What If We Treated Each Other As If We Were All Traumatized?
Okay, hear me out. “Trauma” has moved out of the category of jargon and into the general lexicon and is starting to feel akin to how the word “triggered” is used now. We academics go, “No, no, that word actually means something highly specific,” and then we feel guilty for gatekeeping concepts that may be helpful to others outside our ivory towers. (Is it just me? Please tell me it’s not just me. I don’t think it’s just me. I hope it’s not just me, otherwise my guilt complex is more unwieldy than usual.)
Here are my touchstones for what I’m about to say:
If everything is trauma, then nothing is trauma.
There’s Trauma, and then there’s trauma.
And this is maybe off-topic, but definitely related. Brene Brown and Adam Grant have a new podcast, and on their second episode, Brene gave the most beautiful explanation for what’s uncomfortable and what’s dangerous. She described a lecturer having a student come up to the front of the room and sit in a chair beside her. She then held up an inflated balloon and said, “I’m going to pop this in your face. How do you feel about that?” And the student said something along the lines of, “Um, not great.” The lecturer then said, “Okay. I’m going to tie your hands and feet to that chair and then pop the balloon in your face. How do you feel about that?” Understandably, the student was like, “Yeah, absolutely not.” Uncomfortable becomes dangerous when we have no control over the situation, when our hands are metaphorically (or literally, I suppose, in some barbaric scenario) tied. Too often nowadays, what’s “uncomfortable” gets labeled as “dangerous.” That’s where cancel culture comes from, and that’s where calm, open-minded, thoughtful discourse and thought experiments get shouted down and eventually extinguished. Is my liberal arts degree showing? Yes. Do the kids need to get off my damn lawn? YES.
Now that you know the context I’m coming from, I’ve been dabbling in the concept of trauma-informed care. The 2-second explanation of trauma-informed care is caring for struggling people in a way that, instead of asking, “What’s wrong with you?” asks them, “What’s strong with you?” I’ve subsequently learned that this is a huge tenet of the care our licensed medical social workers provide. But given how stretched thin our lovely LMSWs are, and the overall state of the world (said while gesturing widely around me), I’ve been trying to figure out how to work with parents who are completely shut down when their children are critically ill myself. When nothing we say seems to land, let alone prompt a response. Or, parents who are so disengaged that they cannot come out for rounds, even staying horizontal on the couch in the back of the room with a blanket over their heads when I come in to update them after rounds about what’s going on with their child. These parents have gone straight past fight-or-flight and are stuck, seemingly immovably, in “freeze.” But the care of a critically ill child is rarely a static situation; we need their parents to move with us, otherwise the critical illness will passively reach a foregone conclusion.
Dr. Uche Anani is, first of all, my friend (I’m very, very lucky!), and second of all, a national expert in the provision of trauma-informed care in the neonatal ICU. After my grand rounds, we had breakfast so I could grill her about what practicing trauma-informed care does for parents who are traumatized by their child’s critical illness, with some likely having experienced any amount of trauma (or Trauma) before their child’s life-threatening course. Over almost two hours, I came to see that, in my role as an intensivist, I am not going to be able to “fix” the trauma my patient’s parents have come into the unit with: my cumulative time with them is simply too brief (let alone my training being inadequate). But what I can do is not re-traumatize them during my care of their child. Starting to bring some of this work into my interactions with patients, assuring the parent’s physical safety while doing whatever we can to keep their child’s illness from progressing, fostering psychological safety to have opinions that are different from mine, practicing shared decision making whenever possible to level power differences, and partner with parents in the care of their child, has showed me this is something that cannot be outsourced to LMSWs, members of our Spiritual Care Service or even the bedside RNs. Which then got me thinking…
I think there’s a “there” there for how we treat our medical colleagues. Admittedly, we are highly functional (probably overly-functional, if I’m honest) humans who mostly skew “fight” when met with adversity. Most of us have the emotional resilience and social support to meet challenges without our systems degrading into “freeze.” However, though we’ve been trained to be superhuman (flipping day and night schedules back and forth, taking marathon-length board exams, working way more than 40 hours a week), we are, in fact, human beings. Same neurotransmitters, same sympathetic and parasympathetic systems as everybody else. And, statistically, the same Traumas and traumas. While I may not need to convince anybody in medicine that we were traumatized by the COVID pandemic, let me remind you that abuse and neglect of any sort, loss of a loved one, domestic violence, community violence, sexual assault, accidents and injuries, natural disasters, life-threatening illnesses or serious medical procedures, war, combat, poverty, discrimination and structural racism are all recognized as highly likely to cause trauma. Maybe we’ve used our medically trained superhuman-ness to cope with what we’ve experienced, but that doesn’t mean it didn’t happen. And then we work in a high-risk, high-reward environment where there are huge losses, no matter how smart we are, how hard we work, or how much we try.
What would happen if we took five seconds to create a calm environment to speak with our colleagues about a complicated case? What if I inwardly acknowledged the partner I’m working with, who comes from a marginalized group, had to work way, way harder than I did to get to where we are? (No need to make it an awkward big deal if it doesn’t need to be, but if it needs to be, being a safe space or an ally for people who are not like us is massively important to assure psychological safety in the practice of medicine.) What if we saw a friend who seemed to be struggling and asked, “Hey, what’s going on?” and then really listened to their answer? What if we treated our superhuman colleagues as if they were just like us, human? People who’d been through some things. And come out the other side. And could use a gentle reminder of that.
I truly think I’m onto something. If you agree, email me at jessie@burningbrightMD.com and let me know. If you disagree, email and let me know; I’ll do my best to create a psychologically safe environment for us to type-dialogue.
But, above all, and if nothing else, please take care.