Your Best Life: In the Lowest Moments, An Opportunity for Post-traumatic Growth

Author Richard Karlson, in his classic work Don’t Sweat the Small Stuff … and It’s All Small Stuff [8], writes that how we look at problems determines their effect on us. When my twin brother Michael was diagnosed with cancer 4 years ago [10], I experienced anger and depression. Looking back at my lowest moments, I missed the positive signs or little victories that were just under my nose. Seeing my brother find a way to smile even after bouts with chemotherapy is a sign of strength that I didn’t recognize in real time. But over the span of months, seeing my brother laugh pushed me to accept our family’s circumstances. When I finally embraced reality, I started to see the world differently. I made a conscious choice to not let the small decisions, gripes, or pet peeves exhaust my mental energy. Yes, our family is in a stressful situation, but by simply dismissing most matters as truly unimportant, I found that my life with those around me was richer and more meaningful.

While the negative effects of stress and trauma on brain function are known [4, 14], we can use the challenges in our lives to emerge stronger. In my case, I have deepened my relationship with God, as I see Him, which has helped me find solace in the days where I worry for my twin and our family. I have watched my brother endure the ravages of chemotherapy as well as the pain that cancer causes. Perhaps because of this, I started to notice that following Michael’s diagnosis, I now better empathize with my patients and spend extra time reassuring them about their postsurgical pain. Spending a few extra moments with my patients has made me even more cognizant of how much my vocation allows me to help others. It’s also made me grateful for the relationships that sustain me outside of my work [5]. I am truly grateful for every day and remind my immediate family that I love them and appreciate them daily—something I failed to do in the past when work or outside interests dominated my life.

Psychologists now use the term “post-traumatic growth” to describe positive psychological change experienced as a result of embracing challenging, stressful life events [3, 15-17]. According to psychologist Richard Tedeschi [16, 17], as many as 90% of survivors of trauma report at least one aspect of post-traumatic growth, such as an increased appreciation of life or a deeper sense of purpose. German author Michaela Haas coined the term, and wrote the book, Bouncing Forward [6], which describes how trauma can evoke responses that go beyond resiliency, such as increased strength, spirituality, and wisdom.

All of us have the capacity to control our responses to stressful events and adversity. The execution of any surgical procedure can manifest unexpected stressors, which can prompt us to develop adaptive responses rather than reactions. In fact, stressful events provide the needed stimulus to change. One study showed that those who experienced moderate amounts of stressful events were more likely to develop coping skills, seek support, and gain more confidence in their ability to overcome adversity [13].

My own growth seems similar to that reported by spouses of those suffering from terminal lung cancer who demonstrated increases in interpersonal orientation, prosocial behaviors, and dependability [7]. Richard Tedeschi and Lawrence Calhoun [16, 17] found that many experience growth in five areas: personal strength, deeper relationships with others, new perspectives on life, appreciation of life, and spirituality. But post-traumatic growth is a process, and one may go through certain stages from initial acceptance, to adopting a new mindset, to finally understanding that beneath every stressor lies a gift.

I have found that certain attitudinal changes will greatly facilitate post-traumatic growth.

Acceptance

A key requisite of post-traumatic growth is the ability to accept what one cannot change [3]. Many know this as the Serenity Prayer (“God grant me the serenity to accept the things I cannot change ...”). This acceptance enables one to move forward [12]. I can only change myself and my responses to whatever stimuli my environment and the people within it present. The practice of mindfulness is predicated on accepting the present moment without judgment. When we can become present, we develop clarity and see things as they are, not as we like them to be. Then, with a calm and lucid demeanor, we can better affect change to whatever the situation demands. We can all become more effective positive agents of change when we remain anchored to the present moment.

Adopt a Growth Mindset

As I have written before [9], we can choose to react or to respond to whatever life throws at us. We can see stressors as threats or challenges. Those who thrive during challenges have a high sense of human agency, that is, the belief that one has power over one’s actions or circumstances [1]. Surgeons have much more capacity to positively affect the culture at work and at home than they likely realize. We can create positivity in surgery, clinic, and at home by being the change we wish to see. Others will surely follow.

Look for the Gift

We will find some good in every event and a valuable lesson if we choose to. Those who believe in a friendly universe or higher power have been shown to be more resilient than those who deem the universe as harsh and unforgiving [2].

In a previous column [11], I mentioned how I lost several friends and patients to COVID-19. During the pandemic, I felt obliged to be part of the solution, but because my hospital cancelled elective surgery, I was essentially told to go home. We go into this vocation to help patients heal, but I could not be the difference for them, which negatively affected my emotions.

I needed to look inward and accept that these circumstances were out of my control. What I could control, however, was taking advantage of my free time by being a present husband and father to my family, something of a rarity before the pandemic. Being home was a useful reminder to always try to find the good in your circumstances.

Tomorrow, Try This

• Accept what is and do not run from adversity. There is always an opportunity to emerge with a measure of growth when we face life head on. Trying to change others is folly. All we have to work with is ourselves.

• Prioritize what is important and execute on those things: family, spirituality, friendships, and values. Petty annoyances, perfectionism, gossip, turf battles at work, and the need to be right will not bring joy and fulfillment.

• Write down an example of a challenging time that you embraced and emerged stronger from. This exercise will help our brains be more receptive to the positive.