The searing pain in her belly made Beth cry out and grab her stomach. Fortunately, her sister, who lived nearby, was home from work and could take her to the local hospital tucked away in the little mountain town. Seven hours later, Beth was rushed from the emergency room into surgery after the doctor discovered that her appendix had ruptured an hour earlier.
The surgery saved her life, but Beth was still angry about the whole process one year later. She had a lot to be angry about. The care she had in the emergency room was poor at best; despite her complaints of worsening pain, no one recognized the severity of her situation. Her appendix burst while she was in the emergency room. A few weeks after the initial surgery, she had to undergo a second surgery to repair the damage done by the first. She spent the next four months in bed recovering.
By the time I saw Beth, she was torn between feeling grateful to those who kept her alive and furious that many things went so wrong. We both suspected that the hospital experiences had overwhelmed her. In short, they had left her feeling traumatized.
Perhaps you, too, have had a similar experience as Beth. You received enough medical care to save your life, but the medical interventions so overwhelmed and angered you that you have very little energy left to help you heal.
Warning: Medical Care Can Be Hazardous To Your Emotional Health
Medical interventions can leave you with two intense feelings: deep gratitude that the emergency intervention saved your life and anger or even rage about how the care was provided. While the intrusive life saving procedures or surgery could have been life saving, they also could easily have traumatized your nervous system. Cutting into your body, resetting bones, insertion of needles and tubes, and invasive exams may have been done roughly to save time and perhaps even without your permission. There may have been no time to explain why certain procedures were needed. And if actions were taken to correct the mistakes of the initial interventions, it is no wonder that you are angry!
On going anger and rage can be signs of trauma. Your nervous system can experience medical interventions, no matter that they saved your life, as very activating. The stress depletes you of the ability to relax and move on with the restorative healing that your body so desperately needs. As a result, you are left with a sense of being a victim because, for a while, you really were at the mercy of the medical professionals. Unfortunately, this sense of victimization has the potential to influence how you respond to other medical emergencies down the road.
It’s not uncommon that life saving interventions and trauma to go hand in hand.
The Consequences of Rage and Anger
Ongoing rage and anger are often indicative of a nervous system stuck in the “on” position. A normal response when the nervous system is faced with too much happening too fast is to fight or flee. The fight response is often experienced as anger. Problems arise, however, when you don’t get to discharge all the energy that arises when you face a threat, such as having tubes and needles stuck in you. Let’s see how these arise.
The natural response to threat, when allowed to complete, avoids trauma. Of course, in a medical emergency, it may be impossible to have a natural response. However, it is important to understand the steps that did not get to happen, in order to fully heal. These are:
Step 1. Stop and startle. This gives your nervous system a chance to register that something potentially dangerous is near. In some medical situations, you may too distracted by pain to notice anything else.
Step 2. Scan the environment to locate the threat. In a medical emergency, the threat could come from being in an operating room.
Step 3. Evaluate the situation to determine if it is dangerous. If the procedure involves things going into you quickly or without your consent or understanding, your nervous system could register this as dangerous.
Step 4. Fight or flee if the situation is dangerous. Lots of chemicals are sent coursing through your body to make this happen. As a result, muscles tighten, breathing and heart rate increase, or you want to yell “Stop!” or “Wait!” Unfortunately, these automatic and normal impulses may not happen because you are strapped down or too dazed to speak.
Step 5. Release any residual energy and rest. Ideally you can do this, but if the life saving procedure is followed by further medical complications there may be little time to rest between assaults to your body. Until the anger is directed toward the source of the threat, the fight response can stay locked in the body.
What You Can Do To Recover From the Trauma of Medical Procedures
1. Make your healing process a top priority. If you are still recovering from a medical procedure, take time to attend to your health. Follow the medical advice of professionals whom you trust and give yourself permission to take time to heal. If you push yourself too much, health problems may reemerge later and take even longer to heal.
2. Create a team of allies. Allies can be medical professionals who are willing to listen and respect your self-knowledge and whose opinions you trust. They also are the family and friends who can assist with your every-day needs such as meals and cleaning. If you need help creating a team, ask one person to be your health advocate who can then find other allies.
3. When appropriate, set limits on what you are willing to do medically and socially. When you are overwhelmed, it can be very difficult to think as quickly and sharply as you use to. Traumatic procedures often lead to depression and/or anxiety. Be gentle with your self when you recognize that trauma affects both your intellect and emotions.
4. When your strength has returned, find professional help, who understands how trauma affects the body, to assist with discharging the fight or flight impulses that arose in response to the medical procedures. By completing these impulses you free up much needed energy to support additional physical healing and restore a sense of aliveness. A self-knowing that says, ”I can” replaces the anxiety and depression.
But Wait…
Without the doctor’s help, I would have died. I always felt grateful and now, years later, I’m really angry at how things happened.
It’s not uncommon that our perspective or memory of past events changes over time. With the passing of time, you may now be able to view the total experience, including the unpleasant aspects. This is sometimes made possible because we feel supported enough by others to become vulnerable and let ourselves visit something painful. Or, it may because you experienced something recently that resembled what you went though. An example, would be visiting a friend in the hospital who also had a close call with death. This opens your past and the anger about all that went wrong surfaces.
