#TransformTrauma, a Podcast for the Trauma-Informed Movement

Trauma-Informed Women's Health

Episode Summary

A trauma-informed care model revolutionizes women's healthcare by acknowledging and responding to patients' trauma experiences to meet them where they are—not where a provider expects them to be.

Episode Notes

Content warning re: sexual assault and medical trauma

A trauma-informed care model revolutionizes women's healthcare by acknowledging and responding to patients' trauma experiences to meet them where they are—not where a provider expects them to be. This approach promotes understanding, empathy, equity, and compassion, enhancing how patients perceive and receive healthcare.  

Fostering a safe and accepting environment that encourages open communication can also help healthcare providers better address their trauma, including burnout and professional bias. Adopting trauma-informed policies and practices is crucial for women's long-term physical, emotional, and psychological health.

HOSTS: CTIPP's Whitney Marris and Laura Braden


#TransformTrauma is a Campaign for Trauma-Informed Policy and Practice (CTIPP) podcast. Through coalition-building, advocacy, and policymaking, we’re building a national movement that integrates community-led, trauma-informed, resilience-focused, and healing-centered prevention and intervention across all sectors and generations. 

Learn more at CTIPP.org.


Hello and welcome to the Transform Trauma Podcast. My name is Whitney and I am the Director of Trauma-Informed Practice and System Transformation with the Campaign for Trauma-Informed Policy and Practice, and I'm here with Laura, who is CTIPP’s Director of Communications and Outreach, and we are delighted to have the opportunity to spend time today chatting with Amanda Gill, outreach educator and former labor and delivery nurse with Francisco Health, Lori Hardie, the Director of Health Sciences with Transfr, which provides virtual reality training solutions for workforce development and upskilling; and Lori is also a doctor of nursing practice candidate with the George Washington University, as well as Dr. Cherrell Triplett, an Obstetrics and Gynecology Specialist and education. And we are all gathered here today to have a conversation about integrating trauma-informed approach and practices into women's healthcare. And Laura and I want to begin by extending to all three of you a warm welcome. We are just so jazz to be connecting with you right now and also before we dive more deeply into the details of our topic. Today we are wanting to extend to each of you the invitation to briefly share whatever parts of your story about what called you to this work of promoting trauma-informed principles into all that you do that you might like to uplift just so our listeners can get to know a bit about each of your journeys up to this moment in the here and now, and so, Lori, would it be okay if we invited you to get us started there?

I am a nurse. I've been a nurse for almost 30 years and which, while that sounds like a really long time, but all in women's health, primarily labor and delivery, but also, you know, going to college and postpartum and nursery and nice. So spent a lot of time working at the bedside with women and in an area where it was very potentially very triggering for people depending on their histories. As somebody who has kind of my own personal history, I was always very aware and cognizant of that in my patients and I realized that the nurses, physicians, others working around me on my team were not. But there was no, I mean, in those 30 years I never received any education around Trama. Informed care ever then kind of became my mission to do some of that education myself. But now, as you said, working on my doctrine and health policy, to really make that something that is available to all health care professionals, because it's a small adjustment but it's very impactful, and so that has really kind of become my life's work, is not only for the benefit of patients but for the benefit of all of us who are caring for them and have our own dramas and our own histories and, I think, especially kind of post-COVID it's even more relevant because we've got traumatic people taking care of dramatized people without a lot of tools.

And, Dr. Triplette, would you be willing to share next?

So I just kind of fell into this, you know, into train from care. I like to think after learning about from influence. I like to think that I have practiced it and for the last 15 years without really knowing what I was doing. But recently I've kind of put a framework around it, really really became involved when I made a career change and went from being a doctor to being a person right, and so in realizing my own dramas right and how I was burnt-out and bringing those times to my patients and how I dealt with them and said I have to deal with my own things before I can really provide good care and the care that I want my patients to receive. So in talking with Amanda, it kind of went from there and then met with Larry, and so I'm very passionate about it, especially since I've kind of made a career change, but within the same profession and putting myself first as a person helps me to be a better practitioner and helps me to cover and unfold the dramas of the patients that I do take care.

I also want to invite Amanda to share as well.

