The abuse that a survivor has endured not only leaves scars on the body, it also leaves scars on the mind. As a result of my trauma, my injuries included a broken collar bone, a dislocated jaw, multiple incidents of strangulation, a broken leg, profound hearing loss and a brain injury. I was shot at and had knives held to my throat and thrown at me.
Today I would like to talk with you about those mental scars and how they can affect your patient.
My particular triggers in a medical setting include:
- Extreme agitation and anxiety when I am unable to breathe.
- Being easily startled by sound.
- Being afraid when medical personnel do not ask permission or explain what he or she is going to do.
- Claustrophobia in tight quarters like MRIs.
- Agitation when others enter my personal space without being invited.
So how do these things play out when I receive treatment in a hospital? Allow me to illustrate why listening to your patient when he or she self-advocates or watching for signs of anxiety and screening for abuse or brain injury is important.
Some time ago, I entered the ER at a local hospital unable to breathe. I have asthma and am prone to bronchitis. During the course of a 6 day stay, it was eventually determined that I had double pneumonia. The situation stabilized, it seemed, and I was released. The following evening, I woke up with crushing chest pain that did not go away. Per the discharge instructions, we returned to the ER.
During this stay, a few things were handled very well and a number of things could have been improved upon. Upon arrival at the ER, I was very quickly whisked into a room and breathing treatments began. Chest X-rays and an EEG were started immediately. The wheezing slowed, diagnostics showed no further advancement of the pneumonia or water in the lungs. The attending physician chastised me for coming to the ER when I “should have known it wasn’t a heart attack, that my chest wall was only inflamed by the pneumonia”. He told me he was going to release me.
I advised that I did not feel safe going home in light of the chest pains and breathing issues and insisted on being kept 24 hours for observation. This is where things could have been vastly improved. A number of breakdowns in care occurred.
Upon my arrival in room 9853, two nurses stripped me naked without asking my permission or providing explanation other than they were doing a protocol skin check. I asked “If this is protocol, why wasn’t it followed the previous 2 times I was admitted to this hospital for this same illness over the past week?” I received stony silence. The nurses documented the bruises in writing and photographed all of the bruises I had received during treatment. They asked me if I felt safe at home in front of my husband. I informed them that the question is NEVER to be asked in the presence of a significant other.That could put someone who is in danger at further risk of harm and that patient will not be able to answer you honestly.
Upon surveying the room, it was clear that this room was a non-patient hospital room. It was instead a storage room. The room contained all of the drugs for the entire floor in a locked cabinet, as well as the chemicals for housekeeping. I had my cell phone and photographed the number of people who entered my room for things other than my medical care. The room had a pass-through window for personnel to check drugs in and out. The bed was oriented in such a fashion that I was able to hear the door and window open and close, but not able to see anyone until they were right next to my bed. For a person with PTSD, this can contribute to hyper vigilance and a feeling of not being safe. I asked if it would be possible to either reorient the room for safety as much as possible or for a different room. I received silence.
I entered the hospital with a med list, which was also entered into the computer and available to each staff who interacted with me. During this observation, NONE of my daily meds were administered, including medications for my mental health in spite of repeated requests.
I requested the hospital social worker in light of my treatment and mental state or a peer support specialist. I requested a visit from my pastor and if they could please send a volunteer so I could have some comfort item. I received none of these services. I advocated for myself, my safety and my health at every step of the way. I was not heard or responded to. The biggest heartbreak and disservice is to be unheard, even while using one’s voice.
I was discharged in the evening and the downward spiral of mental health continued. I felt punished for speaking up for myself and asking to be kept for observation. I felt as though my life didn’t matter to the very people charged with helping me to live it. I nearly lost my life to illness and in the days following that stay, I nearly took my life. I developed suicidal thoughts. It took 12 weeks of being in crisis to receive access to the care I needed.
In a hospital setting, the chain of care is crucial. Information passed on by the patient needs to be heeded. If the patient is telling you what he or she needs, please document it and above all, respond. We know we are not your only patient, but our own life is the one that matters to US. You are the ones that can help us to get healthy again. We need you – your knowledge and your compassion as well as your active listening and observation skills.
If you are feeling suicidal, there is help:
National Suicide Prevention Lifeline
To read more about why being “good” is detrimental to our health, please read Aviva Romm, M.D.’s article Being a Good Girl Can Be Hazardous to Your Health – Aviva Romm M.D.
For resources about post-traumatic stress disorder, please visit US Department of Veterans Affairs