Trauma/trauma and Physicians
Apr 09, 2022
When I was a kid, my mom was a Nurse Manager for the Neurology/Neurosurgery unit of our local Level 1 Trauma Center hospital, and so the word trauma was present for me in the medical context. Trauma with a big “T.” And PTSD was something experienced by soldiers during the Vietnam War Era (in WW1 it was called “shell shock”), and occasionally by some with other big “T” traumas. And so it was, even through my medical training. And there wasn’t a whole lot to do for it, or say about it, was what I gleaned from the brief exposure I had to it.
But trauma, big “T” and little “t,” was always there. And it’s far more pervasive than most of us realize.
I can remember specific points during my training where I witnessed things that were truly horrific; injuries or conditions that were severe and where these living people were about to die, unless we, the fallible humans, fixed them. Every single person who has trained in medicine (and I expect in nursing, EMT and many other fields) has been exposed to these events. But most of us were never explicitly taught how to think about it, how to feel, how to process it.
One episode that stands out to me occurred on my ICU rotation. It was me and the Attending alone, and he was busy with a patient with an aortic balloon pump at one end of the hall, while I was closely watching a severely ill woman who was losing blood from her gut somewhere and ordering blood products. At the end of my shift, in the wee hours, she began coughing and spurting blood, and we sent her for an urgent scan, worried it was an esophageal-aortic fistula. While she was in the scanner, I was trying to focus on rounds to the morning team, and I remember heading out to change and hearing a code being called in Radiology overhead. I ran back to the ICU, and the calm, daytime Attending was standing there. I remember asking him what was happening, and he, politely, told me it was time for me to go home, hours restrictions, etc. And I stared at him. “What do you mean go home?” This woman was probably dying. And I had been with her all night (and many other times during her stay). I was sent home not knowing, crying, my mind racing, knowing that she could die before they learned what was wrong, and that she could die if they tried to operate on this. It was a lot to take. And there was no space for processing. Only a push out the door.
What happens to many of us experiencing these types of events, is that we start developing hypervigilance, learning to scan the environment for subtle shifts that could signal danger. We do this over and over again as students, as residents and beyond. We do this in the hospital, in the clinic, and we will constantly find evidence of something having been missed (or not yet apparent), and vow to never let it happen again. Here is a situation that occurred where we felt like we wanted control, where we “should” have had control and didn’t, and something bad happened. And it hardwires the trauma responses of hypervigilance, and over-culpability (I made that word up I think) and primes us to always feel that if we had only worked harder or had been smarter, this wouldn’t have happened.
This is one place where we pick up trauma with a little “t” in medicine; we constantly acquire these experiences, which reinforce our hypervigilance. And then, we find ourselves reactive, suspicious, fearful, and avoidant.
And it’s hard to feel better unless we can step back and accept that this has happened.
Trauma with a little “t” shows up in our lives all the time. In ourselves during our training, perhaps in our childhood, in the exam room with patients who are “noncompliant” and “don’t respond to treatment,” in our colleagues who suddenly lose it.
And we’ll never fix it until we see it, accept it, and treat it in ways that change our neuro-wiring.
For anyone out there reading this, and feeling like this is you, help is available, and often takes a different form than you might think. Yes, there are medications and therapy that are helpful, but other treatments, including Eye-Movement Desensitization and Reprocessing (EMDR), Brain-Spotting, Emotional Freedom Technique (EFT, also commonly called “tapping”), Craniosacral treatments and a host of other brain-body techniques, performed by trauma-informed Practitioners can make a tremendous difference.
The bottom line is this. Get help. Help is available.
Please note, that I am not trauma-informed, or a trauma expert, but I consider myself a trauma survivor and trauma-aware and trauma-curious. Below is a list of some resources and providers from whom you can seek trauma-informed care. If you are feeling unsafe in anyway, please reach out for immediate assistance to 1.800.273.8255. The National Suicide Prevention Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources and best practices for professionals in English and Spanish. You are too important to lose, simply because you are human.
EMDR: https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing#:~:text=Eye%20Movement%20Desensitization%20and%20Reprocessing%20(EMDR)%20therapy%20(Shapiro%2C,Processing%20model%20(Shapiro%202007).
EFT: Psychiatrist Melissa Hankins is a trauma-informed, Certified EFT Provider and Psychiatrist. Find her here.
Brainspotting: https://brainspotting.com/
PTSD Craniosacral: https://www.upledger.com/conditions/ptsd.php
Hi There!
I'm Megan. I'm a Physician and a Life Coach and a Mom. I created this blog to help other Physicians and Physician-Moms learn more about why they feel exhausted, burned-out and overwhelmed, and how to start to make changes. I hope that you enjoy what you read, and that it helps you along your journey. And hey, if you want to talk about coaching with me, I'm here for that too! I offer a free 1:1 call to see if we are a good fit. Click the button below to register today.
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