Sunday, November 28, 2010

Vicarious Trauma

The subject of vicarious trauma has been on my mind lately.

It's always on the back burner anyway, because of my profession. Health care workers, social workers, clergy members, humanitarian aid providers, counselors, and other individuals who confront human suffering on a regular basis are at risk for it. Unlike countertransference (the redirection of a service provider's feelings or unresolved conflicts toward the person being served) and compassion fatigue or burnout (the blunting of empathy and increase in apathy and negative feelings in response to chronic exposure to others' suffering), vicarious trauma indicates a fundamental change involving the caregiver's physical, psychological, and spiritual health. It includes symptoms similar to, but less severe than, those of PTSD, such as hypervigilance, sleeplessness, an increased startle response, nightmares/flashbacks/other intrusions, and avoidance of potential triggers of these intrusive symptoms.

I can only speak from my experience as a physician but I would bet this applies to most professionals whose job involves witnessing or tending to the pain of others. I believe physicians have to strike a pretty precarious balance: feeling and showing enough empathy to provide care that is felt to be good care, with a personal connection, and maintaining enough separation of self to be able to function and provide care that is competent, prompt, and unencumbered by personal difficulties or emotional hang-ups. It's very easy, I think, on the one hand to be too distant, and to fail to connect on a human level for the sake of the work being done, and on the the other hand to get too personally involved, to over-identify with the sufferer - literally what the word patient means - and to be hampered in your caregiving because you have to run to the locker room and cry. A good doctor has to be able to cry, with or for others, but also to be able to postpone crying till later so that good work can be done. It does my patients absolutely no good if I am too busy sobbing for them to be able to hook up a syringe full of pressor and save them from their own shock. I also serve them ill, however, if I feel nothing for them whatsoever.

So to any patients or future patients out there: please don't judge physicians and nurses for staying calm while your life is falling apart or your loved one is in agony. As long as they are calm without being cold, caring without falling apart, and doing the right thing for your safety, they are serving you as best they can. When the time is right, and the work is done, they will allow time and space for that ache in their heart to remind them of you, and of why they strove to be there for you in the first place.

Monday, November 22, 2010

November 22, 1963: Mixed Messages from Trauma Room One

"The first thing [Dr. Robert McClelland] saw was the president's face, cyanotic - bluish-black, swollen, suffused with blood. The body was on a cart in the middle of the room, draped and surrounded by doctors and residents. Kennedy was completely motionless, a contrast to the commotion around him...Dr. M.T. Jenkins, an anesthesiologist, was near the head of the cart, administering oxygen...For nearly 15 minites, McClelland held the retractor as blood ran over its edges. As the other doctors labored on Kennedy's throat and chest or milled around the room, McClelland stood staring at the leader of the free world..." -from an article in D magazine, "The Day Kennedy Died" by Michael J. Mooney

Dr. McClelland has always consistently described a wound in the back of President Kennedy's head through which he observed a bit of cerebellar matter escape. The anesthesiologist, the famous M.T. "Pepper" Jenkins, agreed at first but later decided the tissue must have been cerebrum, not cerebellum - an important difference - and also later changed the location of the wound from occipital to parietal. Those who accept McClelland's version contend that we were not told the truth about Kennedy's assassination. His detractors point to evidence from the four-hour autopsy which indicates a different wound altogether - one that supports the official conclusion that President Kennedy was shot by a lone assassin from above and behind.

Whose version is closest to the truth?

Having been in a number of chaotic clinical scenes, especially those involving tons of personnel, I can understand how people's memories can be a little patchy, erroneous, even conflicting. But the differences in the above two physicians' recollections of what went on during the desperate attempts to resuscitate Kennedy are crucial to the story. Who's right?

Interesting historic note: the only female physician on the scene, Jackie H. Hunt, was - you guessed it - an anesthesiologist.