EP14 - Healing Healthcare: Trauma-Informed Care Revolution

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations beyond modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power.

Hello, my peaceful warriors. Welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am so excited to have on the podcast today Dr. Stephanie Byerly. Dr. Byerly is an obstetric anesthesiologist, and she has over 25 years of experience in this field. She's in practice at Baylor Grapevine, but you're part of a bigger anesthesia group, right? Okay.

USAP Anesthesia.

Yes.

USAP Anesthesia. But she is also a trauma-informed coach and she has a world of experience working within the healthcare community with trauma-informed coaching. And that's going to be so important in learning how we approach conflict personally and organizationally. And I'm so thrilled to have her on the podcast today. Welcome, Dr. Byerly.

Thank you so much. I'm really excited to be here. And I just love the name of your podcast. I think it hits home about all of the conflicted relationships in medicine. So thank you for what you're doing.

Well, it's really been a blessing to me. I feel like personally, I've learned so much, but also having people like you on the podcast. That are doing so much in medicine to help us understand that what we go through as healthcare professionals and the experiences that we've had, we have been taught to normalize them. We talked about this a little bit before we jumped on recording, that there are so many things that we go through as clinicians that really affected us profoundly, and yet we've never been given a way to work with it. And in a sense, almost like you said, we have these horrible experiences. I remember when we were talking about it, a shoulder dystocia before we jumped on. But when you mentioned that, I was thinking about when I was pregnant with our first child, I was doing obstetrics. And of course I was taking call and I had a patient who came in with a fetal demise and she was 35 weeks, almost term. And Had to deliver the demise, and I was pregnant at the time. And I told the nurses, "You need to dress me up in big clothes so she can't see that I'm pregnant. I don't want to walk in there and have her see that." Ended up delivering her demise, and and she did well, and came back to the office to surprise me. She was going to thank me for taking care of her, and I was 38 weeks, I think, at that point. And when she walked in and she saw me. Big and pregnant. And I think she realized at that point that I was trying to hide it from her. I never really dealt with that. I never really talked about it. I just kept on and kept moving. And I think that's one of those things that the work that you're doing as a trauma-informed coach, if I had known 26 years ago, I was like, okay, Stephanie, I need to talk about this because I've just pushed this under and I haven't really talked about it. What made you get into trauma-informed coaching?

So I had become a life coach and really a women empowerment leadership coach. And I've had so much trauma in my life, and one of my daughters has had a lot of trauma. And I thought, this is the next piece that I need to do in my personal growth work. And so I had EMDR therapy for trauma.

Mm-hmm.

And once I realized how profound that was and how much it changed my life, I thought, I'm going to incorporate this into my coaching because I really realized that every day, the way that I was showing up in my personal and professional life was all based on my trauma from childhood and how different it could be. And so I went and Loadstar Consulting and Executive Coaching, they have a course, a trauma mitigation masterclass that I joined. And then I started working with them after I got certified as a trauma-informed professional coach. And so it has just been the most rewarding thing because it really always comes down to trauma in some way, shape, or form. And so when you can help people understand what that means, it's like a weight is lifted off their shoulders. And so it's just so profound. And that's how I got involved and just wanted to learn more and more and more. And so it's a constant evolution. But that's how it started.

How do we define trauma-informed coaching or trauma-informed leadership? What is the definition for that?

Well, I'll just go through a couple of definitions of what trauma is because there are several. But the one that I love is Dr. Gabor Maté, who is a physician. And his definition of trauma is, it's not what happened to you, but it's what happened inside of you because of what happened to you. And so when you really understand the weight of that, that trauma lives in your body and it lives in your nervous system. Another definition is something happens that's too fast, too soon, too much without having the resources you need either internally, externally to be able to process that. And again, stuck in your body. So when we talk about trauma-informed leadership, what that is, is that we are looking at individuals from a different standpoint. So it isn't like, what's wrong with you, but more of what happened to you? That you may be showing up in this way. And it really is understanding that people come to the table every day with different lived experiences, and especially if you come from a marginalized identity— racism, sexism, all the isms. You know, if you're disabled, if you have a learning disability, that people come to the table again with different lived experiences, and we have to have cultural humility. Where we look at people and we don't immediately judge, and we have a different story, a different narrative. And so we approach them with listening, pausing, and again, understanding they're coming to the table with a different lived experience. And how could I have more trust with this person and create a psychologically safe environment where we can co-create together and co-regulate, and I can understand more as the leader what's going on and how to help this person. Not to fix, but just saying, okay, this is a different understanding of what's going on. I may not be the right person to help, but here are some resources. So it's really coming from this place of what happened to this person and how can this be different?

