By Nancy Eichhorn, PhD
Medical Trauma in Patients and Providers: Interpersonal Neurobiology and the Autonomic Nervous System
with Jacqueline Carleton, PhD
Jacquie focused her talk on ‘Medical Trauma in Patients and Providers’. She explained how she came to be involved in this focus starting with the emotional triage her daughter experienced as a medical resident. During her first year of residency, her daughter proposed a specific medication dose for an admitted patient; her attending physician told her to double it. She thought it was wrong but was too tired after 18 hours of on-call duty to argue it. She followed his orders. The patient died. She had to tell the family. Another patient was in her 90s and dying; the patient’s daughter kept insisting on unnecessary procedures. The young resident explained that these invasive procedures would not prolong her life, they would only intensify her suffering. The daughter refused to let go. Dr. Carleton said her daughter was unnerved, devastated.
Then she shared two short stories about her own patients, doctors wracked by guilt and suffering. One doctor was traumatized after dealing with a partial miscarriage all alone in the outback of Alaska. He was greeted by a fully formed face and hands reaching toward him; he’s been haunted by the images ever since, she said.
In our medical world, she said, doctors don’t question the effects on the person and psyche. They need to be aware of trauma to the nervous system and institute simple procedures to alleviate it. How can medical doctors be retrained to be empathic and aware? Her studies have involved the collateral damage to the patient’s autonomic nervous system and how Somatic Experiencing can be used as a treatment modality in medical trauma. Jacquie then offered an in-depth case study of a woman she called Saline, who suffered from procedural trauma.
“I want to kill myself but I’m Muslim, it is forbidden. I would only go from one living hell to another.”
These words started the audience on a painful journey with a 39-year-old woman and her husband who had taken sabbaticals from faculty positions at a prestigious university and moved to New York to heal. A life-saving procedure Saline had had 18 months ago all but destroyed her life. She endured 116 electrical shocks to her heart for arrhythmias without anesthesia; they inserted catheters into her veins with no anesthesia because of her dangerously low blood pressure. She said she survived because she had a high pain tolerance. This young woman spent 8 hours naked on the operating table, no covering, with an all-male medical team, their faces covered by surgical masks, sans one nurse who at one point in the procedure briefly held her hand. She felt raped and tortured.
The doctor delighted in telling all how successful the procedure had gone. It was his story, not hers. She held the trauma within until it overtook her and she had to leave work. Her nervous system had been damaged during this procedure yet no one not noticed. She came from a highly intellectual, non-body oriented family. Inside she had dissociated, she was chaotic; yet, her fight response was intense due to her childhood living in a war zone, in Beirut. Freedom and independence have been her defining values. She was resilient yet fragile; after months of therapy, her fight response was starting to resurface. She came to Dr. Carleton wanting both a cure and evidence for the “lies” her doctor told.
Adult trauma, Jacquie explained, plays out differently than childhood traumas. When an adult’s life is shattered, the trauma is psychically indigestible. Everything in this young woman’s life had changed. “Her emotions played out in the theater of her body” and while talking, they had to allow time for her nervous system to reintegrate—cardiac output changes in the face of threat, and any medical procedure involving the heart benefits from ANS reaction and settling, Jacquie said.
Saline had been told it was an easy procedure, she’d be in and out in a few hours. However, she couldn’t have anesthesia because of her low blood pressure. When the catheters were inserted she said it was not a problem but she was surprised when they tied her down in five places—no one told her about this. And when they inserted an esophageal tube she was berated for gagging. She was berated for her automatic reactions to the electric shocks. At times she lost all feeling in her body; she passed out a few times but was revived. She had gone 24 hours without food. She begged to be untied, covered, fed. The doctors offered stone-cold responses. Panic and terror set in. She remembered the nurse trying to get the doctors to give her a little morphine but her blood pressure was too low. She became a small child begging, pleading; she was pale, weak, wordless. When she was in recovery, she only wanted her mother to stay, not her husband whom she loved dearly. She felt small. She had been told that she would be back to work in a few days. She lay on her parent’s couch for six weeks before she could approach work.
Jacquie worked within this young woman’s resiliency zone (via the social engagement system) using the elements of experience abbreviated as SIBAM by Somatic Experiencing (Sensation, Image, Behavior, Affect, Meaning). Her memories came as moments of clarity and as terrifying shreds of distortion. Working with the ANS processing, they slowly brought up details of the procedure, which were remembered in the context of safety and allowed to discharge.