I've been a nurse for 22 years. 20 of those years I worked in labor and delivery. I had a passion for women's health. Going into nursing school. I absolutely knew that's what I wanted to do. That was where I was destined to be and I adore caring for women. It certainly is applicable to all people in all sections of healthcare. But specifically, like Lori said, in that arena we certainly see patients who that puts them in a very specific, delicate space for possibly being dramatized. I was certainly aware that there were patients who had some sort of history while I was caring for them and I would do an exam or be involved in their care. But, like Lori said, never received any type of education and honestly had no idea how to react. And then when I began work closer with Lori, she was already working in the arena of trauma-informed care in human trafficking. And so when a transition from bedside care to education within my organization I learned more and more about that. I became working part of an alliance in human trafficking, got to know survivors and really learned a lot through those survivors. And now I feel like once you know once I know what I didn't know before. I can't unknow that and I have a deep passion to share that with others, because it's just what we don't know. We don't know what we don't know and they don't know it and it is. No one intends to provide for care. Once we know better, we will do better.

The spaces that you will occupy, how do you go about, on a day-to-day basis, making sure that women feel hurt and empowered, whether they are patients or fellow colleagues?

Like I said, I made a transition from physician to being a person, and that's really my tagline right now in my in my life. So now I just lead with being human and being a person rather than leading with being a physician right. So it puts me and my co-workers and my patients kind of on the same level right and I'm a little vulnerable. So I let them know that I have a little bit of drama, whether I express frustration because I'm running behind or whether I say you know I'm burnt-out or whatever, that that little drama is for me, just to let them know there is some similarity here and some difference, and so I think it creates a space that they feel that they can share right and share some of those things that they may not have shared and break down some of those barriers that we put up, because a lot of it is perception, a lot of it is real, but it kind of breaks down some of those barriers. So I think just approaching patients as a person for and not as a physician, not as a nurse, not as whatever the title is, like. Strip yourself away from the title. You still have the knowledge they're coming to you for something, it's there, but you don't need the title to prove that you have the knowledge. Just be a person, and I think that's the most important thing for me, as I try to incorporate the tenants and the principals and the approaches to inform care when I do interact with my colleagues and patients.

I just want to say I mean thank you for that. To hear a physician talk like that is revolutionary. Honestly, that is not how they were raised, that's not how we are raised. That's not the history of healthcare. You know when you look back into health care, since the beginning we have been taught that we are in control right, like when patients are with us. You're the expert. I have seen many people you know come in to do again. We all come from a background, so those are my biggest references. But you know to come in and do a cervial exam without ever asking for consent. That's not something that you could do anywhere else in the world and not be arrested. Right so. But even when you look back at the history of right and you look at the racial atrocities, the atrocities that were done to women, how we, you know, even came to her. So what Dr. Triplette is saying while it sounds like yeah, that's you know, nice is truly revolutionary when, especially for physicians, because again, that's not the indoctrination that you get. You get the opposite and you know to say to patients when they are, you know in the hospital to ask for consent, to give them, to give over control is not how physicians were trained and not how nurses are trained. And that's a huge, huge paratime shift that we desperately need in healthcare, not just in women's health, but in all the health.

Yeah, I would pick you back off of that and just say: you know, interacting. I'm not at the bedside any more routinely. I'm working more with the healthcare workers, but everyone wants to feel connected. That's what we all want. Right. We all want to feel valued, we all to feel hurt and we all want to feel connected. So when Dr. Triplette talks about arriving as a person in their space instead of it, we have, like Lori said, we have been trained, that they are coming into our space right. This is my house, whether I'm in a clinic or hospital, whatever that looks like, and to change that shift, that mindset that we are coming into the space together. I am part of your team, I am here with you, I'm not talking at you, I am here with you and to create that partnership and to let them be heard and let them be seen. That's huge right that allows allow yourself to be vulnerable instead of being in charge and in control. And that's hard for us as healthcare workers. Again, like Lori said, we were not grown this way, we were raised to be in charge.

Are there also sort of structural issues in the way health care is delivered and organized?

