after I burned out and came back– that I was in the multidisciplinary rounds, which is pretty common in critical care and ICU where all the disciplines get together and discuss the patient of the day, and “hey, what do you have from speech therapy, and from respiratory, from nursing perspective, wound care, all these, add in your two cents so we can get a better understanding, a better picture of the patient care, and how to move forward.” And it came to respiratory, you know, I’m just standing there and they said, “anybody have anything to add from a respiratory perspective?” And I said, yes, and I started to speak and I got cut off. And they just said, well, somebody else started to speak, it was actually a physician, started to speak and said the two cents from the respiratory and just moved on. I thought, well, that was rude, but you know, things happen. Same thing happened with the second person, or second patient, and I thought this…do I even?
[00:16:46] I felt like Chris Tucker. Do you understand the words that are coming out of my mouth? I’m trying to speak here and no one’s even paying attention. So I actually did this, I’m not making this up, so I looked at a colleague, and I said, I’m going to try something. She went, “okay.” So we got to the third patient and they said, does anybody have anything to add from respiratory? And I said, I do, and I started to quote Mary Had a Little Lamb, the nursery rhyme. And I said, Mary had a little lamb and her sheep was white as snow, and everywhere that Mary went, this lamb was sure to go. And not a soul, except for the person standing beside me, acknowledged that I was even quoting a nursery rhyme. They just kept, they just got to themselves, moved onto the next patient. And she just looked at me and said, “I can’t believe you just did that and I can’t believe that they didn’t hear you.” So all of that became ammunition that said to me “what I do, doesn’t even matter.” And that’s, unfortunately, not uncommon for allied professionals because we all are often looked at as “techs” and ” technicians,” and you’re there for the physician to tell you what to do.
[00:18:04] But more and more physicians are feeling like this because healthcare has kind of shifted from this idea of paternalism, which the, whatever the physician says, that’s what we’re going to do because we trust the physicians, we trust the medical practice. But now we have Dr. Google and all of this other information that everybody assumes is correct, and that pendulum has swung to individual autonomy, and we are trying to kind of pull that back ’cause it’s swayed so far to the one side because you have patients and family members that not only are asking the physicians and other clinicians to do some sort of therapy, they’re starting to demand it. And they’re saying, “look, I looked it up, Dr. Google said that you can do this,” and you know, the physician and the other teammates are saying, “well, I understand what you’re saying, but we can’t do this.” And [the patient or family members] they’re saying, “no, we, you’re going to do this.” And then there’s the fear of litigation. And physicians are starting to feel like I’m just here for you to tell me what to do, even though that’s not the case in every circumstances, that feeling is there, so now even physicians are feeling like they’re just a technician. And I think that’s part of the main reason why physicians are starting to burn out, it’s because “what I do, it doesn’t seem to matter because all I’m here is for you to tell me what to do or demand some sort of intervention.”
[00:19:35] Dr. JB: Wow. You know, we have to, we have to take this conversation back just a little bit, back to your “Mary Had a Little Lamb.” What!? Like you were, you were not mumbling, you were actually speaking loudly enough for everyone to hear it and only the person next to you acknowledged what you said?
[00:19:56] RT Jim Damron: Yes. It’s chapter six, I put it in the book because, and I told the person, when I, when I wrote the book, I said, I want you to read chapter six, because I saw her years later, and said, I want you to read chapter six. And she said,” well–.” Just read it. And she read it, and she went, “oh, that was me, I remember when you did that!” Yeah. Unfortunately, I wasn’t mumbling, I was speaking audibly, I was speaking articulately, and I’m sure they heard some noise, but no one was paying attention because no one cared. And the unfortunate/fortunate problem with that was as I had the director, because I stopped going to rounds, and the director came to me one day and said, “we need you up there.” I said, no, no, you don’t, and I don’t– it’s insulting for me to be there because no one is listening anyway. And she said, “well, uh, we really need to be there, that’s part of our job” I go, okay. So, unbeknownst to me, she was there– I don’t think she was there that day, actually, so I don’t want to, I don’t want to assume she was, but I know she was there when it happened. I don’t think she was there when I was quoting, thank goodness she wasn’t there when I was quoting the nursery rhyme, but she was there when they were ignoring me and when that happened again, because this wasn’t a one-time thing, I happened to turn around and I saw her, and I saw just the utter disappointment in her face, that “ugh, I wish this wasn’t the reality.”