Wow. That is so powerful because so often I think in healthcare when we're getting into conflict, so much of our identity is brought into that. And sometimes we don't even realize ourselves as we are in this situation, how much of our own identity has been influenced by what we've been through in terms of trauma. We don't recognize that. And because we don't recognize it, we don't really find a mechanism that we can work through it. And it continues to show up in our conflict. And so being able to create a space or have help to recognize that. I think that's so amazing and so powerful. Also, I think one of the things that kind of plays into that is when we talk about trauma, that definition or that word, trauma can be small, something that we think maybe is not a small thing, and trauma can be relatively large as well. In your experience working with trauma-informed coaching, what do those trauma experiences look like? When you look at individuals going through those traumas, what do those traumas typically look like?

Well, it's interesting. As you mentioned, we talk about these little t and big T traumas. You and I could experience the most horrific thing at the same time, but your body is going to process it different than mine. And so it may have a different effect. And so it really is based on the individual, and it's based on who they had around them when the trauma occurred. And so if you were a kid and say you got bullied at school, if you had people around you that acknowledged this shouldn't have happened to you, I'm so sorry, and they listened to you, and this is no blame or judgment, but very different than brush it off, you're fine. So it really has a lot to do with the external and internal resources that you had available. So when we understand that our nervous system is set in place by the time we're 7 and 8, Based on what happened to us in utero. Now we know until, you know, what happens and how safe you are as a child. If you could imagine that your personality, your way of coping, your body's way of responding with either fight, flight, freeze, or fawn is set in place at that young age. It's incredible. It's powerful, but it's also exhausting because you just think about, I've lived my whole life with these patterns and this framework. That I had no blame in putting in place. This is like how my body sensed how safe I was. And so you're going to interpret traumas or experiences as very different. So Dr. Kimia Sarraf, who's the head of Lodestar, she talks about this, and I think it's very powerful. If you're coming to the table with a lot of trauma in your life, so you're very heightened, you're always scanning for danger, you're waiting for the next horrible thing to happen. And you sense that something is wrong, that there's danger, and you turn around and your body is like, you need to run, but it's a little bunny behind you. And so our brain is misfiring, our protective mechanisms are misfiring. It's like a fire alarm that's going off when it shouldn't. So we're coming to the table with very heightened responsive, and we may be reacting to things in ways that does not make sense to the people around us. They're like, what is happening? Because it's very out of proportion to the situation. But again, our nervous system has been so conditioned based on— it could be a little t trauma, it could have been a big T trauma, it could be compounded trauma, could be one time in our life, but it really is all dependent on your nervous system and how much support you had around you.

Wow.

It's so cool that you are in this space and you were doing this work because as you're talking and you're talking about the little t and the big T trauma, but especially as we come to the table with these things, and these are things that were set in place at a very, very, very young age, that they're not things that we're going to readily recognize, but they play such a big part in how we interact and how we deal with the world and the way that we see the world and the way we see ourselves. That it's almost a lens that we don't realize is there. And so the idea that we see everything through that lens and we see conflict through that lens, we just don't even realize that we see it that way because no one's ever said all of the ways that you are approaching this, these were things that were set in place. And also too, I love how you phrase it. It's in the body that it's something that we have made a part of our physiology. It's such a part of us now. Yeah. That it really does take time, intent, and work to understand that. And that makes us more interactive and also more effective as we're working through these situations. I think this is work that we do individually because the trauma has changed us fundamentally. So being able to take the mask off of that is so powerful, but it's not just an individual thing, right? These are things that can happen within organizations as well.

