Jennifer Hartwell, MD FACS
@traumamom4
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trauma surgeon. thinker. writer. friend. mom. tweets are my own
Kansas City, KS
Joined September 2012
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I'm guessing most people don't realize their physicians go home after work or post-call and have trouble sleeping. Not asking for sympathy, just saying, we toss and turn and ruminate about every decision we make at work. We really care about you. That's all.
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Found out today: not only a national shortage of foley catheters but also Pleurovacs & BIS monitors.
Due to high demand for critically ill COVID patients.
Please get the vaccine. Even if you don’t have COVID, I’m losing the tools I need to take care of you in the ICU.
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I got a call last night asking to transfer a patient from a small town in Arkansas to our hospital…in Indianapolis. 600+ miles away. Because every other hospital they tried to call any closer was on diversion status.
Be patient with us America. We are tired. We are crowded.
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Dang. I just got off a call with a bunch of doctors.
My heart is broken. The level of moral injury, burnout, desperation. I don't know how else to get the general public to understand; we are watching the slow demise of American healthcare; this won't end when COVID is "over".
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In case you didn’t know... that doctor who talked to you so stoically over the phone or through a mask last night, came home this morning and just broke down and cried. Shattered. Exhausted. Held it together for as long as we could... we are really tired. We are only human.
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If it’s insurance fraud for me to bill for a patient I’ve never examined, it’s insurance fraud for a insurance company to deny care for a patient they’ve never examined.
I said what I said.
#peertopeer
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Please order the CT with IV contrast.
The kidneys will be fine.
It's whatever diagnosis we are missing with the non-contrast CT that will damage the kidneys.
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Medical interns will be starting their new careers this week. I think it's important for the public to know a few things about our new colleagues:
1) In teaching hospitals, we work as a team; interns ARE physicians who learn by watching, then doing, with graduated autonomy.
1/6
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Can we stop saying certain patients are “VIP”?
Either everyone or no one is VIP.
Stop insinuating that some patients deserve different or better care than others.
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Getting emails about “delinquent charts” the first day off after a 110h work week is peak anti-wellness.
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Me: Everything is set for your surgery tomorrow. Do you have any questions?
Patient: Will there be residents in my surgery?
Me: Yes, sir. This is a teaching hospital.
Pt: Good. Let the intern operate on me. They have to learn. I know you will be watching.
Man, I love my job!
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This kiddo turns 12 today.
We asked him what he was looking forward to for his birthday.
The vaccine, he said
Happy Birthday, buddy!!!
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If I could give one piece of unsolicitied advice to new faculty, it would be this:
Keep your CV on your computer desktop and update it EVERY time you give a lecture, submit a paper, take a professional development course...EVERYTHING.
Going back and doing this is painful!
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Me (to circulating RN in OR): sorry to bother you but I heard some messages come thru on my phone. Would you mind checking it?
RN: There’s 1 from Scott Hartwell.
Me: That’s my husband. What did he say?
RN: “Hi. Just thinking about you.”
Entire OR: Awww !!
#surgspouse
❤️
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Can we please stop insinuating that new interns are a danger to our patients? They are not. We are a team. New interns are well supported by their faculty and senior residents.
#MedEd
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I’m begging the universe: when you page me, give me a full 10 digit call back number. Please.
No one uses a “house phone” anymore. In the year of our Lord 2023, we ALL use cell phones.
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We are trying to be more sensitive and inclusive in our clinical documentation.
Instead of saying...use instead...
Patient refused...patient declined the intervention
Alcohol abuse...alcohol use disorder
No show...did not attend follow-up appointment
What would you add?
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Patient's wife: Hey, you all are doing amazing work. We are so grateful for you.
Me (gazing out the window): Yeah, thanks.
Patient: Doc, it's hard right now. We know that.
Me (looking back at patient): (silence)
Patient: Doc, I got your back.
This meant everything today
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The most important work I did today generated 0.0 wRVU. I listened. I held a hand. I was an advocate. And these are the 30 most proud moments of my day.
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I am creating a PowerPoint to teach residents how to manage sleep deprivation, tolerate long-haul calls.
