I Wasn’t the Patient in the Emergency Room, So Why Do I Feel Traumatized?
The itching from the poison ivy was driving Elizabeth (not her real name) crazy. After a week of trying to control the spread of the oozing rash, she decided to ask her sister Susan (not her real name), whom she was visiting, to take her to the emergency room. Elizabeth was far from home and did not see any other option. Susan knew the emergency room (ER) was an easy trip from her house. In a couple hours she could be in and out and none the worse for the trip. Or so she thought.
For Susan the trip was a nightmare. In the room next to her sister’s she heard a man yelling slurred obscenities and pounding on his door. She watched as four police officers threw him to the ground and used a tazer gun on him before strapping him to a gurney. She had never witnessed such violence.
Those images stayed with her for months. Nightmares interrupted her sleep. Concentration on graduate schoolwork was impossible. She cancelled her appointments for medical exams and avoided socializing with nearly all of her friends and seriously considered quitting school. After all, she didn’t think she would live long anyway. The sound of sirens made her jump. When her mother was hospitalized a month later with heart problems she could not bring herself to visit. Just the thought of going into another hospital brought back the terrifying images of the emergency room.
Perhaps you, too, have had a similar experience. You have accompanied someone to an emergency room and the experience there left you with second hand trauma. Witnessing the trauma of others affected you as much as if you had been the one who was seriously injured or ill.
Emergency Rooms: Trauma Sites
Sometimes going to an emergency room is the best resource for fast and effective care to address a medical crisis. Lives are saved in emergency rooms. Your presence can be very reassuring to a loved one and be an invaluable resource for them when they struggle to understand what is going on.
Because emergency rooms are crisis centers, however, those who accompany a patient may be exposed to sights, sounds and smells that overwhelm. Often you have very little control over them. There are many potential sources of overwhelm. These include:
· The yells of pain and fear of other patients who are in physical or emotional distress
· The stench of those who have been drinking or too mentally incapacitated to care for themselves
· The expressions of terror on the faces of patients as they learn the awful truth about the extent of the injuries
· The shrill and persistent noise of medical equipment
· The intimidating sight of emergency personnel dressed in the uniform of police and firefighters
· The sight of blood and other body fluids or smashed body parts
· The frantic cries for help from the emergency room staff
· The wailing of those who saw a loved one die
Trauma = Overwhelm
Trauma is a response to anything that overwhelms the nervous system. Trauma symptoms stay with you long after the event has passed. Susan exhibited many of these effects. Others may include panic attacks, rage, depression, emotional or physical numbing, unexplained physical pain, and forgetfulness about significant aspects of the event or a sense of needing to be on guard. These symptoms can severely impair your ability to work, attend school or sustain relationships.
When you are exposed to a strong stressor, trauma symptoms occur when you do not get to release the energy that rises in response to the stress. Unlike animals in the wild, humans tend to override the body’s natural tendency to discharge the energy. Instead of letting yourself shake, cry or even yell after you witness something awful, you tell yourself that you have to appear in control and the pain of what you experienced gets trapped inside.
Avoiding Second Hand Trauma
There are several steps you can take to avoid developing trauma symptoms.
1. Recognize that what you witness in an emergency room has the potential to overwhelm you.
If possible, ask the ER staff to explain to you what is happening to the other patients who are in distress. From a biological perspective, when you are a witness to disturbing situations your nervous system will want to find the source of stress, evaluate how dangerous it is, then take action by fighting or fleeing. Of course in an emergency room taking action may not be possible and this may have to wait until later. By being able to at least locate the source of your distress, you system can relax a little.
2. Take breaks.
Leave the emergency room occasionally to get food, talk with friends or get some fresh air. While some things happen quickly in the emergency room, there is also a lot of time spent waiting for tests to be done or for decisions to be made about a patient’s care. Getting out of a stressful environment can help you absorb all that has happened.
3. Pay attention to how your body wants to release the stress from seeing and hearing others in pain.
While you are in the emergency room or shortly afterwards, notice if you have the urge to cry, shake or quiver involuntarily. Or perhaps you feel anger or become very hot. Let this happen and remember that it WILL stop. If others become distressed by your reaction, let them know that you are ok and will feel better afterwards. Keeping your physical and emotional reactions inside is what leads to the creation of trauma symptoms.
