PedSurg Resource
Wellness Committee
Introduction
The APSA Well-Being Committee supports pediatric surgeon well-being to ensure the best care possible for children.
The mission of the committee is to save lifetimes by supporting the physical, emotional and spiritual health of pediatric surgeons.
We accomplish this mission by:
- Encouraging awareness, promoting innovation and supporting surgeon self-care.
- Disseminating up-to-date continuing education on surgeon wellness, recovery from injury and moral distress.
- Supporting systems for community and peer support among pediatric surgeons with specific emphasis on diversity, equity, inclusiveness and justice.
- Performing research to determine and then disseminate evidence-based solutions to improve surgeon well-being.
- Lead the way for other specialties by example as we create and sustain support for pediatric surgeons throughout the continuum of their careers.
Mary Brandt recently gave a talk on moral injury to the American College of Surgeons Leadership Summit. View the video here.
Three part series on Moral Distress from the APSA Ethics and Wellness committees
Episode 1 What is moral distress
Episode 2 Moral distress rounds
Episode 3 Strategies for dealing with complications and difficult situations
Medical Malpractice Primer
Are you a physician named in a medical malpractice lawsuit? No...maybe just not yet. One-third of physicians will be.
Review the Medical Malpractice Primer created by the #APSAWellness Committee learn about the vocabulary, the process & other important practical considerations.
Peer Support
Click here to learn more and access APSA Peer Support Program.
Three part series on Peer Support and How this helps surgeons recover after an adverse patient outcome.
Episode 1 Moral Distress and Peer Support
Episode 2 Second Victim Syndrome: How Peer Support Can Help
Episode 3 How to Conduct a Peer Support Encounter
Moral Distress and Wellness Toolkit
This toolkit is the collaborative effort of the APSA Wellness, Ethics, and Advocacy committees. We have curated links directed at defining, understanding, and combatting moral distress caused by health policy changes relevant to pediatric surgery. Please direct any questions or concerns related to this toolkit to Sindhu Mannava (svmannava@gmail.com).
Understanding Moral Distress & Injury
Kherbache, A., Mertens, E., & Denier, Y. (2022). Moral distress in medicine: An ethical analysis. J Health Psychol, 27(8), 1971-1990. https://doi.org/10.1177/13591053211014586
- This paper by Kherbache et al. provides a helpful ethical analysis of moral distress that serves as a framework for understanding this issue.
- This webpage from the Colorado Healthcare Ethics Resource provides useful definitions of terms relating to moral distress and injury and tools for identifying moral distress.
Transforming Care: Burnout and Moral Injury Among Clinicians | Commonwealth Fund
- This article from the Commonwealth Fund identifies factors that lead to moral distress, provides definitions, and shares insights on developing peer support and strategies to tackle this issue.
Recognizing Addressing Moral Distress Quick Reference Guide (aacn.org)
- This resource and worksheet from the American Association of Colleges of Nursing (AACN) defines moral distress and shares techniques for identifying causes. Although this resource is catered towards nursing colleagues, there are valuable graphics and points shared here that can be applied universally.
Ethics Committee | PedSurg Resource (pedsurglibrary.com)
- In this resource, the APSA Ethics committee outlines relevant ethical challenges in pediatric surgery in addition to selected videos (created in collaboration with APSA Wellness committee) on moral distress and debriefing these difficult cases.
Strategies for Managing Moral Distress & Injury
APSA Peer Support Program - American Pediatric Surgical Association (apsapedsurg.org)
- The Peer Support Program offered through APSA provides an outlet for debriefing and navigating emotionally distressing scenarios. This link provides information on this service and includes a referral form to enroll in the program. See above section for more details.
Resources for Frontline Clinicians - Johns Hopkins Berman Institute of Bioethics (jhu.edu)
- This resource from the Johns Hopkins Berman Institute of Bioethics provides videos and journal articles related to tackling ethical challenges, moral distress, and moral injury. While this resource was created in response to the COVID-19 pandemic, many lessons shared here can be applied to diverse clinical scenarios.
- This article from the American Medical Association (AMA) shares a strategy called “resilience rounds” which emerged during the COVID-19 pandemic. Here you will find tips for implementing this activity into your organization to tackle moral distress in the workplace.
Emotional PPE Toolkit for Clinicians | Center to Advance Palliative Care (capc.org)
- This toolkit from the Center to Advance Palliative Care (CAPC) shares extensive resources based on the user’s interest and availability. There are individual resources as well as team wellness building activities included in this resource. CAPC also offers a confidential debriefing service to registered users if desired.
