I sat dumbfounded on a stretcher in the psych ED. The woman behind me described her preadmission suicide attempt, and a few doors away a man reviewed the domestic violence that compelled his being flanked by police. My thoughts were twofold: “How did I get here?” and “Why me?”
Minutes earlier, my husband and parents walked me to the unit entrance. Before I could hug them goodbye, a latched steel door slammed shut, separating me from the people I loved most. The guards ordered me to take off my clothes, change into scrubs, and turn over my belongings. My wedding band was the hardest to surrender. I undressed in front of a dozen patients I’d never met.
Suddenly the words people used to describe me no longer seemed to apply: capable, resilient, strong, brave. Everything now reflected a person I didn’t know: helpless, debilitated, fragile, and deeply, deeply afraid. I was terrified of feelings I never learned to feel and thoughts I couldn’t bear to let myself think. My own biases about mental health (that is, psych meds were not for “people like me”) augmented the irony of this ED visit, complete with a stale turkey sandwich and a side of hypervigilance. Hours later I was discharged home, promptly collapsing into boyhood refuge—my head on Mom’s lap and feet on Dad’s.
The ED team had referred me to an outpatient psychiatrist for a next-day appointment. The psychiatrist felt my 30s were “simply my time to have a nervous breakdown.” My current dilemma made sense in the grand history of my life to date. After a childhood of round-the-clock bullying at school for being the gay kid, I moved to New York City for college and watched the second tower collapse on 9/11 a quarter of a mile from where I lived. With further independence, I tried on all types of numbing behaviors that a young person with internalized homophobia and a diminished sense of self does. In my early 20s, with a blossoming career as a dancer, a fractured hip left me immobile for months. I felt betrayed by my body—this instrument I thought I had come to master.
My own injury rehabilitation inspired me to serve others. I trained as a nurse and have worked in palliative care for 15 years. Since I started nursing, the dying patient and the grieving caregiver have been like ever-present siblings. The pain of life (and of death) continued to accumulate throughout my already fragile nervous system. I internalized the gasps of terminal dyspnea, learning the nuances of existential distress and memorizing the shock waves of a pain crisis at the most primal level.
The residue of unresolved angst eventually became unbearable. Months before my ED admission, I started having nightly panic attacks. I would wake up—heart pounding, chest tight, sweat pouring—convinced of my impending death. The medications my primary care provider prescribed provoked dreadful suicidal ideations. Indeed, the morning of the admission, I had been standing in the shower imagining gruesome advice to kill myself. I was sure I was losing my mind. I had nothing left to give or fight with. I eventually stopped functioning altogether.
My psychiatrist’s formula was, in retrospect, obvious: lifelong bullying + living through the catastrophe of terrorism + addictive and destructive behaviors + career-ending injury + bearing witness to human suffering in a broken health system often mimicking frontline combat = nervous breakdown. For my whole life, I had stashed the receipts of these transactions like a hoarder with a gambling problem (that is, shame on top of shame). I was now in physiologic bankruptcy. I had to self-intervene for my own sake—but how does one begin to whittle down a trauma equation like the one above?
I had to learn to listen to the cues of my nervous system. I didn’t know what it meant to feel safe in the body. But this ability to feel safe in the body—in my body—is perhaps one of the most important lessons I’ve learned along the way. It hadn’t occurred to me that my body, the rubble that had been the target of all that abuse and brokenness, was the exact temple I had to enter to heal. I learned to sit in my internal debris and take stock of the damage to my own foundation. Time passed, and the daunting work of telling the truth about my life continued.
A few months after that ED admission—now receiving the appropriate therapy and care—I sat on a hospital panel alongside colleagues, sharing with an auditorium of clinicians the case of a man with advanced lung cancer who had recently elected to allow for a natural death. We planned the last 24 hours of his life with him in detail. My last memory of him is his looking me in my eyes to say he trusted me before I removed his oxygen. He died minutes later—comfortable, loved, as he wished.
As I spoke about the psychological residual of caring for this man, my shaky voice caught me off guard. “I need a break.” As soon as I said it, I knew it was true. What was I so afraid of? Why did I think I had to stifle my pain? I needed to take care of this body, mind, and spirit of mine. Most of all,I needed to stop pressuring myself to explain to other people what I needed.
Clinicians empathized after the panel that they, too, needed a break. They felt validated by my words, and I by theirs. Even though we commiserated from the dugouts of exhaustion, we looked at each other through tears of feeling heard and understood. Our human connection seemed to make the lights in the room brighter and created some space for laughter—the sound of trauma lifting.
My life is intimately informed by the decades of trauma that preceded today. This means that the care I give my patients and their families is also inherently trauma-informed. Snap judgments may defend the idea that unpacking our trauma is “too much” or “too hard” or “isn’t part of our professional duty to care,” but there is a gift here that deserves its due. Learning to feel the depth of my suffering has carved new space to feel joy and love and be moved by genuine compassion for others. Self-love takes grit to be unconditional and to get to the precipice of healing.
I reflect daily on how to best integrate self-love into my practice as a clinician and researcher. Trauma-informed care principles prompt us to cultivate awareness to avoid unintentionally retraumatizing ourselves and others. Adopting these approaches is an admirable ideal but starts with the courage to reflect on our own mental and emotional well-being, reclaim the abandoned and wounded domains of self, and take the space and time to recover from what may be a career—maybe even a lifetime—of stored and unresolved trauma. As the health care workforce confronts unacceptable rates of suicide, moral distress, and burnout, it may be time to come to safe and supported terms with our trauma, both individually and collectively, not only to protect our patients and communities but to survive.
Although I never actually lost my mind, I was extremely tired and traumatized and didn’t know how to ask for the very thing I needed: help. Not long ago,I would have worried that telling you my story would make me look sad and weak. But, in all honesty, it’s a huge relief. It is an unburdening of truth.
It turns out I am a fully feeling human—a husband, son, friend, and nurse—living an unpredictable, fulfilling, and sometimes really hard life. And it also happens that my story, so much of it traumatic, is exactly what makes me capable, resilient, strong, and brave. Because no matter how I spin it, this one life of mine is forever trauma-informed.