How Doctors And Nurses Cope With The Human Toll Of Gun Violence

Gun violence has become a part of everyday life in America and the work of doctors, nurses and first responders, too.

After the NRA told doctors to "stay in their lane" in response to a policy of the American College of Physicians by firearms.

How do doctors and nurses cope with their regular encounters with the human toll of violence? How does exposure to trauma affect them?

Stephanie surgeon trauma Good estimates that she and her colleagues at University Hospital in Newark, N.J., see about a thousand gunshot wounds and stabbing injuries annually.

She's learned a few things, over the years, to help make her job easier.

Her clothes are often bloody after working on someone who's been shot. She makes sure to keep an extra pair of clean scrubs on her hands.

She has learned to make sure the families of her patients are sitting down when she tells them bad news. She also asks a chaplain to join her.

But when it comes to her own health and the mental health of her colleagues, Good says, the encounters take a toll. "Doctors are humans too, and we can feel these things, we can not just bury that."

Some researchers are trying to understand how to deal with trauma cases and they can get the mental health care they can need.

"In medical school and nursing school," says Kristen Choi, a nurse and trauma researcher at the University of California, Los Angeles. "We're really socialized to just shove it down, we're not vulnerable."

Choi is leading a study of the mental health of clinicians involved in the care of victims of 12 different episodes of mass violence. The study includes interviews with doctors and nurses about how they cope with memories of those experiences.

The work is still in its early stages, but it is important to analyze it because it's an area that has become much more important than ever.

Researchers call the psychological consequences of caring for trauma victims "secondary traumatic stress" or "vicarious trauma." Choi says it can appear to be like post-traumatic stress disorder: nightmares, intrusive memories, and what she calls "trauma distortion," or when normal events trigger thoughts of violence or abuse.

Because Choi adds, it's hard to know what might be most helpful. One thing's for sure, Choi says, "it starts with a culture change in our work environment, making space for clinicians to express these things and be heard."

Team debriefing after difficult cases is one example, Choi says, of a workplace activity that might help doctors and nurses at risk of secondary traumatic stress. Expanding access to low-cost mental health care services, she adds, is also important. "There's only one thing we can do in self-care at an individual level," Choi says.

But those who work in the field say that many hospital departments and local emergency medical services have not been enough to protect the psychological well-being of their employees.

"All of us who have been in EMS, we have been able to do this," says Stephen Wood, a nurse practitioner and emergency medic for Boston area special weapons and tactics team. "Those are the cases that you're supposed to really feel no emotion about."

But if people who take care of trauma victims do not find effective ways to deal with what they see, Wood says, there can be unhealthy responses, like alcohol and drug abuse.

"A lot of people or drop out of the field, or you are less than empathetic than you should be," Wood says. "There is a lot of bravado associated with the field," he says, and it is filled with people who do not feel like they can express their emotions.

He has found help through an email list of first responders who share their experiences with each other. He worries, however, that many first responders suffering from secondary trauma may not know they need help.

Like Wood, other people on the front lines often tend to their own care as they can. Marissa Boeck, a trauma surgeon in training at the University of California, San Francisco, says: "How does it work?"

Even so, she says, the consequences of violence that she sees weigh on her. "Once you touch someone, you feel responsible for how they do," she says. "You carry that with you." "I do not think there is anything that will erase that."

Good, the New Jersey trauma surgeon, says the department does not have a formal system for addressing the psychological effects of treating the victims of violence.

She has been actively speaking on the subject of violence against women, and says that kind of advocacy work is also a way of protecting herself against burnout and secondary trauma.

"There is no doubt about this, but nobody ever talks about the horrible things that we see," Good says. "I would probably have a more patient, more compassionate, and more likely to have car accidents."

Mara Gordon is a family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.

Copyright NPR 2018.