Absolutely. And, you know, I don't know if there's many healthcare systems that are not traumatized. We went into COVID already with traumatized healthcare organizations, and certainly COVID took that to another level. And I'm not sure that it came back to even the level it was at before COVID But when we talk about traumatized organizations, what we have to realize is there's much distrust and there's so much uncertainty. So just to explain the way that our brain works, uncertainty to our brain is threat. And so again, we don't get to decide if we do fight, flight, freeze, or fawn. That was set in place at a young age. And so if uncertainty is the day-to-day what we're facing, And mistrust, not feeling like we know what's going on, uncertainty is processed by our brain as trauma. You need to either flight, freeze, or fight. Like, you gotta do something. But what happens when we're in these organizations and we've gone from, you know, stress, healthy stress to chronic stress, then it moves into trauma if it isn't mitigated. And then what happens is— there's this altered sense of what you're interpreting every day. So your brain is looking at things very differently from a very heightened level, scanning for danger, looking at any negativity, because our brain has this negativity bias, right? So it's trying to basically decide, how can I make this the worst possible case scenario to decide if we're safe or not? And so think about that. You go to work every day in a traumatized organization where it's not psychologically safe. You don't feel like you trust people around you. You don't feel like you can trust your administration. You respond to things in a very different way than you would if your nervous system felt safe. And so we come to work every day with these stories because our brain makes up stories, right? It's like, again, are you safe or not? And when you wake up in the morning, your default brain that wakes up is your caveman brain that still thinks we live in a cave. We're going to get eaten by a saber-toothed tiger. We're going to starve next week. And so it's the worst possible scenario, but we think the same thoughts every day. So 80 to 90% of the negative thoughts that we think every day are the same. And so the stories get bigger and bigger and bigger and bigger, and we feel more and more and more unsafe because the uncertainty is there. The lack of trust is there. And it actually becomes harmful to our health. And so we look for ways to feel better. Our body is like, we don't like this. What are we going to do to make ourselves feel better? And sometimes people show up in different ways when this is happening, right? So it may be aggression, rage. It may be someone at work who seems like they're not engaged because they've just become so dissociated and had to step back, and that's their trauma response. So there's just so many different ways that people show up in traumatized organizations. And if we could start to understand that again in the way of, okay, what's going on here? It's not what's wrong with this person, it's what is happening. And it may be just the simple of taking a pause and breathing before you have a conversation with somebody.

Yep. The idea of having organizations that are traumatized, I think, is such a big theme right now. And it's been, and I absolutely agree with you that we already had traumatized organizations before COVID and COVID just exacerbated all of these things within these organizations. And with everything that happened to us, we never really recovered. I think the system is still in this place of Chronic trauma and stress. I absolutely agree with you. We have people who are showing up chronically stressed, and that chronic process has turned and evolved into more trauma over time because unfortunately organizations don't have the tools, don't have the willingness, or both, to actually approach and deal with the trauma. Also, I think it's really interesting, and I see this a lot with conflict, that organizations are so quick to view conflict as negative. As opposed to a pathway to change. And I think you— I would suspect that you also get into this with trauma. Organizations don't want to admit that they have people working within their walls that are chronically traumatized, and that trauma is coming into the building. It exists within the building, and it affects patient care. It affects workplace. It affects burnout. It affects patient care. And because organizations are not wanting to, willing to, able to understand and work through it, Mm-hmm. It just gets worse. It just continues to evolve and it continues to get worse because the organization itself, oh, we don't have trauma, we're fine. No, we all do. Also, I think that the idea of organizations being traumatized kind of goes hand in hand with the concept of moral injury, that this is a systemic issue. It's because burnout becomes something that feels very, oh, you're burned out. I'm working within a system that has moral injury. I'm working within a system that has trauma. And until this is actually worked through, I'm going to continue to sit in this space because I think one of the things that you said so beautifully is that part of, you know, in terms of trauma-informed leadership and as you being a trauma-informed coach, is you're creating a safe space for people to work through that trauma. What are some things that in terms of working through that, what are some tools that you give people to create that safe space to start to work through this?