4. If your reactions seem too big or unmanageable, find ways to balance them with things that soothe you.
By alternating your attention between what calms you and the distress of the ER visit, the strong feelings and physical reactions can dissipate. For example, if your sadness begins to seriously impact your ability to work, give yourself time to enjoy activities that enliven you. Perhaps spending a day at a ball game will provide an antidote to the sadness. Let the emotional reactions run their course.
5. Find others who can support you and understand what you have gone through.
While a lot of attention may be given to your friend or family who was the patient in the emergency room, you too need and deserve understanding and support. Allies may be friends, who are good listeners, someone else who has experienced second hand trauma or a professional counselor trained in understanding how the body responds to intense stress.
But Wait…
The emergency room closest to me specializes in trauma care. Maybe I shouldn’t take my friend there.
In the event of a serious emergency you will want to get your loved one to the nearest emergency room. Following some of the suggestions listed above can help you be less traumatized. If your loved one’s situation is not serious you may want to seek out a hospital whose emergency room is less busy.
I took my wife to an emergency room two months ago. Although she received good care, I notice that I start to freak out every time I drive past the hospital. Could I have experienced second hand trauma?
Yes. It is not uncommon to have delayed reactions to stressful events. For some time afterwards you may become numb and not feel or remember much of what happened. The physical and emotional reactions may not appear until you get close to the place that was stressful. Your proximity to the stressful scene triggers the body to come out of freeze.
I’m surprised that it was I and not my fiancée, who was the patient, who still feels crummy after the ER visit.
Your fiancée may have been isolated enough or not alert enough to notice all that was happening around her. If she received adequate medical care, her experience could be very different than yours. If you were able to walk around you may have seen, heard or smelled a lot more than she and had been overwhelmed by it all. In addition, your presence may have offered her the comfort she needed to counteract the other stimuli on the unit while you had no one to support you.
Susan’s Story Continued
When Susan came to me for treatment, she showed many of the symptoms of post-traumatic stress. The main goal of treatment with Susan was to help her discharge the unexpressed survival energy that she still held in her nervous system. While it was not she who had been strapped to the gurney, witnessing the other patient’s struggle elicited a similar impulse within her.
Some guidelines that I followed in my work with her included:
1. Inviting Susan to imagine having just the right kind and number of allies who could help her fight
2. Inviting her to remember a time when she felt safe any time in her life. By alternating her attention to a time of safety and the time in the ER, she could face the frightening situation much easier.
3. Encouraging her to go into the story, just one step at a time in a non-sequential way. This helped her to not be overwhelmed.
4. Observing her body movements, coloration and breath closely. I also invited her to comment on her internal experience of body sensations and urges to discharge the stress in her own unique way. By tracking her process this way, we noted how her body was finding its own unique way to discharge the stress. For example, at one point in a session, her legs began to move spontaneously in a running movement so she could escape the assault.
After a couple of months of therapy, Susan’s symptoms had shifted significantly. She had begun to enjoy school and friends again. She kept her medical appointments and she jumped less easily when she heard a siren. The nightmares were almost gone, and she reported that she could see a big monster scaring the police away. She also told me she thought if her mother had to be hospitalized again that she could probably go visit her if she had a friend along.
Summary
· Being a witness to events in a hospital emergency room can result in trauma symptoms, even if the patient you are accompanying is not affected.
· Take breaks away from the ER to help you modulate the effects of the stress of that unit
· Recognize and attend to the ways that your body knows about discharging the stress of being in the emergency room.
· Find allies to support you to recover from what you saw or heard in the ER.
Next Step?
If you suspect that you are suffering from second hand exposure to stressful situations, talk to friends or family or read such books as the “Waking the Tiger” by Dr Peter Levine. If you need additional support resolving trauma symptoms, consider working with a professional who understands the biological response to second hand trauma and how to treat you in way that does not overwhelm or retraumatize you.
