Regions Hospital was the first Minnesota hospital to be verified as both a Level I trauma center for adults and children, able to meet the strict standards of providing entire families the highest level of care. Kelsey Berndt, MD, a trauma surgeon and the medical director of the surgical intensive care unit at Regions, joins the show to discuss trauma and trauma-related injuries, health disparities, her team’s interaction with the community and “finding the calm in the chaos” of a trauma bay.
Regions Hospital was the first Minnesota hospital to be verified as both a Level I trauma center for adults and children, able to meet the strict standards of providing entire families the highest level of care.
Kelsey Berndt, MD, a trauma surgeon and the medical director of the surgical intensive care unit at Regions, joins the show to discuss trauma and trauma-related injuries, health disparities, her team’s interaction with the community and “finding the calm in the chaos” of a trauma bay.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Kelsey Berndt, MD
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Well, welcome to the show. I think you guys are in for a treat because today we're going to be having a great conversation with Dr. Kelsey Berndt, who is the medical director of our surgical intensive care unit and trauma surgeon. Welcome, Kelsey.
Kelsey Berndt:
Thanks for having me. It's great to be here.
Steven Jackson:
How did you get into trauma surgery? Tell us a little bit about that.
Kelsey Berndt:
Yeah, that's a great question and doesn't have a straightforward answer. So I think it was really a step-by-step process for me, it started with going to medical school and then I really didn't know what I was going to do. I thought probably anything except surgery, because I didn't think that I would fit in. And there's a lot of stereotypes about surgeons and then I did surgery and fell in love with it and ended up doing general surgery residency. And then, similarly throughout residency, went in with an open mind and fell in love with trauma. And even more specifically, really taking care of the trauma patient in the surgical intensive care unit. I ended up here at HealthPartners after my fellowship, I came to the Twin Cities, did a year at the University of Minnesota and through that connection ended up working here at Regions.
Kari Haley:
That's a good tale of the kind of the winding experiences that we all have through medical education and everything. You kind of mentioned that the stereotypes of the surgeon, so I mean I think us have gone through medical training, gone through medical school, there definitely is that kind of male dominant, aggressive, very type A personality that I think maybe ourselves. And probably even you watch TV, they associate with the surgeon personality. As another fellow woman in medicine, I'd love for you to talk a little bit about what has your experience been as a woman, especially in surgery where I think that stereotype is much more prevalent.
Kelsey Berndt:
Yeah. I think I've had some interesting experiences. I think certainly it's something that's getting better as we go forward in time. I think my experience was a lot easier than the generations of women before me. I always got a lot of encouragement and support, and so that was good, but I also did get some pushback at times, especially about maybe being too quiet or needing to be louder, more assertive. And some people even used a different word for assertive that I won't repeat here. And so that, in and of itself, is kind of a stereotype, certain words are used to describe assertive women. Another sticking point moment was I had someone once tell me in training that as a woman in surgery, you can be respected or you can be liked, but you can't be both. And I don't think that's true, but it was a powerful message that someone else thought that was true. And so it just goes to show that there are still some stereotypes, even though we've made a lot of progress.
Kari Haley:
Yeah. I would echo some of that that I just was having a conversation the other day with another one of my female emergency medicine colleagues and we were talking a little bit about that. There's the personality that you feel is the word that probably I know that you were thinking as well and heard as well. You can either be more towards that and being the one who's not necessarily liked, but very firm in decision making, and called names probably behind their back, or you can be the person who's very likable and that maybe is more quiet and that people may take advantage of or try to take advantage of.
Steven Jackson:
Well, I was just going to say, let the record show that I like you and I respect you. So there is at least one in the world, Kelsey.
Kelsey Berndt:
Ditto.
Steven Jackson:
I remember when I was a med student and I was on my surgery rotation, I was frightened because let's just say it was a hard rotation in a lot of ways. I won't get into a lot of details. I was frightened and a particular intern that I worked under, shared with me how tough it was for her personally. She felt like she always had to prove herself to her male colleagues and her male chief residents and those kinds of things, and always had this inherent stress to do that on top of the stress of performing as a resident, which is stressful for any of us. Have you ever felt that way, like you have to prove yourself or in some sense, do a little bit more or do double the work to get the same recognition as your male counterparts?