[00:21:31] Uh, and it was, yeah. And it wasn’t just, that there was other moments where– and I don’t want to blame anybody in particular, it’s, it’s part of the healthcare culture that were in– everybody there, we’re so compartmentalized. And let’s be fair folks, ultimately, it still falls on the physician. And the physician, it’s easier for, sometimes, for the physician just to go in and push the buttons, change the IV setting, change the vent setting, just do it real quick, and then go back out and tell whoever they need to tell, “this is what I did,” instead of asking the person to go in there and do it. Yes, it’s not as professional as you would like, and it’s a little demeaning, but I can see why they do that because at the end of the day, it all falls on them, but that’s just not ideally how it should be.
[00:22:19] Dr. JB: Yeah, I know for me, times where I’ve been tempted or have done that myself is when there’s a delay, because as physicians, we’re a little impatient at times, right? And so for instance, I’m in the emergency department and I have a patient who’s decompensating in front of me and RT’s not there, and I’m like, I need this patient on BIPAP stat and I have no idea where RT is, then I’ll grab it, you know, and put it on myself, right? Because I need to take care of my patient that’s decompensating in front of me, but, if RT happens to be the department and they come right away, then of course it’s all you, right? Um, and so I can understand situations like that, but when you were rounding, like that’s just completely mind-boggling to realize that people actually go through that, people actually have these experiences in the hospital when they’re doing interdisciplinary rounds, that this– is this, is this just like an anomaly, this only happened to you?
[00:23:16] RT Jim Damron: No, it’s funny that you mentioned that. And you’re correct, I mean, ultimately this is all about patient care, and if, if the right person isn’t there, you got to do what you got to do. So I waited, I’m not going to wait 20 minutes and compromise patient safety and patient health to do what is probably the most “professional” thing to do, no, the most professional thing you need to do is to save the patient’s life, and you weren’t there, so, so be it. And we can blame that on the multiple reasons, but part of it is, of course, the culture. The physician is, you don’t just see– you have to see a hundred patients in five minutes, and ER, times that by ten, you know? You have so much demand and to over-simplify, at the risk of oversimplifying, that’s what burnout is. It’s when demands consistently exceed resources. So when you’re in the ER, how many times can you count where you’re in the ER and you go, “hey, where’s all the patients?” No, you have twice as many patients that you could possibly see. Everybody’s always understaffed, because that’s part of the culture of healthcare, and you have to think about the patients first. So yeah, it happens that you have to wait and you can’t delay, and that’s frustrating because you want what’s done now because talking about patient health, so yeah, I can completely understand that.
[00:24:39] And that’s nobody’s fault in particular, other than it’s probably more just the culture, again, of healthcare, but back to what you said with, you know, being ignored, that actually did happen to a nurse practitioner friend of mine when we were doing multidisciplinary rounds. Sorry, this was funny because it happened to somebody else, thankfully, and the physician asked about–because we also have the virtual screen there– and the physician asked about a particular medicine. I can’t remember what it was, it was Haldol or something, and the pharmacist was there, and he said, “can we get 10 milligrams of it, do they make it in 10 milligrams?” And the nurse practitioner who happened to be in palliative care said, “yes, they do make 10 milligrams,” I don’t remember the actual dosage, but let’s just assume it was 10, “yes, they do make 10 milligrams in that particular medicine.” And the pharmacist goes, “uh, I’m not 100% sure, let me look it up.” And then she kind of looked around, “uh, they do make it, yes.” And she was six feet away, she wasn’t a hundred feet away from this guy, she was right there, and she said, “uh, they do, I’ve prescribed it, I know they have it, they do have 10 milligrams.” And the pharmacist was standing right next to the physician and he’s looking and goes, “um, well, they make 5, let’s see, they have, they have a 15, we could probably take the 15.” And she’s looking around and she makes eye contact with me, and I said, “maybe you need to speak a little louder,” and I said, “maybe you need to raise your hand.” And she said, “hello!” and she finally got everybody’s attention and said “they do make it,” but it took her three times to say that.
