Jan. 13, 2020

Staying strong so you can keep helping. Bushfire special series with Liz Crowe - Part One.

Staying strong so you can keep helping. Bushfire special series with Liz Crowe - Part One.
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Season 1

This is a special episode that we’re rushing out as a resource to our colleagues who are caught in the apocalyptic bushfire crisis that Australia is currently experiencing, but also for anyone who wants to support those in the crisis but feel unequipped to do so. Beyond the current crisis - we also believe that the advice from this episode’s spectacular guest will be a valuable resource to anyone who ever finds themselves in a crisis situation, or regularly deals with traumatic situations that puts them at risk of  compassion fatigue, burnout, and dark days in general. 

Our guest is Liz Crowe. Liz is  an Advanced Clinician Social Worker who has worked extensively for 20 years with individuals, families and children impacted by grief, loss, trauma, crisis and bereavement. She’s worked in intensive care, emergency departments, cancer wards and all areas associated with children’s health.  In her current job in a children’s intensive care unit she is exposed daily to death, violence, trauma and illness and is now recognised as one of the most experienced counsellors in this field in Australia.  Liz is passionate about assisting the community to understand the breadth of loss and grief and how to support yourself, your children, partners, family and friends during times of change and sadness, which is why we really needed to speak to her at this time. 

As expected from someone with such a depth of knowledge in their field we had a lot to talk about. We wanted to make sure that anyone who is currently in the thick of the action with limited leisure time for things like listening to podcasts could snatch a few moments to listen to this, so we’re deviating from our usual long form format and chopping the podcast into shorter episodes, starting with what to do while you are in the midst of a catastrophe such as this one. 

A few useful resources:

Treating burn wounds and smoke inhalation: https://www.animalemergencyservice.com.au/news/vetapedia/emergency-burns-info/

Liz' blog on dealing with grief and burnout = part one:  https://www.stemlynsblog.org/wellbeing-for-the-broken-part-1-liz-crowe-for-st-emlyns/

Part two:  https://www.stemlynsblog.org/wellbeing-for-the-broken-part-2-st-emlyns/

More about Liz:   https://lizcrowe.org/about/

 

