Grace In Tragedy With Dr. Shannon Sovndal



Because of the number of accidents and untoward events that happen every day, the field of emergency medicine is of perpetual importance. But despite how noble the goals of this field are, practicing emergency medicine can take its toll on a doctor after a while. Dr. Shannon Sovndal is a board-certified doctor in emergency medicine and emergency medical services (EMS). Dr. Shannon and Fireman Rob chat about the life of a doctor practicing emergency medicine. Don’t miss this incredible conversation!

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Listen to the podcast here:


Grace In Tragedy With Dr. Shannon Sovndal


I've got a great guest. The experience of this individual is unbelievable, from a TEMS Medic with the FBI to the team doctor of Garmin Pro Cycling Team. He's a board-certified doctor in both emergency medicine and emergency medical services. Dr. Sovndal, it’s great to have you on.


Thanks for having me.


There are a lot of things to go through especially in challenging times like these. Words from an individual yourself are such a huge thing. You have a book and it's a great book. You can go to DrSovndal.com. You talk in your book about a lot of different things like nothing could prepare you for the harsh reality of becoming a compassionate human working as an ER doc. Tell us a little more about the basis of the book.


The basis of Fragile was that life is fragile. That's the title of the book and there's a picture of me wearing my mask. I didn’t plan on having it come out during a pandemic, but it does drive the point home. What I learned from being a doctor and being in emergency medicine and EMS, is you see these moments that change people's lives. It's a split-second moment that everything turns on a dime. To understand that that is there for all of us, meaning we do not know what's going to come tomorrow. That might sound scary. It was scary when I started to have that realization. At first, it took a lot of work to get out of the fear of seeing that life is fragile. If we can get through that kind of fear of it, it's about resiliency because those experiences and critical times in our lives are what opens up the rest of our lives. It allows me to love and be connected with my family fully. I wouldn't trade all that stuff in. You need to experience it all. It's a full-spectrum.


Being an ER doc, it's a dynamic environment. A lot of people don't understand that they have their routines that they go through each week. Being able to read this book and understand in greater detail that these are high-level stress moments. What can they take away for their lives that seem routine?


The funny thing about routine and working in the ER is I used to joke. I have to get my kids to their daycare or their babysitter in the morning, get them to school, and then I would get to my shift, I could sit down and relax. Once I arrived in the ER, I'm like, “I know how to handle this zone. It's harder for me at all getting the kids to school and getting them lunch and all that stuff.” The reality of it is that we all have moments in our life that are fundamental impact moments. Those are what we see in the ER a lot. When you're coming to the ER, a patient might remember everything about that moment because it's crucial for them. It’s an important moment when they're sick or hurt.


That's our routine. That is our workday is seeing those patients one after another. You see these two different perspectives. Early on in my training, one of my attendings had taught me, he said, “Remember to breathe. It's not your emergency, it's their emergency.” That takes a lot of training to be calm in a critical moment. We can all learn from that experience a little bit. There are times in our lives where we need to be the foundation and the solid person for others. Taking a moment to breathe, to step back, and to observe the situation and say, “At this moment, I'm here to help to someone else that's having a crisis.”


In an article that you wrote for Thrive Global, you highlighted four things that we can learn from an ER doc and dealing with tragedy. You covered that first one, breathe, but this next one I love it's, “Don't focus on the why, focus on your why.” Tell me more about that one.


We get so caught up in this world of superficial truths and important things that aren't necessarily important. We feel like they're important at the moment but they're not. We're caught up in this rush wheel of getting to the next thing, getting the next paper published, getting the next job, making a bigger paycheck, and all of these things, they seem so important until we have that moment of impact. That moment where someone in our life is drastically affected by illness or we're in a car accident and we suddenly realized that that isn't what it's important. What is important is the people at home. My wife when I get home, kissing my kids good night, watching the moon rise, watching a sunset. All of these things, that is what’s important. What I'm trying to get at there, we focus so much on unimportant things that figure out why are you doing what you're doing? What is your fundamental why? Even more important, who is your who in your life that you need to connect with?