[00:26:23] And you know, it’s very easy to say, “well, you were just ignored, nobody cares about you,” and the reality probably was it had nothing to do with, they didn’t consider you unimportant, they were just that they were wrapped up in their own world. But, it just goes to show how we don’t listen often to, we’re so wrapped up in our own world that often we don’t listen to other people, and it could be something as simple as a simple question or some people could look at multidisciplinary rounds and go, “well, you know, they just didn’t, weren’t paying attention to you.” But what if you’re doing that to your patient? And the patient is saying, “I’m having a problem with this,” and you’re so focused on the algorithm in your head, and say, “well, you’re having a pain on the left side, it could be any one of these four things, here’s what we’re going to do, we’re going to get a chest x-ray, we’re going to get a film, and then we’ll, based on the results of that, then we’ll go to plan B, okay? Alright, we’ll be back, we’ll have a technician to come in and get the chest x-ray, be back in a few minutes ago.” Wait a minute. What if you could just spend another minute and get to know what’s really going on? Maybe that’s the presenting problem, but that’s not the real problem hiding underneath. And, you know, people would argue, “I can’t do that because I am under so much pressure, so much demand for my time, I have 20 people that I have to see at eight o’clock and I, I just don’t have the time to spend.” And I get that, I get that.
[00:27:54] Dr. JB: Yeah. You know, when you, when you think about the pressure, right, we all have these, these metrics that we’re supposed to be abiding by, we need to get the patient in and out by a certain time, we need to be in the room by X, Y, and Z. So if you spend the extra time in patient, in room one, for instance, then you won’t be able to get to room two by 15 minutes from the time they get to the door to the room, you know? Um, and that’s what we have to kind of juggle as healthcare professionals.
[00:28:25] RT Jim Damron: Exactly.
[00:28:26] Dr. JB: So do you feel like this, this feeling ignored, does that contribute to burnout?
[00:28:34] RT Jim Damron: Oh, absolutely because that’s that third leg of it, which is this feeling that what I do doesn’t matter, that I don’t contribute anything, and I got to the point where I felt like I’m just pushing buttons. I mean, when you’re, when you’re micromanaging and telling me to go and do this, do A, B, C, and D, then you go, well, anybody can go in and change a button on a ventilator. Anybody can go in and turn a knob on a flow meter. You don’t need a degree to do that. What I can do is look at the patient and try to figure out a way– and those who don’t remember analog radios where you try to dial in that station, we didn’t have it in digital, you know– it’s trying to fine, fine tune this machine to better suit the patient’s needs and demands, which changes all the time, and I took pride in that. I took pride in trying to sit down and figure out how best can I manage this patient’s disease?
[00:29:43] And it’s not just about pushing a button, getting some blood work, and going with it. No, it’s, it takes, it’s an art. That’s part of the art of medicine and the skill, there’s a balance there. And I felt like the art was just disappeared and I became just a technician again, I’m just here for you to tell me what to do and you don’t need any expertise to do that. I go, you don’t need a degree to do what I’m doing now, anybody can do this. And again, I started to see that in the physicians where patients were saying, “give him this, give him this, do this,” and you go, well, what do you need me for? You don’t need my medical expertise. And I see that doing ethics consultations, where the family is demanding something be done and the physicians are saying, no, we can’t do that. And there’s this tension and they’re almost looking for risk management and administration and ethics as tools to show the family– extra ammunition, if you will– to say, no, we’re not technicians, we actually have a degree, we are a medical expert, and we feel this is the best course of action. And that’s often what I do with ethics consultations, is to say, “here’s the options medically, based on those options, family, what do you think is the best course of action?”
[00:31:13] I’ll give you an example of that that happened. Trying to be vague, as vague as possible to prevent any conflict of interest and not say anything that I shouldn’t, but I’ve had, you know, the brain death cases. And I had a case where the physicians were saying, you know, the, the family is refusing to allow us to remove the ventilator, and this is happening all over, this is why it’s one of the subjects that fascinate me the most. And so, I went and talked with the family and I said, what are your options? What do you think your options are? I mean, this child– unfortunately it was a child– was clinically diagnosed, apnea test and everything, as dead by neurological criteria. And I asked the physician prior to walking in, what are the options here? I mean, I, I’m pretty adept at this, the information in this situation, but I’m going to ask you, and he goes, yeah, there’s nothing.
