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pregnancy, prematurity

When the doctor has PTSD

PTSD is a normal response to an abnormal situation.

A horrible, terrible, situation.

It affects 76% of mothers who have/had babies in the neonatal intensive care unit.

It affects me.

I’d like to say affected, but it is a scar and like all scars it fades, but never completely goes away. Injuries cause scars. And it is my soul that has been injured.

For me, that is the best way to describe PTSD. A scarred soul.

For many mothers of premature babies, PTSD results from the NICU experience, which in many ways is like a battlefield. But the soldier is your newborn premature baby. And you can’t do much to help.

Many parents live for days, weeks, or sometimes even months not knowing if their baby will survive. And then there is witnessing your baby’s suffering, sleep deprivation, noise, and the foreign environment. It is a constant state of high level stress. Add in the fact that the NICU is an isolating experience, and you have a perfect PTSD storm.

Although my PTSD is not from my NICU experience. I can walk in and out of an NICU without any kind of a trigger. I can feel sadness for the parents and the babies or join in milestone celebrations that only preemie families really understand, such as joining the kilo club or getting the PICC line out.

My PTSD comes from delivering my first baby (I had triplets) by myself in a bathroom. Deep down I knew that pressure I was feeling wasn’t the urge to go to the bathroom. I am an OB/GYN, after all.

That moment of realization as I got out of bed starts the loop of film that, if left unchecked, can play over and over again in my head. I can close my eyes and it is as if I am there. The cool linoleum on my feet. The sound of the bathroom door closing. The frailness of his body in my hands. My screaming.

He was the last baby I delivered. I gave up obstetrics when I went back to work 9 months later. I just couldn’t face delivering a baby in that same room with that bathroom behind my back.

I didn’t realize I had PTSD until I researched the chapter on the mind-body connection for my book, The Preemie Primer. A little ironic. I just thought everyone had high-definition flashbacks of terrible trauma and that avoiding reminders was, well, a good coping skill. My difficulty sleeping, feeling detached, difficulty concentrating, and feeling jumpy, well, I chalked that up to having two premature babies at home who were on oxygen and monitors still essentially critically ill.

There is a lot of mental health stigma in this country, which is stupid. The worst thing I did was bottle it up. I didn’t really have anyone to talk with and I think the prevailing belief was that my additional level of bitchiness was due to the stress of two preemies at home.

For me, not talking about it was agony. I pretended I had twins. I avoided the Mothers of Multiples club because seeing a set triplets was agonizing. I felt I had a dirty little secret. I told people I had twins, but that was a lie. I am the mother of triplets.

As I wrote my book and came to understand the symptoms, it all made so much sense. And of course, I researched prevention and therapy. Experts suggest that talking about the traumatic experience(s) and learning (and practicing) relaxation techniques can help. So I told my boys they had a brother. We celebrate his birthday and talk about him. Not all the time, but it comes up in that lovely, natural way that children approach painful subjects. And now I talk about of myself as the mother of triplets, not twins.

With time the images of my delivery have started to fade. Now it’s like an old program from a television with rabbit ears, not high-definition. And it pops into my head far less often than it did before. Seeing triplets is still hard, but that’s okay. A scar is never as strong as the native tissue, so I should expect some things to be a little hard.

Last week some people in the operating room were commenting on my weight loss and physical transformation. I only see them every 2-3 weeks, so maybe the changes are a little more apparent. They were admiring my abs and one exclaimed, “Damn, and you had twins.”

“Actually,” I replied. “I had triplets.”

And then the silence followed. It always does. Because truly, people don’t know what to say. And you become that mother, the one who lost a baby. And yes, it does color the way some people look at you or think about you. And it’s why I never spoke about it. But silence, I have learned, is bad.

“Yes, I had another son who died at birth. But I only brought it up because if you think getting back in shape after having twins is hard, think about doing it after triplets!”

I smiled, we chatted a bit more, and then I walked away. A little stronger than before I started the conversation.

Scars don’t heal, but they fade.

Talking about it helps.

PTSD is a normal response to an abnormal situation.

That is one of the most important lessons I have learned as the mother of triplets.