He would say that you know, just I mean for one of our labor and delivery sweets, we were revamping them. Just if I think about that, just the way the beds faced, I mean for a woman who is delivering a baby, I mean we walked in the room with her vagina greeting us. I mean that's just that, and I remember being part of meeting with the team that was revamping completely. We're doing our unit. I'm like. Can we change that like nobody wants as you walk-in the room if she's delivering her vagina was the first thing. You see that that's nobody does that like. Where in the world else do you do that? Like show page first? No one. So I mean it's just just that alone. But yes, I mean Striata computer not making contact. You know if someone does, we all have a requirement in all of health care. It's universal that you have to ask those questions. Have you ever had any physical verbal sexual abuse right? It's very standard. We don't ask it, really, usually with much warmth. It's just like a check-in the box right and you're not making eye contact. If someone were to really have anything to disclose, are you providing a space when you're on a computer screen and typing away? So that's something that's certainly you know we are, and I think those who that's all they've ever known? Those who work in hell care. It's all they've known. They have to be taught the importance of being on a-level playing field, making eye contact, sitting level to the patients and staying up at your computer screen and typing. That's huge and and we're not giving the time for it either. Right there's a huge issue of that shortage. Right, I mean, I'd like to be able to say I can kind of keep it all in my head, got it all down and they'll chart it on the computer later, but there's not the opportunity for that either.

Well, to spend the time with them right. You know if you have so many patients that you've got to just you know, keep it moving again. Like a man said, are you really providing the time and space for them to have that conversation? Or are you just? You know? People sense that right when you're in a hurry and you know we talk about the physicians who are, you know, like doing your history with their hand on the door. Or you know nurses who are like you, know you're good right as I'm walking out the door. So, and a lot of that has to do with staffing. But I think too, we don't give healthcare workers the permission to have their own issues right. We don't support them in self-care we don't support positions that way, positions are not supported to be to have the, you know time off to. So it's like how can you continue to pour from an empty cup and when you aren't supporting the people who are giving care all the time? You know compassion. Fatigue is a real thing and it gets to be where, even if you have the time, or do you and then you think okay? Well, if they do say something, what am I going to do with that? Because I've never been trained on how to respond to that. So you're almost like god. I hope they don't because I'm not sure what to do with that. And so, yeah, there's a whole lot of just things that get in the way of really that being able to happen in a way that you know is organic and real. And then you know, I mean we had, as Amanda and I were doing, training for people just in the questions that you know, and it was predominantly nurses, but that they would ask where. You know, I had a nurse one time to say: well, if I suspect this was human trafficking training and she was like: well, I don't have to have their consent to call law enforcement. Do, and Amanda and I are like, I mean, but you might get somebody killed, you know what I mean. So again, it's like, even if you're training them, educating them, they have to know what to do with that information. Right, like we love, to just throw a power point out there on some learning management system and say: okay now you're you're trained, you know, but they don't really know what to do with that. The new ones of that and and I just think, the staffing and the time piece. You know when patients come to us, it's an iceberg right and you're seeing this much and I do think that when you're in health care for a long time you get jaded and you judge people based on this very small. You know we're all human too, and you judge people based on this very small window into their life when, again, you don't know what brought them here, and so I just think it's health care is just such such a minefield for people who have trama and I think, especially when you know that most of the healthcare workers, physicians, nurses, whoever have their own tram and we don't really have the time, the band with, to really navigate that in a way that we need to.

The goal of the system sometimes is really not about providing the best patient care right. Sometimes the goal of the system is about making the most money and being more efficient or, you know, somehow improving the system. But when you also look at the system of health care it's usually led by people that are not medical. So they've never been at the bedside treating patients, or it's been so long since they've been at the bedside treating patients and dealing with the day-to-day of patient care that it's like they've never been at the bedside right. So the system's responsibility to engage people with the knowledge, but also to develop the training and realize that our healthcare workers need this training in order to best care for patients. It's the responsibility of the system to know the community in which they serve right. Because we put this, drama is a very broad term right. And so when we think of drama, we think of very large dramas. Have they for women? Have they been sexually abused? Have they? Do? They? Have? You know, something very big, but dramas can be very small. You know, do they not have the time to come to their appointment because of financial constraints or healthcare or childcare constraints or different things? Do they not come because they had one bad interaction with the physician? And so now they're not coming back again? Do they not? Do black women not come to get prenatal care? Because all they hear on the news is I'm three times more likely to die. So I'm not come to the, to the hospital. So it's all of these smaller perceptions and not necessarily the big dramas that that we see. So it's important for that system to know their community when we do training, when they implement training to implement from a really personal standpoint. You know right now everyone has training right and so, but is it specific to the community that they serve? A lot of people have trauma-informed care, but is it specific to the community that they serve? You know, in the community where I grew up in, you may ask someone if they had drama, they may say no, but then you go through their history and they've been shot three times. Well, they don't see that as drama right because all their friends have been shot right. So you have to make that training specific to the community and really get to know the community. And that is the system's responsibility. My responsibility as a physician is to see how I can adapt, how I approach people to make up for or what the system doesn't offer right, and I have to do it in such a way that it's not the problem of the patient right. So if the system says I can only see patients in 10 minutes windows and I know that this patient is going to take 20 minutes, it's my responsibility to make sure that patient gets there 20 minutes and not the patient's responsibility and to make them feel that they're the problem right. So you know, the system has. The systems that we work in has a huge responsibility and oftentimes I think they just fall.

