From the June 30, 2023 issue of the Transformational Times
Coping with Trauma: What Matters for Patients and Providers
Terri deRoon-Cassini, PhD, MS
Dr. deRoon-Cassini shares her candid advice, based on many years of experience and research in trauma care, for how to better understand the psychologic response to trauma in patients and providers, as well as practical wisdom for how to help them…
The instantaneous loss of control – this is one of the defining features of trauma. In an instant, lives can change. The path that one was on is suddenly unexpectedly different. And our brains take a moment to catch up, to realize what has happened.
Gunshot wound patients talk about hearing a noise and not knowing for moments [no one really can say for how long] that they were just shot, until they feel warm blood, because being shot is not painful, not at first. Car crash survivors often talk about the crunching and shattering sounds of a car buckling under pressure from another object that finally orients the brain to what happened. And then things change, lives change, one chapter ends, and another begins.
After realizing that trauma has just happened, a flood of emotions can follow; fear, helplessness, calm, shock, extreme emotional expression, and even thoughts that one’s life is over.
Some patients who are calm later report how upsetting the calm was, as if they should have responded with the “fight” instead of the “freeze.” The response is based on the individual, but it is undoubtedly disorienting and surreal. And no matter what, we can’t prepare for what our brain does in the moments during and after trauma. It responds to what it just experienced to keep us safe.
Some people in the moment of trauma, called the peri trauma period, have the thought, “this is it; I am going to die.” When that happens, people are at an over six-fold increase in developing posttraumatic stress disorder (PTSD) afterwards.
And it is all because the brain did its job – it assessed a situation, identified extreme threat to life, which signals the cascade of stress responses in the body. Yet, when one survives, things associated with the trauma are now associated with fear, and that is hard to shake. Like an intersection for a car crash survivor, or the location of a fight for a firearm violence survivor. And to keep ourselves safe, we need to avoid those things at all costs.
Medical providers bear witness to so much when caring for injured patients.
The pager goes off, a trauma alert comes in, and they too are unexpectedly linked to a new patient and their injuries, pain, fear. Those in healthcare who care for trauma patients see it all, all while saving the lives of those who are suffering. Loved ones coming to the hospital, wide eyed, tearful, scared, disoriented after a phone call that left them with more questions. And often, the medical team doesn’t have the answers, not yet. For people whose need to be in control saves lives, not knowing if a patient is going to live or die can create an uncomfortableness that is unbearable at times.
Yet, the team keeps going, seeing the next alert that comes in. Other providers who are helping trauma patients recover must find ways to motivate patients to bear the pain to improve their chances of a better recovery, or to dress wounds the team is desperately trying to keep clean from infection.
Some providers listen to the stories of trauma, over and over, to help patients find a way out of the fear and into a new perspective that gives patients a chance at returning to life without limitations. Being present with a patient, whether in the trauma bay, in the hospital, or after, can be hopeful, scary, and everything in between, and yet providers care for patients moment to moment, day to day, often because one has built up a wall that allows the emotions to stay at bay so one can do their job.
Yet, when it is one of our own, someone that you know, things suddenly change. The wall that is the armor protecting us from a rollercoaster of emotions just can’t sustain the blow of worry and concern when a trauma patient is a loved one.
On top of that, as a trauma provider with a patient in front of you, care still needs to be provided. The situation needs the brain to switch to logic instead of emotion so that lives can be saved.
But when a loved one is being cared for, emotions sometimes dictate behavior – telling the loved one what they mean to you, providing them with reassurance, holding the person’s hand to let them know that they are not alone, telling them what steps are next, so they understand what is happening around them – these are all natural human responses to provide comfort when someone is scared. And they matter – they help.
Providing comfort and support is one of the most significant factors that can buffer against psychological distress after trauma. Providing information about what is happening is a way to facilitate coping.
The simple act of human touch - holding a hand or giving a hug - can provide a cascade of biological responses that are positive, for both people, and help move a person out of fear and into a sense of safety.
Whether a provider has 20 minutes with a patient in the trauma bay, days with them while they are in the hospital, or months with them in therapy, they can have a direct impact on someone’s life.
Whether the patient is a loved one or a stranger, the out-of-the-blue nature of trauma creates a link. And that link matters.
Connecting with another while they are suffering, providing them comfort and reassurance, can ground both the patient and provider in belongingness and safety that can set up the next chapter to be better than the last.
Dr. Terri deRoon-Cassini is a Professor in the Department of Surgery and directs the Froedtert & MCW Trauma Psychology program. She will be celebrating 15 years at MCW this September and has an appointment in Psychiatry and Behavioral Medicine with MCW’s Institute for Health and Equity. She is the executive director of our Comprehensive Injury Center, co-directs the Milwaukee Trauma Outcomes Project, and recently co-authored best practice guidelines for post-trauma mental health care for Trauma Centers nationally.