[00:32:13] The only thing that we do in a situation like that is we allow for reasonable accommodation, for example, “well, I’m waiting for uncle Henry to come in, so he can say goodbye,” you know? We can do that, we can allow for that, and some states like New York and I believe Illinois, have actually put in their by-laws couple of days, an actual time period. And I went in and asked the family member, I said, what do you think your options are? And she said, “well, we’re gonna wait and see how, you know, what we can do, we’re going to try this, we’re going to try that…” I mean, she gave me three or four options. I said, you think that we have those options available? She said, “yeah, that’s what the doctor said.” I said, ma’am, uh, the medical options that I just discussed with the physician were zero.
[00:33:01] And I tried to explain to her the difference between dying, being diagnosed dead by neurological criteria versus cardio-respiratory, and it’s difficult for the family members to see that because you’ve got to understand from their perspective, they’re looking at a screen. And they’re looking at this number and they go, “what’s that top number, that, that top number in, in red?” Oh, that’s a heart rate. “Okay, and it says 86?” Yeah. “Well, what’s the number below that? There’s a number and then there’s a slash and then there’s another…” Oh, it’s a blood pressure. “So, there’s that pressure in the blood?” Yeah. “What’s the number below that, that blue number?” That’s, that’s the oxygen saturation. “And then what’s the number, that orange number?” Oh, that’s a respiratory rate. And from the family’s perspective, they’re saying, “so you’re telling me that my loved one has a heart rate, a blood pressure, a respiratory rate, and an oxygen saturation, and you’re telling me they’re dead?”
[00:33:56] Now the medical professional will say yes, but we are controlling all of that, they’re not breathing, we’re breathing for them, and because we’re breathing for them, their heart is still pumping. They don’t hear any of that, they’re looking at that and going, “how can you tell me this patient’s dead when they have all their vital signs?” So it’s really difficult for them to understand and to make that transition, plus you have the trauma and the grief of losing a loved one, especially a child. And that’s what I’ve seen, that the physician gets so frustrated, and not just the physicians, the medical staff, get so frustrated and go, “I can’t do what I know needs to be done because of litigation, because of fear of repercussions, and I need to know if administration is behind me, because I know this isn’t a patient anymore, this is a corpse, as awful as it is, but I can’t do what I want to do.” There’s that moral dilemma. And then if I’m just here for the family to tell me what to do, then what do you need me for? Then, what I do doesn’t seem to matter much. And that adds into all that.
[00:35:01] Dr. JB: Yeah, that’s so true, because so often it feels like you don’t have that back, you don’t have that support. And so, if you go ahead and take a stand say, no, we’re not going to do anything more, then you might find yourself in a hot seat, maybe at an M and M in a month or two.
[00:35:21] RT Jim Damron: Yes. And I think that’s what COVID did for us, COVID, again burnout is when demands continuously exceed resources, so when you have something that you can’t control, because often there’s– I like to break down stressors into two categories, life situations, and lifestyle. By and large, you can control lifestyle, that’s your diet, your exercises, how you cope with things, and you know, your breathing techniques, and meditations, and all those things that tend to help mitigate and decrease and limit burnout, you can control those by and large, but what you can’t control is life situations. You can’t control people’s opinions. Unfortunately, you can’t seem to control politicians and you can’t control something like a pandemic. So when you have this massive demand on top of all the demands that you had, I think what COVID did is it exposed how right on the edge medical professionals are of burning out. And they say, “oh, COVID caused people to burn out.” No, COVID was the last straw, it just pushed people over the edge. They were already on the precipice, but when you throw in this massive demand on top of an already teetering healthcare society and culture, and now not only do you have a limited number of resources, but now, and I was on the committee that had this draft, this policy, of we have to decide what if we run out of ventilators? What if we run out of staff? And I think what it was telling– we had to answer two questions when it came to COVID and that was this, what do we do if we run out of resources? And who makes the decision? So let me rephrase that, who gets the limited resources and who makes the decision who gets the elementary resources?