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Discussion

10 thoughts on “When the doctor has PTSD

  1. Reblogged this on Inspiredweightloss.

    Posted by sweetopiagirl | December 7, 2011, 8:45 am
  2. I too have PTSD. The trauma I survived was sexual violence. While I once had full-fledged PTSD (as diagnosed by the infamous DSM), the symptoms gradually faded until only the occasional exaggerated startle was left. As a 3rd year medical student, I was told by my “mentor” that I would have to leave my “jumpiness” at the door. According to her, I couldn’t be a doctor who was easily startled. She left me with the impression that doctors were not allowed to have scars.

    Fortunately I know BS when I hear it. It is our humanity that inspires us to heal, and it was my humanity that made me vulnerable to PTSD. As it turned out, the occasional jumpiness did not prevent me from doing well on my clinical rotations. I will graduate from medical school this spring.

    Suffering and recovering from PTSD have taught me more about human resilience than can ever be learned in any text book. Yet, the stigma of mental illness still prevents me from signing my name.

    Thank you Dr. Gunter for sharing your suffering and your resilience.

    Posted by Medical Student | December 7, 2011, 3:58 pm
  3. I also have PTSD. But with me, I wasn’t the mom — and I can’t imagine what being the mom is like — I was the sick child. I wasn’t a preemie. I was 12. I was old enough to remember everything, like being forced to walk with kidney failure, septic shock, and peritonitis. Being the sick kid is like being literally being tortured; being the parent of a sick kid (preemie or an older child) is a more silent torture of watching and waiting. I wouldn’t wish either fate on anyone.

    Until the past year or so, I thought flashbacks were normal. I have them everyday. Everyday, I’m still the little girl will an 8 inch gash in her abdomen who’s forced to walk anyway. But I’m getting help, you know. We all have to come back from our trauma in our own way.

    Your journey has been one I can’t imagine. My mother has flashbacks of my sickness, my dying. But she gets to cling to one simple, but important fact: I lived. But my mom’s mom, she lost a daughter. Her grandmother lost a daughter. You have that same strength as them, a type of strength most people will never have to develop. You are so brave, whether you feel like it or not.

    Posted by Carrie Eckles | December 7, 2011, 5:29 pm
  4. Thank you for sharing your story. This is easily my favorite post of yours, although it made me tear up and I hate being teary–still, beautiful post.

    Posted by Amira | December 7, 2011, 5:40 pm
  5. TY :)

    Posted by Nlara | December 7, 2011, 8:30 pm
  6. None of the women in my OR show off their abs…sigh.
    But seriously, thanks for sharing your story. Loss is so painful, especially when blended with guilt. Especially when it hits us in our own area of “expertise”.

    You strike me as a wonderful, caring, thoughtful provider. Your patients are lucky.

    Posted by alaska doc (@alaskadoc) | December 10, 2011, 9:22 am
  7. Hi Dr. Gunter,

    I’m a premed student and I have some questions about practicing medicine with PTSD. Is there any I could contact you in a less public way to discuss them?

    Posted by Avi | March 16, 2013, 11:30 pm
  8. I am also an OB/GYN. I also suffer from PTSD. My first round is from the death of my sons twin at 18 wks. I had a PUSSs the day prior. I can still remember them placing the ultrasound on my abdomen and there being no heart beat. I was devastated! I delivered Emma and held her. We had her cremated. I have her pictures. I still cry every time I read “There are No Tears in Heaven”. My son is six.

    I also have PTSD from being in the hospital for a month in 2012 after an outpt procedure. I had a Bronchial Thermoplasty for severe reactive airway disease I had developed 2 yrs earlier. I had tried everything else. I had even done a c/section with a pneumothorax after a bronchoscope. I developed a dysautonomia after the Bronchial Thermoplasty. Eventually they found Thyroid Cancer. I am now off work due to the dysautonomia. I have the flash backs, anxiety, palpitations just thinking of being in the hospital again.

    Posted by Cindy Phillips | July 11, 2013, 1:31 pm
  9. Hi there,
    I came across this post doing a search on PTSD in doctors, having just been diagnosed with PTSD. Thank you so much for posting your story. I hope that writing about it helped you, and that you are doing well, especially since by now you are raising two two-year-olds! Please accept my heartfelt condolences on the loss of your little one.

    I remember, in a college psych course, learning about the life change stress point thing, with the defining highest stress being the loss of a spouse. i have always thought that was BS. It’s the loss of a child. So many blessings on you, Mom of three. Of course we don’t know each other, but consider yourself cyber-hugged.