I want to dive a little deeper into your TEMS, which is Tactical Medicine when you were with the FBI. That's such a critical thing. If you think about it, most people don't know what TEMS Medic is but you are the life link in essence for those individuals that are breaching the doors and everything like that. Tell me a little bit more about being a TEMS Medic or teaching TEMS Medics that philosophy because you're going into an environment where you don't have control but you're helping those who do.


I fell into the TEMS Medic thing. I was on a rotation when I was training. I picked up a magazine that had a cover article about TEMS tactical medicine and I was like, “That looks cool.” I had some buddies who were law enforcement officers and then one who was an FBI agent. I started talking to him about it. This FBI agent had come from school with me. We had studied together, we had trained in martial arts together. He was a PhD in Biochemistry, and he decided that he didn't like his work as a biochemist. He became an FBI agent. He was like, “That works great.” Through this article and me talking to him, I started to say, “This would be something that would be interesting to me as an ER doctor.”


During residency, we have elective six weeks. I presented to my attendings that I would like to do tactical medicine. They were like, “What's that?” I said, “Here's what I have planned. I'm going to go to Gunsite Academy in Arizona which is a gun fighting school. I'm going to go to Fort Detrick to Maryland, which is the United States Army's medical bio-weapons training facility. I'm going to do these three different tactical medicine courses. I'm going to do this other elective at a hospital.” I put this elective together, they were like, “That's fine.” In the six-week period, I was traveling to all these different training facilities and that was my start. That was how I got into tactical medicine. My contact with the FBI agent, he said, “Come and be our tactical medic.” That's how it started.


It is a stressful environment because you're leapfrogging in essence and helping those individuals that need help while you're in a steer environment. Looking at the next thing that you highlighted was building character sucks especially when you're building character.


It's true. This is fundamental. Every day, I try to focus on being good at my job. It's extremely important to be mindful that you're spending time trying to be great at what you do. I have this whole talk that I give about 300 seconds. That's why our training group is called 3Hundred Training. We focus on 300 seconds a day to your greatness. That's such a little time commitment, but it's a commitment that so many of us don't do. There's no excuse not to commit to that 300 seconds because if you come home late at night and you're like, “I'm tired.” The extra five minutes doesn't make you any less tired. It's a mental game.


That building character thing is part of this and that every day you have to focus on getting better. Every day you have to make yourself a little uncomfortable. That's why building character sucks is because you don't get to build character for free. You don't get it to say that I was building character. You have to suffer through it a little bit. That's what I urge everyone to do is make yourself uncomfortable every day. You’ve got to build that character every day and it does suck. It sucks for everybody but that's how you get better.


This is highlighted in that book Fragile. Everybody can go on there at DrSovndal.com. You can get your own book. I also wanted to highlight what you were talking about with that 300 training. It's a training group for first responders. It's 3HundredTraining.com. Tell me more about that group.


That came about from what I do. I do a lot of medical direction for different agencies and they're always looking for education. We want it to offer a high-level education that was fun. It wasn't uptight that is practical. For example, you can learn things from a textbook that they'll say, “We're going to work on the airway. Let's talk about lemon rule.” They'll name the mnemonics and they’ll have you repeat the mnemonic back. You're like, “I would never do this in real life.” What our focus is how do I make you perform at the moment as an EMS provider and as a doctor. What we want to do is save lives. I don't care what you can recite from a textbook or how good you do on a test.


Fragile: Beauty in Chaos, Grace in Tragedy, and the Hope That Lives in Between

I want you to be great in your practice in what you're doing. What 3Hundred does is it focuses on fundamentals. We were focused on three pillars for everything. There are three different things that you need to be great at doing your job well. The first is you need to have a strong textbook-based or knowledge-base of information. That's the first pillar that you need to have. You then need to have technical skills. You need to be technically sound, manipulating the tools that whatever you're doing whether you're a firefighter, a police officer, or EMT. You need to be able to operate your tools. The third pillar is you need to have scene control. You need to be able to control the situation so that you can do your job. It’s breaking it down to those three pillars.


We focus on the practicality of how do we get the job done because our goal isn't to show up at a patient's side and get them to the ER. Our goal is to get that patient home to their family. That means that we need to do our job well to get them to the ER and then we need to set the ER up for success like the ER has to set the OR up for success, the OR has to set the ICU up for success. That's how we get patients home. It's a focus on taking a patient from the moment of impact to getting them home and doing it with real practical information.


