Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

The 12 Steps of Recovery: Surviving a Disaster

4/7/2016 10:07:39 AM | 19 comments

I recall a portion of a lecture in my second year of medical school that I attended (yes, I attended them all) with uncanny clarity.
The lecture was on oncology by a physician from MD Andersen Cancer Center in Texas. While the cancer portion is hazy, the physician closed by stressing that we should always put our family ahead of our practice and our patients.
He assured us that at some point in our career, we would all hit a dark spot that would test us. Most likely it would be a malpractice case.
He said during these times, it would only be our faith, our family, and a small circle of friends that would help us through. It would not be our colleagues, our hospital, or the medical staff, as they would let us alone and avoid getting involved.
On October 1, 2015, my personal and professional life rapidly came unraveled.
I had just returned from our annual Partnership meeting completely energized. My shift began as any other at 6 a.m. At 10:30, I was feeling the effects of no breakfast and too much coffee when the EMS signal went off without the typical tones. I heard the voice of the EMS operator alerting us that there was a shooter at the local college. There were multiple dead, multiple wounded, and the shooter was still active.
In the ensuing seconds of shock, I realized that my 18-year-old daughter Olyvia was at UCC (Umpqua Community College). I texted and called her over and over with no answer. I feared she was dead or dying. I also knew I had to get ready for what was going to happen. We were going to be overrun with patients.
We readied as best we could. I met the first patient at the door — mostly to see if it was Olyvia. It was not until I was getting ready for my third patient some 40 minutes later that I finally received a text message from an unknown number that caused me to drop to my knees and cry.

In the ensuing hours, days, and months since that fateful day, I have reflected, thought, cried, struggled, and at times completely unraveled.
The following are 12 observations that I have collected:
  1. As a physician at a rural site, you have a higher chance of caring for your friends and family members when a disaster strikes. Hire not just partners but those you would want as your family's personal providers.
  2. My perception of my ability to handle such a situation on my own was absolutely false.
  3. I have become much more labile emotionally.
  4. I have appreciated (more than ever) that emotional pain has physical manifestations. Headaches, chest pain, nausea, muscle tension, insomnia, irritability, and inability to concentrate.
  5. I have had to reassess what is truly important in my life, and with help, create a new roadmap.
  6. I have a newfound appreciation for patients suffering with PTSD and the physical and mental issues that come with it. I am grateful that I have the resources, ability, and wherewithal to seek help, as I am confident that many of our homeless and other struggling patients are where they are in life because they have none of these.
  7.  Everyone deals with tragedy, trauma, and loss differently. Every reaction, even to the same event, is unique. Each reaction deserves respect.
  8. Recovery is a journey. Some steps are longer than others. Some are more painful than others. Everyone is at a different space in the process.
  9. Our personal lives affect our work. Accept and acknowledge this. Be sympathetic and sensitive to this among fellow providers and teammates.
  10. Offering each other support in times of need means a lot and does not take much. A text, an email, a phone call (of which I received hundreds) means a lot — actually, much more than you know. A personal inquiry, a hug, an interested listener, or a shoulder to cry on is even more powerful. (Thanks to all of you who have offered these.)
  11. It does slowly get better. Seek professional help early and often. Self care techniques and methods that got us to this point in our careers likely won’t be enough.
  12. I can now add my Partners, Partnership, APPs, and MedAmerica, as well as my hospital administration, to the list of people one can count on in times of need.
I am getting closer to a point where I can think about the events of October 1 without welling up, with a goal of being able to talk about it, and maybe even helping others in the same situation. Long-term goals include being able to thank others in our community for their heroic efforts on that fateful day. We collectively saved lives, including my daughter's.
I applaud our Partnership for offering a resiliency program (that I thankfully participated in prior to 10/1), and I encourage everyone in our partnership to attend at some point.
What we do on a daily basis is rewarding, but does take a toll. We give our all on every patient and every shift. Career longevity is a foundation of our partnership structure, model, and philosophy.

"A good pilot (ED doctor) is compelled to always evaluate what's happened, so he can apply what he's learned. Up there, we got to push it." — Viper, Top Gun


I have often said: "We do what others can’t or won’t do, and we do it 24 hours a day, seven days a week, nights, weekends, and holidays."

  1. You have to take care of yourself before you can take care of others. (I know, the title says 12 steps. So this one's a bonus.