Supportive resources for Colorado healthcare workers (cohcwcovidsupport.org)
- Another tool born out of the COVID-19 pandemic, this webpage from the Colorado Healthcare Ethics Resource shares information on emergency helplines, stress reduction strategies, resiliency resources, a psychological first aid kit, and more.
Trauma-Informed Care - The American Association for the Surgery of Trauma (aast.org)
- This guide from the American Association for the Surgery of Trauma (AAST) provides a framework for Trauma Informed Care (TIC) and includes educational resources, journal article links, and implementation guides for integrating TIC into the workplace.
Trauma Informed Care can help break the cycle of violence | ACS (facs.org)
- The American College of Surgeons (ACS) Improving Social Determinants to Attenuate Violence (ISAVE) workgroup published a paper discussing strategies to break the cycle of violence. In this press release, highlights of the paper are shared along with a summary of recommendations.
Health Policy Advocacy
Health Policy and Advocacy Committee | PedSurg Resource (pedsurglibrary.com)
- The joint APSA/AAP Section on Surgery Advocacy committee offers the opportunity to learn about the pediatric surgeon’s role in health policy advocacy. Subgroups within this committee have taken on a variety of issues including firearm injuries, food insecurity, environmentalism, and patient autonomy and rights. In this webpage, you will find toolkits relevant to subgroups and opportunities to get involved in health advocacy. The reproductive rights toolkit is housed under the "Patient Autonomy" subheading and provides information and resources related to abortion restriction and pediatric surgery.
SurgeonsVoice | ACS (facs.org)
- This resource from the American College of Surgeons (ACS) guides surgeons and trainees through health advocacy by providing easy-to-use links to contact lawmakers on a number of health policies which impact our patients. SurgeonsVoice also includes a toolkit on conducting advocacy at home, engaging audiences on social media, and meeting with legislators.
- The American Academy of Pediatrics (AAP) has a long legacy of health advocacy. In this resource, you will find a digital advocacy guide compiled by the AAP with guidance on engaging with lawmakers, moving issues forward, learning more about political issues, and more. The AAP also creates advocacy reports which summarize existing ventures and accomplishments thus far.
Grief and Suicide Prevention
1. The Five Stages of the Grieving ProcessGrief.com
2. Supporting a Grieving Loved OneAmerican Foundation for Suicide Prevention (AFSP)-10 Ways to Support a Loved One Who Has Lost Someone
3. Conscious Conversations Understanding feelings, respecting boundaries, and being present for those experiencing loss. Community Virtues & Agreements
4. The Dinner Party Community Support Program
The Dinner Party is a platform for grieving 20- and 30-somethings to find a peer community and build lasting relationships. Since 2014, The Dinner Party has connected more than 13,000 grieving peers to one another - including 2,000 since the start of the pandemic. They screen, train and support a growing network of peer hosts and connect them to 12 to 15 people nearby who share a similar age and loss experience.
5. Resources for Those Affected by Suicide
AFSP.org: The American Foundation for Suicide Prevention (AFSP)
Speaking of Suicide A site for suicidal individuals and their loved ones, survivors, mental health professionals and others who care.
Healthcare Professional Suicide Prevention The pandemic, healthcare professional burnout, overcoming the stigma of seeking support for mental health and current events in our communities have all taken a toll on our well-being. The AFSP offers resources to raise awareness, prioritize physician mental health and seek help.
AFSP Support Hotline 1-800-273-8255 or text "TALK" to 741741
AFSP-Get Help Here Support for yourself or those who may be at risk for suicide.
Today.com The family of emergency department doctor, Lorna Green, shares their story of her April 2020 suicide.
Suicide Response Toolkit In the event of suicide within a physician residency or fellowship program, it is critical to have a plan of action already in place. This toolkit gives you a foundation for establishing a plan and serves as a practical handbook to consult at the time a suicide death does occur.
View the Honest discussion about suicide video.
6. Physician Support Line
The Physician Support Line is a national, free and confidential support service made up of 600+ volunteer psychiatrists, joined together in the determined hope to provide peer support for our physician colleagues and American medical students as we navigate the many professional and personal intersections of our lives. No appointment is necessary. Please do not wait till there is a mental health crisis before seeking help. www.physiciansupportline.com
Call our National Support Hotline:1-888-409-0141.
