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orbemnews · 3 years

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A Year of Risk, Fear and Loss for Families in Medicine Gabrielle Dawn Luna sees her father in every patient she treats. As an emergency room nurse in the same hospital where her father lay dying of Covid last March, Ms. Luna knows firsthand what it’s like for a family to hang on to every new piece of information. She’s become acutely aware of the need to take extra time in explaining developments to a patient’s relatives who are often desperate for updates. And Ms. Luna has been willing to share her personal loss if it helps, as she did recently with a patient whose husband died. But she has also learned to withhold it to respect each person’s distinct grief, as she did when a colleague’s father also succumbed to the disease. It’s challenging, she said, to allow herself to grieve enough to help patients without feeling overwhelmed herself. “Sometimes I think that’s too big a responsibility,” she said. “But that’s the job that I signed up for, right?” The Lunas are a nursing family. Her father, Tom Omaña Luna, was also an emergency nurse and was proud when Ms. Luna joined him in the field. When he died on April 9, Ms. Luna, who also had mild symptoms of Covid-19, took about a week off work. Her mother, a nurse at a long-term-care facility, spent about six weeks at home afterward. “She didn’t want me to go back to work for fear that something would happen to me, too,” Ms. Luna said. “But I had to go back. They needed me.” When her hospital in Teaneck, N.J. swelled with virus patients, she struggled with stress, burnout and a nagging fear that left her grief an open wound: “Did I give it to him? I don’t want to think about that, but it’s a possibility.” Like the Lunas, many who have been treating the millions of coronavirus patients in the United States over the past year come from families defined by medicine. It is a calling passed through generations, one that binds spouses and connects siblings who are states apart. It’s a bond that brings the succor of shared experience, but for many, the pandemic has also introduced a host of fears and stresses. Many have worried about the risks they’re taking and those their loved ones face every day, too. They worry about the unseen scars left behind. And for those like Ms. Luna, the care they give to coronavirus patients has come to be shaped by the beloved healer they lost to the virus. Working through grief For Dr. Nadia Zuabi, the loss is so new that she still refers to her father, a fellow emergency department physician, in the present tense. Her father, Dr. Shawki Zuabi, spent his last days in her hospital, UCI Health in Orange County, Calif., before dying of Covid on Jan. 8. The younger Dr. Zuabi almost immediately returned to work, hoping to keep going through purpose and her colleagues’ camaraderie. She had expected that working alongside the people who had cared for her father would deepen her commitment to her own patients, and to some extent it has. But mainly, she came to realize how important it is to balance that taxing emotional availability with her own well-being. “I try to always be as empathetic and compassionate as I can,” Dr. Zuabi said. “There’s a part of you that maybe as a survival mechanism has to build a wall because to feel that all the time, I don’t think it’s sustainable.” Work is filled with reminders. When she saw a patient’s fingertips, she recalled how her colleagues had also pricked her father’s to check insulin levels. “He had all these bruises on his fingertips,” she said. “It just broke my heart.” The two had always been close, but they found a special connection when she went to medical school. Physicians often descend from physicians. About 20 percent in Sweden have parents with medical degrees, and researchers believe the rate is similar in the United States. The older Dr. Zuabi had a gift for conversation and loved talking about medicine with his daughter as he sat in his living room chair with his feet propped up. She is still in her residency training, and throughout last year she would go to him for advice on the challenging Covid cases she was working on and he’d bat away her doubts. “You need to trust yourself,” he’d tell her. Updated March 12, 2021, 9:30 a.m. ET When he caught the virus, she took time off to be at his bedside every day, and continued their conversations. Even when he was intubated, she pretended they were still talking. She still does. After difficult shifts, she turns to her memories, the part of him that stays with her. “He really thought that I was going to be a great doctor,” she said. “If my dad thought that of me, then it has to be true. I can do it, even if sometimes it doesn’t feel like it.” Love tempered by risk and horror In the same way that medicine