It's really profound and I really appreciate you all shining a spotlight on these barriers, both institutional and internal, and you're really illuminating how profoundly countercultural the trauma-informed frame is. And, Dr. Triplette what you just shared about the importance of contextualizing, how folks show up and the ways that you all have really illuminated the institutional challenges, because the owners needs to be on the system, not on the individuals who are already overtaxed within those systems. You've just really made me wonder because you've each been successful in implementing this drama informed frame. How have you overcome some of these barriers and challenges?

I think for me I go against the system. I have the privilege of and say privilege because I worked in a private practice right. So I was the system right so I couldn't make up my rules and when I went and so I made up the, so I would sit with my patients. Although I had 50 patients in a day and 10 minutes slots, everyone knew I was running late, but everyone knew that they would get their time. So I made myself onable to my patients. My patients knew almost just about as much about me, I know about them. So I just made up my, my own rules and as I met my patients understood their needs, then I would just change the rules daily or weekly or whenever I needed to. Now when I went to the hospital which you know I did not own then I just bought a little bit of that with me. Sometimes it went over well. Sometimes I said I got called to the principal's office because it was outside the rules of the system. But that's OK because it takes courage from healthcare workers to highlight what is wrong right with our practices and with our systems and if more healthcare workers, if more physicians, if more people treating the patients continue to highlight what is wrong and have that courage, they can't ignore that right. But I think so many times we're so overwhelmed as healthcare workers with our own things right and trying to meet the obligations of the system that we don't want yet one more thing to do, because we know if we highlight a problem, the next thing they're going to say is: well, how should we fix it and you should fix it right. And so we have to overcome that and we just have to put that fear aside and do what we can, even small little things to to fix things. Because the ultimate care is patient care right and meeting the patient where they are not what we think they should be, not what we want them to be, but meeting them where they are. And so sometimes that takes a little bit of bravery, right, encouraged and going against, sometimes what those established norms are.

Not to speak for Lori, but I'll jump in and say that Lori and I are both rule breakers. So you know I would jump off of what Doctor Triplet said and say that you know we are both rule breakers, so we didn't wait for people to ask for the education because no one's coming to me. For instance, you know I'm still at within the hospital system, Loria's not anymore and no one's coming to me saying gosh, will you please tell us about trauma-informed care. So I just incorporated in the classes right, I just talk about it. I teach paramedics out in our community and so forth and I just talk about it. Talk about, you know, asking permission. I talk about getting consent and consent. Always every time, every time you touch someone in any fashion, you know and I just incorporated ad and you know, talk about try inform care, because a lot of times when I say try to inform care, I mean this is how foreign it is. They think I'm talking. Healthcare providers think that I'm talking about a drama like, oh, you mean, are you talking about when someone gets hurt? They're Natrona, like Moravice accident. I mean they really don't even understand. I'm talking about emotional and mental drama right. So I'm just again incorporating it and then you know, developed relationships within administration and within the corporation. You let's provide some education about this. How could I do this? And you know again, if they're not having to spend money on, they're more likely to do it. So, you know, put myself out there without costs right, already paying my salary. I just include it in that.

I think it's a space where you ask for forgiveness, not for permission. Right, you just do what you know that it's right, and then on the back and you say, oh, I'm sorry, but it's the right thing to do. So that's how I approach things now. Even when I teach my residents, upcoming physicians and medical student, I say: if you know it's the right thing, just do it and just ask for forgiveness later. But usually you don't have to ask for forgiveness, because if you're doing the right thing, then people will see that it was the right thing to do, even if it was outside of the confines of what the rules were.