The leader creating this psychologically safe environment, and you're you're not the one to try to help somebody to deal with their trauma in the way of them processing it. You know, so always giving them resources about how you start to look at your trauma. A book that I have everybody read when they're learning about trauma is the book by Oprah Winfrey and Dr. Bruce Perry called What Happened to You? Because that explains. Explains trauma and what it does to our nervous system and basically to our physiology. And it's critical to understand that trauma is not a memory; it's a reaction. So when you get into one of your modes of fight, flight, freeze, or fawn, it isn't because you're remembering a specific thing that happened to you; it's because your nervous system is saying you're not safe because it's remembering something is similar about this. And so when we approach people that way. And then sort of give them some resources and say, these may be some other things, some counseling here, or some resources. Because as the leader, you're not really expected to be the one to help them process that. But it's really giving people grace and space and understanding that hurt people, but healing people heal people. And so even just to start this process as the leader, because you've probably been traumatized too as the leader. How you're showing up and what you're creating in your team. And so when we say, okay, you know what? I'm traumatizing my team by the way that I'm showing up. We have to be very compassionate, like radical self-compassion for ourselves that we're not broken. There's nothing wrong with us. It really just couldn't be any other way. But now there's a way to start understanding maybe how I've been showing up. And I really started to understand that as a leader because I was showing up in a way that was traumatizing my team. And so when you start to understand that and things start to change and people are like, okay, wait, she's doing something different, there's an opening that things can be different because they can. It's slower, closer work, as Dr. Akemi Asaraf says all the time. I mean, this is difficult work. It really is because A lot of times we have to really think about the things we've been through. We have to process that with a professional. It's painful, but it happens quick because again, it gives you freedom. It gives you this sense of, oh my gosh, like this weight that's been on my shoulders that I had no idea what it was. When it starts to lift off, it's that you stop numbing. You stop looking at the world about danger everywhere and you start to see flowers and you go outside and you're like, oh my gosh, I hear the birds. Again, it's just such a different, it's a different, you become a different person. Your brain is different. There's room for you to feel safe. And I think that's one of the main tenets is you have to have safety in your nervous system, but your body has to trust you that it's safe. And so this is a very, it's a long process, but again, when you first start doing it, it starts to shift immediately and it's so freeing. It is so freeing. I, it changed my life. I mean, when I had my trauma therapy, they talk about 6 months of EMDR therapy is like 3 years of talking therapy. It's just, it's incredible when you start to give your body back some safety and start to understand why you're like, oh my gosh, this is why I've been responding this way my whole life. You know? And it just makes so much sense.

Yeah. I love how you talk about self-compassion, you know, that as you're approaching this process, as you start to, because when we start to really verbalize what trauma does and how we have that within ourselves and how that changes our interactions, that there is that self-compassion that has to be part of that process, you know, as we're working through that. And you start to understand, well, these are things that the trauma in me, as I have these interactions, this has contributed to the conflict that I experienced that I find myself in right now.

Mm-hmm.

And so the idea of having self-compassion. Going into that, I think is so beautiful. One of, one of my favorite phrases is compassionate accountability, that I am, I went through something that I'm accountable for, but I'm being compassionate to myself as I work through it. And I think that's so powerful. Also, I think the idea that we start to understand how the trauma that has lived within us may have an effect on the other people we work with. And so we are actually trying to enhance our ability to work with other people. You and I both have spent a lot of time working in obstetrics and working in operating rooms. And I think as a result of that, we've been able, unfortunately, to witness a lot of trauma that has occurred. How have you been able to bring this to people in healthcare? How can we get— this kind of trauma-informed coaching to be something that everybody in healthcare can have access to?

