Medical Trauma - A Personal Case Study

(A Chronic Illness/Transplant Post)

My recent post about medical trauma and PTSD resonated with many readers, so I am offering this follow-up post with a deeper dive into my own experiences with both of these co-existing conditions. It’s still May, which is Mental Health Awareness Month, so what better time to share?

Content Warning: This post includes a first-person account of a recent hospital visit that triggered my own PTSD.

Anyone with a chronic illness can tell you that repeated medical encounters can be both physically and mentally exhausting. Additionally, those who have experienced life-threatening medical experiences can tell you how traumatic those events can be. When you combine the two – frequent encounters and life-threatening experiences – you create an environment which can lead to medical PTSD.

Medical trauma involves the emotional and physical reactions to negative experiences with medical illness, severe injury, procedures, and treatments. Many different medical diagnoses and treatments can be stressful for people and lead to symptoms of PTSD.

It's expected for someone to have difficult reactions following significant medical interventions, but these feelings should naturally decrease over time. But what if they don’t? This can lead to PTSD caused by medical trauma.

It’s important to point out that when I refer to the term “medical trauma” that it doesn’t mean that the medical personnel who performed whichever procedures caused the trauma had any ill intent. I’ve found that most people in the medical field are genuinely kind people who care about the well-being of their patients. But the procedures themselves can be traumatic, especially to more sensitive people or those who have a history of prior trauma.

Below, I discuss my own struggles with medical trauma via a recent medical encounter. As someone with a deep history of PTSD, through both my childhood and early adult life, I know that I can sometimes interpret mundane interactions as harmful. This does not mean that anyone acted with ill-intent, but instead, my nervous system perceived those actions differently based on my personal history.

This was originally written as an essay for a medical-themed anthology, but it was not selected for publication. That’s good news for you because you get to read it here instead of subscribing to a medical journal.

Photo by National Cancer Institute on Unsplash

First Do No Harm

Chronic illness is accompanied by repeated medical encounters which can be both physically and mentally exhausting. Medical intervention for life-threatening illness or injury can also be a traumatic event. When you combine the two – frequent encounters and life-threatening illness – you create an environment which can contribute to medical PTSD. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) described being diagnosed with a life-threatening illness as a type of traumatic event which may lead to PTSD.

As someone with a deep history of trauma, through both my childhood and early adult life, I am aware that I sometimes misinterpret mundane interactions as harmful. This does not mean that anyone acted with ill-intent, but instead, my nervous system perceives those actions differently based on my personal history. After undergoing my second heart transplant surgery, I realized that I suffer from medical PTSD.

During a recent encounter in which I underwent a left heart catheterization at the hospital where I received my second heart transplant, I experienced an unintentional exacerbation of my trauma. Upon my arrival at the facility, the fluorescent hallways and sterile smell immediately set me on edge. I tried to suppress the rising feeling of unease as my husband and I walked the length of the main hospital corridor to my next appointment. I sensed that I was beginning to spiral when we walked past the elevator bank to the critical care tower and my husband pointed it out and asked, “How long were you in there?”

I walked faster, hoping to pass the elevators as quickly as possible, but the elevator doors opened, releasing a team of nurses and technicians pushing a patient in a hospital bed, face and body obscured by mounds of white bedding and medical equipment. One machine sang the familiar song of the ventilator. “Doo-doo-dee-doo!”

Panic rose in my throat and froze like a lump of ice as that sound slammed me back to the days in ICU. I couldn’t swallow. I couldn’t breathe. I thought I might throw up. My pace turned into a jog. I had to get away from that sound as fast as possible. I fought to avoid breaking into a dead run.

At the next appointment, my nerves vibrated on a knife’s edge, but I pretended all was well, smiling and joking with the nurses as I went back to be prepped for the procedure. I waved goodbye to my husband as he left to get lunch. He wouldn’t be needed until after the procedure, and we both felt it was unnecessary to keep him in the waiting room for several hours.

Once I reached the curtained cubby for pre-op prep, the physician’s assistant came to speak with me while I changed my clothes. The nurse urged me to continue undressing while we spoke since my case was the next one scheduled, and I removed my leggings under cover of the voluminous gown designed for a person twice my size.

While the PA did her routine assessment, the nurse laid out the IV kit on the bedside table. The frozen lump returned to my throat as the impending ordeal of the IV stick filled me with dread.

“I’m a hard stick.” I interrupted my conversation with the PA to address the nurse. “I’m sorry, but my veins are terrible. Do you have an ultrasound? You’re not going to get a vein on the first try. I want to save us both some pain.”

The nurse looked up and I read annoyance in her freckle-rimmed eyes. Immediately my desire to be the golden child, well-behaved enough to avoid punishment, unearthed from the deepest part of my being. Childhood taught me how to twist myself into knots to avoid disapproval, especially from someone who could possibly cause me pain.

“I’m sorry,” I said. It was the first apology of many I would utter that day.

