“Reclaiming Your Life after Medical Trauma” with Author James Jackson

Jeremiah Hodshire (Host): I’m excited to be in the studio today, I’m always excited to be in the studio, but even more so today because I have a returning guest with me, someone who has presented before on a very important topic, which we’ll talk about in just a minute as a summary of our previous podcast, but it is my pleasure to have you in the studio physically, last time you were virtual, Doctor James Jackson, co-founder and director of behavioral health at the ICU Recovery Center within Vanderbilt University Medical Recovery Center. Is that correct?

James Jackson (Guest): That’s right.

JH: Just want to make sure I got it all out there. We introduced you last time, phenomenal response from our listeners, because we were talking about a subject that at first was highly controversial, still really is in its own way and divided this country, it really did, and caused significant disruption in our healthcare system. Yet you took an opportunity to write about that, and it was about long Covid, and I never knew about long Covid until you actually presented that and the impact and effects of it. So, it was exciting to learn then about something new and from there we have promoted that. We’ve received a lot of comments about the work that you’ve done and so, when I found out that there was a second book that you wrote, I was even more excited to get you on the podcast and so today, I am excited to have you in the studio with us to share some exciting news of a new publication, which we’ll talk about in just a minute. So, let’s stop there, before we jump into the meat and potatoes of our discussion today, just talk a little bit about yourself. You are co-founder and director of Behavioral Health at the ICU Recovery Center and I guess the question one would ask is, because that’s a niche type service, is what led you to go there? Why do you do it? What’s the passion behind it? Give a little perspective about what it is.

JJ: Yeah, it’s a good question. When you write a book, you do book signings and you tell stories. You try not to tell the same story and so, at a book signing I did at Vanderbilt the other day, I talked about the day that my wife and I were at a restaurant in Nashville, Chinese restaurant now closed, called August Moon, and we got fortune cookies, like people do, and I opened mine and the fortune said, you will prosper in the field of medical research. That’s what it said.

JH: Is that right?

Oddly.

JH: How weird is that? I mean, that cookie isn’t made for everybody.

JJ: Exactly. So, it’s strange and I did take it a little bit as a sign, I really did, and I was a couple years into my career, I was doing a little clinical work, mostly research, and I felt like I was kind of betraying my birth right. I thought I was really supposed to see patients full time all the time, and at the time, my career was looking like it was going to be grounded a little bit more in research, but in in clinical research and in research on outcomes in ICU survivors. That’s what I was starting to study. That fortune cookie nudged me, it really did, forward to jump into a field that was emerging and that field was asking questions like this. We help people survive, they leave the ICU intact, we pat ourselves on the back because of a job well done, and we assume that everything’s fine, but what if it’s not fine? What if these patients who were in the ICU, in the CCU, what if they have brand new problems that they didn’t have before? What about that? Are they falling through the cracks? Have we forgotten them? Maybe we’ve introduced some problems they didn’t have before and that’s what we started studying at Vanderbilt; this notion that survivors had brand new challenges because of the effects of their illness, and as we started pulling the thread, the whole sweater started unraveling. That’s really what happened. We learned that we were on to something. We were on to something that, in the context of critical illness, has been called post intensive care syndrome. It’s an entire syndrome. And so, when I began engaging ICU survivors and survivors of cancer and survivors of transplant, the theme that cut across all of these populations was trauma. It was really trauma. They had been traumatized, and as I worked with them, as I realized that they didn’t have much of a voice and no resources, I really decided somebody’s got to shine a light on this. And that led to the creation of this book.

JH: That’s incredible. So, for those listening today who may not know your background, you don’t just wake up one day and write books. So, talk to us a little bit about what got you here. I mean, where did that journey start and what do you do, what were you doing on a day-to-day basis?

JJ: It’s interesting. I grew up in Portage, Michigan. So, 50 miles from here. But a long drive actually down country roads, as I found out.

JH: Sure is.

