Medical Trauma

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.

Previously, 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 that might lead to 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. 

Below, I discuss my own struggles with medical trauma.  As someone with a deep history of trauma, 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.

Recently, I returned for a checkup at the hospital where I received my second heart transplant.  This was my five-year transplant anniversary, and it was celebrated with a lot of medical tests.  Just walking into the hospital with the bright lights in the hallways and the sterile smell in the air immediately set me on edge.  I tried to suppress the rising feeling of unease as my husband and I walked from my first appointment at one end of the hospital to my next at the opposite end.  This required us to walk the length of the familiar main hospital corridor. 

I sensed that I was beginning to spiral when we walked past the entrance to the critical care tower and my husband pointed it out then asked, “How long were you in there?”

Immediately, my mind snapped back to that hellish week following my transplant surgery.  Trapped in delirium, certain I was going to be murdered by the very people who cared for me, I fought anyone who approached my hospital bed.  My combativeness landed me in restraints but being held down in a bed against my will only surged more traumatic memories to the surface. With my body immobilized, my mind stumbled through a minefield of painful memories and hallucinations determined to break my will to live. 

Pushing the rising feeling of panic to the side, I picked up my pace, hoping to pass the elevators at the base of the critical care tower as quickly as possible.  Just as we crossed in front of the bank of elevators, the doors opened, and a team of nurses and technicians emerged with 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-do!”

Panic rose in my throat and froze like a lump of ice.  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, sprinting away from the elevators and my husband who had no idea of my internal struggle. 

I checked in for my next appointment with my nerves on edge, but I tried to pretend that everything was fine, smiling and joking with the nurses and technicians when I was taken back to be prepped for a left heart catheterization.  Everything moved quickly, and I had not finished changing out of my clothes and into the hospital gown before the physician’s assistant came to talk to me. I pulled off my leggings under cover of the voluminous gown that was designed for a person twice my size.

While the PA did her routine assessment, the nurse started laying out the IV kit on the bedside table.  That frozen lump returned to my throat as the impending ordeal of the IV stick in my terrible veins 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.  They roll, blow and collapse.  Do you have a vein ultrasound or someone who is your IV ninja?  I’m not kidding.  You’re not going to get a vein on the first try.  Just trying to save both of us some pain.”

The nurse looked up and I read annoyance in her freckle-rimmed eyes.  Oh shit.   I was being a problem patient.  Immediately my desire to be the golden child, well-behaved enough to avoid punishment, surged from the deepest part of my being, coming out of hiding from fifty years ago. 

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

The nurse disappeared and another appeared in her place.  The PA continued with her questions while the new nurse took my right arm and started examining my veins.  Wordlessly, she started lathering my arm with the sterilizing solution then BAM! The first needle broke my skin.   I sucked in a large breath, trying to focus on the conversation with the PA while the nurse dug around painfully in my vein.  Finding nothing, she withdrew the needle and BAM!  Needle number two.

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.  By now, my mind had left the building as dissociation tried to take me away. I have no idea what the PA said to me during her visit. Vein number two was fruitless, withdrawn, then BAM!  Needle number three broke my skin.

“Fuck!” 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 and the ability to feel pain.

The PA finished up and left the room.  My mind was scrambled, and I could not recall what we discussed during her short visit.

The original nurse, the one with the freckles, had watched the other nurse who stabbed my arm three times with no success.  She walked around my left side and picked up that arm, her fingers running across 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 started swabbing my thumb. 

“Please, not there.”

BAM!  The needle thrust into my thumb, and I saw stars.

“OW! OW! OW!” I cried. 

Suddenly, the male nurse I met the last time I had this procedure appeared on my right side.  He was the one who successfully placed an IV on that visit. 

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

“Please stop!” I pleaded with the nurse who was digging around in the vein on the back of my thumb.

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

She started filling vials with my blood for the required lab work.

“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 male nurse holding my right hand.  “Maybe you could get an IV in my arm?”

“You’ve got an IV already started,” the freckled nurse replied.  “Your case is the next one up. This is a successful IV placement.  I just need to secure it.”

She wrapped my hand with so much gauze it turned my fist into an unusable club, the IV access pointing up at a 45-degree angle.  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. 

When the technician flushed the port in my thumb, I felt the burning and asked again if it could be moved.

“We can’t do that in here,” the tech replied, going on about caseload and no time to reposition an IV.

The procedure room was ice cold, and I shivered uncontrollably on the table.  The vibration caused the machine monitoring my heart rate and breathing to alarm.  Someone asked me to hold still.

“I’m sorry,” I responded, my words as automatic as a flinch.  “I’m sorry.”  The tears were running freely from my eyes by now.

Another technician said she was giving me something to relax, and I drifted off into a drug-induced slumber, no longer caring if my thumb hurt or the room was cold.

Later, I awoke in the same prep room.  The male nurse was there, pulling the sheath from my groin and holding pressure to stop the bleeding.  I cried out when he pushed down on my groin and lower abdomen, causing excruciating pain.

“She has a hematoma,” he said to the freckled nurse, and she left to get the surgical PA. 

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

By this time, tears were running down my face and I was involuntarily squirming to escape the pressure on the incision site on my groin.  “I don’t know.  Bad.  It hurts bad.”

“I need a number.”

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

My experience with pain was skewed.  A normal person would have called it a ten, but I experienced my personal ten on the pain scale when I had osteomyelitis in my sternum following the transplant.  That was the worst pain I ever felt.  The feeling of my bones rotting inside of my body.  They refused to give me anything for pain at that time, and I did not expect anything now.

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

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

For several days after the procedure, the pain stayed with me, forcing me to hobble around the house, but I’m now able to perform my normal activities.  The extra pain that my own mind caused itself due to medical trauma is still lingering, but I’ve learned how to block it out.

Before anyone gets upset, please understand that none of the hospital staff did anything wrong.  I own the fact that my reaction is my own problem.  My trauma response was primed by my walk through the hospital, and the pain from the repeated attempts to insert the IV set it off.  To the outside observer, I was a whiny patient who doesn’t like to get an IV.

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.  There have been times in my life that I have lived with bruises on my body, hiding them from others as well as myself.  Now, I live in a better, happier place, but the sight of bruises on my skin can still pull me down into a deep sinkhole of sadness.

I’m grateful for this gift of life, and I’m grateful for the medical care that allows me to continue living this life.  But I really wish I had better veins.