Tuesday, December 4, 2012

Dear Moms, How do you cope?

I'm currently doing the dreaded stint as the chief resident in the burn unit.  Its a particularly grueling rotation, lots of getting called in from home, crazy sick patients and lots of terribly sad stories.  It is taking an emotional toll on me, and I've been missing out on seeing by little peanut.  For the first time since I've come back from the lab I've gone two full days without seeing her.  I have cried a record number of times after countless family meetings at the end of hours of doing everything we could.  Thankfully, I've had a fabulous and amazing team of interns, nurses, chaplains, social workers and support staff to be on this journey with me.  However, despite the support, the one thing I haven't managed to cope with very well is the non-accidental injuries.

I have always found child abuse unbelievable horrifying, but as a mom, my horror about this has reached new levels.  In particular, a recent child I operated on, who is very similar in many ways to my own, has left me having nightmares every day in which I see her injuries on my precious daughter.  I wake up gasping and anxious and immediately go hug my daughter or go to her room and stare at her while she sleeps.  I've talked to other moms with similar experiences, a pregnant NICU fellow fighting the nightmares about her unborn child mirroring the illnesses she saw each day, the burn unit nurse manager who I sat and chatted with in her office about how this unit makes you so hypervigilant about protecting your kids, but the one thing we fail to come up with is a solution.  How do you make the nightmares stop?  I even talked to my own mom, who doesn't need to be in medicine to understand the disturbing fear a parent feels anytime they see another child harmed.  (My mom is awesome by the way, just want to throw that out there because she is my greatest mentor as I navigate this crazy journey of motherhood!)

So, tomorrow I will go to the spa, and try and lose my thoughts and replace them with relaxing calm.  I will continue to listen to my mindful meditation CD's as I drive home from a particularly horrifying day of work.  I will continue to delight in my beautiful, amazing blessing of a child each moment I see her.  And, I will pray for the beautiful children who have endured hurt and pain and pray that they someday receive the love they deserve.



  1. When I see child abuse cases, they make me want to vomit. Particularly when I think about what the daily lives of those children must be like. Then I take those feelings and imagine myself putting them on a shelf in the back of my head. They are still part of me, but I seem to be able to avoid letting them permeate all my thoughts if I don't go to that part of my brain to pull them off the shelf. It allows me to focus on my work -- what I CAN do to help these patients -- rather than fixating on the horribleness of it all.

    That, and I give my daughter lots of hugs!

    I don't know if this is helpful... maybe I'll have a tougher time compartmentalizing when I'm back in the clinics and see this sort of thing on a more regular basis.

    1. Thanks OMDG, thats great advice, I'm definitely going to try that.

    2. I think I just decided I never want to work in peds because of it. The Peds Pain unit was soo awful, my attending was barely able to control herself. I love being around kids, but I can't handle sick kids.

  2. god, i can't wait to read the comments/suggestions because i too have a story (several but this was my first): during my tox fellowship, i witnessed a non-accidental ingestion leading to a death in a 1.5 year old who had be neglected enough that she was the same weight as my then 8-month old son. the spontaneous tears stopped about 6 months in. the nightmares/daymares stopped when my son passed the 1.5 yo. but whenever i have the same ingestion (even in an adult), i get at least one nightmare or crying spell.

    i honestly believe doctors/nurses/healthcare providers often have some element of post-traumatic stress disorder. especially those of us doing higher risk specialities once we're out of training - emergency medicine
    (mine), surgery, ob...

  3. When I did a month at the crime lab during my training there was a rash of crime in LR and that included child abuse deaths. I held it together until I saw my fifth or sixth one and I left work, drove down to the River, and cried hysterically for about an hour or so. What made me even more angry is the lack of attention and justice most of these deaths receive in our system, I talked to one of the forensic pathologists extensively about this. I talked to a young attending at the time about how hard it was for me to see and she said, "Where I trained in California they had a whole room. Just for kids. They assigned me to it because I wanted to be a pediatric pathologist. It was awful." That month was back in 2006. I don't think about it as much as I did, but it took me a few months to get over it. As much as I love the idea, I would not be able to be a forensic pathologist, because of the child abuse cases. Or if I was, I would have to have targeted therapy sessions to cope, I imagine. I think of that forensic pathologist who sits in court as an advocate for the abused children (souls), often in vain, as a saint to this day. Spa will help. Time will heal, but we are forever imprinted by our experiences, good and bad.