I love that because it truly talks about fragile like you were saying in your book. How fragile everything is because it is the chaos that we're trying to make into something that's functional and something that's going to be efficient.


The chaos that we're talking about, that's in the title of the book so the book is called Fragile: Beauty in Chaos, Grace in Tragedy and Hope that Lives in Between. Where that title came from is it was my struggle with what I was talking about. I was ready to be a hero. You sign up, you go to med school, you're going to be a firefighter, and you're going to work on an ambulance. All of us want to be heroes even if we don't admit it. We're doing this job because we want to step in when someone's in trouble. The problem is that you have so many interactions where you fail, where you're not the hero because it didn't work outright. I use that analogy of baseball, you stepped to the plate so many times and you have a lot of strikeouts for every home run. The funny thing is that I don't even remember the home runs. I only worry about the strikeouts. I thought I was going to be a hero and now I'm dealing with this feeling of despair and loss because I can affect a patient.


I saw how much it affected them and their family. I struggled with that for a long time and I was depressed for a period of time. I use the analogy of a black hole. Those emotions start to suck you in, it makes you negative, it starts pulling you deep where you can escape, and it can be too much. That's why we see a lot of PTSD, depression and suicide, and care providers which are a goal of mine are to help prevent that from happening and help people be more resilient. From my personal experience, I felt that struggle. If you can avoid getting sucked in, if you can sit on the event horizon of that black hole and you can come back, it opens up your perspective to everything. I wouldn't trade it all the person I was back when I started this several years ago to the person I am now from what I've seen. I've had a lot of tears and a lot of suffering because of it but how much I enjoy every moment of life. I couldn't have that any other way.


You led perfectly right up into that last thing that you were talking about that you can learn in dealing with tragedy is loosening the grip. You tell a great story about a little boy named Samuel. Do you want to give us a little bit more about that?


The story is in Fragile. It is not a book of stories meaning it's not like short stories about the ER. I don't want people to think that's what it's about. Fragile is about what we've been talking, that there is beauty in chaos and there is grace in tragedy and there's hope that comes from this to help us move forward. Each of these stories is slipping into this bigger picture. If I could show you the outline, you would see all these funny color-coded tying the book together. Fragile did start with the Samuel story. That's not his real name but Samuel was a boy that I took care of. I struggled taking care of this kid. When you have a kid that you lose in the ER, it takes a piece of your soul away. It’s the way I describe it. It's difficult because in the ER that I was working in, there's one ER Doctor. Even though you have these bad things happen, the ER is still open for business. You don't get a time out to go and say, “I want to go home now. I want to do an after-action breakdown of this.” You still have to work. My struggle with that is how that chapter came about is one night, I was upset about it and I was like, “I'm going to write the story about this.” That's the beginning of Fragile. It was the story of Samuel.


It's interesting because you speak to my heart too. I feel exactly what you're talking about because it's so hard to loosen that grip on something that has taken so much of your life in what you're saying, taking your soul. Going back to a lighter side, you also worked as a Garmin Professional Cycling Team doctor. How was that?


It was great. I raced bikes in college and I pursued that for some time. I met a lot of people racing bikes. When I became a doctor, I still had those connections. A team needed a doctor for a particular bike race for the US Pro Challenge. They asked if I could do that. I said yes. That worked out well and the team started to grow and soon it was a UCI, a full-blown professional team. It was a Forest Gump a little bit that I met the people and then we became big. I found myself then being the team doctor for this cycling team. It was great because you spend a lot of time in Europe. Cycling is a European sport. I've done eight Tour de France’s and Tour of Italy's and had a team. We won the Tour of Italy one year. We've had top tens in the Tour de France with Christian Vande Velde. I got to meet those riders and observed them being great. That's a lot of where my greatness approach comes from is seeing these pro athletes in what they can do and how they push their body and it's truly amazing to get a watch.