JJ: My mom and dad talk about how there was a tiny library in Portage, the Portage Plaza, and I would walk in as a little boy, and you could hear my cowboy boots clicking. In high school, I desperately wanted to get into honors English class. The door was slammed shut on me; I was not a good student. I was not a gifted communicator, but was interested in it and wanted to do it. So, over the years, I wrote papers, I wrote grants. I began to be aware that I was an effective communicator, and I think that led to some confidence that I could write some books. I wrote one book. Once you write one book, you realize you can write another one, but the goal with the books always, and I think this is so important, is they need to be practical. You can learn to write an academic paper, that no patient will read, by the way. Very often the challenge to me is, and a lot of my examples have to do with food. People have pointed this out, I don’t know what that means, the challenge is, how do you put the cookies on the shelf where somebody could reach them? How do you take complicated concepts and make them accessible? And I think one thing, this book, Reclaiming Your Life for Medical Trauma, does, is it takes some complicated concepts and it distills them down and it makes them accessible, and that’s the goal. Stephen Covey, who you know well I’m sure, he had this great analogy, had so many, one of them was; there’s a ladder on the wall and a guy’s climbing it. He gets to the top. He’s so proud, and then he realizes it’s leaning against the wrong wall. He’s horrified. I think in writing a book; in communicating a message with patients, you’ve got to make sure the ladders against the right wall, meaning we need to communicate something that is interesting to patients. We need to communicate something they’ll embrace. If we don’t do that what’s the point?

JH: Absolutely. Well, I’m excited to talk about this and so much more. Before we dive into all of those topics, for our listeners who may be listening in Texas, California, wherever they don’t know you. Do you have a fun fact about yourself that would maybe humanize you to our listeners? Like, is this guy real? Is he just, up in the ivory tower just writing books and smoking pipes?

JJ: I’ll share a couple of things. You mentioned the nationwide scope of this podcast. It’s lovely. The people from Colorado who are listening will know that there is an alligator farm in southern Colorado and they have alligator wrestling school.

JH: Really?

JJ: Back in the day, you could pay $100. Wade into a swamp. Grab an alligator by the tail. Post with some pictures.

JH: Well, someone could, but you did.

I did, with my good buddy Bryan Fox. Big daredevil. I don’t know if I’d do that today. I did the six-foot alligator. I was too scared to do the eight-foot. The other thing that I think of when I think of coming to Portage, there used to be a celery museum in Portage, of all places. Even people in in Hillsdale don’t know about that. Not too well known. They had a character, a big celery suit, and his name was Mr. Crispy, and for a couple summers, I walked in the parade and I was Mr. Crispy.

JH: That is so cool. Such fun stories, I’d say. Well, isn’t that incredible? We humanize ourselves and these stories make us real to our listeners. So, it’s incredible. I did have the chance to go to Florida, where I took our children to an alligator farm, Gator Land. I love it. Couldn’t get over the smell right away but they wrestled, and my son wanted to do it and I did not let him. No way. I watched the first time that one of their performers or gatekeepers there was doing it, and I thought, no way, can’t make it happen. So, if you can wrestle an alligator in life, you can tackle pretty much anything.

JJ: The main memory I have of that, there was an alligator wrestling handler, I guess you’d call him, a nice guy. He was showing us the ropes. And as he was wrestling a Gator, one of his front teeth fell out and he picked it up off the ground and popped it back in.

JH: Well, those things build character.  So, you wrestled with alligators. Well, that’s a fun fact. Now I want to get into really some serious notes here because the book Reclaiming Your Life from Medical Trauma, which just came out at the first part of May, and for our listeners, we’re going to drop this in the show notes. We’re talking about medical trauma, and that trauma can create barriers between patients and access to the care that they desperately need, and so, I’m excited today that Doctor Jackson will share his perspective. He’s an expert in behavioral health, and as an expert, he put that into words. As an author of a recently published book on this very subject of medical trauma. We’ll talk about symptoms of medical trauma, healing strategies, and, of course, what all this has to do with rural health.

JH: So again, great to have you in the studio. I want to talk about the foreword. I want to talk about the purpose of this book, and I want to get to the bottom of, Reclaiming Your Life from Medical Trauma. It’s a unique topic, and it’s one that even as a hospital administrator I don’t think about. That’s pretty sad. Now that I’m sat here, I’m kind of awestruck. So, as I look at you, I’m thinking, what should I be doing as a CEO? Maybe my listeners are asking the same question, because many times in our industry, we fix and we send. We’re not on that other end, but that’s the continuum of care, and that is just as important in the post discharge of a patient, but sometimes after the discharge planner meets with them, they get them signed up for home care and we go our separate ways. I have not read the book because it’s obviously recently been released. I want to learn a little bit more about the book, Reclaiming Your Life from Medical Trauma and what prompted you to dedicate this title, I mean, we know the story of the preamble of, the fortune cookie, but there had there had to be something inside of you. Was it your own CCU visit? Was it a family visit? I mean, this is a niche.

