how it affects us . With neither a positive nor negative valence , most of us go through the motions , often with detached apathy . One EM resident said these cases don ’ t affect her at all . She ’ s an empathetic person who connects well with ED staff and consultants , so she is probably wrong .
Kyle Fischer et al . wrote a paper on Trauma Informed Care for violently injured patients in the ED . The article covers PTSD ( 80 % of gun-shot survivors vs . 3 % general population !) and the repeated onslaught of neurobiologic and psychosocial effects of prior trauma . He highlights the indirect but also direct trauma health care workers experience : assault , abuse , threats , vicarious trauma and secondary traumatic stress that contribute to burnout . We do not teach learners how to cope with these traumatic scenes : medical students report “ extremely inadequate support ” and 40 % of residents do not feel well-prepared to manage their own feelings .
Fischer cites interventions that have worked to reduce PTSD in violent trauma patients : working with PTSD specialists , motivational interviewing and cognitive behavioral therapy . One randomized controlled trial resulted in only 8 % of patients returning with violent reinjury ( vs . 20 % in controls ). We cannot find any research on post-traumatic growth in penetrating or violent trauma patients , and very little such in healthcare workers . As with the coexistence of fear and awe in the Sublime , PTSD and post-traumatic growth clearly coexist within individuals . We must recognize that the change point can create opportunities for growth , help us find meaning , and make us stronger , more resilient humans .
People in crises experience true dread , uncontrollability + unfamiliarity + unimaginability , with accompanying suffering and a sense of unfairness . We can harness evidence-based techniques to improve resilience : the belief we can influence events , our intention to find meaning , and our conviction to learn from positive and negative experiences . Let ’ s connect with our patients and each other to find the change point and grow together , once “ the worst is over .”
References
Acosta J , Prager JS . The worst is over : what to say when every moment counts . San Diego , Calif .: Jodere Group ; 2002 .
Bartels J . About the Medical Pause . https :// thepause . me / 2015 / 10 / 01 / about-themedical-pause /. Published 2015 . Accessed May 23 , 2021 .
Baruch J . I told my emergency medicine team to ‘ move on ’ after a horrific patient death . That was a mistake . Statnews . 2017 . https :// www . statnews . com / 2017 / 08 / 02 / emergency-medicine-trauma-doctors /. Accessed May 20 , 2021 .
Clewis RR , Yaden DB , Chirico A . Intersections Between Awe and the Sublime : A Preliminary Empirical Study . Empirical Studies of the Arts . 2021 .
Fischer KR , Bakes KM , Corbin TJ , et al . Trauma-Informed Care for Violently Injured Patients in the Emergency Department . Annals of emergency medicine . 2019 ; 73 ( 2 ): 193-202 .
Huecker M , Shreffler J , Danzl D . COVID-19 : Optimizing healthcare provider wellness and posttraumatic growth . The American journal of emergency medicine . 2020 .
Levine SK . Trauma , tragedy , therapy : the arts and human suffering . London ; Philadelphia : Jessica Kingsley Publishers ; 2009 .
Lewis B . A Medical Sublime . J Med Humanit . 2020 ; 41 ( 3 ): 265-287 . Marchant J . Cure : a journey into the science of mind over body . Edinburgh :
Canongate ; 2016 .
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TRANSCENDING TRAUMA
Pennebaker JW , Smyth JM . Opening up by writing it down : how expressive writing improves health and eases emotional pain . Third edition . ed . New York : The Guilford Press ; 2016 .
Ripley A . The unthinkable : who survives when disaster strikes and why . 1st pbk . ed . New York : Three Rivers Press ; 2009 .
Vigil NH , Beger S , Gochenour KS , Frazier WH , Vadeboncoeur TF , Bobrow BJ . Suicide Among the Emergency Medical Systems Occupation in the United States . The western journal of emergency medicine . 2021 ; 22 ( 2 ): 326-332 .
Dr . Huecker is a practicing University of Louisville emergency medicine physician and faculty member .
Dr . Nash is a practicing University of Louisville trauma surgeon and faculty member .
JULY 2021 17