is often a passion grown from a set of values passed from one generation to the next, it’s also one shared by siblings and one that draws healers together in marriage. About 14 percent of physicians in the United States have siblings who also earned medical degrees, according to an estimate provided by Maria Polyakova, a health policy professor at Stanford University. And a fourth of them are married to another physician, according to a study published in the Annals of Internal Medicine. In interviews with a dozen doctors and nurses, they described how it has long been helpful to have a loved one who knows the rigors of the job. But the pandemic has also revealed how frightening it can be to have a loved one in harm’s way. A nurse’s brother tended to her when she had the virus before volunteering in another virus hot spot. A doctor had a bracing talk with her children about what would happen if she and her husband both died from the virus. And others described quietly weeping during a conversation about wills after putting their children to bed. Dr. Fred E. Kency Jr., a physician at two emergency departments in Jackson, Miss., understood that he was surrounded by danger when he served in the Navy. He never expected that he would face such a threat in civilian life, or that his wife, an internist and pediatrician, would also face the same hazards. “It is scary to know that my wife, each and every day, has to walk into rooms of patients that have Covid,” Dr. Kency said, before he and his wife were vaccinated. “But it’s rewarding in knowing that not just one of us, both of us, are doing everything we possibly can to save lives in this pandemic.” The vaccine has eased fears about getting infected at work for those medical workers who have been inoculated, but some express deep concerns about the toll that working through a year of horrors has taken on their closest relatives. “I worry about the amount of suffering and death she’s seeing,” Dr. Adesuwa I. Akhetuamhen, an emergency medicine physician at Northwestern Medicine in Chicago, said of her sister, who is a doctor at the Mayo Clinic in Rochester, Minn. “I feel like it’s something I’ve learned to cope with, working in the emergency department before Covid started, but it’s not something that’s supposed to happen in her specialty as a neurologist.” She and her sister, Dr. Eseosa T. Ighodaro, have regularly talked on the phone to compare notes about precautions they’re taking, provide updates on their family and offer each other support. “She completely understands what I am going through and gives me encouragement,” Dr. Ighodaro said. The seemingly endless intensity of work, the mounting deaths and the cavalier attitudes some Americans display toward safety precautions have caused anxiety, fatigue and burnout for a growing number of health care workers. Nearly 25 percent of them most likely have PTSD, according to a survey that the Yale School of Medicine published in February. And many have left the field or are considering doing so. Donna Quinn, a midwife at N.Y.U. Health in Manhattan, has worried that her son’s experience as an emergency room physician in Chicago will lead him to leave the field he only recently joined. He was in his last year of residency when the pandemic began, and he volunteered to serve on the intubation team. “I worry about the toll it’s taking on him emotionally,” she said. “There have been nights where we are in tears talking about what we’ve encountered.” She still has nightmares that are sometimes so terrifying that she falls out of bed. Some are about her son or patients she can’t help. In one, a patient’s bed linens transform into a towering monster that chases her out of the room. A nurse’s purpose When Ms. Luna first returned to her emergency room at Holy Name Medical Center in Teaneck, N.J., after her father died, she felt as though something was missing. She had gotten used to having him there. It had been nerve-racking as every urgent intercom call for a resuscitation made her wonder, “Is that my dad?” But she could at least stop by every now and again to see how he was doing. More than that though, she had never known what it was like to be a nurse without him. She remembered him studying to enter the field when she was in elementary school, coloring over nearly every line in his big textbooks with yellow highlighter. Over breakfast last March, Ms. Luna told her father how shaken she was after holding an iPad for a dying patient to say goodbye to a family who couldn’t get into the hospital. “This is our profession,” she recalled Mr. Luna saying. “We are here to act as family when family can’t be there. It’s a hard role. It’s going to be hard, and there will be more times where you’ll have to do it.” Kitty Bennett contributed research. Source link Orbem News #families #Fear #Loss #Medicine #risk #Year