JJ: It is. I mean, I appreciate all those comments. And I think, by the way, if you leave here with a decision to start being curious about this issue of medical trauma, I think that will be an amazing thing. It is a personal pursuit for me, medical trauma, pursuing medical trauma, and it was born out of a dynamic where if you sometimes see something that is jarring enough, you can’t really unsee it. I really cut my teeth at Vanderbilt, and this is where I relate so well to the work you’re doing. I cut my teeth doing home visits with our research subjects, who often were life flighted from rural Kentucky or rural Georgia, rural Tennessee to Nashville, and I would drive to their homes. I would sit with these folks, primarily rural, around their kitchen table, on their porch in a holler on the side of a mountain, very classic kind of Appalachian, and I’d ask them to tell me their stories. I’d have a survey I’d give them about depression and PTSD and other things, but I asked them to hear their stories, and in that personal setting where they were vulnerable, I began to learn that, and the research bears it out, 1 in 5 or 1 in 6 of them had significant symptoms of PTSD, and many of them had pretty meaningful issues with claustrophobia from being in restraints. Many of them were terrified of going to the E.R. now, because the E.R. was the place where they had been admitted to the ICU and that was scary for them and I could go on. So, I heard these stories that they shared about how difficult their lives were due to the illnesses they were having and their specific stories. I remember the story of a woman who had had this emergency surgery and it was really terrifying for her, and when I met her, she had a bunion on her foot and it was easy to remove. It was no big problem, but it was making it hard for her to walk. She needed an elective surgery, and she was about to lose her job if she didn’t get it, because her job involved a lot of walking, and she was going to not get the surgery. Didn’t get the surgery because the fear of that tiny surgery was so profound, and as I began hearing these stories, I thought, somebody really needs to speak for these people and I’m not the only one who’s speaking for them, but I’m one of a few people that are committed to doing that. It’s a huge problem if we look at the scope of medical trauma, if we just look at numbers, patients following emergency C-sections, some studies would say, they have rates of PTSD that are comparable to those in Vietnam combat veterans. If we look at people who had cardiac arrests, there’s some studies that say that one and two of those patients have significant symptoms of PTSD.

JH: A follow up question. So that’s even if the baby survives. You’re saying they still have it.

JJ: Yes, exactly. They do. What typically happens JJ is in that inpatient setting; nurses are lovely and OB’s are kind and hugely concerned and then when they leave that birthing center, right when they leave the hospital, these folks are often left to navigate on their own, and they have flashbacks and nightmares and a huge range of symptoms. They have no idea what’s going on because they think PTSD only happens to someone who’s in combat or law enforcement.

JH: Let’s talk a little bit about what your goal is for the reader who has suffered medical trauma. So, is there hope? I guess what algorithm are we taking somebody through? Are there stages of this with them? So, if someone was to pick your book up and says, you know what, that sounds like me. Some people spend months in the ICU, for traumatic accidents. I know someone that spent six months. My dad spent over a month in an ICU, decades ago, he burnt his ear off half his face from an automobile accident where he was working on an engine. The trauma that my mother talked about up until her death about having to change the bandages of my father because they released him too early in her mind from the ICU and just the trauma my father went through, rebuilding an ear and those things. So, if that person was to pick this book up, is the intent of the book to raise awareness, or is it to give strategies for how to deal with that trauma?

JJ: I think it’s threefold and your examples are really powerful, and I would add something to them and that is I talk a lot about the ICU. I’m embedded in our ICU, but medical trauma often develops even in situations that we might think shouldn’t be or wouldn’t be that traumatic, but what I’ve learned is it’s a very dangerous thing for me to do. It’s very unhelpful for me to say no that doesn’t rise to the level of a trauma. That’s not bad enough.

JH: Well, because we’re taught that here. In our world of medicine, does that meet the trauma criteria? Designate trauma designation does that and so, we have this algorithm of oh, it doesn’t meet to that, but to your point, who’s defining that standard, because the victim, the person who suffered that, that should be in their eyes.

JJ: It should and it’s a much kinder approach. I mean, it’s interesting, and I’ll come back to your question, but I got a great tour of your hospital just a moment ago, and it was so lovely. I got in an elevator there, and I’m intensely claustrophobic, by the way, and the elevator opened it was very fine, all good, but the reason I’m claustrophobic is because at a VA hospital in Albuquerque, New Mexico, I was stuck on an elevator for a while, and it was just a little thing, I was safe, I was fine, but it left this huge mark on me. Left this gigantic mark on me. I had a panic attack, and this fear of small places started and it hasn’t gone away. So, from that I learned, wow, just a little thing can make a big impact, and that’s informed the way that I engage patients, but as it relates to the purpose of the book, I think it’s probably threefold. One, to shine light on this problem that is widely overlooked and ignored. Two, to give people, not false hope, but real hope, not unicorns and rainbows, but real hope. Three, to say, if you get the help you need, if all of your symptoms don’t go away, we can find a way to help you live a rich life. I think number three is important, especially because, as you know there are some medical problems in the in the medical arena, in the mental health arena. They’re pretty intractable right. Chronic pain would be one. Like we want to help people crack the code, but often it’s not going completely away and too frequently I encounter patients and they say something like this, and I have much empathy for this, they say if all of my symptoms go away, I’m going to be okay but if they don’t, I’ll never be okay, and I worry about that in the context of trauma. I’ve said it myself with my own challenges. So, the invitation to patients is let’s not set it up that way. Let’s not imagine that the only way for you to be okay is for all of your symptoms to go away. Let’s help you find a way to be okay, even if they don’t go away.