Kelsey Berndt:
I think I have felt that way at times. I think as a woman, sometimes there's a narrow window that you can fit into between those two extremes. And I think it's worth pointing out that for women of color, that window is probably even narrower than for white women, because gender is one aspect of privilege, but so is race and all these other factors as well. Generally, I did feel like my accomplishments were recognized and that I was taken up the value of my work, but certainly there were times, especially when people are saying, "You need to get in there and be louder," or sometimes seeing maybe my male residents, maybe getting a little more autonomy in the OR [operating room] a little bit earlier sometimes. There we're small things.
Kari Haley:
So we kind of talked, you are this trauma surgeon and trauma can be a lot of different things, so could you tell us a little bit more about what trauma is, what types of trauma there are, who are you taking care of, or what is your patient population?
Kelsey Berndt:
Yeah, so I think that's one of the things that I enjoy about being a trauma surgeon is I really take care of all different kinds of patients. So Regions Hospital was the first hospital to be a Level I trauma center for both adults and children. And so we take care of all ages and we take care of all different kinds of injuries, so we break trauma up into two big groups. So there's penetrating injuries, which is gunshot wounds and stabbings, those sorts of things that you hear about on the news, but that's about 9% of what we take care of. The other 90% is what we call blunt trauma. So that's falls, car crashes, motorcycle crashes, and those sorts of injuries. As I mentioned, we partner with Gillette [Children's Specialty Healthcare], so we take care of children, this kind of a multidisciplinary approach, meaning the trauma surgeons help take care of them and also our specialist in pediatrics, so we partner in taking care of those patients.
Kelsey Berndt:
And then, what is a Level I trauma center? So that just means we're able to provide the highest level of trauma care. So meaning we have our fully-staffed emergency department, we have our trauma surgeons in house 24/7, and then we have access to all the specialists. So neurosurgery, plastic surgery, orthopedic surgery, ICUs, pretty much anything you could imagine.
Steven Jackson:
So basically, come here.
Kelsey Berndt:
Come here. And the whole family can come here. We also take care of a lot of older folks. As the population ages, we have more and more trauma patients who are older in that above-65 age group. And so that's another area that we look at optimizing care. So the full spectrum, you can take care of the whole family.
Steven Jackson:
That's awesome. I know just being a person of color, in some views of thought, there is an unwritten rule that you have to work a little harder to get the same recognition. Now, again, I say unwritten because it's not written anywhere, but I notice with my own lived experience in that aspect. I have had to work a little harder to get the same recognition, almost find a cure for something to get the same recognition as somebody who signed their name in some cases. And so I understand to a degree what you're saying. And speaking of people of color, we often... We can start off by talking about the weather on our podcast and I always end up talking about trust because trust is just one of those fundamental principles that's in everything, all things equity and in health, we're going to talk about trust.
Steven Jackson:
What has been your experience with the concept of trust and maybe building it and maybe sometimes affecting it negatively when it comes to those tense trauma situations when people of color and their families come in?
Kelsey Berndt:
Absolutely. This comes up a lot in any clinical practice, but especially in trauma. And trust is so important and it's something that I think we all want to establish with our patients, and sometimes it's more difficult than others and certainly race is a factor. And that relates to a history of the medical system not being fair to people of color, and so my approach is starting with empathy. So I might not know what it's like to be a person of color, but I know what it's like to not feel heard or to not feel like something was fair. And so trying to approach those feelings...
Steven Jackson:
That's awesome.
Kelsey Berndt:
... from that perspective. One of the other speakers on the podcast was talking about cultural humility. And so I think that's a really great way to look at that and be humble and say, "I'm not sure what this person's experience was exactly, but I need to believe them and have empathy for what they're feeling." And we can have boundaries with that empathy. We want to be respectful, we want this to be a place of healing. And sometimes emotions can escalate in a high tension situation. But yeah, I would say empathy is my key to that.
Kari Haley:
And I think that's really huge and I really applaud you for doing that, especially in the line of trauma, because I think that... I mean, it's really something that's very prevalent and unfortunately I think is a lot of violence, especially in certain communities in different cities. And I think it's really easy to get jaded and to start judging the patients based on the violence that is part of their lives and it's not necessarily a true choice as a part of their lives. And I can think back to small comments that were made about patients and that probably still do. I think we're doing a much better job, honestly, even in the last couple years about thinking harder, about what we're saying and what we're thinking and telling each other. But I really applaud that empathy, because I think it's really hard to do. Sometimes, when it's something that... It's hard to watch. Trauma is very traumatic to experience and even as a provider, it's hard because you're experiencing it, not necessarily the same way as the patient, but you still are experiencing the trauma.