    I’m a pediatrician–I’ve been a doctor for 26 years. I’ve always been a resilient person, with plenty of tough things to deal with from early life. I’d gone through the therapy in early adulthood and midlife to come to some peace with my family of origin, and with my divorce. I’ve had a successful, if occasionally bumpy career, but I’m well-thought-of–the sort of person all the young docs come to for advice and support. I’m the sort of person that the specialists pick as the primary for their complex patients.

    I’ve actually had PTSD for many years, but it was well-controlled–I just can’t do sex abuse evaluations–but am in a work setting where these are typically referred out anyway.

    I am currently on a leave from work after a series of difficult cases at work. In the space of about 3 or 4 weeks, I’ve had to manage some scary things in the office–I am not on the hospital site but at a small satellite clinic–and I haven’t done inpatient work in 7 years. My 29-weeks-pregnant, insulin-pump-dependent colleague went into a hypoglycemic episode and started vomiting after-hours while we were charting, and was refusing an ER visit (she went, but @#$%!). A custody-dispute sex abuse allegation case (not my patient) got onto my schedule for “diaper rash” and I had police and CPS in my office all day. Then I had a 6-week-old in septic shock, nurses couldn’t get IV access, it took transport 2 hours to arrive–I put in a scalp IV, something I hadn’t done in, oh, probably a decade, and an NG tube and a sugar binky. That baby made it, thank heavens. Then the cappers came when I ended up doing cross-cover on the “email-your-doctor” thing, and stumbled onto a message from a mother whose child was gravely injured while out of the country. I heard her screaming on the phone, read and responded to her fear and blame and rage, then came to understand the family was requesting records, presumably for legal action. And the next day, my beloved 15 year old niece was in the ED on suicide watch, diagnosed with an eating disorder. I couldn’t get the screaming mother’s voice out of my head. And I couldn’t stop worrying about my niece.

    One of my good girl-friends described the series of events as “well, you got paint-balled”–a series of rapid-fire shots. Apt description. Yes, as doctors, we sign up for this stuff. These are all the types of situations we’ve all handled. But, wow.

    All of this is against the background of recent health issues for me–I am coming up on the 2 year anniversary of my radical hysterectomy/oopherectomy/pelvic node dissection for cervical cancer. Thank God no chemo or radiation. I had never returned to anything close to my pre-surgical energy level or fitness. And more importantly, I had not completed the grieving work. I did the typical doctor thing–back to work too soon, minimizing what happened, living in the fishbowl of undergoing my treatment at the same center where I work. My boyfriend broke up with me 7 weeks after my surgery, and I grieved a little, but dismissed that too as “good riddance.” I go through every 3 to 6 month repeat paps, and though my recurrence risk is wonderfully low, and less as time goes on, there’s always the fear of a cancer recurrence hanging over my head. A few months ago I lost a good friend to a breast cancer recurrence. Different statistics, same fear.

    My leave is almost over. I have been meeting with a wonderful therapist, and relying on friends a fair amount. My medical friends and my non-medical friends have been great, as is my own physician (who is also a friend.) Thank heavens, my niece is stable, and knows I love her. I got to enjoy a little time at Christmas, rare for a medical career, though I still have the guilt that my colleagues have had to cover. I am trying to cope with the idea that I may have to cut back my practice for awhile, maybe permanently. And I want to restore my full health and energy.

    Mostly, I want my funny, fun, really smart and efficient self back. I want work to take a somewhat smaller percentage of my life so that I can experience what the rest of life has to offer. I want my resilience back on track, and to enjoy the things I’ve worked so hard for. I know I’ll get there, but like the usual physician, I’m impatient.

    To Dr Jen, let me thank you for being the “trigger” to tell my story, and to sense a kindred spirit. Between the two of us, we’ve put in our time in DRs and NICUs. We’ve been on the other side of the stethoscope, and lived to tell the tale.

    To the younger physicians and medical students above, and any other medical people who read this: Yes, you can have an amazing career even with a history of trauma and PTSD in your life. I would hasten to add that it will likely make you a better doctor. Only through pain do we learn true compassion. Only through healing ourselves can we truly provide hope to others. Only through acknowledging our own humanity and frailty and mortality can we truly live, and help others heal along with us. Do plan to avail yourself of professional help along the way–any one who goes through what we go through can benefit. You owe it to yourselves.

    Holiday blessings to you all. We are not alone.

    Jean

    Posted by Jean | December 26, 2013, 11:02 am

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