In what other profession are the newcomers welcomed with a lecture on physical self-preservation?
We need to break this culture of "exhaustion as a badge of honor".
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Academic medicine seems obsessed with defining success as rising through the ranks as a Chief, Chair or Dean.
This is just your reminder that success comes in so many flavors, and often times feeling professionally fulfilled has nothing to do with a title.
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You need to hear this advice today:
Slow down.
You don't have to solve every problem, reply to every email, complete every project today.
Relax.
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Lots of unsung heroes today...if anyone knows this guy...tell him I said thanks. He ran up to the podium between every speaker and Clorox wiped the mess out of it. “Not anymore
#COVID19
. New team in town!”
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1/2 Met with med student (MS4). Says she wants to be a
#surgeon
but has been told not to because: lifestyle, family, too hard, surgeons are mean. We need to end this narrative. Bring strong, balanced, dedicated men and women into surgery, change the culture.
#rethinkwellness
...
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I'm really bad at saying "no"...but I have recently instituted a personal rule...decline meetings, webinars, & courses that begin after 5p, occur on weekends, w/ very few exceptions. This is empowering & protecting my family from "work-creep".
#boundaries
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Got confused for a medical student today.
Y’all…I’m a PGY 17.
“Oh sorry! You just look so young!“
It’s my Sunday smile. ☺️☺️
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While I don't have actual data to back it up, I think that anytime I buy dinner for the on-call crew it has more of an impact than a $50 donation to a giant organization that launders it into "wellness" programs and "resilience" training.
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6) Healthcare is getting harder for all of us. But we love our work & we deeply care about you, our patients. Those of us who teach the next generation of physicians in academic medicine, are humbled & proud to do so. Take a second to welcome our newest colleagues!
6/6
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4) Many residents sacrifice time with family, friends, and even delay major life events like marrying or starting a family, to fully dedicate their time to the art of medicine. So try to be patient and appreciate that level of dedication.
4/6
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I am working on saying "no" to people, to protect my boundaries
Today, I had to say "no" and it started with me feeling anxious, worried I am letting someone down, like heat rising on my face
Then I felt empowered because I realized what I did was say "yes" to me and my family
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The
@AmerMedicalAssn
could have chosen any hill to die on, and they chose this one. 🤦🏻♀️
They are showing just how out of touch they are.
I love my APP colleagues; we are truly a team. I can’t do my job without them.
Very poor move, AMA.
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2) Residents are both the back of the house AND the front of the house crew. They provide the bulk of the exceptional bedside care and keep the wheels of the hospital turning 24/7 with ALL of the phone calls, paperwork, conversations, and procedures they do for our patients.
2/6
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#DamarHamlin
’s hospital course is not a football game. We are not owed the play-by-play. Let’s respect his privacy and support his family in focusing on him. We don’t deserve updates or statements.
Prayers for Damar, his family, and everyone close to them.
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Sometimes the most important decision we can make in surgery is deciding NOT to operate.
It's ok to approach the end of life with dignity, grace, compassion, and peace.
Sometimes less is so much more.
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5) On some services, residents will receive 200+pages/texts, see 30+ new patients, round on 25+patients, perform procedures and surgeries, and complete mountains of paperwork in one 24hr shift. Be patient. Share grace.
5/6
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@AlexSimmondsMD
Started a case the other week...scrub tech said "We heard you like the Omni better than the Bookwalter." I said, "I like whatever system is open on the back table when I need it."
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You know what separates real friends from “friends”?
When you drop a text...and they read right thru it and know what you need is not a text reply...but a call.
#friends
#mentalhealth
#rethinkwellness
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3) For some interns, both the best and worst days of our careers will be spent in training. It's grueling work, but mostly incredibly rewarding. We work 80+ hours/week, 24+ hours in a row, to provide continuity of care for all of our patients.
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Hi my name is Jen. I make daily to-do lists that would need 37.5 hr to complete but my brain tells me I can totally do all of that in 8 hr and then I get confused and grumpy when my to-do list isn't done by dinner time. And I've been doing this for 20 years. I'm a slow learner.
