Am I Experiencing Vicarious Trauma?

Authors: Jennifer Hughes, PhD, and Alisha Bowker, LCSW, UMC Trauma Recovery Clinic Team

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At times it can feel nearly impossible to find the motivation to keep showing up to work, week after week, especially after working long hours or dealing with crises and looming deadlines. Working in the medical and helping fields, especially, we are often overwhelmed with horrific stories of violence, pain and trauma, which can dramatically alter the way in which we understand the world, ourselves and others.

The clinical term for this phenomena is Vicarious Trauma (VT).

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What is Vicarious Trauma (VT)?

Vicarious Trauma can be defined as a change in a helper’s inner experiences after working with people who have experienced traumatic events. Trauma can be defined as a deeply or distressing event that one directly witnesses or hears about. This can include natural disasters, interpersonal violence, war, divorce, childhood abuse and so on.

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Does Everyone Experience VT?

VT is a natural consequence of being an empathetic human, and being exposed to a population who has experienced trauma. Those often impacted by VT are social workers, case managers, doctors, nurses, first responders, etc. It is an inevitable hazard in these lines of work and, unfortunately, cannot be avoided, but definitely can be addressed and managed.

VT can also extend not only to helping professionals who work with this population, but also to the caregivers or loved ones of a survivor.

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How Does VT Impact My Life?

Vicarious Trauma is an ongoing process that slowly builds over time the longer we are exposed to the stories of trauma survivors. It generally begins to impact us in three different realms:

  1. Identity: It begins to impact our identity, which changes the way we see and define ourselves.
  2. Worldview: It impacts our worldview by skewing the ways in which we understand others or understand how to interact with those around us.
  3. Spirituality: It can impact our spirituality, and replace feelings of hope with feelings of cynicism and despair.

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VT Versus Burnout

Vicarious Trauma is different than burnout, as it truly only develops after being exposed to traumatic stories. Burnout is a state of chronic stress, particularly in a work environment, that leads to physical and emotional exhaustion, cynicism, detachment and feelings of worthlessness.

While the symptoms are similar, burnout is generally not rooted in trauma exposure.

Signs and Symptoms of VT

Some of the most common signs and symptoms of VT fall under these 5 areas:

  1. Cognitive: Intrusive thoughts, sounds or images about the traumas an individual has been exposed to, difficulty concentrating, constantly thinking about survivors outside of work, becoming more cynical or negative in one’s thinking patterns.
  2. Physiological: Ulcers, headaches, chronic pain, stomach aches, sweating or heart racing when reminded of a trauma
  3. Spiritual: Lose hope, see others as bad or evil and lose sight of the good in humanity, difficulty trusting our own beliefs
  4. Behavioral: Hair trigger temper, isolating, using unhelpful coping to manage big feelings (drinking, drugging, gambling), need to control everything and everyone
  5. Emotional: Lose touch with one’s own self-worth, isolate from loved ones, feeling overwhelmed or emotionally restricted

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So now that we have the language to define the symptoms we are experiencing, what can we do about it?

Thankfully there is an answer for this and it can be broken down into three phases:

Anticipate and Protect, Address and Transform

  1. Anticipate and Protect: Arrange things ahead of time to anticipate the stress of your work and its impact on you.
    • Become aware of VT and start to look out for signs and symptoms. Intentionally plan for a healthy balance between your work life and personal life.
    • Find a support system, particularly amongst colleagues who share this language and can support you as needed.
  2. Address: How you take care of yourself in and out of work
    • Engage in Self-care: Attending to yourself physically, spiritually, emotionally and psychologically
    • Self-nurture: Engaging in activities or things that provide comfort, relaxation and play
    • Escape: Getting away (whether literally or mentally)
  3. Transform: Transform the negative aspects of this work into positive connection and meaning
    • Create Meaning: Find ways to hold onto your values and identify even in the face of trauma
    • Infuse current activities with new meaning: Mindfulness, Connection to others
    • Challenge negative beliefs: Actively challenge negative thoughts or cynicism/ Re-frame your thinking

While vicarious trauma is a very common and inevitable consequence to the work that we do, the exciting news is that we have the tools to fight back. This is an ongoing process that will continue to look different at different stages of our careers, so it is a process we must continuously be engaging with.

Both individually and collaboratively, begin to identify the signs of VT in your own life and use the template above to make a plan for how to begin addressing and counteracting these symptoms.

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Remember, you are not alone with your vicarious trauma, and do not have to manage it alone either.  

Season’s Grievings

Author: Sonia Malhotra, MD, MS, FAAP, and Director of Palliative Medicine and Supportive Care at University Medical Center New Orleans

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The Holiday Season is one full of celebration, joy and gathering for so many.  But for many individuals, especially those living with a serious illness, the Holiday Season can seem like more of a burden than a joy. Coordinating appointments, making sure there are enough supplies to last through days when pharmacies and stores are closed, and contacting healthcare providers are only some of the challenges those living with a serious illness have to face.

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Additionally, the Holidays often bring about stressors, anxiety and grief over the inability to travel and the loss of other abilities, the diagnosis of a serious illness, and often the loss of loved ones.