Kelsey Berndt:
Yeah, I think that's a good point. I mean, and sometimes those feelings and those experiences catch up to us. Sometimes it's hard to have a reaction in the moment because there's a job that needs to be done, so you sort of compartmentalize for the time being, but it tends to come out later. I think having a support system, having support of colleagues is really important.
Steven Jackson:
So as a rehab doctor, and I've said it in previous episodes, I'm not usually running toward colds, I'm running away from them. And I say that tongue in cheek obviously. If I'm needed at a cold, which hopefully I'm not, I'll be there and I'll be ready. But that's sort of, in terms of a rehab doctor's DNA, that's usually not there, at least it's dormant, for all the scientists out there. With that being said, you guys, meaning you and Dr. Haley, you guys are the epitome of the emergency. If somebody's seeing you, it's an emergency, something's wrong and they need help and they need it fast.
Steven Jackson:
When I see patients, I'm able to develop relationships over time and I get to learn a lot about them as people and know their families, those kinds of things. How do you reconcile not really being able to establish, and maybe you do establish rapport, but obviously if you establish rapport, it has to be probably fast tracked because there's a lot you have to do, you have to get consent to do this exam or this surgery. How do you reconcile that with the lack of time as well as I guess the urgency of the moment?
Kelsey Berndt:
Yeah, that's a good question.
Steven Jackson:
That's a tough one, right?
Kelsey Berndt:
That's a tough one, yeah.
Steven Jackson:
Mic drop. Mic drop.
Kelsey Berndt:
The reality is sometimes we don't have time for a full consent. In a real emergency, consent is sort of implied, the consent to, "Please save my life." Certainly when we have time to have the discussion, we want to get that full consent. But yeah, sometimes there is the limitation of time in developing that rapport. Maybe that's one thing I like about working in the surgical intensive care unit is I get some of that time later, if not in communicating with the patient and when communicating with their families, that's kind of more the arena where we do our rapport building, I would say
Steven Jackson:
If I can just jump back in. I guess this is related, but going back to what I just said, as a rehab doctor dot, dot, dot, emergencies don't excite me, in fact emergencies give me PTSD. Why, and Dr. Haley, you can jump in on this too, what is it about that emergency that I'm putting on my cape and I'm running or flying to the trauma bay to take care of business? Tell us about that excitement that you have with what you do and how you do it.
Kelsey Berndt:
That's another hard question. I think I really like finding the calm in the chaos, so I think some people, if they've been in a trauma resuscitation with me, I really try to get the room as quiet as possible. So sometimes that room is really loud, I'm really pulling people to be quiet, we want to hear one person at a time, we want to be very systematic if we can. Sometimes we're not there very long at all, it's a straight shot to the operating room, but other times it's very systematic, going through what we call our primary survey, where we're looking at airway, breathing, looking for any bleeding, that's the C for circulation, we call it the ABCs. And then kind of going on from there.
Kari Haley:
Yeah, I'd agree with that. I mean, I think I always try to describe it to my non-medical husband as kind of like I enjoy the organized chaos of the emergency department, because it is completely chaotic, but you kind of find your own kind of inner algorithms. And I think that's a big thing with trauma, it's very much, once you know the steps, you know the steps, and you stick to those steps. And you develop that in medical emergency situations too, very algorithmic, step by step, so you find that calm or that organization within the chaos. And it's actually really, almost a peaceful feeling once you can feel it and get there. But sometimes it takes a really long time to do that and sometimes it just doesn't ever happen, but it's a nice feeling when you feel like things have gone well and smoothly.
Steven Jackson:
I'm starting to sweat just thinking about all this emergency stuff. Oh, well. Well, I appreciate what you do for sure. And as an organization, we've made a stance when it comes to addressing issues of health care disparities and health equity being an anti-racist organization, and really, truly defining what that means and how that looks. When it comes to the population that we serve, we have patients that come in, and again, they're scared for many reasons, not only because of the trauma and the reason for them being in the hospital, but maybe there's a fear and maybe a lack of trust because of a previous bad experience, or maybe just some lived experience through others in the home. Are there any things, or are there any initiatives or endeavors in the trauma side of things where we're intentionally reaching out, or intentionally they are, say, marketing ourselves so that we are more palatable to those that may have issues with trust with us?