Joyce Newmyer
Wade, I could tell when we talked briefly about this incident that it had affected you very deeply, but I certainly didn't understand the complexity and the fact that you didn't know where your precious daughter was for awhile. I still have the green wristband you gave me. I will use it as a reminder of those who suffered that day -- those who died and were wounded as well as those of you who are still dealing with the shock waves that follow. I will also use it as a reminder of these things you learned and will seek to apply them to my own life and work. God bless you for stepping into the unknown each day. It's a privilege and a pleasure to serve with you.
7/14/2016 9:46:10 PM

Wade - thank you for your honest and candid blog post. I think I will probably refer back to your "13" steps several times in the future, as I grow as a person and as a physician. Thank you for all that you do...for your family, your community, and for CEP (both nationally, and especially for us up here in Portland!)
4/18/2016 1:49:49 PM

Kevin Keating
Wade-Appreciate you sharing your thoughts. This is truly an amazing story. One that as a father I hope to never experience. I can not imagine how difficult this was for you, your famimy and your community. The fact that you can share this story including the text message with us all means a lot about the kind of father and doctor you are and I am sure translates into compassion and exceptional care for your community. Emergency medicine does a good job of keeping us all in check- makes us not take too much for granted but this experience I am sure has put more emphasis on the importance of quality time with family- perhaps that hug with your daughter is now a little longer. Thanks for doing what you do and appreciate the reminder about CEP's vast support network as well.
4/14/2016 11:10:09 PM

Chrissy Paley
I recall when you spoke at I believe partnership and you were so engaging and light hearted. I learned more than I probably have ever wanted to about NASCAR!
This, 12 steps, is equally engaging and interesting and so important. Thank you for sharing what we all probably share to a smaller extent but you remind us that it's ok, it's common to our profession and there's light at the other side.
What a blessing for your patients that you have trudged through the pain and what an even better provider/person you must be having gone through it.

Thank you Dr. Fox
4/12/2016 9:29:57 PM

Barbara Victor
Thank you, Thank you, Thank you! Remembering who we are, why we are here, what we do because we can ... when others can not ... rings true to me. Your experience enlightens us all.
4/12/2016 4:32:53 PM

Tif Hackett
Thank you for sharing your lessons learned and reminding us all that what we do matters every day.
4/11/2016 5:42:27 PM

Shaun Partlow
Thank you so much for sharing your experience and your insights with us, Wade. Those who know you and your team were shaken that day, too, as we followed the news reports. There was so little we could offer from afar. But I hope you and all your folks know that there are hundreds and hundreds of CEP ears to listen and shoulders to be cried on. I hope no other site ever goes through what you people so bravely endured, but if we/they do, Roseburg is a shining example of what can be done. And your message, like the resiliency program, is important to have heard first. Thank you.
4/11/2016 5:17:11 PM

Savoy Brummer
4/10/2016 6:42:21 PM

Julie palmer
Wow, what a powerful story. Thank you for sharing. I wish you and yours the best on your road to recovering from this crazy tragedy.
4/9/2016 12:07:07 PM

Lori McLeod
Great insight to a tragedy that has become all too familiar in past decade. Hopeful that stories like yours become less and less common. God Bless you and your family.
4/8/2016 9:21:17 PM

Michelle Willis
Wow- what an amazing story -appreciate your thoughts and your 13 steps are all so true and useful, thank you for sharing. I agree family first!! God bless you and yours.
4/8/2016 5:39:44 PM

Sarah Maurer
Thanks so much for sharing, Dr. Fox. I really feel like this kind of honesty can help others who find themselves in the same situation. Wishing you all the best on the road to recovery and rejuvenation!
4/8/2016 2:51:17 PM

Anne Bruce
Dr. Fox, your poignant article, "12 Steps of Recovery: Surviving a Disaster" is both timely and topical. I have read and reread your piece and the idea of doctors attending a resiliency program is brilliant. I found your 12 steps to not only be a survival guide but a field guide for dealing with almost any family, career or community issues that strike hard and fast and to the core of what we hold most dear—often when we least expect it. Thank you for these insights.
4/8/2016 1:09:20 PM

Phoebe Byers
Such a moving post! Thank you so much for sharing this incredibly personal story. It's inspiring to hear the personal growth that can occur after experiencing something so painful and tragic.
4/8/2016 12:10:39 PM


Thank you for the courage to share this. I hug my family stronger the more years I spend in this humbling career. Your reminder is profound.
4/8/2016 10:00:17 AM

Rudy Zaragoza MD
Wade, thank you for sharing your personal experience and reflections of that fateful day's events; and thereafter. I found your insights deeply moving and helpful in regard to how we as providers process traumatic events; in addition to how we relate to our patients during difficult circumstances. It's times like these that help us reset our zero, and re-establish our true priorities. Our hearts go out to: you, your family, and your entire front line ED team that bravely responded to the needs your community that day. I'm proud to have you as my Partner.
4/8/2016 9:47:18 AM

Jon Brummond
Love this article! Great observations, insight and compassion. CEP America is fortunate to have physician-leaders like you at the bedside to keep us all focused on the important stuff! Thank you for sharing and contributing.
4/8/2016 9:36:04 AM

Kevin Riggs
Thank you for expressing your thoughts and emotions in writing, I am certain we can all benefit from your sharing! Even in your moment of helplessness, you still provided excellent care for those involved with the shooting and for that, I applaud you.
4/8/2016 8:18:28 AM

Cyndy Flores
Thank you Wade for sharing. Your 13 steps are invaluable and help the rest of us to remember the important things about who we are and what we do and why we do it. And that family always comes first. You, the folks at Roseburg and the families and victims of this day remain in my prayers.
4/8/2016 7:28:35 AM