We've got to move to a place where you don't have to go against the grain for this to be the right like. That's the goal, that this is the expectation and not, you know the few who are really prioritizing the patients in themselves. Honestly, because I think those go hand-in-hand and you know I mean just as long as health care is a poor profit business, this will always be the way that it is. Because dealing with drama and social determinants of health, the things that we know really impact individual and community and population health, which 80% of does not occur in a hospital or a physician's office. It's the safety of where they're living. Do they have access to food and education? You know what's going on at home are. Are they surrounded by violence? I mean, just like Doctor Triplett said, does everyone you know has been shot or you know there's constant violence around you? Those things are really what determine the health of of a community, right of of the nation. And as long as health care is for profit, we are engaging in reactive. We are reacting, we are not pro active and we never have them. We don't invest in primary care. We don't invest in having resources for you know transportation to get to. You know. Can you get your prescriptions? You know, do you have a language barrier? Can you understand what the instructions were? We don't invest in those things and the reason that we don't invest in those things is because that's not how the system gets paid. The system gets paid by the number of procedures they do, the number of patients they see what are the outcomes of the care that they provided. You know the whole quality shift from. You know it used to be that they just got paid on quantity and then there was a ship toward value based purchasing where you know, like in doctor triplet's world, you know it's your percentage of sections or it's your percentage of whatever, and that's how they get paid by the care and medical, who are the primary payers for health here in America. As long as those are the he metrics and hospitals have to make a profit to stay in business, they have no incentive to do some of these more proactive things. And then you know, it's up to folks that are again willing to go against the grain.

And that has come up a couple of times so far in the conversation of this importance of individual stepping up, becoming educated, rallying colleagues. And yet, I wonder: are thereways? You know what's it going to take? Is it getting it into educational curriculum during the training process? Is it the association stepping up? I know they do a lot of work in the burnout space for the healthcare providers, but I haven't seen too much on. You know, trauma-informed care for patients in or for the staff at large. Or is it going to just take a renegade band of spicy women to make it happen? What is horrible? How do we see each other? All right? I mean yes, right, like you would prove that right , but at a systems level you know how. How do we crack that nut?

Well, and that's really the focus of my, I mean. This is why I went back to get my. So my project in health policy specifically is because the longer you know, you start at the bedside and then you get into leadership and you know you're doing institutional policies and you're making change at an institutional level. But you realize pretty quickly that until this is more of a national policy, nothing is really going to change. You know you have pockets now where you can look to examples in Massachusetts and certain states that have done these trama informed. You know projects that have had great success in healthcare in, you know, justice involved, youth and decreasing recidivism and all of these things. But until it's ingrained in what is the expectation for these systems, you're not going to have that. So my project. So I live in Indiana and my project is around getting trama and form care mandated, getting a bill sponsored and passed for the state to Manda Tram and for her four nurses, that it's part of the cirriculum as they are training and that it's also part of their continuing education annually that hospitals, whoever their employers are, are obligated to provide. You know every year when you work in a hospital there are annual mandatory things that you have to take. You do, you know how to work the fire extinguisher, things like that. This needs to be part of that. You know we're talking about more than 70% of the population and you know if this is the majority of people that we are seeing, then it needs to be mandatory because they're not going to do it. No one is going to do it just on their own good will, because again it comes down to money for hospitals, like I talked about, that's not how they get paid. When you look at nursing education and doctor triplet can speak to medical. That's not my expertise. That's not my world. But I know for nursing, all nurses to get licensed take what's called an influx test, that's your boards that you take. All schools who provide nursing education that are accredited teach to that test because their federal funding is tied to those past rates. So until it becomes something that is on that test, they don't you know. There's no incentive for them to provide that education and there's the real barrier to them of well, what do we only have a limited amount of time? What do we remove that is on that test? To insert this, then? Where does this go? And it's not because you know, I mean, I have done, I mean, and I both have done at the college level. You know professors who just on again on their own accord, were like: hey, I'm teaching population health. I need somebody to come in and and talk about human trafficking and try to inform care. And you know cycles of abuse, but that's not baked into their cirriculum and that's nationwide. So I think to answer your question is: yes, it has to be something that is part of a broader policy and expectation and and tied to money, because you know, unless it's tied to the bottom line, you don't get it, you don't get it, you just want.