  4. On the note of targeted therapy sessions, the psychiatry residency program at my institution (and this may be standard across all psychiatry, I'm not sure) requires the residents to attend "supervision" for half an hour once a week. It's basically a sit down session with an attending who both mentors and acts as a therapist so that the residents can appropriately deal with all the horrible things they see. I've often thought that this would be beneficial for many other specialties, particularly pediatrics, since it is so hard to watch children suffer, not to mention the horrors of NAT.

  5. I work in pediatrics and see many of the diseases and injuries that are every parent's nightmare (neurology). While I can second what OMDG says about compartmentalizing, it is also (maybe counter-intuitively) helpful for me to remember that, in many cases, I am meeting kids and parents on one of the worst days of their lives. It really focuses your attention on your job as a physician and what can be done to get a child or family through their situation in the best way possible. Though the inflicted injuries are always devastating.

    And I harp on everyone I know to wear a helmet.

  6. I refer to this type of thinking as "intrusive thoughts" and I can't say I do much better with my own. I do a lot of hugging my own children and compartmentalization. I am fortunate to not deal with much child-abuse in my line of work, although the amount of grief and anger can also take its toll. I always remind myself that you can't protect yourself from every misfortune, no matter how careful/loving/healthy/mindful you are towards yourself or your child.

  7. I am working in pediatric surgery. I am grateful for still feeling hurt and touched by things like that. I am NOT dead inside, I can still react with an appropriate response to a horrible thing.
    Two years ago there was a organ explantation in an two year old - who looked just like my little son, and had the same age, on christmas eve. That was so horrible, but I still think, that it actually helps the parents if I can actually feel their pain.
    And I pray.

  8. A supportive spouse helps (common refrain here). (Un)Fortunately, many of the horrible things I witness make the local news. And without violating HIPPA, I tell my husband to check the local news - he has to anyway for his job - but it's our code for this type of day. He gives me hugs and space and tells our son to do the same.

  9. Thank you for sharing your experiences. I haven't yet been around the "real" patient horrors...but even being in pathology can do a number on thinking about what could go wrong with the next pregnancy. At least there are others who understand.

  10. Abby- I have been thinking about the "supervision" model for a while.
    Doctors have such a heavy load and for so many reasons, professional (confidentiality) and personal, are not really able to talk to anyone about the stories they carry in their minds and the heaviness and sadness in their hearts. I think compartmentalising is necessary but its not a fix.

    For me, as a very young nurse, living in a very isolated disadvantaged community I had to attend two successful hangings of teenaged. I moved into health promotion to protect myself from on call responisbilities so I would not have to deal with it anymore. A few months later a good friend hung himself. A medical student as it happens. His funeral was one week before I started medical school, in a new state, where i had very little social support. That was when the nightmares started for me. Several months after my terrible call outs compounded by my grief for a much loved friend.

    I have now completed my 5th year out of medical school. I firmly believe we should begin in medical school, with regular face to face "checking in" counselling or "supervision" sessions. To learn good coping mechanisms for when we are faced with hard things, to learn how to get help before the wheels fall off. I feel as though medicine is one of the last frontiers of macho-ism. ANd you just have to be ok. We are only human. I also think we tend to fall in the trap of recognising the problems for others and not so much for ourselves. HIgh rates of drug and alcohol use, relationship issues and suicide seem to point to the fact that we do in fact have problems...

  11. Too many "facts" in the last sentence ;)

    Selah- I hope the day at the spa helped, and the cuddles.When I was having nightmares I did eventually get counselling...and it was the best thing. So I think a few sessions might be a great way to go. (In all your spare time...another stressor)


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