JH: It’s powerful to consider that. Sometimes in our lives, in healthcare, it fits the list and we check it off the list and we say that meets the medical necessity for that designation as trauma, but really to give consideration to in the eye of the person who is suffering, which is I think you found during your first book, long Covid, that, there was just almost a dismissive spirit about those who suffered with that and we still have it today. I mean, I’ve had, how many people come up to me and say, we’re over that Covid thing, why are we still doing masking? What is it? Oh, that was a joke. I’ve shared with you my personal story. I don’t know if you remember it, but my healthy brother-in-law, at 56 years of age, who was, just everyday American guy working a job and running a business and doing everything, contracted Covid and he died about a month later and my sister, who had terminal cancer at the exact same time, passed away a few months later, and so, no one would have ever expected the trauma. One of the things that that just really would grind me and still does to this day, is when people tell me that that was a made up, disease, infiltration, etc., and, it’s almost dismissive in nature, and it’s almost like we can’t memorialize the person anymore because it’s so dismissive. So, when we focus on this particular issue of trauma from the ICU, you’ve done a lot of work in behavioral health. Talk a little bit about the intersection of that. So, this is a physical ailment. Someone’s admitted at the ICU for months, weeks, days. It can even be days. Let’s not let’s not minimize it, I mean, a day in the ICU can be traumatizing. I mean, you hear the beeps, you hear the sounds, you hear people screaming, but then someone who has longer stays there. I would assume there’s an intersection at some point where the physical needs that we’re trying to address intersect with the behavioral. The psychological. Talk to us about that intersection.

JJ: Sure. The first thing I would say is that nobody starts at zero and by that, I mean when somebody develops a trauma, they’ve already had a little trauma, or maybe they’ve had a lot of trauma, and we know that people with medical challenges often have complicated trauma histories that make them a little more susceptible, both to getting ill or they influence how they manage their care, and so sometimes it’s a little bit of a setup that is, you wind up in the ICU, you already have an anxiety disorder. If you layer more anxiety provoking experiences on that, not surprisingly, it’s going to be a problem. The cut point, if you will, at which mental health issues develop. I think that’s anybody’s guess, but you can see it happen in real time and often what you see is you see people and their families who were quite optimistic that this issue was going to get tackled quickly, and when they start to realize it’s a different story, that really begins to sink in and that’s hard for them. Or if they get rapidly better, they’re about to leave the ICU and then they get worse. What we know about trauma is it really thrives in the context of unexpected outcomes. So, when you’re 94 years old and you know you’re longing for heaven because the rest of your family is there, and it’s not as stressful as being in the ICU when you’re 34 years old, and we see that a lot. There are people with the risk factors, and when you when you put them in contexts where those risk factors are going to be overrun, they struggle with things like trauma.

JH: It’s a great perspective, but even when you look at a friend of mine for many years who was 99. He wanted to live to be 150. He was fighting for life. All-around family members were dismissing, saying, he’s had a good life, he’s okay, but he’s looking at me, and he said from your lips to God’s ears I want to and he fought. Oftentimes we’re dismissive, because medical trauma and ICU trauma can impact all ages.

I think it’s a really good counterpoint that nobody, typically, is excited about this phenomenon. It impacts some more than others. But in every case, it’s really hard. It’s always hard.

JH: So, let’s talk about the family member, the friend, who has someone that they in their life and their family who has been through ICU medical trauma, wherever it is, what are the symptoms? Psychological? Physiological? Could you help describe what that looks like? I mean, is there signs?