If you look at the Tour de France and a human body is not meant to do that. It's a crazy thing to watch that. As a team doctor, it's got to be intense for you because you have to monitor all the things that are going on with these athlete's bodies while at the same time making sure that they're at the high premium top of their game to be able to win the tour. What does that look like?


It's tricky because the Tour de France is not healthy. It's not healthy to race your bike that hard for three weeks in a row and do that many miles. The first piece of it is observing them race up a mountain. When you're in the team car and they're climbing up. You're watching them ride their bike and the speed at which they're going. Heat is coming off their body and steam in there like a machine. It is amazing to me to watch because you're like, “That is truly perfection of the human body working the best.” To get to your question, it's tricky because it's not healthy, they are at redline to win this race.


It is a fine lining that if they go a little bit faster, they go a little bit harder, they're going to get hurt, they're going to blow, and they're going to have all these problems. You are trying to straddle that line of, “Where is your engine tachometer and where can it stay for this three-week race?” I was keeping them in the fight because it's a big emotional roller coaster as well, meaning good days and bad days. Part of being a team doctor is being a psychologist because you have to keep them motivated. You have to know that they're eating right. The first week of the tour matters for the last week of the tour. It's a chore getting them hydrated, sugar in their body, and food in their body.


You're monitoring all of that stuff. In addition to that and the fact that these guys are riding their bikes at 60 miles an hour down the Dolomites or down the Alps and there are bad accidents. I don't think I have PTSD but I think about PTSD a lot. The sound of bikes crashing and frames breaking, it's a memorable sound that gives me pause and the creeps. People who haven't heard it, you're lucky but hearing that action and then you have to pick up the carnage that happened because of that, it's crazy.


I want to get back to that 300 seconds per day because I love that philosophy. Three hundred seconds per day to greatness. You look at your life and you look at the different things that you have to do on a daily basis. What are some of the things that you do in the 300 seconds to be able to make your life better to be able to move forward?


Let me frame it. The 300 seconds is personal meaning. It was a tool that I used. When we talk about getting to greatness, you're going to need to commit much more than 300 seconds a day to greatness. We talk about Malcolm Gladwell in 10,000 hours and all of those things, all that stuff holds true. The problem is that we have that end goal focus and then we get so lost in the minutiae during the day that we get off track and we feel we're off track so we never get back on track. That's where the 300 seconds comes in. It is a tool to get you on track. It's a tool to test whether you're being weak-minded or you're in the game. When I come back to that 300 seconds, I say, “That's five minutes.” No matter what's going on in the day, if you think of the 300 seconds and you say, “I can't do it now.” You've suffered a defeat for the day.


When you look in the mirror, there's no hiding. You said, “I couldn't do my 300 seconds because I was too tired.” That's you giving in because there's no reason that you can't do that 300 seconds. Even when you have a busy shift at work, you have to deal with the kids, you have to pay your taxes, you have to do all these things, and you can find the five minutes. Honing in on that five minutes of quiet brain time, committing to what your end goal is, that is so honest that if you say, “I have an end goal that I want to be a doctor, I want to be a firefighter, I want to be an EMT or I want to play the guitar.” Whatever your end goal is, if you truly say that I want to do that, then you should commit that 300 seconds a day to it.


What I do, I fall off all the time. There are days when I do the 300 seconds, but what I do is I look in the mirror and I go, “You can’t. You're being a tool, you’re weak.” The next day I do, I have a mirror test and I tell myself that you’ve got to get back on it. What do I do? I don't do 600 seconds. I do 300 seconds. You’ve got to get back in the saddle and do it again. The 300 seconds changes for me. I use it for my intervals as well as for bigger goals. Sometimes, I want to focus on the guitar and so I'll say, “For this next week or this next two weeks, I'm going to do my 300 seconds on playing a certain chord progression or learning a new song or doing something right. You'll be amazed if you commit that 300 seconds how much better you get.


In residency, you would be afraid on rounds that you're going to get yelled at. Some attendings were not the nicest to me and knowledge was protection. I had a senior resident say, “Read every day. Every day, pick up the book and read at least a little bit from whatever rotation you're on.” I started to do that and I was blown away by the number of times that something I had read for five minutes was what I was getting pimped on in rounds. You would come up with the answer. They would yell at you and you would give them the answer and then they would be like, “You're no fun. Let me pick on somebody else.” It was total protection. Everyone out there that's reading this blog, whatever you do, I would push you to read a little bit on what’s that excellence that you're looking to every day because it comes up all the time that it helps out in your current life.