Kelsey Berndt:
Yeah, we are. We're very early in some of these projects, but it's something that has been very important to many us as trauma surgeons and also in working with our emergency medicine colleagues and the hospital in general, we are in the early phases of trying to work with some community groups, because I think that's important. I think there's a growing shift in viewing violence in particular through a public health lens. And as something that's a public health crisis that needs to be intervened on outside of the walls of the hospital, people who are involved or injured through a violent mechanism are at risk to have another occurrence. And violence is not only harmful to the person who's physically injured, it's harmful to our communities, emotionally and economically. And so really looking at trauma through a broader public health lens is important.
Kari Haley:
I think that's really huge.
Steven Jackson:
Yeah, that's awesome.
Kari Haley:
Because like you said, we don't have the access to build that rapport on the front end. Usually, it's very much a, "We got to do this now or we have to make these decisions now." And sometimes you get the opportunity to do it in the ICU and build a little bit on that tail end, but it's really hard to do any sort of proactive kind of relationship building for our trauma patient population. And I think that it's great that the trauma program is thinking about that and wanting to do more because I think that our communities that we serve, definitely deserve to have that. And I hope that it would build a better relationship with our patients, with our hospitals, and what their expectations are when they come.
Steven Jackson:
Yeah, absolutely. Absolutely. I think we're always making attempts to reach out to the community, especially now over the last few years. As I said, we've made the stance, are taking the stance to address disparities that we see and live through. And I love the health equity advances, particularly in the trauma bay, ER bay, understand we have video tablet interpreters in every room to expedite care, because obviously if you have someone where English is not their first language, where there's a barrier, and obviously you're at risk for harm if you don't communicate appropriately. So I think one of many advances that we're putting forth to meet our patients where they are, and I think that's awesome.
Steven Jackson:
How has COVID-19 affected, I guess you personally, as a trauma surgeon and how has it maybe affected the trauma surgery network in general?
Kelsey Berndt:
Yeah. So, similarly for a lot of folks, there was a lot of uncertainty at the beginning of the pandemic. We really weren't sure what COVID was going to mean for the hospital, for the community. We didn't know if we were going to be, as trauma surgeons, kind of redeployed throughout the hospital into other areas. That ended up not happening and part of it was because even through the pandemic, while elective surgeries and other procedures were kind of put on hold. And trauma didn't really stop it, our volume stayed the same. In fact, 2021 was our busiest year to date.
Steven Jackson:
Wow.
Kelsey Berndt:
And so, aside from more personal protective equipment, so N95s and goggles in every trauma activation, not much ended up changing for us. The first couple months maybe was a little bit slow and everybody was really hunkered down, but after that, it was kind of business as usual for our trauma service.
Kari Haley:
Yeah. I mean, soon after the pandemic started, I mean, we had such significant events in our area and significant civil unrest.
Steven Jackson:
Yes.
Kari Haley:
And I think that that probably played a role in trauma kind of coming up as an upswing in things. I'd like to hear a little bit more too about, what is your thoughts and vision, we won't hold this to you.
Steven Jackson:
I will. I will.
Kari Haley:
In five years? But what would your hopes be for trauma's interactions with the community and how your department really is able to work with your patients in an out-of-hospital setting or to help build that trust?
Kelsey Berndt:
Sure. Hopefully I don't overspeak here, but we're starting very early phases in partnering with community groups, but there's a lot of movements and documentation about hospital-based violence interruption programs, and this sort of provide more what we call wraparound services. So it starts when people come into the hospital and kind of see what resources they need while they're here in the hospital and then extend that out. So are there any community circumstances that we can help with and then continuing community outreach? And so I would like to see us have something more complete like that. I'm learning the more and more that I do in health care and leadership is that it's all baby steps. Everything, every step you make, you find out there's three more steps you have to do that you didn't know about. And so it all takes a little bit longer, but I think there's motivation to get there. And so hopefully that's in our future.
Kari Haley:
That's awesome. And this is a genuine question, because I'm not even sure myself, but are there resources that you are partnering with any of the psychiatry or psychology for trauma victims? Because that's a huge piece, I think, on the healing from trauma.