Welcome back to another episode of the vehicle.We're going to skip our usual intro and get straight down to business because we have an important message to share today.And we need to do it quickly.This is a special episode that we rushing out as a resource to our colleagues who are caught in the apocalyptic Bushfire crisis that Australia is currently experiencing but also for anyone who wants to support those in the crisis, but feel unequipped to do so beyond the current crisis.
We also believe That the advice from this episode spectacular guests will be available resource to anyone who ever finds themselves in a crisis situation or who regularly Works in a traumatic situation that puts them at risk of compassion fatigue burnout and dark days in general.
Now, I know that we always ask you to share the podcast with your friends.But this time we really really want you to think carefully about whether it is anyone that, you know, who could benefit from listening to this episode and share share share.We really want to get this message.Reach out there to the right people who need to hear it just a very quick.
Thank you to the team at animal emergency service that is jurado's day job.They actually arrange the session and pay for it as an in-house resource for their teams during this crisis, but then somebody had the insight to suggest that they share it to the rest of the world through a podcast and luckily they knew somebody who has a podcast Gerardo.
How guest is Liz Crow Liz is an advanced clinical social worker who has worked extensively for 20 years with individuals families and children impacted by grief loss trauma crisis and bereavement.She's worked in intensive care emergency departments cancer Wards and all areas associated with Children's Health in her current job in a children's Intensive Care Unit.
She is exposed to daily death violence trauma and illness.It is now recognized as one of the most experienced counselors in this field in Australia.This is passionate about assisting the community to understand the breadth of loss and grief and how to support yourself your children parents family and friends during times of change and sadness which is why we really needed to speak to her at this time.
As expected from someone who has such a depth of knowledge in the field.We had a lot to talk about we wanted to make sure that everyone who is currently in the thick of the action but limited Leisure Time for things like listening to podcasts could snatch a few moments listen to this.
So we are deviating from our natural usual long format and chop in the podcast into the shorter episodes starting with what to do while you are in the midst of a catastrophe such as this one.So let's get to it these Crow.
Welcome to another episode of the Vaudeville podcast.We have a very special and very important episode today.We're going out of the box and we've got more than just one case today.We've got a whole panel of guests.I am going to let everybody introduce themselves first Gerardo.
It will know Gerardo a team co-host here the bit bolt emergency veterinarian in Brisbane, Australia.And I'm Alex Hines.I'm one of also one of the emergency bits here at animal emergency service.And yeah, I'm really Lester.I'm one of the Critical Care Specialists in the Intensive Care Unit.
We've got Liz crew here as a special guest.We're very excited to have her on just pick our brains and ask some questions and get down to some nitty-gritty of difficult questions.I think and what people are going through at the moment requires now, I'm Liz crazy.So I'm actually a pediatric social work.
I specialize in critical care and need to give a disclaimer that I'm not representing my place of employment and anything I say is my personal professional point of view outside of my work, but I've been working in critical care for a long time and I have some expertise around loss and grief and I'm just finishing a PhD on staff wellbeing for people who work in kind of critical care environments and in areas of trauma supergroup super privileged to have you onboard.
Thank you for coming in pants.I'm very excited to talk to you.I've been Stalking you for the last few days and his thank you a talk a bit of a crisis in the moment with the bush fires and it's affecting all of our animals, which means veterinarians are implicated in the crisis Alex.
You've been very involved in the treatment or sitting up treatment and helping some of the the Animals, would you be able to paint a bit of a picture what's actually happening in the country with the fires wide why we're talking about this today?Yes, he would it's such an important topic at the moment.
I think just to sort of give you a better picture Lee's there's vets out there.They're dealing not only with the thought of losing their homes and their communities being destroyed, but they're also having a large number of animals brought to them domestic animals wildlife, of course and livestock and these vets are most of the time not familiar with dealing with these kind of injuries.
They're coming large numbers.They've got limited resources.And there's also a really high expectation on them about you know for that for them to save every animal and we know that that's not always possible particularly in the fields that we work.And so that's the expectation put on to them by people out there but also that the expectation of put on themselves.
Yeah.So yeah, it's you know, it's a really difficult time and I think there's a lot of it's out there who want to be able to help I know vets.Beyond borders have had over 1500 vets who want to go out and help but one thing I find really interesting.Trusting is that a girl that I was talking to last night?