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rachelthompsonauthor · 6 years

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Is it possible to balance PTSD and real life? It is, if you realize you have it, know what to look for, and get the help you need.

It wasn’t until a few years ago that I realized, after dealing with migraines for over twenty years, they could somehow be related to the childhood sexual abuse (CSA) I experienced when I was eleven. No neurologist had ever asked about my past. Why would I think there would be a connection?

I started therapy in my mid-thirties for postpartum depression – my shrink was great. He helped me deal with the here and now of anxiety and depression. Triage, if you will. We eventually delved into my past and he diagnosed me as having PTSD from the CSA. (I wrote a post all about migraines and treatment here if you’d like to start with that post. That’s not what this post is about.)

You have to understand – I had no concept whatsoever why I hated crowds and noise, why going to Disneyland with my husband (at the time) and kids made me cry and tremble (it’s supposed to be the happiest place on earth, right?), or why slamming doors and drawers (my ex was a slammer) made me jump as if I were in a horror movie.

I pushed myself through these experiences for years, not realizing how much worse that made the hyper-vigilance. How would I know? While my shrink was helpful in many ways, we didn’t discuss a connection between PTSD and my current chronic pain.

Migraines have had such a huge effect on my life since my late-twenties — how can I not have known about this PTSD link? It’s mind-boggling.

Fast forward another ten years or so: I’ve written and released Broken Pieces (in 2013), moved to a new city, separated from my now ex-husband, and started seeing a new trauma-informed therapist who shows me all kinds of studies showing the link between PTSD and chronic pain. (Not every survivor of sexual trauma gets PTSD – typically, it’s anywhere from 30% to 50%; Source: Harvard School of Public Health).

Let’s talk more about PTSD, pain, and how to balance it all.

Defining PTSD

Post-Traumatic Stress Disorder is defined as a state of extreme anxiety and hypervigilance which begins after some type of traumatic experiences such as a rape, military combat, or natural disaster.

The symptoms of PTSD may include reliving the traumatic event over and over again, avoiding people or places that remind you of the trauma, or exhibiting symptoms of the flight or fight reaction. (Source: Very Well Mind.) (Freezing is also a natural response to trauma. To learn more about the three types of freezing, read this informative article from Jim Hopper, Ph.D. in Psychology Today.)

PTSD and Pain

It’s well-known that people with PTSD are at higher risk of heart disease, immune disorders, eating disorders, addiction, and depression. But did you know that we’re at higher risk of pain issues (e.g., migraines, back pain, fibromyalgia) as well? Most survivors don’t. I didn’t. In fact, most physicians and other health-care practitioners don’t know (or at least don’t ask about it when taking a patient’s history).

My own experience was fairly unique, in that I was a Big Pharma rep – I called on dozens of neurologists as a rep who treated migraines. I saw several as a patient. One, in particular, was ‘the guy’ – well-known internationally as The Migraine Doctor. Not once did he ask about my past or PTSD. Just threw a triptan* at me and said ‘if it works, you have migraines. If it doesn’t, you don’t. And don’t smoke. You’ll stroke out and die.’ Yea, charming.

*Triptans are formally known as serotonin receptor agonists. Triptan drugs work like a brain chemical called serotonin. This helps quiet down overactive pain nerves. In other words, triptans reverse the changes in your brain that caused your migraine.

Point is: with all of the training (and I sold neurology and migraine meds), with all my interactions with internists, neuros, GPs, FPs, nurses, PAs, etc., not once did we discuss past trauma as a connection to pain. This is major gap.

Tip: Find a physician you’re comfortable with, and tell him/her about your sexual trauma. I’m very open about it now with all my healthcare practitioners. They are welcoming, and it often changes their treatment plan.

Studies show that pain is one of the most common physical problems reported by people with PTSD. This finding holds true no matter what types of traumatic events they experienced—for example, a motor vehicle accident, physical assault, or combat injury. People with PTSD are also more likely to report pain-related disability.

In one study of volunteer firefighters with PTSD, approximately 50% were having pain (mainly back pain) compared with only about 20% of firefighters without PTSD.

In two other studies, from 20% to 30% of patients with PTSD had frequent and chronic pain symptoms.

You can also look at this situation in reverse: Many patients with chronic pain problems also have PTSD. In fact, from 10% to 50% of people getting treatment for chronic pain have PTSD as well. These rates of PTSD are higher than those found in the general population. (Source: VeryWellMind)

Why is this? Think about it. If you are tensed up due to hyper-vigilance, you may suffer from tension headaches which can lead to migraines *raises hand*. From this same article:

Some symptoms of PTSD may cause pain. For example, PTSD-related hyperarousal symptoms often cause tense muscle pain that can become chronic. More below on hyperarousal (and no, it’s not sexual, ya dirty creatures).

…and the light bulb goes on

Three Main Symptom ‘Groups’ of PTSD

PTSD is complicated. Though it can affect each person in many different ways, there are identifiable characteristics which are grouped in this way:

Re-experiencing: manifests as if we are reliving the event(s) through flashbacks, dreams/nightmares, or intrusive thoughts. There isn’t a day that goes by where I don’t experience some kind of flashback to when I abused as a child. The thoughts pop up out of nowhere during the course of my day.

Sometimes I expect them if I’m working on my books or poetry, or watching a movie or reading a book that has that kind of content. Most of the time, though, these flashbacks are unwanted visitors that come and go.