[00:37:20] I was talking to a physician and he brought up an excellent point. When you start, because the common response was to have a triage committee, if it gets to this point where it’s “we’re in this mode of triage and having to go to limited resources, we have a hundred vents and we have 300 patients that need it,” you know, or whatever the case may be. Alright, well, if I, as a physician have to decide who gets the resources, then who’s my patient because the physician’s job is to advocate for their patient. Well, if every physician is advocating for their patient, it doesn’t get, doesn’t get anywhere, so if you have a committee formed of who else, doesn’t matter who it is, whether they’re physicians and healthcare professionals, ethicists, et cetera, if they’re the ones making the decision, then I don’t have control, you want to talk about losing autonomy. And you have that stress added into the idea of, I’m trying to prevent myself from getting sick, I’m trying to keep patients alive and I’m watching patients die left and right, and now you’re telling me that there’s a potential that I’m not going to even be the one to make the decision, to advocate for my patient? So then, who’s my patient, is it the one in front of me or is it everybody that potentially may come in? And that really pushed people over the edge. And unfortunately there was, uh, you know, Dr. Lorna Brene was a perfect example of being pushed over the edge and she took her own life. And that’s the ultimate horrible end of, sometimes, burnout and this idea of depression and, you know, who’s to say what was going on with her prior to, but, you know, that’s the horrible end result sometimes of being, of feeling like what I do doesn’t matter, I’m emotionally exhausted, and I just can’t take this anymore.
[00:39:20] Dr. JB: Yeah, and part of that though, is feeling like you’re the only person that feels that way, right? Because if there are more than one, if there’s more than one person feeling that way, you may not get all the way to the point where you feel like your only way out is suicide. I think part of it is “what is wrong with me that makes it, that I am feeling this way?” Right? “There must be something inherently wrong, I just can’t handle it, I can’t, I can’t cope, there’s something wrong with me,” when in fact it’s not you. It’s the situation that you find yourself in.
[00:40:07] RT Jim Damron: Yeah, you’re exactly right. That’s an excellent point because there is a stigma associated with any mental health issue, and we would associate severe depression, suicidal ideation, those are mental health issues. And when you’re a physician especially, you’re the one that everybody comes to for help, and then if you are standing there thinking “I can’t even deal with this situation, I should be able to handle the situation, I’m the one that people come to for problems and I can’t handle my own problems, and I must be the only one, like you’re saying, because everybody else seems to be fine.” And the reality is is no, nobody else is fine, just about everybody else is having the same thoughts as you, which is, “is anybody else having this problem?” You know? And it goes back to the classroom, you know, you being in a classroom and, “does anybody have any questions?” And nobody raises their hand, and it takes one person to raise their hands, “I don’t understand what you just said,” and then twenty other people go, “yeah, I don’t either, I don’t know, I don’t either, I didn’t get what you just said.” And then you go, wait a minute, why didn’t you all ask the question?
[00:41:22] Because then everybody was afraid to be the one that admitted I don’t understand, or in this case, I’m having a problem, but when one person does, when one person stands up and says, this is happening to me. I mean, you look at the Me Too movement and all of these harassments and assaults that are happening towards women, well, it took one to two people to finally say, I’m not doing this anymore and I’m bringing this to the light, and then all these people seemingly come out of the woodwork, and you go, wait a minute, “this, this is actually happening everywhere.” And of course it’s specifically in Hollywood and the entertainment industry, but not just there, but it’s just very prevalent there, but then you start to realize this is actually more systemic than we thought. And I’m not saying that every physician experiences or every healthcare professional experiences suicidal ideation, I mean, there’s plenty of statistics out there that says that physicians are a little bit higher than most vocations, one, they say anywhere from one to one and a half to three times more, it depends on the study. That’s why I love studies, I mean, it’s basically any data that you want, you can find, and not to diminish, not to diminish statistics, but yeah, I’ll, I’ll jump on that in just a second.
[00:42:42] But you’re right, that idea that I’m alone, and I’m the only one experiencing this and that, going back to your original question way back when, which is why, how did you get into burnout? Burnout? Where did that come from? It really came from me stopping and asking people, nurses, healthcare professionals, physicians, educators, what’s the number one problem that you’re facing right now? And everybody said, “oh, burnout.” I said burnout, really? I thought I was the only one. I mean, I, I don’t know anybody else that quit and came back, and everybody said, “oh yeah, I’ve been through that.” Some of them didn’t quit, actually, most of them didn’t leave the profession, they just went through a period where they were just burned out. And that’s the thing. You can still work and be burned out. You can still function. You can still treat patients. You can still assess them. You can sit behind a computer screen and chart until your eyes bleed, as they say. You can still function and be burned out, you’ll be less effective, but you can still do it. And that’s how we convince ourselves, “well, it’s just one of those things you go through,” and it’s not just you.
[00:43:54] Dr. JB: Yeah, part of, part of tackling the stigma is talking about it, having conversations like you and I are having, sharing stories so that people realize that they’re not, they’re not alone.