And she's right on the front line.She's doing long shifts every day helping a lot of wildlife, but she said she feels like it's never enough.You know, you just you just feel like there's always more to do so that feeling of just helplessness even for those guys who are right there soon.
Ali you you tell me some stories yesterday about a friend of yours who's right on the on the front line pretty pretty confronting stuff.Yeah, I think again he got flowing in and he's just walking through the bush and euthanizing just shooting, you know anything that's suffering.
So from koalas two kangaroos with burnt, you know, I don't think that can't and it needs, you know, it needs to be done.That's the kind of thing, but then it's just a huge but then Whoosh land is so dense.And so it's so vast.It's still going to be a lot of animals out there that are slowly and slowly dying over these next few days and you just hope it can end as quickly as it can for them.
So they're tough a tough job, but I think people go in, you know, you know you go in just you know, when you're doing the best you can and doing for the right reason.Yeah.The reason we wanted to talk to you Liz is the it's to help the people involved in these situations because obviously there's a there's a lot of suffering and there's a lot of horrible things that they'll be dealing with that they may not be prepared for more even if they are prepared in this particular situation, but then also on a wider scale, how do we deal with as primary caregivers?
How do we deal with the stuff that you see and that you and that that to have to cope with on a day-to-day basis and then particularly in a crisis situation like this.I've a story something that that made me think of this before that the fire started.I'm on a on a social group on a Very social group page where people will often speak up if they're having a hard time with anything and to try and get support from other veterinarians and there was an instance completely unfair related that I found really interesting where it was an older and way that it's applicable or not.
But all the mail with it, I think to me it was most striking because typically the male's don't don't speak up as often who had a case come in brought in to him they resist.I think it was a stray cat it was Wasn't in a good way and it's some some nasty wounds and stuff and he dealt with it, but then you found it.
He's really struggled with it.It really moved him or hate him.He spoke up on the on this bridge because he was it was surprised at how upset he was and how much it bothered him afterwards.So my first question is what is it about particular cases or instances or situations that are they things that that you could preempt that are likely going to trigger something in you.
Was it completely random?What do you see in your line of work?So first of all, I think it's really important to acknowledge.This is unprecedented what we're seeing like, you know, there's no comparison to this.So I would expect that the Vets who are having to deal with this on the front line completely feeling overwhelmed because this is new on a scale that no one could have predicted.
So, you know, I was at it and you know benign dinner.A last night with a group of people who felt overwhelmed by the bush fires and that's from the safety of an urban city where nothing they own or no one they love is going to be impacted.
So I think first of all this is brand-new, these are brand-new emotions because nobody you know, it's not like they're going to be able to get on this forum.Then we're going to be able to tap into someone anywhere globally who's going to be able to say yeah, we did this.Yes, we've had this I mean it seemed fires around the world.
On this scale.So for people to feel overwhelmed, you know, because I guess what you're asking is a couple of questions, but people are feeling overwhelmed that's normal.But I think one of the main messages I'd like to get through to the vets is to normalize the abnormality and the depth of emotion that they're going to be experiencing because it's new and to not pathologize it, you know, I think we live in a very much in a world where if you have an emotion, we almost want to give it a Broadway.
A musical like you know, why am I feeling sad today?Like let's focus on that sadness.Let's and in actual fact, it's not it's not a healthy way to deal with every day today emotions.So when people are going to bed at night and they're reliving what they've experienced and they're fatigued and their continued my goodness.
I've got to get up and I've got a face this and do it again tomorrow and tomorrow and tomorrow and then on top of that people have lost their own properties or they're still at risk of losing their properties to feel overwhelmed.Can I just say Hundred percent normal to feel like they're going to be crippled by it.
Although it's going to have an expiry date completely normal.So, you know, I've got friends who are intensivist have been doing dealing with the burns from the volcano in New Zealand that crisis is still going on, you know for those doctors and nurses and health professionals and those families that crisis is continuing and people are tired and fatigued and there's no one to give them a break in the Vets are going to be a needs.
Excellent.Situation people will probably be worried about post-traumatic stress disorder.I would imagine.So again just to kind of assure people you can't have PTSD for the first four to six weeks.