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I cried with 2 of my sons yesterday. We are all overwhelmed, so exhausted
It would be easy to feel like a bad parent cause my kids are in tears
Truth is...knowing I raised my boys to feel ok to cry...and that they're willing to talk it out with mom...well that's a parenting win
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11 days ago my husband had a stroke.
Tonight, I’m on trauma call. I went to the ED to see a consult, walked past CT scanner to witness a “stroke alert”.
Let me tell you…my heart skipped a beat.
My husband is doing well, but our lives are forever changed.
#strokerecovery
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Normalize tears in the workplace.
Sometimes it’s the only way we know how to communicate.
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Can we start a petition to get rid of the "clear liquid diet" once and for all?
Zero nutritional value.
Highest aspiration risk.
Wastes a day "advancing diet"
Start with full or regular diet instead.
Thanks for coming to my TED talk.
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If you are wondering how much a medical helicopter ride from Hilton Head Island to Charleston SC is, the answer is $87,000. 🤯
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@doc_on_the_run
There are no “dumb” consults. A consult is a request for help. Go see the patient. Provide your expertise. Reassure the patient. Communicate with compassion. Repeat as necessary.
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@ecalhoun21
As a trauma doc who frequently takes transfer center calls, the correct answer is, “Yep. Send them. Just give me a quick recap of the story so I can have the right specialists ready. We got you.”
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@JJcolemanMD
I feel like
@traumadoctors
@EAST_TRAUMA
&
@WesternTrauma
should make a
#yesnochallenge
@tiktok_us
video with safety tips for
#COVID
and
#holidays
.
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And in medicine, we feed each other well!! Residents ordered cookies for my birthday 🎂!
@KuSurgery
@KU_Surgery
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It’s not that we are afraid of working hard or long hours. We are tired of watching people die unnecessarily. That’s what crushing our spirits in medicine.
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I hold the title Chief Wellness Officer. WE are not well right now. WE won’t be well until we create a world that is safe for our Black colleagues, friends. I see you. I hear you. I stand with you. I will speak up for you.
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Post call and now time to play the popular game of “Dang it! Where’d I park?”
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This. It IS a public health problem. We didn't reduce rates of other diseases by not studying them and just hoping they would go away.
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Perpetual survival mode is not what we are built for.
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Clear liquid diets are useless, taste horrible, are non-nutritive and should be abandoned.
There. I said it.
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While every death is a tragedy, let's not forget that every time a child is hospitalized w/ COVID: a parent takes time off work, misses time with their other children, incurs large bills, a child misses school, a relationship is strained.
Adults: we can help by getting vaxxed.
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@EM_RESUS
And even say "this is just here to ward off the evil spirits." And the nurses love me for this move.
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Who’s taking care of the patients? 100s (1000?) health care workers from
@IU_Health
@IUMedSchool
@IUHealthTrauma
@Dr_AMeagher
@pbatesmurphy
@joyofmedicine
@Brandypjones
take to the streets to stand up for
#BLM
#WhiteCoatsForBlackLives
@indy10people
Wow!!! This is so awesome!!!
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Ok. This made my week. To all of you weary folks out there, we ARE making a difference by patiently and compassionately sharing the data and telling our stories. Keep at it. One. Person. At. A. Time.
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I was asked today about what programs I think are best for
#wellness
.
None of them. My answer is…none of them.
The correct answer is: Anti-programs.
Give people their time back. Make their lives easier. Leave them alone.
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What real friends say when you’re having a rough day:
“This s*** is hard. You ARE doing a great job. This place, these patients need you (but not more than your family and you need you). I appreciate you. But never as much as your family will. “
#medtwitter
#rethinkwellness
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Mortality is not the only outcome we should measure after trauma or illness.
It's just that it's easy to measure cause it's binary: dead or alive.
The morbidity, the long-term effects, of illness and trauma are harder to track but are no less devastating.
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My 2nd grader practicing
#StopTheBleed
. Tourniquets placed in each kids’ backpack. 20 seconds to save a life.
@traumadoctors
@EAST_TRAUMA
@StopTheBleed
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On today’s episode of “Very Busy ICU Service” we normalized crying on rounds.
