Category Archives: PTSD

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Free agent

The Agency contacted me yesterday.

“Yes?” I say.

“Are you free?” Dispatch always sounds so disinterested.

“Yes, I’m free.” I try not to sound annoyed. I am too good at my job. I’ve given up on dating. This frees me up for the Agency.

“Room two.”

Room two has a woman who looks frozen. I introduce myself, a stranger, her previous person left.

“Are you sleeping?”

“No. Well, I fall asleep but then I wake up. Nightmares and my heart beats so fast. Then I can’t go back to sleep.”

“Did something happen?”

Her face tightens all over. She wants to tell me but not let the emotions out. “A scam!” Now the dam is cracking and falling apart. The story comes out bit by bit. “They opened an account in my name! Took out a loan! I am so scared. And ashamed. We could lose the house.” Not many tears. She won’t let them.

“Ok, I think this is a PTSD reaction. The not sleeping is really common. Can you talk to your husband?”

“I’ve snapped at him! We never fight! Forty two years!”

The monsters are visible now. Clinging to her, but some are coming to cling to me. Fear, shame, grief, anxiety, fatigue. They aren’t really that big, because she has been a careful person, a wise person. But this has cracked her open because she never expected it.

“Have you contacted the authorities?” We talk about what she has done, the practical bits. She has already made wise moves. It’s the feelings that are upsetting her.

We pick something for sleep, a low dose, not one of the newer addictive ones. An antidepressant that will hopefully make her sleepy. Close follow up is even more important, to be sure that she is starting to comfort the monsters. Many of the monsters are crying for her. I think they will be ok.

She is more comfortable before she leaves. She brought the feelings out and I was not horrified and I did not shame her. They weren’t so bad after all, when she brought them out in the light of day. It’s when they are fighting to be felt and heard that they feel so dark and dangerous and frightening.

I leave the room. She will be back in a week, sooner if she needs to. One of her monsters smiles at me tremulously as it clings to her. I smile back and nod. I think they will be ok.

For the Ragtag Daily Prompt: agency.

I write this and then start humming. Yes, this is the right song.


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Flooded

Trigger warning: trauma and feelings.

I cry because
the laundry overflowed
the sewer blocked again
we might have to pull up the floor
and lay it down a third time
I hate the laundromat
water runs across the floor
as fast as the tsunami
crossing the fields
crushing the houses
catching the trucks
in Japan

I cry because
I have to ask for help again
Help comes
but the memories of asking
when it didn’t
help didn’t come
and I was abandoned or humiliated
rise up and overwhelm me
I am flooded
I am helpless
someone help those people
The shaking earth is bad enough
But the ocean rolling inland
Over all
Breaking all
Beams to toothpicks
Those are the memories that rise up
And flood me
I think of the soldiers
and victims of wars and disasters
and PTSD
tsunami
of memory

__________________________________

Written before 5/2011. I have posted before, but couldn’t find it on a search. Posted today at a friend’s request.

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Frame

What is the tree and where is it?

I am still thinking about the Inflammatory Brain Disorder Conference.

The researchers and physicians are talking about the immune system as if it is broken in Long Covid and ME/CFS and the other illnesses, but I am not sure I agree. Maybe the immune system knows what it is doing. Maybe Covid-19 is a really really nasty infection and the immune system sends out antibodies to make us stay down, stay in bed, rest and keep from catching something else. Maybe an antibody that suddenly makes you weird will make you isolate and hide and not interact with the other potentially infectious humans.

Ok, the inflammatory brain disorders that destroy the brain, those are not adaptive. However, I’ve thought that MC/CFS was a “repair mode” since residency.

When I had my third pneumonia in 2014, I refused to admit to myself that I had chronic fatigue. It was sort of obvious. I went back to work six months after I got sick and seeing just four or five patients left me exhausted. I would come home and sleep on the couch. I also skipped breakfast, because I would go to sleep as soon as I ate. My blood sugar was fine and it was not a food allergy. It felt as if my body wanted to do repair work and wanted me to sleep while it was doing the repairs. I would sleep after lunch. For the next six months of work, I slept twelve hours a day and hoped that I would not have more than five patients. Also that I would not get sick.

We had everyone who had upper respiratory symptoms or a cough wear a mask and I wore one too, hoping to not get another pneumonia. That worked. I only got sick when I went to work in another hospital clinic system. I kept walking into rooms with patients with their masks off. I got Covid-19 in a mere five weeks there, after going a year at my clinic without getting it.