I think that something that I'm really struck by in that is this aspect of really we have all of the evidence that this works and still right. It's really finding those values and catering to exactly what messaging you need to think about in order to make this compelling. And one of the things we know, just you know for our listening audience, is that, in addition to having the proof, stories really matter, and so I'm just wondering if you might be able to share some brief stories where integrating trauma-informed approach really did lead to significant breakthroughs in attending to patients well being, just to get both the head and the heart sort of engaged in this conversation.

The first thing I want to say is, like I said, I never received any education. I never heard of Tom informed after having been at the bedside for 20 years. Never once, and I mean that 20 years was just the end of that. 20 years was just three years ago. This was not a long time ago, of course, never once woke up and thought I want to go traumatize somebody. It never crossed my mind that that's what I was doing and I will point the finger at myself first and say: looking back, I know that I did and it hurts my heart and my soul because that was never my intent. I didn't know how to do better. So you know now I can think of a space where I was working, caring for patient again in labor and delivery within the last couple of years. I had picked up a shift after having learned this and I had a patient who was in active labor and lots of pain and, you know, needing to have her service checked to find out where she was in this process. So we could kind of figure out a plan of care for her and I never thought that was aggressively going. I would normally probably just talk. I'm going to go ahead and check you and start doing those things right, didn't think. But I changed that that verbage to. Is it okay if I go ahead and check you, you let me know when you are ready. Right and it's just minor, and that was always my intent. That was always my my thought when I checked someone. But that's not what I was saying. You let me know when you're ready because she's writhing and paid. The last thing she is of a contraction is then put my hand on her vagina right like that is not helpful and that's not beneficial and it's not going to change our plan. I care from this minute to the next and you know people are rushing in because she was moving quickly. An they're trying to get her moved to a room and so forth. But and they were waiting on me. But and you know, it's easy to especial who you're young new nurse. I wasn't young new nurse, so I don't care, but he you're young new nurse. It's easy to need to do this because people already. An there's some physician waiting on me and Estesia wants to put in her girl and all these things. An you're feeling that pressure and it was just changing those words and she was in control of that. She ran the show, I was there to serve her and partner with her and she directed it and that's the way it always should be and I realize now, and this is why I say education is, I did do it wrong a lot of times because I didn't know better. So I'm i'm not above anybody. I've done those things because I didn't know better. It was never my intent. I don't think it's anyone's intent, but I know that that just changes the game right. It changes the game and when you can, location and you let them run the show and I'm here for you and I don't want to do anything to you. I want to work with you. So just, I mean again, that was just a minor example, but I certainly felt like it was valuable and I think it sets an example to the other people that are in the space without even being overly intentional.

It's very customary when women come for there, there to their gin. My assistant or medical assistant would put them in the room, take their history and then she's like okay, get undressed from waist down and the doctor will be in right. And it wasn't until I left private practice that I realized how dramatic, how demeaning, how uncomfortable, how anxiety provoking it is for someone to sit there in a paper gown and bear their sole about medical problems to you right. So I have since switched my approach and so now I have no one. Get undressed before I talk to them, they just come into the room, they sit there and then I asked you're here for your annual. Would you like to get undressed? Would you like for me to do an exam, a breast exam, a pelvic exam? Would you like a paper? And sometimes I find that people say no for the information or I'm here for something. So it's it's it's not again meeting the patients where they are not what you expect them to be. Our expectation is you're here to see me. So therefore you have to remove your clothes because I have to examine you right and that's on me right to to reframe how I approach patients, and what I found is that I get a lot more information. They get a lot more information. I get the best of them. They get the best of me when we're both sitting there comfortable before kind of moving forward. But for 15 years, 18 years, you know I just saw everyone and talked to everyone, basically necked right, and so just realizing how how vulnerable they are right and how that volubility may prevent them from really addressing what they actually came there for. So just realizing the things that I was doing to them was either dramatizing them for the first time or re dramatizing right again. So just even making that small change and letting them lead the conversation and lead what I do next is a better approach than than me always leading.