All right, and you can't really say anyone with had PTSD when you're actually still in the acute crisis.So the crisis hasn't ended.Okay, what a lot of your vets.I would imagine are experiencing.Is called a cute critical stress and our brains are very clever, you know, we've evolved in very primitive environment and then we had this massive escalation in the world around technology and exposed to things and our brains are still the same evolutionary brain, but not really have caught up.
So whenever you have an experience that is overwhelming and frightening your brain wants to lie low lay those memories down.Solidly to make sure you don't do it again.Yeah.All right.So it's why when you're crossing the road and the lady in front of you gets knocked over on The Pedestrian Crossing that night you go to bed and you can still hear the Screech of the tires.
You can graphically hear the sound of when the older woman got hit by the car you can you know, if you're drinking something you can taste the drink in your mouth.Your brain is saying hey, I really didn't like this emotion.I didn't like this experience.
I'm going to lay it.It down to the next time you're on The Pedestrian Crossing.You don't walk behind an old person you don't, you know, like, you know, it's trying to say to you don't do it.Don't do it be there again the problem is that when you work in critical care that's job.And so we have to teach our brains and lots of ways that we don't have to go into this flight fright or freeze mode.
We don't have to load the memories down.But because this is new I would imagine lots of your vets, you know, it's trying to lay it down so they go to bed at night and might only be getting a few hours sleep.Probably the senses may still be overwhelmed.They can still smell fire.
If they're still there quality's terrible what they can see visually if they still you know their surgery and they can hear animals in distress.So they actually may not even be getting a chance to completely Escape that even for a couple of hours but their brains going to be saying we don't like this.
We don't like this.Let's I'm going to make you think about it think about it think about it because I don't want you to do it again tomorrow.Mmm, so firstly Don't Panic by that that is your that is Is a normal human response to a completely add normal situation when your brains doing that to you.
It's almost like an NEC replay, you know like that used to be on the TV.We just seeing it over and over again.You want to flick it into your frontal pre-record text, which is you're thinking gray and even saying to yourself, thank you brain.I don't need to think about this anymore takes it away from you and magdala and your limbic brain and puts it into your frontal cortex.
By the way.I'm not a trauma X trauma specialist, please.Pick me apart.This is how I make sense of it.And it's you can say to your brain.I can have some rest we have to do this again tomorrow.These emotions are normal because what we're experiencing is abnormal.I am safe.
I've done a good job.I have to do this again tomorrow brain.I need to rest because of these things and it doesn't mean that all of a sudden your brain and go.Oh, sorry about that.Oh, we've got making you have those memories night-night, but just to keep reassuring yourself.
I am safe.If what I have done today is enough.I'm doing the best that I can you know to to tell yourself those things to try and give yourself and to assure yourself that you've done the best you can I mean Alex you've just said it's never going to be enough.You've got another vet friend Ellie who saying, you know, I go out and I keep thinking the bushes dense and you know in any area of Crisis or trauma, if you're a humanitarian you're going out and there's you know tens of thousands of people there's been a genocide event or people are starving.
We started thinking about all the people with mental health problems in the world, you know, like how do you solve that and stuff?But the thing is that we've got to think about what's out what is realistically at influence of change.What do we have the potential to do?Because if they exhaust themselves out, I mean this crisis could go on for weeks yet exhausting southbound.
It's worth noting tomorrow, you know, when I leave the hospital each day, I could say all this still families who are grieving.There are still people who miss me.There are still people who might need My skills and my expertise or whatever, but if I don't go home, it means shoes day.I'm not working as effectively Wednesday.
I'm poorer Thursday.I'm poor again Friday the next week.I might get bitter and twisted about it.Like I actually don't like it when I'm even at work.It's counterintuitive.So for all of you who are out there who may be suffering, you know, we can't do what you're doing.
We can't help you in a but I feel like I want to say to the It's doing this the world is holding you, you know, the people you are in people's thoughts and it while it may not feel like enough it's more than the rest of us can do and if you have worked for our day or two hours a day or a 13 hour day and you have to go and do something else including rest and recover so you can go back out use that time wisely so that the next day you're cognitively as on board as you can to be baking.
Sensible decisions with limited resources and what you have to do and where you have to go that's great advice.Yeah, absolutely.Thank you.Because it's your brain is and your thoughts kind of like a radio station.
Hey, yeah, he keeps on playing and playing its and you can't turn off the radio station.Yeah, and it's really trying to decide what it is that you listen to and almost years you're saying like thanking your brain not remembering the book thing is happiness trap or so.Yeah, and that was in there that will concept really kind of changed the way that I deal with stress on the floor.