If we talk, I'm going to talk about Lodestar Executive Coaching and Consulting that I work with. They're an amazing organization that goes into healthcare organizations and teaches leadership this. So it has to start at the top and work its way down into everybody in the organization. For cultural change and everybody to be on the same page that they want to have this become part of their culture. I have been coaching with them for 3 years and have been going to the same organization. And I have to say, the change over the 3 years has just been incredible. Culture change takes a long time, but it has to start at the top. But when we start talking about this, people are so They're so like, wait, I want to know about this because it just clicks and makes sense about when you think about your day-to-day interactions in medicine. And so when we start to say, okay, what if we start teaching this in medical school, residency, right? This type of coaching, this type of organizational change, how different this would be and how different our lives would be as physicians and how different the burnout rate Would be right, and so if you think about the people that go into healthcare, there are some studies to show that the higher your ACE score, so your adverse childhood experiences, the more likely you are to go into medicine. So I'm convinced there's four things that drive people to go into medicine: you were traumatized as a kid, you were sick as a kid, so you saw healthcare workers as these amazing noble people. Your voice was marginalized as a child, or you were elevated to a caregiver as a child. And so it gives you this sense that taking care of people is this noble thing, and you're gonna control their lives because your childhood was out of control and nobody was there to nourish and take care of you. And so these are the types of people that are drawn to medicine, and then now we're betrayed by medicine. And it's a mortal— it's like a soul injury. And we can't believe we've dedicated our lives to taking care of others, and this is what's happening to us. So that kind of gives you a sense of these very compassionate people, altruistic people who are in this very harming system, and what that really does to us on a day-to-day basis and the things we see. And the things we're being asked to do by administration and all of the things, and that's why it's really killing all of us is because we're like we can't we just can't believe that this is the state of what's happened.

That what you just said in terms of the people who go into medicine and the way the system has formed around us, and now that we feel literally betrayed. By the system that trained us and within which we're working now, that probably more that resonates so hard with me because when you said like the four types of people that go into medicine, it's like wow, that's so true. That is so true. That is we did not happen here by chance. These were things that we were actually led into medicine because of something that was in us. And now that we're in this system that is so traumatized, there's no recourse. There's no place for us to go. And so unfortunately. The system is traumatized. We are traumatized. And now in this system, because none of us recognize it, conflict occurs and it's so magnified and it's so prevalent because we don't have the understanding of what we brought to it. We, none of us have had that illuminated for us. So when you talk about teaching this in medical school, I'm over here saying, yes, please. Dr. Glockenflecken, the one who does all the stuff on TikTok and everybody knows Glockenflecken. One of the things that I think is so cool about what he did a TikTok a long time ago about you walk around with a computer in your pocket all day long. You can look up stuff, you can use AI to research stuff, but things like managing conflict, working through our trauma, being able to understand the business of medicine. These are the things that we probably really do need to learn in medical school. We need to start these at a very young age because those are the gaps in our education. That are directly related to the level of burnout that we're experiencing right now. If you look at the absolute epidemic of burnout that's occurring in healthcare, and you trace that back to the trauma that we've all experienced, it's so much more than COVID. Everybody likes to talk about, yeah, we all got traumatized in COVID. Oh, no, no, no, no. And I agree with you. It started so much earlier, but that's impacting our professional and our personal lives so much in the practice of medicine. So. I 100% agree with you. This is something that we all need to learn. As a trauma-informed coach, and you've, and I love how you talk so beautifully about how this has impacted you personally and how you're bringing this to other organizations. And you've actually been able to see that culture change. But one of the things that you also talked about is it really was more of a top-down, that there had to be somebody In leadership that said, we are in a trauma-informed, we are in a, we are in a traumatized organization. We are traumatized professionals. We need to begin to work through this. Is there ever a time that you've seen maybe somebody who was lower down, maybe not somebody who was in leadership, but somebody else within the organization who really started this process of, hey guys, we're in a traumatized organization and we need to start to work through this? Can somebody else be the agent for change rather than somebody who's at the top?