Well, and I think everything that Dr. Triplette  is talking about is about that power differential and flattening that power differential between I'm the doctor and you're the patient, and how powerful that is right. Her willingness to, you know, share her own vulnerability to not be know. I'm the expert in the room. I'm going to direct all of this. You're going to do. What I say is very understated, but so powerful. I mean, like she said, the littlest, biggest change. I mean that's huge, and there are so many physicians who just and again not to fault physicians because it's all of us, but that we're not trained or not even to feel they feel this pressure. I mean, you know, I've trained a lot of physicians in doing resuscitation, for example, and feeling the pressure of. I've got to know everything. I have to be the leader. I have to have all the answers. If I don't then I appear weak and people are going to think that I don't know what I'm doing or that they can't depend on me or trust me or whatever, instead of allowing themselves to say: well, what do you guys think? Right even to 13? So it's not even just with patients, but with their nurses, with their staff, to say what am I missing or what do you guys think or you know, like she said, to engage the patient in. That is just not where they come from. You know, that's just not how we train doctors in America. We just don't and again, that's why I feel like this has to be part of that train, not only the training but, you know, ongoing education. But I was thinking in terms of an example. I may and I both, when we were working with a local anti trafficking organization, had a patient. We would go and sort of be their advocate with them during medical visit and you know, showing up to this patient was very, very reluctant to go, even though she had some really serious chronic health issues. She was basically in liver failure, but she had been trafficked for 40 years and she had been so ill treated within the health care system. You know she was told that as a prostitute, prostitutes can't be rated, not possible. She had all but given up on-going into the health and we know that 80 to 90% of people who are in trafficking interact with the healthcare system right because they they're getting. You know they're getting pregnant, they're getting beaten and they're getting, you know, whatever they end up in the or, in, you know, an unit. And so she was having a span of her liver. So she was going like to image, and so I was to meet her there in the waiting room and she was so ill that she couldn't walk. She was in a wheelchair and they had positioned her, so it was one of those waiting rooms that's kind of like open to the hallway, you know, just sort of open to everything. It wasn't like a closed in space, but there were sort of like cheers in, like a semicircle on either side and then you could walk-through they put her wheelchair smack in the middle. And as I'm walking up to her, and as again, a lot of what I know and do is just based on my own history in my own complex PTSD is, I can't have my back open like that right, I just it's so unnerving and so I could see her eyes just darting and her head on a swivel. And so I, just without even saying anything in my head, thought I have to move her. And so I went up and I said: are you okay if I move you over to this corner and she was like, oh god please, and as soon as just moving her to the corner where she could see in front of her who was coming at her and who was in her space, you could just feel the, you know, like desolation of how nervous she was already nervous about this appointment. Right, and and so again, we would do training and Amanda and I would talk to, and I'm like that's very simple. Right, like where do you position them in a room, is very simple. Right. They should be able to see who's coming and going. But that's something that you may not necessarily think about. If you haven't been trained to do that right, if that's not your own personal history or you've not had that education, nobody tells you that right, I mean it makes. When you think about it, you're like, oh yeah, that makes sense, but it's not something that we would just naturally do. And the other example, I think as a patient myself, which again was so simple and this was actually so, Doctor Trickle was my doctor and this was actually an in her office that I had an appointment with and she was doing an exam and most of the time. You know I'm right most of the time, but you never know what's going to trigger you from day-to-day right and for whatever reason, as she's doing this, just my normal life annual thing. And she was lovely. Right. I mean she was very now asked me and we talked and she was great, but for whatever reason it just so I'm laying there doing like the silent waterfall, you know and in my mind, like just get through it, just get through it. That has happened before, where providers either didn't recognize it or recognized it and didn't address it because they didn't know how to. She immediately realized what was happening and you know, as a woman we've all been in that lovely position in the stirrups right and she kind of just put my knees together and like peered at me over my knees and said: do you have a history? And I just nodded and she said we're just going to take a break and she like took my legs down, put them together, covered me up, sat on a stool next to me and I said I'm so sorry and she said: don't be sorry. She said you're fine, let me know when you're ready and if you don't we don't have to finish it if you don't want to and I'm sitting there just feeling, you know, stupid, embarrassed like you know, and she was like I'm just going to stay here and answer emails. Girl, you take all the time you need just to normalize it. I'm not. That's enough, her schedule. I'm not being a pain in the, but you know she's not upset with me and within just a minute or two I'm like all right girl. Let's go, I'm goin. Let's just finish it, you know, and she's like, be sure, yeah, and afterwards I told her, like, gave her crops and said: you know, you don't understand how great you did in that. Keep doing that and and I said something. I said, you know, mentioned, trama informed and she was like, what. What's that?

Now she's doing. You're doing it, girl, you're doing!

You're doing it really well, but you know again she was just like what that. What is that?

Tell me more.