We stood in a circle and honored our emotions. All of them.
Sadness. Frustration.
Fear. Anger.
Exhaustion.
It’s ok to be a doctor...and be human.
#rethinkwellness
@IUMedSchool
@IU_Surgery
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Thru tears, I told my unvaccinated son, "Sorry buddy. It's not safe to have a big unmasked birthday party."
I said the same thing last year
He's turning 12. All he wants is the vaccine for his birthday
This is hard on everyone
Let's get vaxxed & have birthday parties again
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Today was hard
Busy. Tough case
Cried in the quiet room w/family
Got some tough news from colleague
Stayed late to sign 85 notes. Feeling sad, salty
Last thing I did: write email, copied everyone, thanking them for hard work today.
It does feel good to be grateful.
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This is very concerning. Should this be part of the conversation about “what is an FTE of an Acute Care Surgeon”? We should build time for sleep cycles.
@mademoya
@pbatesmurphy
@elliotthaut
@JJcolemanMD
@rwinfield11
@DissanaikeMD
“The link between lack of sleep and cancer is now so strong that the World Health Organization has classified any form of nighttime shift work as a probable carcinogen."
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Called for a peer-to-peer. Waited 18 minutes on hold to hear: "Ma'am this is just the scheduling line. We schedule peer to peer calls from 9am-3:30pm"
Bro. Let's be clear. If you only work 9am-3:30pm, you are not my "peer". You are an insurance employee.
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In heaven, they give you all the walks you want, they toss the tennis ball all day and night, and there is an endless buffet of cheese and peanut butter. I’m just sure of it.
Rest easy, Einstein. We love you!
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My super power is changing the channel in the physicians lounge from Fox News to Disney Junior.
This is better for everyone.
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Remember in 2020 when we kept saying "flatten the curve" so we don't overwhelm our healthcare resources, you know like ICU beds and stuff?
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Caught off guard today, first day rounding in ICU since my husband's stroke
The alarms made me a little jumpy; I winced as I ordered a CTA head/neck for a patient; I was hyper-focused on every patient's neuro exam
Our work and our life are so intertwined...we can't turn it off
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On the way home from
#EAST2019
, saw flight from DTW to IND cancelled, awesome
@Delta
attendant connected me to these other folks in-flight, we rented car, drove thru the night...home. Capped off an incredible
@EAST_TRAUMA
meeting with
#adventure
#connectedness
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@llsquared79
Yep. Everyday it’s something else. Oh yeah…and running out of staff/workforce too. We are all exhausted.
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VACCINE UPDATE:
15 hours post
#vaccine
injection:
My arm hurts a little bit.
End tweet.
#ThisIsOurShot
@IU_Health
@IU_Surgery
@IUMedSchool
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What a beautiful difference a day makes!!
Yesterday, Scott was hardly able to stand without assistance, today, he took a short walk!
@MUSChealth
Neuro ICU knocking it out of the park! And nursing staff is being VERY patient with me being a patient's family member!! 😆
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Did you know people who are intentionally grateful are happier and less likely to experience burnout? This year, it’s been hard to choose
#gratitude
on some days. But I’m gonna try. I’ll start with this sunrise from my bedroom window. Now your turn...
#rethinkwellness
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I was reminded today that just showing up, just being myself…is enough.
In a world where we seemingly compete in every aspect of our lives…being the best & most worthy spouse/parent/friend/employee/boss/influencer/leader…
We tend to forget that we are enough…just as we are
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4am: I wake to a text announcing active shooter across street from my hospital. I texted on-call partner. He is ok.
9am: I see news 9 injured in shooting in Cincinnati. My son has friends there.
My god...this is not how Sunday mornings are meant to be.
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And just like that…last trauma call in Indy, in the books. It was a busy night with several challenging patients…but these
@IU_Surgery
residents stayed calm, did great work, and kept me smiling. So proud. I will miss you!!!
