Shirah Vollmer MD

The Musings of Dr. Vollmer

The Medical Trauma

Posted by Dr. Vollmer on December 18, 2014




Why go to medical school, if all you want to do is talk to people? I used to ask myself that question, and at times, I still do. Yet, periodically I am enormously grateful for my medical education, as is my patients. LuAnne, seventy, comes to mind. Knowing her for many years, I saw a healthy and vibrant woman who ate well, slept well, and exercised regularly. She has friends, a husband, children and grandchildren. Her family of origin is mostly healthy. Her mother is going strong at 95. She has no known risk factors, with a normal blood pressure, normal glucose levels and her thyroid is intact. Suddenly, I get a call from her husband that she has undergone a procedure for a pulmonary embolus. She had trouble breathing, went to the Emergency Room, was admitted and then devices were put in her veins so that the clot did not stop her breathing. Sure, a non-medical person can read Dr. Google and educate himself on the issues, but for me, with my background, I instantly knew what she went through and I could instantly talk to her husband about the details of her medical care. Moreover, having gone through these emergencies with many patients, I could imagine the psychological trauma which might ensue. The new-found vulnerability. The tremendous fear for the future. The immediacy of the present. Cycling through medical emergencies has given me the perspective and the wisdom to know both from a technical point of view about what the next steps are going to be, but also from a psychological point of view about the game-changing experience this will be for LuAnne’s mental interior.

At first, LuAnne was in denial. “I am lucky” she tells me, meaning that she did not die. “Yep” I say, “I see that, in the midst of being unlucky,” I remind her, to suggest that she was struck by lightning, and as with all traumas, there is initial pull for gratitude, sometimes followed by a tremendous sense of victimhood. Over time, LuAnne’s anxiety has sky-rocketed. She is afraid to go far from home, as that is where she feels safe, even though her trauma began at home. The downstream experience of this medical emergency has yet to flow, but together we are prepared for a lot of discussions about what this all means for her. Understanding the pathophysiology helps us a lot. We can work with her known versus her feared limitations. I can comfortably communicate with her other physicians. I can help her understand her new medications and I can help her ask good questions when she sees the doctor. I can also point her towards mindfulness classes to help her cope with her fears. LuAnne appreciates my medical background, so maybe for that alone, it is good I went to medical school.


8 Responses to “The Medical Trauma”

  1. Eleanor said

    Oh my…I was literally LOL when I read this post because I read it in-between printing personal thank you cards with my beautiful “ relaxing cortisol lowering” images of water to send my hand written appreciation to selected Texas Heart Institute physicians that were key to saving my life last February when a frightening emergency (that nearly took my life) happened during my elective cardiac ablation to correct Afib. I could quickly get into my soapbox mode on this subject of emergencies/ physicians, etc etc and the benefit of psychoanalytic thinking for recovery, but I will resist :-)….!

    We all are familiar with the “hero surviver”….you know…the one who is soooo thankful, so brave, so blessed, so courageous, so strong, so amazingly positive about everything, so unafraid….the kind of person who makes highly respected pronouncements like “I would never ever wish this on anyone”….or “this is god’s plan and he is in complete control so that relieves my anxiety”…and on and on.

    Well even before my intubation tube was removed after I awoke from my medically induced coma after hemorrhaging, cardiac arrest, then open heart surgery, one of my first thoughts…literally….was “well I’m certainly going to need my insights from my many years in psychoanalysis to overcome…over time… this shock (many described it as “being hit by a freight train”). Enough said….yes emotions are complex and must be recognized, understood and worked and reworked on deep and complicated levels. Cortisol and Adrenaline levels can go through the roof and many times early in recovery, fears of venturing down the block on foot alone can be overwhelming.

    So here’s to psychodynamic methods and thinking that stays with one long after analysis has ended. The reasoning and insights have become hard wired into the brain, so to speak. As yes, some humor is vital!! And yes, these days I’m over the top thankful to be as well as ever and still exploring emotions, a bit wiser and maybe a little more opinionated…;-) One other thing…medical knowledge does help…my physicians husband and son and certainly Dr. Google have been incredibly helpful in many ways including helping me with what questions to ask my doctors which I may not have thought of.
    Good blog post Shirah.

  2. Shelly said

    Shirah, you make yourself sound like you went to medical school as an aside and then left medicine and now practice something else, or you became a healer and went to medical school just for the knowledge. That is very far from the truth. You are a medical professional. Your patients need you and rely on your medical knowledge to know the interactions between their medical ills and the effects of their medications and ones they prescribe or if some of their blood tests come back abnormal, etc… I would hate to think that if a test has an outlier you would say to a patient, “I really don’t know about that, check with your physician!”

    • You are right, Shelly, but at the same time, since I do not practice primary care, I need to know the scope of my practice. Yes, I prescribe medications and I need to stay on top of that, but I also depend on my general practice colleagues to help me determine if there are other things going on. Your point is well taken, however, as you correctly remind me that being a physician is such an integral part of who I am, I forget all of the value that gives me. Thanks.

  3. Eleanor said

    Shirah, Shelly’s comments about your medical training has had me thinking over the holiday weekend. My personal feelings about psychoanalysts and medical training are very one sided in some ways, and I’m a probably too opinionated about this but I’ll share my thoughts anyway. In my (and my daughters) experience with psychoanalysts, we had physicians who were not only psychoanalysts but medical doctors that were boarded in both psychiatry and neurology. They not only had general medical training but also some training in neurology also. (My daughter had massive medical issues with her disabilities)….. They also had an understanding of the neurophysiology and neurochemistry of the brain as well as their psychodynamic perspective. I honestly wouldn’t have wanted to work with someone who didn’t have these qualifications. (I realize this is not a fair statement to those superb non physician psychoanalysts thus my reason for qualifying my feelings as “personal and from my experience only)…..This is one of the reasons why I get so concerned about the state of psychiatry departments in our medical training institutions these days. I also seem to remember you mentioning psychodynamic work is going more and more to those with non medical knowledge.

    • Thanks, Eleanor. You, as usual, bring up a very important point. There are those that are tragically struck with complicated medical conditions who deeply benefit from a psychiatrist/psychoanalyst as part of their medical team. This shortage of such people-psychiatrists/psychoanalysts-deeply saddens me, and looking towards the future, I lose a breath thinking about people like your daughter who may have no option for this kind of help. As it stands now, in most places in the country there are few psychiatrists/psychoanalysts, but going forward, even big cities like Los Angeles, have fewer and fewer psychiatrists/psychoanalysts. Hence you sharing your personal experience is so helpful to this discussion. Thanks Again.

      • Eleanor said

        Yes Shirah, sometimes having some medical knowledge can be profound and I can give one example I have never forgotten and it’s stays with me to this day and helped me after my medical emergency I spoke of. When we met with my daughter psychoanalyst (trained in psychiatry and neurology) after her death from an epileptic seizure we were given the advice…”there is no one to be angry at here”. i.e.: sometimes bad things happen …they just do. He knew enough neurology to be familiar enough to give us this advice. Focusing on anger and blame can be a distraction and hinder recovery. So yes…medical knowledge can be vital at times.

        • That is so interesting, Eleanor. Without medical knowledge there can be tremendous projections about how and why people take ill and pass away. Those projections are fascinating, but often easily tempered by the science that we understand. Sometimes, with therapists who are not physicians they accentuate rather than minimize those projections and in those moments, the MD/psychoanalyst makes a world of difference. Thanks again.

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