It's like, okay.What is this this this this this and it's kind of like I was stop stop stop.Stop stop, and then you try to suppress it.Fight it and fight it it is come that he brings it's like adding fuel to the Flames flames and you make your thoughts even more and you and then you tell your brain and go to stop it stop it shut up and then it gets louder and louder and louder.
Well, if I said to you now everybody whatever you do, wherever you are don't think about polar bears don't think about polar bears in any possible way.The first thing you think of is a polar bear on the ice and polar bear slipping down at the all their polar bear.So, you know for you to go to bed at night and say, you know, these are these people that are doing this amazing work, you know, I mean not to think about about I can't think about I've got to go and try and get to sleep.
I don't believe you know, whereas if you're kind of saying okay these thoughts are there but what am I going to pay attention to?I've had to pay attention to that for the last 13 hours.Now, I'm going to pay attention to I need some fluids.I need some food.I need to speak to my partner.
I need to Skype my kids.I need to soak in a bath tub or relax or you know, whatever it is that you need to do to pay attention because tomorrow we have to pay attention again and And when you are in crisis, it's very easy, you know for that radio to get louder and faster and faster and faster for as an actual fact, we know know that the more you slow it down more concise more, you know, the more reflective you're going to be the better decisions you're going to be able to make and that's what people you know, these are extraordinary circumstances.
If you've got limited resources where you push it.Yeah, and you know again if you talk to people who respond, you know, following a disaster and there's you know bodies down everywhere.Sometimes you know doctors and nurses also have to triage like that person is going to die.
So I've got to invest in time in the people that we can actually save and but that's all you having to do the same thing, you know, there's you know, as cruel as it is, you know, like to swiftly use the name of the animal so that you can move on to an animal that may be able to recover is an important decision to be able to make and you've got to be at your best to be able to do that.
So self-care has A part of that just what you were saying before about the triage process.That's something that I think is really important in those very first days where there was this huge number of animals coming in and the Vets out there just there just couldn't even work out where to start I think going back to the basics what we do know as medical professionals, which is you know, which patients can I not save it all in which case Humane euthanasia is going to be the way to go or which of these are going to die first and which ones do I need to try To pay attention to because it can't possibly look after them all within the space of the next, you know, however many minutes or hours.
So I think that's you know, that's really important.And one thing that we've done is to provide resources for them as well that they can easily access out there because a lot of them when they reached out to me knowing that I was an emergency button.It was really by social media to say.
Hey, I'm out here.There's no you know, there's no I don't know who to call.A lot of the electricity was out and things like that.And so they would just like can you help me?I don't know how to start so being able to provide them with now they have an online resource library that can just go straight on because don't forget some of these vets don't know it's coming either, you know.
Yeah last week they were okay, they weren't in a five affected Zone suddenly sweet.Oh my goodness.I'm one of them now, I'm one of these vets and burns where I'd imagine is not a common thing that you would see in animals just like, you know, even in humans we sub huge Burns unit, and they've got more and more specialised.
Because you know we have less people smoking we have you know strict laws around heaters now, so you just don't see it as regularly as so I know if we're not seeing it as regular humans, you would really see it animal and now you're going to be seeing it on Master you're trying to learn new skills and triage and worry about your own family safety and your own property.
So if you can like what we're asking of people is really extraordinary, so they've got to expect that they're going to feel stressed and feel Stretched and pressured because it's so new and it's extraordinary.It's like we will hopefully never see this in these volumes across the world ever again.
And it's one of the things that I thought might be important to talk about is that people are in crisis for a range of reasons.The one is they may have been having to euthanize a whole lot of animals.The other thing is that they might be holding onto a space about physical threat to their own family to themselves and to the kind of immediate future, but I think there's also a kind of existential crisis that's going on for the general Community like is Is climate change have we contributed to the is this something when our about to see every three or four years ago?
So, you know so for people on the ground, I imagine they're also doing the should we be blaming something do I now have to become a political activist?Do I have to start living my life?So for those people who are on the ground best thing I'd say is don't make any big decisions in the next two months don't decide that said I need to move to the city.