Very rarely do these flashbacks trigger me, and my guess is I’ve become so used to them, I just go on about my day. Once in a while, though, I will be triggered out of nowhere.

Tip: What triggers you may be different than what triggers me. Make note of past triggers and discuss with your therapist. Work through them IF you feel it’s okay. There is a vast difference between being upset and being triggered. Ignore social media’s definition. Trust your instincts.

Avoidance: is exactly what you think it means – consciously or subconsciously changing your behavior to avoid scenarios associated with the event(s) or losing interest in activities you enjoy. It can also mean ignoring our health and mental health needs because that would mean acknowledging or talking about our experiences, which can be so shameful and debilitating for many survivors, they’d rather suffer in pain than seek help.

Shame is powerful. So are you. Remember, you’ve done nothing wrong. If you’re in pain, get the help you deserve.

Hyperarousal: okay, buckle up for this one. Hyperarousal can take many forms. Here’s a list from Medical News Today:

find it hard to go to sleep or stay asleep

feel irritable and quickly lose their temper

find it hard to concentrate

constantly feel on-guard (hypervigilance)

be more impulsive than usual

feel like their muscles are more tense than usual

feel pain more easily

feel their heart beating faster than usual

feel jumpy and be startled easily

breathe more quickly or less deeply than usual

have flashbacks about a traumatic event

Hyperarousal can cause trouble sleeping, anger, concentration issues, and impulsiveness (as well as what I referred to earlier: avoidance and re-experiencing). Therapy can take many forms here and is so incredibly helpful in teaching us ways to cope with these issues.

Dissociation

Not all survivors experience dissociation, which experts explain as the mind escaping the body until the assault is over. I experienced it. I didn’t know because I didn’t have the language for it. I simply watched myself from a tree while the abuse occurred each time, waiting for it to be over. After that, I dissociated frequently throughout my childhood and teen years, mostly in times of stress, until I could do so on demand.

I still can – quite the party trick.

For me to dissociate without being aware is rare, though it happened recently this past summer at a small, local art gallery where my daughter interned. Hot, crowded, loud — I completely checked out mentally, yet I had no idea. I grew quiet, my eyes were glazed and unblinking as I rushed from here to there.

My guy figured it out and hustled me out of there, but even he didn’t recognize what happened at first except that I acted strangely. I didn’t have any way to tell him it was happening because I didn’t know myself.

Tip: Talk to those closest to you about dissociation. Tell them what happens when you dissociate so they can look for clues in case you’re unable to identify when you’re in it. Let people help you.

Triggers

What does it mean to be “triggered?” In recent years, people on the internet casually (and oftentimes, callously) refer to being triggered, particularly in response to political conversations. Beyond that, survivors themselves often confuse triggers with stress. Stress is a normal part of our everyday lives and everyone experiences stress; triggers are specifically associated with anxiety.

From a mental health perspective, being “triggered” more narrowly refers to the experience of people with PTSD re-experiencing symptoms of a traumatic event (such as exposure to actual or threatened death, serious injury, or sexual violation) after being exposed to a trigger that is a catalyst or reminder. (Source: VeryWellMind)

It can be hard to tell the difference for survivors if you’re constantly in a state of anxiety and worry, and feel as if everything is a trigger for you. This is why seeking mental health services is crucially important. Most of us are ill-equipped to know the difference.

I’m not a shrink, yet here are some handy tips I’ve learned to use when faced with situations you’re not sure how to handle:

Is what’s bothering you somehow linked to your past abuse in some way? Is it causing a flashback, avoidance, or hypervigilance (as mentioned above)? Then that’s likely a trigger.

Alternatively, if you find yourself angry at what somebody said, that’s a normal stress reaction and you are likely not triggered. You are a normal human having a normal emotional reaction to stress.

Tip: Whenever you feel stressed out, write down what it is specifically that’s bothering you. Is it a daily activity, someone’s voice, specific foods, the time of day? Journaling can be extremely helpful in determining what is a stressor and what is a trigger.

There is a lot to manage when you have PTSD as a result of sexual trauma (or any kind of trauma). Don’t diagnose yourself. Get help. You deserve it. We all deserve it. We deserve love, compassion, and support.

And always remember: you did nothing wrong.

Read more about Rachel’s experiences in the award-winning book, Broken Pieces.

She goes into more detail about living with PTSD and realizing the effects of how being a survivor affected her life in

Broken Places, available now on Amazon.

The post How To Effectively Balance PTSD and Real Life appeared first on Rachel Thompson.

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