The nurse disappeared and another arrived. The PA continued with her questions while the new nurse took my right arm and started inspecting my veins. Wordlessly, she lathered my arm with the sterilizing solution then BAM! The first needle broke my skin. I sucked in a breath, trying to focus on the conversation with the PA while the nurse dug around painfully in my vein. I felt myself sliding away into dissociation. Finding nothing, the nurse withdrew the needle and BAM! Needle number two, also with no results.

I tried to keep my composure, but a single tear escaped the corner of my eye as I struggled to follow what the PA was saying. Her words sounded like the teacher on the Peanuts cartoons. The attempt on vein number two was fruitless, withdrawn, then BAM! Needle number three broke my skin.

“Ouch!” I exclaimed involuntarily. “I’m sorry. That really hurt!”

The nurse withdrew the needle, packed up her gear, and walked out of the exam room having never said a word to me.

“I’m sorry,” I called after her. I felt ashamed for having terrible veins.

The PA finished her questions and left the room. I could not recall a single thing we discussed during her short visit, but it would be logged as an office visit for my insurance.

The original nurse, freckled one, had watched the failed attempts at IV access. When we were alone, she walked around to my left side and picked up that arm, her fingers running over the veins in my arm and hand before settling on a vein in the back of my thumb.

“Please, I don’t want an IV in my hand,” I said to her.

She snapped open the sterilizing solution and swabbed my thumb.

“Please, not there.”

Just the two of us, she ignored my pleas. I had no witness, no advocate. She held my left hand in an iron grip.

BAM! The needle thrust into my thumb, and pain bloomed brightly from my hand all the way up my arm.

“OW! OW! OW!” I wailed.

A male nurse appeared on my right side. I recognized him as the person who had successfully placed an IV in my arm on a previous visit.

“Hold my hand,” he encouraged me, taking my right hand in his meaty grasp.

“Please stop!” I pleaded with the nurse who kept drilling the vein on the back of my thumb.

“I’ve got blood,” she replied. “Hold still and relax your hand. Stop making a fist.”

One after another, she filled vials with the required amount of blood for the lab.

“When you have the blood you need, could you please move the IV to a different spot? That really hurts.” I turned to look at the burly nurse holding my right hand. “Maybe you could get an IV in my arm?”

“No time. You’ve got an IV already started,” the freckled nurse replied. “Your case is the next one up. This is a successful IV placement.”

She wrapped my hand with gauze until my fist became a club, the IV access pointing up at a 45-degree angle. Minutes later, when I transferred from the gurney to the table in the procedure room, the awkward angle caught on something, and I yelped with pain. Fire shot down my thumb when the technician flushed the port, and I asked again if it could be moved.

“We can’t do that in here,” the tech replied.

I shivered on the metal table in the cold procedure room. The spotlight of the surgical lamps caused flashes behind my eyes, turning my vision to a sea of silver fish swimming lazy laps. My empty stomach clenched while my nerves sparked with pain and anxiety, adding to the shivers from the cold until I was shaking uncontrollably. The vibration caused the heart monitor to alarm. A disembodied voice ordered me to hold still.

“I’m sorry,” I responded, my words as automatic as a flinch. Tears ran freely from my eyes, dribbling into my ears, as my teeth chattered and my thumb burned. “Can I get a warm blanket?”

The technician muttered something then pushed something into the IV. My thumb burned for a second before I drifted off into a drug-induced slumber, no longer caring about pain or cold.

Back in the same cubby, I awoke to the male nurse pulling the sheath from my groin and holding pressure to stop the bleeding. Fireworks of pain burst through my belly when he pushed down, and I heard my screams coming from outside my body.

“She has a hematoma,” he said to the freckled nurse. She disappeared through the curtain and returned with the physician’s assistant.

“What would you rate your pain?” the PA asked me.

Tears streamed down my face as I squirmed to escape the pressure on the incision site. He was pushing as hard as he could, holding pressure to stop the internal bleeding.

Assigning a number to my pain was an algebra problem I couldn’t solve. “I don’t know. Bad. It hurts bad.”

“I need a number.”

“I don’t know. Seven? Maybe eight, nine?”

“Give her some fentanyl,” she told the nurse and rattled off a dosage.

I was surprised to receive pain meds, but it was probably given to stop me from squirming rather than for pain relief. When the warm rush of the drugs washed over me, the pain dulled along with my senses, and I nodded off once again.

The hematoma healed slowly, but my flesh recovered. My mind, however, took longer to come to terms with the traumatic feelings triggered by the experience. The absolute loss of control over my body plunged me back to my time in ICU, and even further back to long ago years when I was assaulted.

The medical staff was not intentionally cruel. They were rushed for time and couldn’t coddle my sensitive response. If I had not been on edge from the walk through the hospital – the sights, smells, and sounds triggering my previous traumas - perhaps the experience would not have seemed as harsh. Still, having zero autonomy over my body dredged up many deeply buried and painful feelings.

For several days after the visit, as the failed IV sticks blossomed into black roses across my right arm, and the hematoma spread a purple stain from my left groin to my right hip, I felt the emotional pain worse than the physical pain. Despite these challenges, I’m grateful for this gift of life, and I’m grateful for the medical care that allows me to continue living this life. I’m going to keep pushing to survive until my final breath.