Crisis: Leading and Following

By: Jennifer Leiser, MD

“Murdered? What do you mean exactly?”

The human brain is not programmed to receive horrible and unexpected news. I just couldn’t get the idea to enter my head. My colleague’s voice on the phone was patient yet insistent as she repeated herself. Our talented, vibrant, brilliant resident, Sarah Hawley, was dead, shot in an apparent murder-suicide by her partner.

Not really knowing what I should do, I walked down the hall to the residency offices. The program director had already left for an emergency meeting with the graduate medical education office. Our program manager was in her office talking urgently on the phone, face averted from the door. Other staff did not know yet, still going about the tasks of an ordinary Monday morning. We called everyone into the common area for the news. Stunned silence washed over us.

In moments of extreme stress, humans freeze in shock. I felt my brain would not work right, that I couldn’t think of what to do next. I am supposed to be a leader here, helping my team through any difficulty. What am I supposed to do?

We think of disaster preparedness in terms of natural disasters or other calamities. Outside my office door hangs a handy chart to help me if I start to panic.

“Earthquake (Drop! Cover! Hold on!)
Fire (Activate alarm, proceed to Assembly Point)
Medical emergency (call 911)
Acts of violence (call University Police at XXX-COPS)
Remain Calm!!!”

This disaster was not on the chart.

Humans do other things in extreme moments: we turn to each other. Taking the news upstairs to administration, I walked into the physical and emotional embrace of colleagues who shared the gift of caring. The residency had a plan within the hour. Faculty fanned out to find Sarah’s intern classmates and tell them in person. The chief residents convened to figure out coverage for all immediate responsibilities. Other residencies at University of Utah stepped up to release our residents from their obligations. Clinic managers rearranged schedules.

I also learned that someone did prepare for this kind of disaster. The University of Utah Resiliency Center was formed several years ago to address questions of burnout and to foster wellness and resiliency among our staff, faculty, and students. Among the programs of the Resiliency Center was a Crisis Response Working Group, which now responded to our need. Counselors, chaplains, and media response specialists stepped up to help us. Resident support groups with facilitators were arranged for the same day. Administrators organized an emergency department meeting. Our senior vice president and university president came to meet with us. Shocked, bereaved residents and faculty were surrounded by caring professionals who knew what to do and say.

We received an outpouring of support from colleagues at the University of Utah and from across the country. Family medicine residencies in many states sent condolences. University of Utah residents in other specialties sent cards. Many took the time to write personal notes of support. Gifts, flowers, and emails poured in. Department chairs and faculty from everywhere reached out. It was truly heartening to receive so many expressions of caring.

Five months later, the new normal is stabilizing. Sarah’s picture is still on the residency poster on my office wall. Little things still cause pain, like the moment I find she is still on an email list. Her memory tree is leafing out at Red Butte Garden. Sarah’s parents have formed a lifelong bond with her classmates. A wonderful new resident matched into the gap in our second year class.

It is hard for me to conceive of a greater trauma to strike a residency program. In my personal definition, the first duty of leadership is to protect your people. Stunned like everyone else, I struggled to find a footing for myself so I could fulfill that duty. By grace I found this is not something to do alone.

What helped us through?

First, we have a long-standing culture of caring for each other. Over years of working together, we have built relationships of mutual dependence and accountability that spring into action whenever one of us is in need. At the moment of crisis, everyone leaned in to give all that they could to others.

Second, preparing for disaster means more that defining an assembly point. Lessons learned in prior crises helped our institution build the team that was ready when we needed it.  

In the end, we turn to the comfort of each other.

For more on Sarah Hawley’s life and legacy, click HERE.
Those wanting to donate to the memorial fund to support the annual lectureship can do so by clicking HERE.
For more on the University of Utah Resiliency Center, click HERE.

Jennifer Leiser, MD, is an Associate Professor (Clinical) and serves as Division Chief in Family Medicine at the University of Utah in Salt Lake City, UT. Dr. Leiser currently practices at the Sugar House Clinic.

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