JJ: Yeah, there are signs. There are some reliable signs. So, one sign that stands out a lot is what we call medical avoidance, and that medical avoidance takes all sorts of forms. I mean, recently I was interacting with a patient who had been a deacon at his church, and a big part of his calling, I would say, was visiting people in the hospital, and he now was absolutely unwilling to do that. He’d stopped, because it was too activating to be in the hospital. I’ve had other people who will say, man, the way I drive to work, it takes me by two hospitals. Now I drive 30 minutes out of my way, and that’s a lot like the old sort of Vietnam veteran who won’t watch movies with Rambo on TV. That’s classic avoidance, but it’s more severe than that. There was a study done in New York by my friend Don Edmondson, and in that study, they looked at people who had had cardiac arrests with PTSD versus without PTSD and what they found out was that if you had a new cardiac arrest and or chest pain, let’s say, without PTSD you got in your car and went right to the hospital, but if you had a new cardiac arrest and you had PTSD, you didn’t go right to the hospital. You took three times longer to go to the hospital and that was because you kept hoping that you wouldn’t have to go to the hospital, and as you know if you need to go to the hospital, the longer you decide not to go to the hospital, the by the time you get there, now you really have to go to the hospital. So medical avoidance is one, medical hypervigilance is another one and that has to do with profound preoccupation with health in a way that is not really in your best interest. So, this would be somebody who had had cancer, let’s say, and they are worried about a recurrence, but they’re worried far more than would be rational, and so, every little thing they notice is reflective of cancer, and it’s kind of over-identifying with your illness.

JH: So, family member friends detect that. What is their next step?

So, they could buy them a copy of this book. I think that that actually would be a practical idea.

JH: Well, we’re going to give 20 copies of this. So, to the first 20 individuals that comment on our post, Hillsdale is going to purchase those, and so, if anyone’s suffering, we don’t want that to be a barrier. We want to care of that.

JJ: So, that could be one and on a more on a on a more sort of practical note, though, invite them to consider talking to a mental health professional. I think for some people that’s a big step. So, I think the easier step is let’s start by bringing this up to your PCP. Let’s start by talking to your PA, your nurse practitioner and they can decide if you need to take it to a different level or not, but I think that would be a good start. Nudge them in the direction of talking to a healthcare provider about it, because help is available and if you get help, you get better.

JH: So, let’s talk about the family member, the friend, who has someone that they in their life and their family who has been through ICU medical trauma, wherever it is, what are the symptoms? Psychological? Physiological? Could you help describe what that looks like? I mean, is there signs?

JJ: Yeah, there are signs. There are some reliable signs. So, one sign that stands out a lot is what we call medical avoidance, and that medical avoidance takes all sorts of forms. I mean, recently I was interacting with a patient who had been a deacon at his church, and a big part of his calling, I would say, was visiting people in the hospital, and he now was absolutely unwilling to do that. He’d stopped, because it was too activating to be in the hospital. I’ve had other people who will say, man, the way I drive to work, it takes me by two hospitals. Now I drive 30 minutes out of my way, and that’s a lot like the old sort of Vietnam veteran who won’t watch movies with Rambo on TV. That’s classic avoidance, but it’s more severe than that. There was a study done in New York by my friend Don Edmondson, and in that study, they looked at people who had had cardiac arrests with PTSD versus without PTSD and what they found out was that if you had a new cardiac arrest and or chest pain, let’s say, without PTSD you got in your car and went right to the hospital, but if you had a new cardiac arrest and you had PTSD, you didn’t go right to the hospital. You took three times longer to go to the hospital and that was because you kept hoping that you wouldn’t have to go to the hospital, and as you know if you need to go to the hospital, the longer you decide not to go to the hospital, the by the time you get there, now you really have to go to the hospital. So medical avoidance is one, medical hypervigilance is another one and that has to do with profound preoccupation with health in a way that is not really in your best interest. So, this would be somebody who had had cancer, let’s say, and they are worried about a recurrence, but they’re worried far more than would be rational, and so, every little thing they notice is reflective of cancer, and it’s kind of over-identifying with your illness.

JH: So, family member friends detect that. What is their next step?

So, they could buy them a copy of this book. I think that that actually would be a practical idea.

JH: Well, we’re going to give 20 copies of this. So, to the first 20 individuals that comment on our post, Hillsdale is going to purchase those, and so, if anyone’s suffering, we don’t want that to be a barrier. We want to care of that.

JJ: So, that could be one and on a more on a on a more sort of practical note, though, invite them to consider talking to a mental health professional. I think for some people that’s a big step. So, I think the easier step is let’s start by bringing this up to your PCP. Let’s start by talking to your PA, your nurse practitioner and they can decide if you need to take it to a different level or not, but I think that would be a good start. Nudge them in the direction of talking to a healthcare provider about it, because help is available and if you get help, you get better.