And this is normalizing that and not being afraid to say out loud without pushing from details right, without like digging into it. Just something's going on with you. Let's take a break, and that's fine and you can talk about it if you want to. Not you know, I mean it was just very. She clearly was available to listen if I wanted to, but she wasn't pressuring me for what's this about, what's going on?

And I want to say, because I don't really have, like when Dr. Triplette talks about the big dramas right like tha's what we think about is that I don't have a history myself, right like I'm sure I got something minute or whatever, but I don't tell people all th time. Huge class like the Saint. Survivor led on my part like I was raised in a minivan and drive many an so. But it has to be survivor led. This education has, like we have to be educated, those of us who educate others. It has to be survivor led because I know what I know. There's a lot o people who have done research and that's all very valuable, like I don't mean to disclaim that it has. There has to be research and science and in all that behind me, the ass that's been proved and so on and so forth. But it has to be survivor, led, you know, to to have worth behind it, to have the meat behind it. And just hearing these words melts my heart because we don't you know. It kills me to think that I did things that was ever harmful to a patient. It breaks my soul and now I just feel like everyone needs to know it. How do I? How do I make sure everyone knows this? Because my god, I don't I don't want anyone else to feel like that. You know, and again, it's just it's you don't know what you don't know, and once you find out, and I wish I had known sooner, I wish, and it is. It's small things. These aren't massive, these are. It's not massive, it's small things. It's asking permission. It's you know, knocking and really waiting till someone lets you come in the room as opposed to knocking as you walk-in you know it's not having them sit in a paper gown. Right. I mean, these are just small things that literally are transforming to people. It is transforming and I don't I don't want to manipulate the conversation, but one of the biggest lessons that I took I took away, and Lori knows this, is that now I felt like when someone was under my care when they came in and I just knew there was current drama in their lives, like you couldn't feel it in the space whether there was some one with them who was answering for them and speaking for them. You felt them withdraw when that person entered the room. What have you? You just knew there was something not safe in their current situation. I really thought that it was my role to keep them from going back into that right, to quote unquote. Save them like if I let them leave and go back with this person or back to that unsafe living situation, have failed. I'm sending them back out to an unsafe situation and I thought I had failed. I mean, and it hurt me. I can think of exact situations where I discharged them and thought, well, God knows what's going to happen to him. But then what I've come to learn is that is not my job, it is not my job. That may be what is best for them, and maybe the very best answer of all the options they have. And my job is to keep them safe and let them know that I am a safe space, and the space that they are going to take up when they're with me is going to be safe. They're more likely to return, they're more likely to trust and they may one day see that there are other options, and that is a long process, and it is not my job to decide when they're ready for that, if they ever are, and that was the biggest lesson that I learned.

And again, how we're trained, especially physicians, are trained to save at all. That save you, save the life, no matter what the quality of life is. You save them right. That's the win, that's the goal. And so it's very difficult for people in health care to think that they're not wearing the cape right. I mean it's very nurse sisic of us, but but I get it right, like when you literally are doing life and death things and you know that you're doing that. You believe that you are doing that for their best right. We really do believe we're doing that for the best of the patient. But it's very hard for us to think about not saving but providing safety as being the goal. That's very. That's a huge kind of mindshift and I know Amanda has talked a lot and about. You know I know I've made mistakes, Dr. Triplette talked about. I did this for 15 years and now I know better, and so we always, when I teach drama, inform care at the end I have a poem that I read and I kind of show that my angel. When you know better, you do better and if it's okay with you, I just want to read it really quick because it's really toward healthcare workers who are just now learning this or understanding this. So it says, despite our good intentions, we may have caused harm. Despite our best efforts. We may have retreated survivors. We now know we could have done better and we will to anyone we may have harmed. We hope you have been able to walk your own path of feeling. We thank survivors for what they taught us. Help us walk together in peace and joy as we choose to forgive ourselves, because our intent, my intent, is never to shame doctor mercy. We were not given these tools and and that's okay right, we can do better from here.

I love that and I think the fact that the three of you all are able to be so open and vulnerable with your stories and with your journeys it's going to make a big difference, because you know that's you connect through emotion, you don't connect through facts right and so, as as a patient who has been through her own healthcare related trauma, just even hearing that too gives me a lot of hope. So I think it's a beautiful way to rap the conversation. Thank you so much for being with us today. We really appreciate.

Thank you, thank you.