Physician Support Topics: Physician Support Resources
7. Healthcare Professionals Facebook Support Groups:
Physician to Physician Facebook Group: Healing the Practice of Medicine is a forum for physicians only (MD or DO or osteopathic or allopathic medical students) to discuss the epidemic of burnout, from a physician’s perspective including contributing factors, previous experiences as well as learning about applying evidence-based interventions.
First Responders Facebook Group: Grief Anonymous is a forum for all Healthcare and First Responders
We lost our beloved friend and colleague, Eric Jelin MD, to suicide on May 13, 2021. His wife, Dr. Angie Jelin, shares the eulogy that she delivered during the Johns Hopkins Hospital celebration of life that occurred in the weeks following his death. She hopes that his story and her words will help others that may be suffering in silence and serve to advocate for normalizing mental health wellness and treatment in our profession.
For so many families, today is a normal, happy day. That’s because my husband, Dr. Eric Jelin, fought so valiantly, so doggedly, to save their children’s lives. Eric was a renowned pediatric surgeon. As Director of the Johns Hopkins Children’s Center Fetal Program, Eric helped pioneer techniques to save lives for conditions many other doctors deemed lethal.
From the day I met Eric Jelin on the Vandy courtyard at Harvard Medical School nearly 20 years ago, I knew that life with him would be an exhilarating ride. The deal was sealed when we somehow both matched for residency at the University of California San Francisco, without couples matching. Eric never disappointed. He proposed on the Golden Gate Bridge complete with a limo and the surprise arrival of our parents. Max and Kyra were born during our training in San Francisco. Diana Farmer sold us her husband, Chico’s, M3 BMW convertible, fondly referred to by our kids as the “windy” car. We would drive it up the Northern California coast to Mike and Gretchen Harrison’s ranch for olive picking. And in those moments, life was perfect until we had to clean up the inevitable vomit in the back seat. He went big on birthdays, including hot air balloon rides and a first-class trip to Paris. Last summer, we celebrated Eric’s birthday and his R01 grant with a lobster feast in our backyard, despite the pandemic! We braved masks and socially distanced. In fact, we frequently braved frigid temperatures to enjoy friends during the pandemic winter. Eric knew how to live.
As we all know, Eric was extreme. He was ferocious, dedicated and wildly devoted. That unbridled, obsessive “Eric intensity” was most often funneled toward medicine and the people he loved. This was a man who called in Paul Sponsellor, the chief of pediatric orthopedic surgery, to set our son Max’s broken arm on Thanksgiving because no one else was sufficient for the job. He drove to the hospital to get lidocaine so he could personally suture our daughter Kyra’s foot in our living room because nobody would do it as well as he could. He even flew his brother Ben and Ben’s wife Shannon to Hopkins so that Jeanne Sheffield, the division director of Maternal Fetal Medicine could deliver our nephew, Hunter. He brought that same fierce commitment in the way he cared for his sister Sandra when she was diagnosed with glioblastoma, managing, studying and meddling in every aspect of her care for years on end. We saw it in the way he fought to protect his parents, brother and his sister’s family after their devastating loss.
Everything he did, he did 150%. He was all in! Operating on a complex case, accelerating his Tesla at full speed down the highway (and then making sure he had his drone on hand to capture it), absorbing and cherishing every detail and new development in Max and Kyra’s lives.
Eric was also complex. He was full of compassion for his friends, family and patients. His empathy and endless dedication to his patients made him feel alive, while simultaneously being a source of pain. He had a magnificent, gargantuan brain; one that could problem-solve medical miracles where everyone else could only see dead ends. It was a brain that also could remember the most embarrassing thing anyone had ever done and call upon it at any moment, for maximum effect. But that unstoppable, unparalleled machine inside his head simply could not be turned off. It was his super power and his albatross. He was very aware that the best parts of him were so connected to the more difficult parts of him and that caused him pain too. But these pieces of him were inextricably tied together and made him who he was - the man, friend, father and husband that I loved and that we will forever remember and celebrate.
For me, Eric was more than just a husband, he was a partner in every sense of the word — as a doctor, a parent and a friend. We supported each other. Our worlds were so completely intertwined. We had our own two-person brain trust that was always in sync and, because we were in separate subspecialties, we were never in competition. We discussed every school decision, hospital case, aspect of medical care, grant idea and even debated who would get voted off the island on Survivor. Very few partners are lucky enough to move together the way we did every day. And we brought out the best in each other.
Our research overlapped and Eric would review all of my manuscripts and — because that was Eric — sometimes even by the end truly believed the ideas were his and would decide to be first author.