I spoke to a friend yesterday. She was talking about her damaged immune system. I said I didn’t think of it as damaged. With enough stress and infection, I think the immune system gets primed. And then it is as if it has PTSD: the immune system says, “Enough already! We are not going to LET you overdo and get sick again! We are putting you DOWN to sleep if you overdo!” It is an extreme version of “listen to your body”, as if the body is shouting. The immune system is hyperalert and goes all out if there is any threat or suspected threat.

Maybe we need to be more gentle with ourselves and each other. The US culture is so oriented to production and work and money as success. But is that really success, if we work 20 hours a day and drive our immune system to desperate measures?

Maybe we need to learn to relax. To take time off. To breathe.

And the talk about Mast Cell Activation Disorder said exactly that. We need to teach how to go from the sympathetic fight or flight crazy to the quiet, relaxed, parasympathetic state. That quiets the immune system down very nicely.

It won’t fix everything, I am not saying that. But it is something everyone can learn. Slow breathe, in five and out five. Practice.

Breathe.

______________________________

The tree is a Redwood and it’s in the Chimacum Woods Rhododendron Nursery. Not just rhodys and on the Olympic Peninsula.

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Make space for the difficult feelings

I am watching a four part video from the UK about illness and trauma.

The first part is about how trauma memories are stored differently from regular memories. Regular memories are stored in files, like stories in a book or a library.

Trauma memories are stored in the amygdala and often are disjointed and broken up and have all of the sensory input from the worst parts, including the emotions.

The therapist is talking about healing: that our tendency is to turn away from the trauma, smooth it over and try to ignore it.

However, the amygdala will not allow this. It will keep bringing the trauma up. And that is actually its’ job, to try to warn and protect us from danger!

The therapist counsels finding a safe time and place and safe person (if you have one) and then making space for the trauma to come back up. One approach is to write out the story, going through that most traumatic part, but not stopping there. What happened next? Writing the story and then putting it aside. Writing it again the next day and doing this for four days. As the story is rewritten and has an ending, even if it is not a happy ending, the story is eventually moved from the amygdala to the regular files. People can and do heal. They may need a lot of time and help, but they can heal.

I am not saying that four days of writing stories is enough. That is one approach, but nothing works for everyone and people need different sorts of help. There are all sorts of paths to healing.

In my Family Practice clinic I would see people in distress. With some gentle prompting and offering space, they would tell me about trauma and things happening in their personal life or work life. Things that were feeling so overwhelming that they could not tell their families or friends and they just could not seem to process the feelings about it. I would keep asking what was happening and give them the space to tell the story. Many times when they reached the present they would stop. There would be a silence. Then I would say, “It seems perfectly reasonable that you feel terrible, frightened, horrified, grieved, whatever they were feeling, with that going on.” And there was often a moment where the person looked inwards, at the arc of the story, and they too felt that their feelings were reasonable.

I would offer a referral to a counselor. “Or you can come back. Do you want to come back and talk about it if you need to?”

Sometimes they would take the referral. Sometimes they would schedule to come back. But nearly half the time they would say, “Let me wait and see. I think I am ok. I will call if I need to. Let me see what happens.”

When a person goes through trauma, many people cut them off. They don’t want to hear about it. They say let it go. They may avoid you. You will find out who your true friends are, who can stand by you when you are suffering. I have trouble when someone tries to show up in my life and wants to just pretend that nothing happened. “Let’s just start from now and go forward.” A family member said that to me recently. Um, no. You do not get to pretend nothing happened or say, “I wanted to stay out of it.” and now show back up. No. No. You are not my friend and will not be. And I am completely unwilling to trade silence about my trauma for your false friendship.

Yet rather than anger, I feel grief and pity. Because this family member can’t process his own trauma and therefore can’t be present for mine. Stunted growth.

People can heal but they need help and they need to choose to do the work of healing.

The four videos are here: https://www.panspandasuk.org/trauma.

This song is a darkly funny illustration: she may be trying to process past trauma, but the narrator doesn’t want anything to do with it. And he may not have the capacity to handle it. He may have his own issues that he has not dealt with. And maybe they both need professionals.

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trauma bunnies

We can work it out, the song says. But no, maybe not, not always.

Trauma bunnies together. Walking. Why would you walk with me, I am so down? Oh, you are a trauma bunny too. Walking on the beach, slowing down, looking at rocks. The walks get longer and longer. You bring FOOD and tell me I have food insecurity. I laugh. But it is true.

Comparing notes about childhood. You say yours was worse. Yours was terrifying. You ran away over and over and over, but came home. Small children need food and shelter. You get older. A neighbor says if you run away now, you will never stop running. You do not run away permanently. But you still run.