I don’t have the energy to face everything that happened when I was in the hospital.
It’s wise to let your body heal first and not delve into the trauma until you are feeling stronger physically. Your body needs to have the energy go toward healing physically rather than rather than redirecting it to resolve the trauma. One way to gauge if you
I had to believe the doctor knew what he was doing when I had the emergency surgery and all that followed, even if there were serious complications. If I just let myself think that things actually did go wrong, I would freak out.
Errors happen and knowing that they could affect your care can be scary. Most likely, your doctor was well-trained and spent years learning and mastering his craft. At the time of your crisis, you may not have any option but to put your trust in him. Your life depended on him. Unfortunately, things can and do go wrong. Medical care is complex; many people such as lab staff, nurses and physical therapists may have been involved in your care. With so many different people using so many different pieces of equipment, there is a chance that the doctor may have made a poor decision based on what they reported to him. In addition, the doctor’s personal concerns may have distracted him when you needed his help.
It’s understandable that you would brace yourself against wanting to look at all that went wrong. However, there are several advantages to looking at what happened. The first is that you will get a sense that the medical interventions are actually over. While you may appreciate this intellectually, your body may continue to feel as though any future medical interventions will be life- threatening. Consequently, you may unnecessarily avoid preventative health care procedures. In addition, you may develop long-term physical discomforts that are more related to your fears than to your physical injuries. Third, your anxiety could become so strong, if it goes unresolved, that you may be unable to offer support to others who need your support around medical procedures.
What About Beth?
When I saw Beth, she had regained her health physically and was ready to look at the times she was in the hospital. Several principles guided our work. First is that the reptilian brain that controls our response to threat does not have a sense of time. As long as Beth was imagining that something happened a certain way, then her body responded as though this was true right then. If she imagined something that was relaxing, such as having her husband always next to her as an advocate, Beth and I noted that her breathing slowed and her shoulders dropped. This relaxation in turn facilitated the release of energy that held fear and anger. Frequently, she experienced this as slight tremors throughout her body or a spontaneous defensive gesture of pushing someone away or telling them to stop.
Another principle was to work slowly enough so as to not overwhelm her nervous system. I did this by interrupting the telling of the story when she appeared agitated and about to loose the ability to stay connected to her body.
By imagining that there was plenty of time to evaluate and carry out each intervention, Beth gave her nervous system time to complete each biological step. For example, she imagined that the doctor explained everything first; this allowed her to go through the startle, orientation and evaluation steps. The imaginary presence of her husband helped her to feel enough support that she could complete the fight responses. We concluded each session with time to rest, the last biological step.
Beth’s nervous system gave us clues as to when she was ready to terminate therapy. When she thought about all the things that went wrong, she no longer felt drawn into an emotional reaction. At home, she no longer exploded when something small went wrong. Instead of wanting not to go near doctors and hospitals again, she began to seriously consider working as a patient advocate in the local hospital. She wanted other patients to know they had an ally and that if things went wrong, she wanted to reassure them that they could move through the trauma.
Summary
1. It is not uncommon for life-saving medical care to also be overwhelming or traumatizing.
2. On-going anger or rage can be indicative that you are overwhelmed.
3. It is possible to recover from traumatizing medical care by attending to the biological steps that you are naturally designed to complete when you face a threat.
4. The following steps can help you to recover.
a. Make your healing a top priority.
b. Create a team of allies.
c. Avoid situations that unnecessarily overwhelm you.
d. Seek professional support that understands how trauma affects the body.
Next Step?
If you recently had a disturbing medical procedure, take time to recover physically.
Once you have regained your strength, consider working with a therapist, who understands the impact of trauma on the body, to help you process the trauma. Just doing talk therapy to help resolve the trauma symptoms rarely works.
Even is the medical procedure happened years ago, you can still resolve the trauma. It is possible to move past coping to thriving after a difficult medical procedure.
Read books about medical trauma such as Prepare for Surgery, Heal Faster: A Guide to Mind-Body Techniques by Peggy Huddleston or Trauma Through a Child’s Eyes by Peter Levine and Maggie Kline.
I bring a total of over 15 years experience to this kind of work. This has included over 10 years of experience with clients with serious dissociative disorders as a result of prolonged childhood traumas.
Drawing upon my training as a licensed massage therapist and as a licensed professional counselor, I am skilled in working in ways that help the client integrate and reverse the psychological, emotional and physical effects of trauma.
Since 2004 in addition to maintaining a private practice, I have worked in the public health sector as an emergency mental health clinician for those in crisis, shock and pain. As a life long learner, I am committed to ongoing professional development. This has included five years postgraduate specialized training in treating trauma.
Holding a Masters of Arts degree in Contemplative Psychotherapy from Naropa University, I am a licensed professional counselor and adjunct faculty member at Naropa University. I am a graduate of the Hakomi Institute and of Peter Levine’s Somatic Experiencing© trauma training and a member of the International
Society for the Study of Trauma and Dissociation.
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