JH: Absolutely. One of the things that I’m going to put you on the spot for, and it’s not part of the initial outline that we discussed, is, all right, now that I hear this, I’ve got to ask you the question. What can healthcare executives who are listening to this podcast do to change this? What would you say if you were in my seat as a CEO? At the end of the day, all responsibility stops right here, and so, what suggestions, ideas, advice would you give to the hospital CEO listening today that says, I want to help solve some of these issues and not be part of the problem. What steps can a hospital take, executives take and I guess let’s before you answer that, I want your sincere response to why is this being overlooked by healthcare professionals and mental health professionals today?

JJ: I think it’s overlooked because for many people, it’s an invisible problem, it’s not always evident this medical trauma, and I think it’s overlooked because people feel a great deal of shame about it in this context. Let’s take an example involving cancer. Someone gets their chemotherapy. Someone gets whatever treatment they get. They bond with their oncologist. They ring the bell, as they’re walking out of the cancer center. It’s beautiful. They feel like the only emotion they should feel is gratitude, and so, if they feel depression, if they feel anger, if they feel sadness, they feel like that negates somehow the gratitude they’re supposed to feel and they feel significant shame about that, and they don’t bring it up, and that’s why I think and I think with our patients, I’m constantly inviting them, I’m constantly asking them to embrace the idea that you can feel gratitude and sadness at the same time. One doesn’t negate the other. Make space for the negative emotions, but it’s hard for them to. It’s why they don’t talk about it. I think I would invite CEOs and leaders of organizations to recognize that there is this gigantic hidden problem that they likely are not aware of. That is probably very probably the most common form of trauma that nobody talks about. We talk about combat properly. We talk about trauma from sexual assault, and it isn’t about what trauma is worse, but there are other traumas we talk about, and this is one that doesn’t get the attention that it deserves. If you look at the number of people who have a cardiac arrest, who are in the ICU, 5 million people every year in North America. If you look at the number of people diagnosed with cancer who have epilepsy, Parkinson’s all times, and all these things, if even 1% of those people had medical trauma, we’re talking about millions of people around the world every year, and that medical trauma is important because it has adverse consequences for everything from healthcare utilization to divorce rates to compliance with care to you name it, it has meaningful consequences, and I think one way this could begin to flow downhill from CEOs to providers is for hospital leadership to say to their providers, let’s start inquiring with patients about medical trauma. It can be a simple question; you recovered from your cancer. That’s lovely. But how are you really doing? You’re back for a follow up scan, are you having some anxiety? I think there are ways that thoughtful providers can integrate some comments; doesn’t need to make the appointment a lot longer. I think when you begin peeling the layers away, you’re going to find something underneath.

JH: Incredible. As I reflect upon it and I shared with you, my first introduction to medical trauma, what my father had suffered, but before that, I was the seventh child of seven, and the OB-GYN told my mom that she should abort me because she was not going to survive the delivery. She chose not to and I’m glad of that because I’m here today, but she suffered significant trauma, and back in the early 70s, you just dealt with it. Women were having children, and you just you deal with it, and so, I’ve watched that unfold, what was really striking and the point that you raised that I want to send you a little bit is what you feel after ringing the bell, because I have an example. My mom was 82 when she rang the bell. She walked down the hallway cancer free. My wife and I took her home that day from ringing the bell. She was very excited. We get her home, and I said, “mom how are you feeling?” She goes, “I feel guilty.” I said, “you feel guilty?” “That your sister couldn’t ring the bell.” My sister had passed from cancer, and we don’t even think about even in that victory, the trauma, and then she started talking about the young girl that she saw at the cancer center who didn’t get to ring the bell. Even in healing, there’s still a message here that they’re still impacted by trauma.

JJ: It’s true. I mean, it’s a great point, this idea that that even in a capital ‘V’ victory. There’s some complexity. And I think, in the, in the array of interventions that I use with my patients sometimes, the simplest or the most effective and simply encouraging them to think in terms of “both and” rather than “either or” is really helpful. And it’s just this idea of making space for uncomfortable emotions and not trying to push them down, because what I found is, well, at our old house, we had a pool in the backyard and it was fine. I didn’t love it because occasionally I had to clean it, but if you take a beach ball and you try to push it down, it pops back up in your face. Negative emotions are the same. If you try to push them down, they’re going to pop up. If you notice them, you can learn to live with them. You can make space for them, but if you try to push them away, they’re going to bite you.

JH: I have a sincere question and I want you to answer to the ability that you feel comfortable, but is there ever full victory and healing from such trauma? Give me your perspective. Is there something that someone’s going to experience?