My childhood has no bruises to the skin. But the bruises to the heart are a nightmare. You finally say that I win, my childhood was worse. But I was not trying to win, I want to say. I was just telling you as you’ve told me.

We have both survived damage and coped. I have the resource of a grandmother with money who paid for medical school. I apply without telling my parents, after my mother says, “You don’t want to be a doctor. It’s too much work.” I am a poet, a writer, being a doctor so I can study people and have children and be certain there is food. Job security. And food security, true. With a husband or without.

You fight school all the way, but when you are told that you will be a failure or in jail, you decide that you will prove them wrong. You are still proving it. You won’t tell how you make your money, not to the locals, but the new car every two years tells them you have money. And it’s the wrong kind of car: a liberal car for a professed conservative. It stands out.

We start playing trauma bunnies after six months. You want me to come to dinner and I turn New Yorker and direct: is this a date? You are surprised. I set the boundaries and you think about it. And say yes.

But trauma bunnies is not as much fun as the beach. We get close and intimate and then you run. When you run, I run too: the other way. I don’t chase you. You haven’t experienced that before. You keep coming back. Why aren’t I chasing you? Because I too am a trauma bunny, remember?

Back and forth: close and far, together and apart. All holidays become times when you run, so that I will not be part of the family. I announce that I am now your mistress and you can’t be with my family either. Back and forth. Closer and then you refuse to come to my son’s wedding. Far again.

You say the summer will be very busy. You say your focus is music. You say we can go to one beach. One beach? For the whole summer? I run to europe and you are surprised. I ask, are you too busy to have me around? No, you say. But when I return, you have a friend staying with you. Intimacy disappears.

I am tired of it. My daughter is here.

At last I bring up sex: are we done with that?

No, you say. We have visitors.

Wouldn’t stop me, I say.

You say, sex is still on the table. Then you hem and haw. You say sex is not important, you can take or leave it. The friendship is more important. Well, the friendship is most important, but sex IS important to me and hello, it’s damn insulting of you to say you can take or leave it. Leave. This is all triggered by your yearly family get together. You need me at a distance so you won’t be tempted to invite me. You don’t want me there so I am distanced again.

And I am done, done, done. I dream of a small child, a wild woman, a woman doctor and someone new: a quiet woman. I think about the quiet woman and I ask the other three. Yes, they say.

The quiet woman is the adult. Not the mask of the professional, not the wild defense fighter, not the small child. The small child has healed. She is the connection to the Beloved, to the source of the poems. She blesses the others. The quiet woman takes over.

The quiet woman takes over. She says goodbye, farewell, Beloved keep you and bless you, you may contact me any time.

You are in your cave alone and do not answer.

You may end up there, alone, alone, alone. You want freedom most of all, you say. Another song: freedom is another word.

Yes it is. People can change and grow. But some want to and some don’t and sometimes we don’t grow at the same time.

Yes, says the quiet woman. Sometimes we don’t grow at the same time.

Fade to quiet.

______________________________

I took the photograph from a canoe at Lake Matinenda in Ontario, Canada.

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gently

I try to be so gentle with you
trauma drama boy

I know just what it’s like
though mine is not the same as yours

you run away, though
again and again

saying that you would never try
to hurt me ever

that is a shut down
really

since you disavow all intention of hurting
you do whatever you want

your attitude is that if I am hurt or sad
it’s my own fault

you take no responsibility for failures
as a friend

trauma drama boy, you run away
once more

and this time
I’ve had enough

This time
I let you go

Beloved bless you and keep you
for the days you have left

sending love
goodbye

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Embodying a dream

I wrote about the two dreams I had one night, with seven people. Two babies, a boy and a girl. Two professionals, a woman physician and a male policeman. Two rebels, a woman and a man, the man lying or at least misleading the rebel woman. The rebel woman trying to do something that she suddenly realizes is not important and is, in fact, foolish and dangerous. And a quiet woman.

I have been thinking about the quiet woman ever since. My Meyers-Briggs type in medical school came out INTJ, but we are not one thing or another. We have preferences, but we all have to use all the skills. I can be extroverted. I had to work on feeling, that was the really difficult one for me after a frightening childhood. I can pay attention to facts though I sweep them into the intuition very quickly. Medical school is facts and facts and facts, except then there are parts that turn out to change as science changes.

The eighth person is a quiet man. He is not present in the dream. I am thinking about him. I wonder if I will have another dream when I am ready.