I don't want to be a rural vet anymore because I couldn't Couldn't possibly cope with this.Hopefully you will never see anything like this even remotely even media in your lifetime.Yeah, so in a crisis and in an extreme grief reaction, which I would imagine this is it's not the time to make big decisions.
It's not the time to think about don't want to be better anymore or we need to move house or you know, if we've lost everything we definitely don't want to rebuild here because I don't want to be anywhere where there's Greenery.I want to go and live in a concrete jungle because I know I'm safe, you know, it would be normal to have those emotions.
But not the time to make those decisions if you're thinking those thoughts just put it on the back burner be very gentle about it.Like okay, it'd be okay for me to have those thoughts but I don't have to make a decision today or tomorrow.
That's something that as this crisis of Bates and I really have time to reflect on this to make those decisions then because I think there is an existential crisis to this and you know, when Ali was sending me photos from her friend who's out there.It looks like Baron Wars I needed it doesn't look that different than after Chernobyl or after Hiroshima.
You know, there are whole communities wiped out with all of these, you know deceased animals or animal suffering and houses destroyed and it's like a shell of a life for these communities and there is a grief associated with that as well.
It's not just what people are having to do in terms of I'm off work.It's like where is my community and my friends and what do we do now and realistically how do we rebuild you can't make any of those decisions today?And you can't make any of those decisions in the crisis and maybe some people will move the maybe some people for them the meaning or the growth will be I'm going to recommit to this community and this is important to me and maybe they will just make that decision and change their mind and 18 months.
That's okay, but it's never a good time to make life decisions.It's when you're in a crisis, and that's exactly what people are there in a crisis.One thing that gives me great.
Hope is I am seeing a strea come together as a community more solidly that I ever have experienced in my whole life still wish we didn't have to have the Bushfire still wish people didn't have to suffer.But if something good can come out of that, you know that you guys want a podcast today.
Hmm.It means that we are back in touch with the fact that we are our Humanity.We have more in common with each other.Yeah, then we have differences and that is a positive thing.Hmm.I've got to say I've Just astounded by the support from around the world, you know, it's incredible to see that and I think it was that that photo that was on the front page of the New York Times on New Year's Day of the kangaroo across thick going across the burning building and all of a sudden the world was like Australia needs help.
Yeah, and just the you know, the messages and the support and of course their donations because let's face it.It's just a huge rebuild that's going to require is going to require millions and millions of dollars and that's what has been pledged.It's just yeah, I think I would want people over there overseas to know how much that's meant to people here, you know to know that the world's behind us and you know for some of our better in the thick of that you've probably not in touch with that so you don't have time to come home and you know, turn on the news and say oh what's happening like how much of people poaching you're in the thick of it?
And to be honest at this point.If you listen to this podcast while you're in the acute stress, I'd say don't tap into that.Don't come home and look at the news and see what's happened.Don't you don't look at pictures of how bad it is four hours away from you or you are in enough crisis.
You don't need to flood yourself with more images and things around that what I want people to hear is that there are people in every corner of this universe who are thinking of you who are standing well wishes to you and your community that people are pledging to do things like for myself.
I'm thinking in the next Twelve months.I'm going to cry and visit Kangaroo Island for the first time as a tourist and spend dollars and you know contribute something that way like people are thinking of you and what you're doing.We think is phenomenal and extraordinary and takes great courage and selflessness.
So if you get to listen to the podcast tap into self care and know that what you've done today is being appreciated and valued.Thank you again for listening.We hope you found value in that and if you did I'm gonna ask you again.
Please share it with anybody who you think could benefit from listening to this episode.For those of you who are out there who want to help out at want to contribute.There is a community of people who still need our support and that Community is your fellow veterinarians in the areas of Australia, which are affected by the fires veterinarians are They're treating Wildlife treating domestic pets even treating and taking care of livestock.
And these veterinarians have themselves.Also either lost the clinic lost.Their homes may have lost loved ones or have actually lost the community that is supporting their business.If you want to support those veterinarians on the ground in these areas that I urge you to donate towards the Amy a benevolent fund the Australian Veterinary Association.
And fund you can find it on www.ada.gov.Cam dot a you forward slash donate.

Liz Crowe