Kelsey Berndt:
Yeah. So Regions Hospital does have a psychotherapist who works mostly with the burn unit, but she does also see some of our trauma patients and that's a really valuable resource. And we utilize her as much as we can and we'd love to have more of that too, because that's really important. And also, our social workers are a huge resource. They help with community resources and screenings for housing insecurity, substance misuse, violence at home. We do also have an addiction medicine service, so they see patients if that's a concern. There really is a whole team here and we do our best to try to help people.
Kari Haley:
That's awesome. That's so good. And I think one of my other follow-up questions here too, is we kind of talked in the beginning about you being a woman in surgery. And I know that there's been a few new women also joining the surgery department. How important do you feel that bringing in diversity into your department is for serving the community?
Kelsey Berndt:
I think it's super important because it helps bring different perspectives, things that maybe I might not even know to think about or consider. Someone with a different background could bring that to the table and say, "Hey, we're having a struggle connecting with this patient. Well, have you thought about this?" Or even just the way that we're structured and set up. I certainly think the more viewpoints the better.
Steven Jackson:
Are you involved in any mentorship opportunities for any rising surgeons or any rising female surgeons that are looking to follow in Dr. Berndt's footsteps?
Kelsey Berndt:
I am not in anything formal right now. And it's something that I've thought about and something that goes back to the question about diversity. It's really natural for people to be drawn to people who are similar to them. And so I think when you're in a role like that, you need to keep your eyes open for people who maybe aren't completely similar to yourself and reach out to them. And so I've tried to be intentional about that with some of our residents in kind of a non-formal way. I will say, going back to the stereotypes about surgeons kind of having this reputation from being gruff, I think I've surprised some people.
Kelsey Berndt:
We have this Critical Care Research Institute here and there are a lot of young people, undergraduates that intern through that. And I've actually had, on two different occasions, had them reach out to me and shadow me. And I think that goes back to being approachable and just connecting, giving people that opportunity where they feel like they can ask, but certainly I think it's important to be intentional looking around for folks that might need some mentorship or even just someone to be an advocate for them.
Steven Jackson:
You often hear the phrase, "You can't be what you can't see," and you can use that in a lot of contexts. And in your case, what would be your message to the rising young, female surgeon, again, who wants to go into trauma surgery and maybe she's been told, "That's not where you belong or you may not fit, why don't you do another specialty?" What would be your message to that young lady that's out there?
Kelsey Berndt:
Yeah. I would say I definitely heard things like that coming through training. I used to joke about the thing that made me most like a surgeon was that I was determined to do what I wanted to do, the way that I am without changing. And so maybe there is a little bit of that stubbornness in me.
Steven Jackson:
There you go.
Kelsey Berndt:
I think, even here at Regions, we've had more and more female surgeons. I think nationally we're seeing more women in leadership. So just in the American College of Surgeons, over the last couple of years, the president has been a woman, a vascular surgeon. And now the executive director of the American College of Surgeons is Dr. Patricia Turner, who is a Black woman. And so that provides some more visual representation of what we want to be. And I think most of the surgical organizations, the American College of Surgeons and the Eastern Association for Trauma does have a focus on diversity and inclusion. And so I think that's a good step forward.
Steven Jackson:
Well, there are a lot of voices out there and they come in all shapes and sizes, and colors, and creeds. And I'm so appreciative obviously to you, Dr. Berndt, for gracing us with your presence and your experience, but also for just our organization for making the commitment to hearing all voices, not only to be diverse, but to be inclusive, because I think when we're not, we miss out on greatness in the making. And so listen, we just want to thank you for your time. Thank you for your commitment. And on behalf of all the patients that you see and families that you interact with, thank you for just what you do.
Kari Haley:
Yeah. No, and I just love to tell the story of how I was thinking about, "We need to have Dr. Berndt on this podcast," is we are having a shared trauma patient. And I just looked at you and we were, it was kind of a very intense time and I was just thinking, "Wow, she's a badass." I'm just going to say it. Like, "We need to have her talk about her experiences." And I know that your commitment to wanting to better the community and the patients that you serve is just like the icing on the cake for why you should be on this podcast.
Steven Jackson:
Absolutely.
Kelsey Berndt:
Oh my gosh. Thank you guys so much. I'm blushing under my mask.
Steven Jackson:
Well, again, maybe we'll have you back. And again, keep doing what you're doing and we'll see you in the hallway sometime.
Kelsey Berndt:
Sounds great. Thank you so much for having me.
Steven Jackson:
Off the Charts is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production service is provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.