JJ: I think it’s rare that people would have the equivalent of ‘there is absolutely no cancer on the scan’. I think trauma leaves a mark. I think there are people who heal so completely that they don’t have a diagnosis of PTSD anymore. That’d be a great outcome, but it does leave a mark and I think it’s important to say to patients, we don’t need to scrub every symptom out of your life for you to be okay. I don’t know that I talked about this on the previous podcast, but I’ll mention it here. I was diagnosed with OCD in 2018. So, I went to see the psychologist, she’s amazing, and I said the way that I’m going to be healed is we’re going to get rid of all of my OCD, and I think she may have laughed. I don’t know if she did. I really thought I could. I thought I could pull it out, like a weed, and I had this insight that has proven to be powerful, that, you can live with things that you don’t want and that’s in some ways, I think, the most powerful message to our patients, which is we’re going to get you the best treatment we can. We want you to see the best psychologist we can. Whether you live in urban or rural America. Let’s connect you with the right resources and if that experience of treatment isn’t as curative as you hope, you can still live a really rich life.

JH: You can. Absolutely. So, let’s talk. As we close out today a little bit about what is treatment look like because, you had indicated go to your primary care provider, talk to your PA or NP talk to a mental health professional. What is there after talking is what do you suggest. I mean, is someone going to take a tour of an ICU as part of the therapy or give us an understanding of what that means.

JJ: Sure. Well, you’re referencing something called prolonged exposure PE, and that doesn’t mean literally that you need to go to an ICU, although some people do, but in the universe of treatments for PTSD, there are prolonged exposure. There’s something called cognitive processing therapy. There’s something called written exposure therapy. It’s kind of alphabet soup, there’s so many, and providers can connect you with those sorts of resources. There’s a form of therapy called acceptance and commitment therapy that would be, I think, useful for you to learn about in the context of teaching your providers, and it has to do with this idea that that to be okay, you don’t have to change your symptoms, you need to change your relationship with your symptoms. So that’s actually really powerful.

JH: And that’s teaching health professionals.

JJ: It is I mean; it is it’s also teaching patients, if you think of, I have a Christian faith, and so I think of Paul and Silas in the New Testament. They’re in jail. They’re in jail and they’re singing, and so, it’s not a simple thing, but acceptance commitment therapy helps patients find a way to thrive even in the midst of these difficulties, people can find that treatment. Self-care, I think is really important, and I think it’s a little bit underrated. I think people are very dismissive about self-care, and the reason I think they’re dismissive is many of the people who promote it act like it can solve the very most severe challenges, and of course, it can’t. If you have profound major depression, that is going to be so incredibly difficult that it’s going to require inpatient care. You’re not going to fix that by sitting on a park bench watching ducks, but if that’s not your story, there can be incredible value in participating in community and engaging in nature and exercising like we know that. So, there are a lot of ways to help. But it starts with an openness to the idea that this experience really was traumatic, and it starts with the courage really to begin to ask for help. So that would be the invitation. Brené Brown famously said, you can choose courage or you can choose comfort, but you can’t choose both.

JH: Incredible. It’s been very insightful today with you. So, for our listeners today, the book Reclaiming Your Life from Medical Trauma, we’re going to have 20 free copies that’ll go out to our listeners who would like to receive a copy of this book. Also, I’m going to purchase books for our leadership team here, because I think it’s an important aspect that we have to look at in the continuum of care is what happens post discharge to our patients, and it may actually help us not see higher incidence rates of depression or anxiety or fear. So, there’s great things that I believe are going to come out of this, and so very excited for the work that you are doing. Before we close today, I would just like to get a quick update because you’ve spent a tremendous amount of time on long Covid. Wrote a book about it. You’ve lectured. You’ve been across the country. Can you give us an update on that work? How’s that going?