[00:44:08] RT Jim Damron: Yeah. And that’s part of the reason why I wrote, I hate to have a shameless plug, but that’s part of the reason why I wrote the book was one, I wanted to have a book. I said, I want to have a book, and it was just one of those dreams, so I wrote down these personal narratives and personal stories. And what was ironic is what, and I said, hey, I want to, I’m going to focus on burnout and have some tools to help you manage burnout, et cetera, et cetera, that was my idea, but what I found was it wasn’t the tools that I came up with to manage burnout that was the most helpful, it was actually writing the stories. Because by writing the stories, it gave me time to reflect on that situation, find the significance and the meaning and the opportunity, what did I learn from that? But it’s therapeutic. And I said, this was therapeutic alone, just me in front of a computer screen or in front of a piece of paper, writing down the thoughts and the feelings that I was having, and then also looking at it from another perspective, i.e. the family or the patient, which increased my empathetic skills. And it was, it was looking at it from their perspective and reflecting on my own perception and idea of that situation that really helped me get through this and protect myself down the line. So I’m a big proponent of narrative medicine, that was the first class I took in my graduate bioethics program, was narrative ethics and about using narration, narratives and personal reflection to help you deal with what’s going on and getting that out, and sharing that, like you’re doing. That’s why, you know, these podcasts and what you do in getting the word out, and getting the exposure, and the awareness is going to help people realize that I’m not the only one going through this, there’s lots of people going through that, and that’s one of the benefits– there’s a lot of negatives– but that’s one of the benefits of social media.
[00:46:01] Dr. JB: Yeah, and your case, you stepped away for a few months, and then you slowly made your way back in, and then you’re still incorporating your work as an RT ‘ ’til this day?
[00:46:14] RT Jim Damron: Yes.
[00:46:15] Dr. JB: Which is, is great because with Hope4Med I’ve, I’ve been featuring variety of people and of course, when you become enlightened that, oh my goodness, I actually am burnt out, some people may leave medicine, but the goal of Hope4Med isn’t for people to leave, but it’s to make our experience better. To really take into consideration our wellness and make that more central. And by realizing that yes, we need to have a focus on our mental wellness as well as all other aspects of wellness. So it sounds like to me, you came back in and you, you realized that, you know, maybe working full-time as a respiratory therapist, isn’t the best for you in terms of your mental wellness, maybe you need to just continue being able to work just a few days a week and pursue some of your other passions.
[00:47:12] RT Jim Damron: Yeah. That was part of what I call finding your niche and every discipline has different areas, and that’s what happens a lot is, you know, you get into medicine and you go, well, do I want, do I want to be a general practitioner? Do I want to focus on dermatology? Do I want to focus on dermatology, emergency medicine? You know, what do I want to focus on? And, and you learn that. And the same thing happens in nursing, same thing happens in respiratory, usually respiratory has a lot less avenues to choose from, and I realized very early on that I have to be teaching. I have to be learning.
[00:47:51] That was really the motivating catalyst behind that, because the best learning you can do is teaching, in my opinion. So I was teaching prior to going into medicine, and I said, and I got away from that and I realized I have to be doing that, or that to me, teaching was a huge resource, so it’s like having extra fuel in your tank. I can handle some of those demands if I’m doing some education. So I realized after I left and came back, that I need to be incorporating that. So I took every opportunity to teach and to teach all kinds of different disciplines, and then it was years later that I said, I want to try to do this as a career as well. So I started to speak and started getting the training to speak professionally and also create classes and courses, and still incorporate that resource of teaching and educating and helping others, not just with burnout, with medical ethics and whatever the topic may be, because that was my niche, that was what refueled me. And unfortunately for me, it took actually walking away to realize that, and you know, you try to prevent that for others, which is another wonderful benefit of having this podcast. To say, what, what things can I do to help me prevent from getting to that point, but also not just to stop from burning out, but maybe to actually excel and to really get to the point where I’m actually impacting others and not even having to worry about– my goal is to help people is to get to the point where burnout isn’t even an issue.
[00:49:33] Dr. JB: Yup. So one last question is about your involvement with, involvement with ethics. How did you get involved with the ethics?
