On this week’s episode, Dr. Andrea Austin returns to discuss trauma and how physicians can process the difficult situations they may be exposed to at work.

My name is Dr. Andrea Austin. I’m an emergency medicine physician. I’m also a simulation educator and director of a simulation center at Southwest Healthcare. I’m author of the book Revitalized: A Guidebook to Following Your Healing Heartline.

Emotional trauma is something that’s starting to become a little bit more popular in the lay media, but I still find that a lot of physicians don’t really know what it is, or if they have some concept, they recoil from it because it’s like, “Oh, that’s a problem that my patients have. It’s not something that I have.”

Well, here’s the thing about emotional trauma: none of us get through this world without experiencing it.

One of the best books that I’ve read on the topic is What Happened to You by Oprah and Dr. Bruce Perry. Essentially, they say that trauma is something that we experience through living, whether it’s a family member dying or, certainly for us as physicians, attending to people that are dying and getting bad news.

I also like Faith Harper’s definition of trauma: it’s something that “kicked your butt.” She uses a swear word there. But essentially what we can say is trauma is something that affects you. Armoring up and saying that “dealing with really traumatic things as a physician doesn’t affect me” isn’t really true. What we know from neuroscience is the only people that aren’t affected by things are sociopaths that don’t feel things. We don’t have many of those in the physician community.

Trauma happens, and the good news is, it’s not all bad. Trauma can change us, help us grow, and help us connect with people. Omar Rita has a fantastic book that talks about the woundedness of caregiving work, and to accept and embrace that we will be wounded or traumatized by this work, but the story doesn’t end there. There’s a lot we can do to process that trauma.

Processing trauma is so important and something I wish I had known at the very beginning of my career. Some of us may be more familiar with talk therapy—I had a patient death that’s affecting me. I’m going to go talk to a therapist.

Certainly, talk therapy can be helpful and has its place. And honestly, people often don’t even need to go to a therapist. Having a colleague or friend to talk through something can help us process. But when you find that you’ve talked about something and are still having post-traumatic stress symptoms—flashbacks, ruminating, brooding over it, it keeps coming up, or you notice hypervigilance, that every time a kid with a similar complaint comes in, you are going over the top in diagnostics or stressing members of your team—those are signs that you have trauma and these interactions are triggering you because talking isn’t helping.

What we know from the trauma literature right now is that bottom-up therapy is very important. Bottom-up therapy refers to—and I know this sounds crazy, but this is what all the literature is showing right now—trauma doesn’t just reside in our brains, it also resides in our bodies. The body-mind connection is mediated largely through the vagus nerve. We have to figure out ways to get the trauma processed and moving through our bodies.

There’s a lot of research right now, and even the Veterans Administration is supporting modalities like eye movement desensitization and reprocessing (EMDR) or other movement-based forms of trauma processing, which could be dance, art, or music therapy. All of these different modalities get our bodies moving and can help us express and process the trauma.

And the other thing I’ll say about these bottom-up or somatic approaches that involve movement arts is they don’t involve reliving the trauma. Another sign that you might have unprocessed trauma is that there’s a case or story that you keep repeating. You keep bringing it up to colleagues. You go into detail about it. You tell your trainees and residents, “Don’t mess up, don’t do this thing,” and you go into all these details. That might be a sign that it’s unprocessed. The movement-based forms of processing don’t involve you rehashing and reliving and retraumatizing yourself. You can get it out without having to retraumatize yourself by talking through it again.

Throughout my training as a medical student and residency, compartmentalizing was modeled: you will go from one room in which you gave somebody a terrible diagnosis, into another room in which you’re supposed to entertain and play with a child. And the way you do that is compartmentalizing.

The issue with compartmentalizing is that what just happened, breaking that bad news, is still inside of you. A better practice that’s not talked about in medical education is safely containing. This is, again, something from the psychological realm.

Safely containing is: if you’ve just been in that patient room and had to break some bad news, or it was really a sad, difficult case, instead of walling yourself off and detaching from it (which is actually what compartmentalizing is), you don’t leave your body. You stay with that emotion and that feeling of, “Wow, that was a difficult case.” And you tell yourself, “I need to flag this case. I am mentally putting this in a safe container.” They encourage you to visualize putting that memory into a safe. So you could visualize: “I’m walking this over and I’m putting this interaction into my safe. I’m going to have to come back to this.”

Coming back to it might be thinking about it on your drive home. It might be that I do need to talk to a colleague about this, or I want to journal about it, or I just want some quiet moments. It often doesn’t take a ton of time. In my yoga class or my dance class or on my run, I’m going to attend to this.

And then from there, you can decide what you need to do. It may be something that’s affected you very deeply, and you do need help from a therapist or trained professional to process it further. Or it may be, “Yep, I’ve thought about it, I got it, and I’ve made my peace with that interaction.”

There’s a really important concept related to trauma called the ACEs, or Adverse Childhood Experiences. I would encourage every physician listening to do their own ACEs. You can go on the CDC’s website, and they have a page on adverse childhood events, and do your own.

What happened in your familyhood, your family situations, your childhood—it’s still in you. Glennon Doyle uses this great analogy, that your family upbringing is your software, and sometimes our software needs an upgrade. Some patterns that you have from childhood related to traumas that you experienced may get reactivated. Certainly, working in medicine, in which we deal with very difficult situations on a routine basis, may push those buttons for those early ingrained patterns and behaviors.

Measure your own ACEs. If you’re fortunate and you find out that you have a very low score, that’s fantastic. But even just being aware of this helps for your colleagues and patients.

People that were very draining for me to interact with frequently had high ACEs scores. These would be the patients that had problematic behaviors; maybe they were asking for medications or things that were inappropriate. Now that I recognize that their ACEs score is high, they’ve had a lot of adverse childhood events, so I can be more compassionate in that moment and get to the root of what may be driving some of their problematic behaviors and help them more effectively.

I think that’s a key thing for all physicians, to do your own ACEs score. If there are some things you need to attend to, please do, and then be aware that your colleagues and patients may also have unprocessed adverse events from childhood.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

This transcript has been edited for readability.