There was nothing Eric loved more than our kids, Max and Kyra. There are so many parts of Eric that I wish I could take with me, that I wish could live on. But then I look at Max and Kyra and see the best of Eric in each of them. Max, I see Daddy in the way you solve even the most complex problems – with a unique concoction of brains, stubbornness and boundless creativity. The way you studied the Rubik’s cube until you could master it with ease, making it somehow look easy to the rest of us. I see Daddy in your mischief and your skills of persuasion, sometimes I wish you had inherited fewer of those skills. Just the other day, I told you it was bedtime and you said, “Mom, you need to google the average bedtime for an 11-year-old, mine is WAY earlier than the average.” I see Daddy in the way you take care of your sister (though I would prefer a little less teasing). And Kyra, I see Daddy so much in you too – Daddy’s little girl. I see him in the way you can work a room, unlike anyone else, making every person think you are their best friend and closest confidant. And the way you can bring up any embarrassing story about anyone and make them think it’s a compliment. I see him in your cuddles, in the way you take care of others and how much you love to face time the Cousins Club. I see him in your sweetness and your silliness. These are just a few examples, I could go on for days describing how all of the best of him is in both of you. In fact, sometimes I wonder where all of my DNA went.
And Eric is here in all of us. He’s here in your operating room (OR) playlists, in the inappropriate OR jokes you will tell in his honor, and in the commitment to getting to know each other as people he enforced in us all. And he’s here in his patients and their families, those he treated and those whom he never met but for whom his research will impact for years to come.
As we gather here today blindsided by grief, I hope that we can forge some lessons from our pain.
It is unclear to me why Eric’s death became public immediately. Think about how you learned of his passing, who told you, who did you tell? It was only known to physicians and medical personnel who are bound by HIPPA. One would think that we would treat our colleagues and their families with the dignity and confidentiality that we provide our patients, but instead the news about Eric spread across the entire country within 24 hours. I was bombarded with emails, phone calls and texts with questions, before I had even had a chance to tell our children. That should not have happened.
The public nature of Eric’s passing, however, brought an outpouring of support that is proportional to the loss that we have all felt. It has brought people together and made us question how we can better support each other and readdress societal views of mental health.
I want everyone to know that this was not Eric’s choice. This very acute and overwhelming bout of mental anguish he felt manifested in physical pain and prevented him from seeing the positives that life had to offer. In a few short months, his mind spiraled into an uncontrollable tornado of negative thoughts. His surgical and academic work environment accelerated this downward spiral.
It is impossible for me to fully comprehend how deeply Eric suffered at the end of his life. But one thing is clear to me: in his distress, Eric could not see any clear path forward. He couldn’t see a way to get out of an acute crisis without compromising his future as a surgeon. The stigma and shame associated with a major depressive episode made him feel that he would never be respected again after seeking treatment. The pressures to return to work to maintain his status to preserve his career that he loved and that he had spent a lifetime building pushed him back before he had taken sufficient time to recover. This is no one’s fault, but a product of a deeply entrenched culture in which we falsely see physical health as a condition and mental health as a choice.
I wish that Eric could have understood the unimaginable love and support in his life, even in his pain. But he was both ashamed and prideful and did not want others to know his suffering.
I can’t tell you how many stories I have heard over the past few weeks of people, mostly doctors, who have someone they love that has experienced something similar, and how many people have told me that they themselves have had similar episodes of depression including those that are related to their work or patient complications. I know that COVID-19 likely magnified a lot of Eric’s personal struggles, like it did for many physicians around the country. While I am happy these conversations are emerging from the shadows and that people are sharing, it shouldn’t take a tragedy like this to spark them.
We are doctors. But we are also human. We owe it to each other to remember that. I hope that we can learn from Eric and support each other, congratulate instead of criticize, provide opportunities instead of shame. I hope we can normalize mental health diagnoses and treatment in our profession, so that the next doctor in crisis sees a path forward. That’s another way that we can ensure that Eric Jelin keeps saving lives.
I want us all to remember Eric not for the way he died, but for the way he lived. Let’s tell stories about him often. Please always share your most Eric memories with me and with Max and Kyra, but feel free to make them a bit more PG. Let’s take care of the people around us and take care of each other the way Eric took care of all of us. Let’s bring laughter with us into every serious room, possibility into anything that might seem impossible, and kindness to each other when doubt is the overriding feeling.
I know we will continue to need your support in the days that follow and Max and Kyra and I are planning to live life the way Eric did with his spirit in our hearts.
Eric -- Max, Kyra and I love you and we always will.