Palliative Medicine is the interdisciplinary care of patients with serious illness such as cancer, blood disorders, heart disease, neurologic disease, liver and kidney disease and advanced lung disease to name a few.

It provides this level of care in 4 areas:

  1. Pain and Symptom Management, including managing symptoms that affect the quality of life
  2. Communication about Healthcare Decisions, Plans of Care and Coordination of Care
  3. Emotional & Spiritual Support for Patients and their Caretakers
  4. Hospice, End-of-Life Decision Making and Support, and Bereavement Services

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November marked the celebration of National Hospice & Palliative Medicine month. 

However, each month in the life of our patients LIVING with serious illness brings awareness of the challenges and struggles we need to celebrate. Serious illness and Palliative Medicine are NOT about end-of-life care. Rather, Palliative Medicine and its care of the seriously ill focuses on finding ways to ensure that our patients and their caretakers are LIVING with the best quality of life they possibly can.2017-NationalHospiceMonth_Logo

So how can patients and their families survive this Holiday season with a Serious Illness?

  1. Establish Priorities: Choose the Holiday traditions and activities that have the most meaning to you. Create and prioritize activities based on your state of mind and energy level.
  2. Depend on Loved Ones to Fill In: This can be especially tough for those who like to do things independently. However, it is important to be realistic about what you will have energy to do. Ask for assistance, take assistance when it is given and be clear about your own limits.
  3. Plan Ahead: This is especially important if you have dietary restrictions while undergoing treatments. Talk to your healthcare team about rescheduling treatments that may leave you feeling under-energized during important family gatherings or traditions.
  4. Be Selective with Your Time: Do things and be with the people who energize you, not those who deplete you. Don’t feel the pressure to fulfill obligations, do the things that matter the most
  5. Acknowledge and Share Your Feelings: It is okay to feel sad, anxious and even angry. Give yourself the permission to have these feelings and share them with trusted loved ones and healthcare professionals. Use support groups and online communities as often or as little as you need.

The Holidays can be a stressful time for those living with a serious illness and those caring for a loved one with a serious illness. Keep in mind that nurturing yourself and allowing others to nurture you will help in the celebration and reflection of these times.

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Stop the Bleed, Save a Life

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Authors: Jen Avegno, MD (LSU Emergency Medicine Physician) & Rebecca Schroll, MD (Tulane University Trauma Surgeon)

A nightclub. A country music concert. A Congressional baseball field. These are normally places of leisure and entertainment, but in the past year, they have become scenes of unimaginable tragedy where innocent victims have been targeted for mass murder and injury.

As doctors at University Medical Center’s renowned Level 1 Trauma Center and Emergency Department, treating victims of violent injury is our job and something we do every day. With our fellow dedicated team members, we are proud to serve our fellow Louisianans on what is often the worst day of their lives.

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Although we are professionals who are trained to handle anything that comes our way, it affects us personally, too.

We are mothers, wives, neighbors, and citizens of this great city – and it’s hard not to put ourselves in the shoes of the grieving family members and friends we see after a violent trauma.

When we talk to others about high-profile tragedies like the recent Las Vegas concert shooting or the Washington, D.C. shooting of Representative Scalise and others, we often hear remarks like “I feel helpless” or “there’s nothing I can do to help.”

And yet … there is.

Anyone can save a life – and UMCNO is making it easy to learn how.

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Through partnerships with our two medical schools, we are proud to bring the national Stop the Bleed program to our community. New Orleans has long held the dubious distinction of having one of the highest rates of violent trauma from shootings and stabbings; now it’s our turn to lead the way in turning the tide. Stop the Bleed was developed by the Department of Homeland Security and American College of Surgeons to teach anyone – especially non-medical personnel – the basic skills needed to identify and control life-threatening bleeding in any emergency situation.

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Imagine you’re jogging in the park and you come across someone with a badly broken leg who is losing blood rapidly. With Stop the Bleed training, you can quickly and easily stabilize the victim while EMS is on the way.  It’s an empowering feeling to know that YOU can save someone’s life, and a natural way to prove we are a community that cares for each other.

The only thing more tragic than a death is a death that could have been prevented.

Because we believe so strongly in this program, UMCNO is hosting FREE community classes every two weeks – open to anyone. Or, if you’d prefer, UMCNO medical staff can come to you and give a free training in your school, business, church or other organization.

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We have also put together special Bleeding Control kits containing the supplies that can be used to help stop bleeding.

Our goal is to put a kit in every school, place of worship, large building, and public space in the city.

Since the program started, UMCNO has trained nearly 1,000 of our neighbors, colleagues and friends. We’ve given the training in schools, organizations, security agencies – to anyone who’s asked.

In partnership with Ceasefire New Orleans, we have set up a great community training kick-off event October 16 at Kermit Ruffin’s Mother-in-Law Lounge. Come eat some great food and second-line while you learn some valuable skills!

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To learn more about Stop the Bleed at University Medical Center New Orleans or sign up for a class, visit: www.umcno.org/stopthebleed.

We lead the nation in celebrating life in New Orleans … together, let’s lead it in saving lives, too!