Emergency Medicine: It's extremely important to be mindful that you're spending time trying to be great at what you do.

You hit it on the head. It is personal and if you miss a day, and it's funny always on training days. It's like, “I missed an hour yesterday. I'll do two hours a day.” It's creating that habit like you're saying.


The habit is a long game like you said.


You’re a father, you're a husband and you do this great podcast Match on a Fire: Medicine and More with your wife. I love the banter between the two of you. Is she a paramedic?


She's a paramedic firefighter.


Tell me a little bit more about that podcast because I listened to a few episodes. I loved the back and forth. It's funny because I have a wife as well and it's a great conversation.


She's made for TV and podcasts. She's beautiful and her voice is great. I always joke that I need her on the podcast because people like listening to her voice than my voice. When we first started the podcast, that doctor friend called me and he was like, “The podcast was great. Steph’s voice sounds good, your voice sounds different. It sounds funny.” I'm like, “I'm a dude. She's a beautiful woman. Her voice sounded great to me too. I agree with you.” It's great because the purpose of that again was to have real-life discussions on what we deal with in the field and how we take care of patients. We felt like it was a great interaction to have a paramedic talking with the doctor because we're trying to do the same thing, but we certainly approach things differently and from different perspectives. That was the fundamental impetus behind the Match On Fire.


I like to end the segments all the same way. I have some questions for you. I don't give them to you prior to because I want to get those truthful answers coming out here. Here's the first one. What is one thing you haven't done that is outside of your comfort zone?


Parachuting. I'm afraid of heights. I overcome my fear of heights with the fire department and stuff but I do not like up there. My sons want to go skydiving and I'm like, “Let's wait.”


It's one of those things that you’ve got to do. I've done it a few times. It's fun once you do it. What's your favorite quote and why?


I have a lot of quotes but I particularly do like, “No fear, no surprise, no hesitation, no doubt.” That's Miyamoto Musashi who was a famous samurai. He offered The Book Of Five Rings which is a famous tactical type of book.


Here's the tough one and you'll like this one. If you could pick to have coffee with three other people, it can be deceased or alive, at a firehouse table. In other words, you know nothing is off the table when you're at a firehouse table. Who would it be and why?


I would probably choose Neil Armstrong because he's my hero. I would choose Jesus because I'd want to get a read on it myself. The third one would be my grandfather.


That's a good three right there.


It will be an interesting conversation between the three of them.


Lastly is the rapid round. All it is, there are two things. All you’ve got to do is say one of them. It is not a psychology test. It is for fun. Paper or plastic?


Paper.


Soup or salad?


Emergency Medicine: Hone in on five minutes of quiet brain time that you can spend committing to your end goals.

Salad.


McDonald’s or Taco Bell?


Taco Bell.


Camping or hotel?


Camping.


Fly or drive?


Fly for sure.


Sleeping late or wake up early?


I wake up early.


Run or walk?


Run. I definitely don't walk.


Partly sunny or partly cloudy?


Partly cloudy.


Fire or water?


Fire.


Use a porta-potty or continue to run or drive to the next physical bathroom.


Not porta-potty. I was a bike racer. You become tight with a porta-potty.


I didn't want to put nature in there like a tree but that would have been easy. Coke or Pepsi?


Coke for sure.


Go big or go home.


Go big.


Dr. Sovndal, it has been a pleasure to have you on. People can go to DrSovndal.com and find your book as well as your podcast. I will have you on again because I know there will be more books coming out from you but thank you so much for coming on.


That was great having me. I appreciate it. Thanks for your time.


Thank you for reading and we'll see you next time.


Important Links:


About Dr. Shannon Sovndal


I also run a training group for first responders:

3Hundredtraining.com

I have a podcast for first responders:

Match on a Fire: Medicine and More


I released a new book in May 2020

Fragile: Beauty in Chaos, Grace in Tragedy and the Hope that Lives in Between.

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