Emergency medicine, the untold trauma…

I started practicing emergency medicine on July 1st, 2000. I was freshly out of my family medicine residency. Filled with optimism, fueled by passion, driven by compassion, I truly enjoyed this work. I loved my work so much that I remember watching the TV series ER during my days off. I became my work, and I never regretted my choice. I loved the challenges. I loved the adrenaline. I loved the mostly positive results that competence in my work could bring. I loved the gratitude I received from patients, the recognition from my entourage, the status. I was proud to say: “I am an emergency physician”.

In 2018, I decided to quit this practice for different reasons, not because I grew tired of it but because I still loved it and found that I could not practice it the way I wanted to. I retired before work would retire me, it was a difficult decision. I had to shed a part of my identity. I had to reinvent my life. It was as difficult as it was exciting. I entered a kind of existential withdrawal and accepted it with kindness because I wanted to live differently.

Today, in 2022, I have changed in many unexpected ways. I have become more sensitive and more aware. Many of the life events I experienced humbled me. Anything traumatic that could happen to a doctor, I experienced it. If you can imagine it, I survived it. However, there is still an untold, almost invisible trauma experienced by people who work with the suffering and pain of others. This trauma must be revealed because few people are aware of it and nobody talks about it. I have no doubt in my mind that I am not the only one who has lived through such an experience and I humbly accept to share my story.

The Center for disease control (CDC) defines trauma as “An event, or series of events, that causes moderate to severe stress reactions, is called a traumatic event. Traumatic events are characterized by a sense of horror, helplessness, serious injury, or the threat of serious injury or death.” This definition is in line with the DSM-V diagnostic criteria of post-traumatic disorder.

There is a movement in modern psychology and psychiatry recognizing that trauma is much more than traumatic events characterized by a sense of horror, helplessness, serious injury, or death.The concept of trauma is also much larger than post-traumatic stress disorder.

I love Gabor Maté’s description of trauma:“Trauma is not what happens to us; it’s what happens inside of us as a result of what happened. Trauma restricts and narrows our worldview. Disconnection from self is the result of trauma. Trauma reprograms our nervous system so that we are always constantly in “survival mode”, preventing our growth. Trauma can cause us to see danger where there is none and, conversely, not recognize danger or even suffering when we are confronted with it.”

I recently recognized that, in some ways, I had experienced such trauma while working in the emergency room for two decades. As much as I loved the job, I didn’t see its effects on my personal life until it started to fall apart.

Let me explain.

An appropriate strategy for dealing with a difficult situation can become inappropriate over time or in different contexts and create suffering. It is important to be able to recognize this to realize how insidious trauma can be.

Twenty-two years ago, I was fresh out of my family medicine residency, a young, full-time emergency physician. From my first day on the job, I felt the immense weight of my patients’ expectations, fears, suffering, and hopes. In my first week, I went on my own, alone, to tell families that a loved one had passed away or to give a new diagnosis of metastatic cancer with no reasonable hope of surviving a year.
I did all this in about 15 to 20 minutes cycles, about 20 times a day, and continued this race from patient to patient, one diagnosis after another. One patient after another, one diagnosis after another, just keep them coming. Cancer, next patient. Back pain, next patient. Pneumonia, next patient. Cardiac arrest, next patient. Stroke, next patient. Broken ankle, next patient.

Emergency medicine is about being able to keep the pace, over and over, without stopping and with little time to feel or be touched by the sheer amount of suffering we witness. I loved this frantic pace. How did I thrive in this environment? I hardened myself. I built walls of emotional defense letting out empathy and compassion but preventing myself from being touched by the suffering and pain of the other. I was tough and I was proud of this.

Unfortunately, without realizing it, this strategy crept into my personal life, I carried it in my home and that is how trauma slowly manifested itself. I became so good at stepping back and detaching emotionally that I never complained. What do we have to complain about? Do we have cancer? No. Are we in a wheelchair? No. Are we in palliative care? No. Just stop complaining. This was mostly an internal dialogue, but some of it carried on in my personal relationships, with family, and with my friends.

This strategy blinded me to the suffering of others when I was confronted with it, and I now recognize it as traumatic. It was also equally harmful to me because it did not allow me to have moments of discouragement, to have different opinions, to set limits, to say no. By accepting everything, you build a different kind of wall, you slowly fade away.

Ultimately, this tactic eroded my family life and led, along with other negative influences, to a divorce. My initial reaction was typical; it’s not my fault. I never complained. I always did the right thing.

I think you get the idea…

The trauma manifested itself in me as a result of external influences to which I deliberately exposed myself. Through the strategy I used to thrive in this emotionally challenging environment, I became desensitized to my suffering and that of my loved ones. While I thrived in my work, my personal life slowly eroded away to the point of no return. I will never be able to rebuild what I have lost, but as a tribute to those who have been loved and hurt, I can share my experience in the hope that perhaps someone will recognize this pattern in their life and be able to avoid such unnecessary pain.

It has taken me six years to understand this, to put words on this new awareness. I share it in the hope that it might reach and change one soul, for the better.

Over time, with self-reflection, growing awareness, and the help of a very understanding, compassionate new life partner, I am slowly changing. I am becoming a more sensitive, more humble man, open to the idea that suffering is not measured in absolute terms but on a very personal scale. I must admit that it’s a work in progress, and I have frequent relapses.

Every day and for the rest of my life, I will actively try to offer presence to those I love. I will be a better listener, more open and vulnerable, and try to recognize emotions that arise in my relationships. Sharing pain and being welcomed, understood, and accepteddespite its presence, no matter how big or small is the first step to healing.

Love is about celebrating life together; it’s about being there for one another through the good and, especially, the bad times.

If you work in a high-intensity emotionally charged workplace, like the operating room, the intensive care or the emergency room, you probably have felt annoyed by your partner’s worries, anxieties, and frustrations. It’s quite possible that you don’t think they’re as important as what your patients have experienced during the day. Now that you are able to recognize why you feel this way and how much it can hurt you and your loved ones, you can lower your barriers, realize that you can open yourself up to the emotions of your loved ones and welcome them into your life, showing them that your empathy and compassion need not be reserved only for the suffering you encounter in your work.

If you have someone in your life who works in the health care field or in another frantic and intense profession (police officer, firefighter, social worker, soldier, etc.), you have probably felt this pattern or at least part of it. There have certainly been times when you simply wished you could share some form of frustration or sadness in your life and felt dismissed. Now that you understand the origin of this reaction, you can point it out with compassion. You have a hero in your life, this person has gone out of their way to do essential work, to save lives, etc. Don’t accept being dismissed anymore, please gently bring them to understand that you too, need their empathy and compassion.

I suspect there is an epidemic of these “never spoken of” traumas. As the pandemic tested the limits of our resilience, this epidemic has grown and is affecting many lives, many families. Let’s talk about it openly.

I hope this message resonates with you, colleagues, friends and all those who get up every morning to save lives or help build a better world.

If you recognize yourself, your spouse, your child or a friend, please share this message and talk about it.

Thank you.

Martin Pham Dinh