JJ: I will and there’s also a short rural health story in this book, if I can mention that. We’re doing a large trial at Vanderbilt called reverse long Covid. There are other people around the country doing the same. I think some of these treatments are positive, are promising. We haven’t found the, the magic cure yet. I’m not sure that that’s going to happen, but people are working hard and I’m glad that the topic continues to be on the lips, in the hearts, in the minds of thoughtful researchers and clinicians, because for too long, I was a little worried that people would forget about it completely. Out of sight, out of mind. So, a lot of efforts are being made. We’ve got a long way to go. Backing up and making a quick comment about rural health. There’s story in the book about a patient I saw many years ago. He was from far off in the country, and I was a young psychologist. And I said to him, he was a hunter in Tennessee. And I said to him, the standard, “do you see things that other people don’t see?” I was trying to ask him if he had psychotic symptoms, and he said, “yes, I see things that other people don’t see.” And I thought, oh my gosh, well he’s delusional, and I said again, “do you see things that other people don’t see?” He said “yes.” I said, “can you tell me?” He said, “I’m a hunter. I’m out in the woods with my friends. They don’t see a deer, but I see a deer. I see things that other people don’t see.” You’re like, well, of course he did. He did. And so, it is reminded me of an insight that, that practitioners in urban areas like me in Nashville, in Detroit, in Ann Arbor and wherever Chicago that we need to remember when we engage our patients in the rural health community and that is, don’t take your assumptions about health and wellness and symptoms and all of that and put it on them. Let’s take a minute to really listen to what they’re saying, and I think that applies to medical trauma.

JH: Such a tough, message to get across, because in today’s time of bringing patients in, quickly, quick appointment turnaround times, we do have to remember to stop and to ask those meaningful questions. We’re going to put in the show notes how to access this. So, if you’re not available for one of the first 20 listeners who get a copy and you want to purchase a copy, we’ll talk about how to do that in the show notes and, I’m sure you’ve heard, Doctor Jackson, of all the challenges rural hospitals are facing across the country, and it’s only getting worse. HR1, also inappropriately called the One Big Beautiful Bill, is gutting hospitals. I fought my own party on this because I am absolutely opposed to it. It’s going to harm Americans. It’s going to harm individuals and rural communities. It’s going to harm the people that we need to take care of, that we, as men of faith, have been told that we have to take care of, the widows, the sick, the elderly, those folks, and so, unfortunately, it’s happened. It crossed the finish line signed by Congress, and it removes $1 trillion of Medicaid reimbursement to hospitals to be able to cover and to receive enough funding to provide the service to the Medicaid population. So, in the midst of all of that, you have payer challenges. The commercial insurance doesn’t want to pay it. You got tariffs, you got increase in wages. All these factors, and we have a turnover occurring right now in this country of healthcare officials. So, I want your perspective. What sage advice, you know tumultuous times that we’re in right now. You can’t turn on the television. You can’t listen to your feeds and not hear the devastation that’s happening. The prediction of 734 hospital closures in the very near future is very disturbing, and so, what advice what tip would you give to the new leader today? Or maybe it’s a maybe it’s a seasonal leader who’s just struggling to know how to balance all this. What sage advice from your experience and the work you’ve done would you give to the to the listener today who’s saying, I don’t know if I can do this? This is a lot of work. It’s a big task ahead of me. What sage advice would you have for?

JJ: Yeah, I love that. I love that as a closing question. I think it seems straightforward, to me that is, you’re going to be able to survive these difficult seasons if you make what you’re doing not a job, but a calling. Make it meaningful. It’s meaningful work. It’s not so simple, but you need to find a way to frame it as meaningful work. Even as you do that, you need to take care of yourself, you need to be mindful of your boundaries. You need to be aware of what you can handle, but if you don’t find a way to cast it as meaningful work, I think this is an environment that is very hard to survive in. So, make it meaningful work.

JH: Simple as it may sound. My mother always said when I was age 11 and I started working, we were very poor. And, kids had to work. And, we’re talking about work and the value of work, and she said, if you love your job you’ll never work another day in your life, and you’ve heard that phrase before but that’s very true. If you have passion for what you do and you put purpose into it, you can go a long way and you don’t have to go out and conquer hell with a squirt gun. You don’t have to get your name in a book. There are other meaningful ways. These are all great things, but there are other meaningful ways that in your local community, you can still have impact.

JJ: You can, you can. To me, the beauty is it’s not hard to make it meaningful work because it is meaningful work. What a privilege. What a high calling to engage these rural patients, Like, I mean, one of the beautiful seasons of my life, as I noted, was driving all around the rural Mid-South, getting to know people and recognizing, oh my gosh, like, this is the car that you’re driving. It’s not built to work and yet you are so brave you’re getting in that, with your glaucoma, with your oxygen tank, and you are driving, 100 miles to a hospital. Oh, my. If you’re doing that, what a privilege it is for me to care for you. What more important work is there than being advocates for these rural patients who otherwise wouldn’t have anybody to advocate for them? It’s a holy calling.

JH: Well said. Thank you so much for joining us today. Great to have you. I look forward to having you back for maybe your third book. We’re going to promote this because it’s so important that our hospitals across the country understand the importance of helping our patients deal with medical trauma. So, look forward to having you back on the next episode.

JJ: Thanks so much. Thank you very much.