Oh, absolutely. And if you say we're lower down in the leadership chain, or maybe we aren't in leadership, if you learned, started to understand all this and then you brought it to the next level that you, you could, because I'll tell you, when you start to understand it, you can't unsee it. It's just not possible. So we're really starting somewhere, one toe in the water, learning a little bit. And I'll tell you that what happens is you start showing up very differently. In your organization and people start noticing and they feel much more connected to you because you become safer for them. And then they want to start, they're like, hey, what's going on? You're showing up very differently. Because again, hurt people hurt people. Trauma begets trauma. But when you start showing up differently, other people co-regulate with your nervous system. It's that limbic resonance that we have as humans that lived in tribes together. And someone starts to feel safer and they're like, hey, we need to bring this to the organization. And so that's the way that it can start as well. And it's resilience as well. That's limbic resilience when people start to show up in this trauma-informed way. And yes, again, it's a slow process, but you just got to start. And it doesn't just affect your professional life. Your personal life will shift. Your burnout starts to shift because the number one thing is feeling a sense of agency and control. Because when people, when they're in these traumatized situations, the number one thing is the lack of control. They have no agency. They feel trapped. They feel like there's, it's unrelenting. Nothing is going to get better. But when you start to feel like you have choice and agency, Everything starts to shift.

Wow.

I love that so much because I think so often when people are in traumatized organizations, they do feel helpless and powerless to affect change. If they're not in a position of leadership, it's not something they can start, but it's something they can start for themselves. And then as they start that for themselves, and all of a sudden, like you said, people start to feel safe in their presence. They are creating that little cone of safety right where they are. And then as they do that, all of a sudden people are like recognizing, well, this is a safe space. I see this person has changed how they show up. I want what this person wants. And that produces a ripple effect for the organization. And that way you can actually start to change the culture right where you are. And so the idea that we can do that no matter where we are within an organization, but ultimately.

Yeah.

We are still doing something positive for the other people that we work with and for the organization that we're in because we're starting with ourselves. So the fact that people can do that and the power that that has, I think is beautiful. That's one of the most amazing things that you can do. I mean, you're doing it not only for yourself, but you're doing it for the people around you and you're doing it for your patients and that becomes something. That can be epic. So I think that's beautiful advice for sure. Dr. Byerly, people want to find you. Where would they find you online?

On Instagram and Facebook and LinkedIn, it's @stephaniebyerlymd.com. And my website is stephaniebyerly.com. Would love to talk to people. I incorporate my trauma-informed coaching into my women empowerment and leadership and life coaching. Women are more traumatized in leadership. And so that's one of the things that I really focus on is that and lifting up those labels and all the things that we do to ourselves. But I would love to talk to people. I could talk about trauma all day and just about how it does— our lives don't have to be the way we think that they have to be forever. It doesn't have to be that way.

Yeah, absolutely. And one of the things that you said that I think is really such a great place to think about this is that as we're starting on this process, once you see the trauma, once you see the effects of it, you can't unsee it. So once we have that illumination of not only our start to work through our own trauma, but to see how that affects how we show up at the table, how that affects our interactions, how that affects how we come into conflict, and the fact that we can actively do something for ourselves.

Mm-hmm.

To change how we show up. You talked about taking a pause, taking a break. Well, that requires some elimination. And you talked about the fact that as we live in tribes, that limbic resonance that we have, people will feel that. They may not be able to define it, but as they feel it, they'll realize that something has shifted. And so it's that shift, I think, is what we're after. And we all want to see that. And you are definitely doing such beautiful and powerful work in this area. So thank you for what you're doing.

Thank you so much. And thank you for having this on your podcast for people to hear about, because the more people that are talking about it, the more we can create a revolution to help people heal. It's exhausting. It's metabolically, it's just so draining when you live in this mode all day. And it isn't like when you come home, you're not in that mode anymore. It's like 24/7. Your, our bodies are exhausted.

Yeah. I hope we can actively start to look at it, illuminate it, and actively change it. So thank you very much.

Thank you so much.

All of our listeners, thank you for joining us on Scalpel and Sword. Thank you, Dr. Stephanie Byerly, for being so generous with your time and your experience. And until next time, my peaceful warriors, be at peace.

Every episode is an invitation. To speak, to negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.

Thank you.