[00:49:43] RT Jim Damron: Yeah. Ethics was always a passion in terms of, you know I have a background in theology and, and this idea that we ought to behave in a certain way, and I thought, well, how do we incorporate that in a pluralistic world? Because here we are in a healthcare setting and we’re saying, this is, ultimately what we’re saying is, this is how you ought to behave. And we have the medical boundaries or the ethical boundaries of the principles of bioethics, which is pretty universally accepted, of autonomy, and beneficence, non-maleficence, and justice, and those are our boundaries to help people behave and act accordingly and ethically, but how do we break that down to individual situations? And I, I kept seeing, and I’m going to go into further research in this area of different belief systems, and saying, well, I know that’s what you, Mr. Doctor, Ms. Doctor say, I should do but my belief system says, I’m doing this. And how do you merge the two? I mean, how can you sit there and say, well, they’re right, you’re wrong. You’re right, they’re wrong. And the reality is it’s not really a right or wrong. The medical ethics is just all gray, the right/wrong thing, the black and white things aren’t even an issue. “I want an antibiotic to treat this cold.” No, it doesn’t work. “Okay, well, I have an earache.” “We’re going to cut off your foot.” No, that’s complete futility, that doesn’t work, we’re not going to do that, but what about all the different areas of gray? What would be better?
[00:51:29] So I was fascinated with the idea of how, what’s the best course of action for this particular situation, but it’s still based on objective, ethical guidelines. It’s not all subjective. So that’s why I like to have, and ideally you have a medical professional saying, this is our medical objective options, based on those medical objective options, subjectively, patient or family, which opt-in options do you think is better for you? So there’s the objective element and the subjective element. And that fascinates me of trying to get them, and everybody, not just the family or the patient, but also the physician, how do we get to a point that we can agree on the best course of action? And it might be a decision that the medical professional will say, “well, I wouldn’t do that.” I would choose to go through chemo, for example. And then maybe the patient says, “no, you said 50/50 chance, I’m not going through that because I’m tired, I’ve been through that before, I’m choosing not to.” And it’s coming to that agreement. And I always find that fascinating because at the very end of the day, we’re trying to do what’s best for everybody, especially the patient.
[00:52:45] Dr. JB: Those experiences are quite draining from the healthcare professional’s standpoint, those are hard, hard conversations to have, and it’s great to have somebody like you, um, to help guide us through these difficult situations.
[00:53:01] RT Jim Damron: Yeah. It’s a resource and that’s ultimately what it is, if you can provide a resource for somebody because of how medicine has progressed. And to not to extend it further, but, you know, you go back 150 years and you say, well, doctors didn’t have to deal with this, you know they were, doctors, and they were lawyers, and they were theologians all at once. Yeah, because medicine wasn’t that complicated to them!
[00:53:21] Dr. JB: Exactly. Yep. Not that complicated
[00:53:24] RT Jim Damron: Now it’s so much more, it’s more and more complicated every day because as technology advances so does the complexities of the issues, and in its wake are these ethical dilemmas. And if you can provide a resource to a physician, to a staff member, and to a family member, to navigate these waters, then it’s better for everybody.
[00:53:48] Dr. JB: And the provision of resources helps with these ethics consultations and the provision of resources helps with burnout, so I thank you, I thank you so much for. So we are nearing the end of our time together and so I have a couple last questions for you. First one is, if my listener wants to get in touch with you, Jim, how can they do so?
[00:54:15] RT Jim Damron: Best way is to go to the website, which is jimdamron.com, no, E’s, so it’s J I M D A M R O N dot com, and you can reach me there and also get some more information. And that’s the easiest way if you want to connect, or you can connect with me on LinkedIn, that’s primarily where, um, that’s pretty much the only social media I do. I have to set my limits and my boundaries. Um, so you can connect with me on LinkedIn as well.
[00:54:38] Dr. JB: Okay. And then do you have any last minute words of wisdom for my listener?
[00:54:47] RT Jim Damron: What I would leave with is what you brought up, which is you are not the only one experiencing this, whether it’s burnout, whether it’s this stigma of depression and you don’t want it to get to a point where you not only can’t do it today, but you can’t do it anymore. And on the very rare occasion, maybe it isn’t for you, but for the most part, I think for the overwhelming majority of people, this is something that you may experience, but there are resources. There are ways to not only navigate it, but to get through it better on the other end. Just don’t think that you’re alone.
[00:55:26] Dr. JB: Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic, the greatest podcast ever broadcasted or prerecorded. Come learn some, each one, teach one. I’m done.