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Today begins 2mo respite b/w jobs. I feel free & hopeful for the first time in a long time. My plan:
Read, journal
Rest
See friends, family
Be present, positive
Exercise
Limit SoMe, 24hr news cycle
Practice self-compassion
Express gratitude
Show up ready for new job in May
10
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Today, I cleaned out my office. I end my 6-year-run
@IU_Health
&
@IU_Surgery
this week.
I packed the books & diplomas & grabbed my hand written
#12steps
card. I’ve not been in formal recovery, but I’ve walked alongside enough friends to know this wisdom transcends all of life.
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Guys, let's be clear. This is stupid hard work, this
#rethinkwellness
thing. The doctor/researcher/student/APP gig. This life. So let's do this together. Let's dig in. Let's get real. This is not your momma's yoga. I'm all in. Let's do this!!!
@IU_Health
@IUMedSchool
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Surgery is a small world; trauma surgery is a smaller world; and women in trauma surgery even smaller. We are a small but mighty group...fierce in our loyalty to support one another. Humbled to be in this little group.
@EAST_TRAUMA
@traumadoctors
@WesternTrauma
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I'm ♥️ every Tweet about
#match2022
today. Including those brave enough to share they didn't match. It's true this day doesn't define you.
Also holding a tender spot in my heart, knowing that residency is hard. Medicine is hard. We need to carry one another on this journey.
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Many tweets about hospitals, health systems being bad to their people. Going on record saying
@IU_Health
@IUHealthPhys
@IUMedSchool
breaking that narrative. Being awesome! Protecting income, feeding, clothing, protecting us. No place perfect, but my home team doing awesome!
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Dear iPhone, for the record, you don’t need to auto correct to “ducking”. I promise I will never use that word. K. Thanks.
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12yo son(2x vaxxed) (haircut + baseball practice soon) Mom…I have a little sore throat. So…
Me: sorry buddy. Maybe we should test real fast?
12: sure?
(15min)
Me: (naughty word) It’s +. Byyyeee.
12: (scampers up to his room)
Me: Dude. Awesome kid for speaking up!
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@MicahPollak
and
@gbosslet
are national treasures. Selfless COVID warriors who have donated thousands of hours of their expertise to Hoosiers and the world. Thank you both!
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I am a trauma surgeon. I’ve seen a counselor to help with anxiety and to process through some really tough cases. I’m a better surgeon, wife, and mother for the help I sought out. Thanks
@choo_ek
for speaking your truth.
#rethinkwellness
I’m an ER doctor. I’ve seen a therapist and have been on antidepressants. Our system considers this a red flag, instead of a positive signal that I’m taking the best care of myself possible. This needs to change.
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Post-call: In the last 36h: prepared to cric suspected COVID pt, learned how to re-use PPE, read document advising how to ration vents, canceled clinic appts for elderly patients at hi risk for COVID. Please, for the love of everyone,
#StayHomeSaveLives
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@TraumaSoapBoxes
@joederosacomedy
Hi Joe. I’m a doctor. Nurses saved my patients in residency. In fellowship. As a new attending. And…yesterday. Shut up Joe. You are alive because of nurses. I’m alive because of nurses. I don’t look like an idiot because of nurses. News flash: nurses run healthcare and I ❤️ it
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@TopKniFe_B
Put bottom gloves on BEFORE gown, then have scrub tech cut "thumb holes" in white cuff of gown...about 1in hole does it. Put gown on, put thumbs through holes, put over gloves on. This trick has basically ended the bloody hands issue for me.
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Prozac and a therapist have a made a world of difference for me.
I am less anxious, depressed. I am sleeping better. I am a more focused and compassionate wife, mother, friend, and physician.
This is a tweet about
#johnfetterman
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Your organization will never love you back.
Work for patients, colleagues, mentees...
We are replaceable...
Except to those to whom we have made the biggest difference.
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We are trialing Trauma “player” “baseball” cards for our patients at
@IUHealthTrauma
.
Hope to make it easier for patients to keep track of their treating team.
Bring some humanity to our care. Get to know us.
#behindthemask
#traumateam
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2/2... said to her while choking back my own tears. Had a long talk with my husband today about re-organizing my priorities to be home more.
#yesitshard
#YouAreNotAlone
#rethinkwellness
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