I am attending some workshops on line for treating trauma. It is quite fascinating. They talk about working with clients who have aspects like my dream: a small child with trauma. A “fake adult”, aka “adaptive child”, with the tools that the child develops to survive in their childhood. Helping the “fake adult” recognize that some of coping tools may not be helpful or necessary any longer. First, they thank the “fake adult”, for protecting the traumatized child and for surviving at all and for not giving up. I think this is so important, to acknowledge that we have to thank that part of ourselves that did what it had to, that did what it could, to survive. And this can include things that we are ashamed of or fear that others would hate us for if found out. We had a temporary doctor at the hospital who described being a boat person escaping Vietnam at age 8. They were picked up by pirates. “We were glad to see the pirates, because we had run out of water. If the pirates had not picked us up, we would have died.” So there is perspective: death by dehydration or pirates? And she went from a refugee camp and then through medical school and became a physician. Survival and success and I hope that she is thriving.

I like it when a dream has such recognizable symbols. My now retired Unitarian Universalist minister says that we can sit with dreams for a time. What do the symbols mean to me? What is the dream telling me? My dream is in part telling me that I do not need to have the rebel woman lead: she can rest and let the quiet woman take over. And that I am very tired of rebel men who mislead me or run away. I woke up and thought, oh, yes, I see! I am tired of that and ready for change.

Change and transformation can happen throughout our lives, at any age. I welcome it.

Blessings and peace you.

___________________

The photograph is Sol Duc and Elwha enjoying doll bunkbeds. And acting like siblings do sometimes. And then they curl up together.

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Adverse Childhood Experiences 13: on gratitude

I saw a meme today about gratitude. It is saying that some people look at a garden and see thorns and weeds, but others see the roses. That we need to have gratitude. I think this is simplistic and papers over the trauma and grief that some people have. If they have endured a highly traumatic childhood, who am I to say they should focus on the roses? They may have a very good reason to see if there is something like a thorn that can hurt them before enjoying the roses.

I work with many patients with high Adverse Childhood Experience scores and mine is high too. I don’t tell my patients that they should have gratitude. I tell them “You survived your childhood. You have crisis wiring. Good for you. Some of your learned crisis survival wiring may not serve you as well now as it did when you were a child.” Then we discuss whether they want to work on any aspects and the many many different approaches. One example: a man who sleeps very lightly. He said that it was lifelong. When asked about his childhood he says, “We would have to leave in the night when there was shooting in my neighborhood. It was a very dangerous area.” I said, “I am not surprised you sleep lightly. You HAD to in childhood to survive. Is this something you want to try and change?” He thought about it and decided, no. Once it was framed as learned in childhood to survive, he stopped worrying about “normal”. He was satisfied that the way he slept was “normal” for him and he wanted to wake up if he heard shooting.

I think we have to ask why a person sees thorns and weeds in a garden before we judge them. My first thought with a new and angry or hostile patient is always, oh, they have been badly hurt in the past. What happened? I don’t worry that the anger is at me. I know it’s not at me, it’s at the system or a past physician or a past event. Under the anger there are other emotions, usually fear or humiliation or grief. I have brought up Adverse Childhood Experience scores on the first visit sometimes. One person replies, “I am a 10 out of 10.” The score only goes up to 8 but I agree. He was a 10. He stated once, “The military loved me because I could go from zero to 60 in one minute.” Very very defensive and very quick to respond. The response may seem extreme and inappropriate to other people: but it may feel like the only safe way to be to my patient.

I grew up hiding any grief or fear in my family, under anger, because grief or fear would be made into a story told for laughs. In college, a boyfriend told me I was an ogre when I was angry. I started working on it then and it was difficult to tame that. The person who took the longest was my sister: she could make me explode until I was in my residency. Medical training was excellent for learning emotional control, at least, on the surface. After my mother died, I had to do the next piece of emotional work: open the Pandora’s Box of stuffed emotions, mostly fear and grief, and let them out. It was such hard work that my day where I saw the counselor for an hour was harder than my ten hour clinic day. I did the work, for two long years. Blessings on the counselors who stood by me while I worked through it.

I do not think we are ever done with that sort of work. I think, what do I need to learn next? What is this friend teaching me? Why is this behavior frustrating me and I have to look in my inner mirror. Why, why, why?

Blessing on your healing path and may you not be judged.

Link about ACE scores: https://www.cdc.gov/violenceprevention/aces/about.html

Sometimes I do feel like a fossil, now that I am middle aged. For the Ragtag Daily Prompt: fossil.

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Straddle this place

Straddle this place, where we look at history again and again, admit horror and mistakes and cruelty, and work together to build a future.

Indigenous Peoples’ Day 2021: Reflecting on Indigenous leadership in labor

For the Ragtag Daily Prompt: straddle.