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Tuesday, November 10. 2009
Doctors do not "crack under stress." Not stress from their work, anyway.
Anybody who can handle 48 hours on, 24 hours off as an intern in a big city hospital for a year does not "crack under stress." On my busiest night, I by myself admitted 24 patients to the hospital from the ER. Only one died in the process that busy night, as I recall. An athletic 45 year-old diabetic dad with an MI. Some died shortly afterwards, though.
The worst night that I remember in the ER was a Saturday afternoon when two large families in small cars had a head-on in a parking lot. We had to separate the hopeless parents and kids from the others, fast. There were only two of us on duty. I think two or three kids and one parent survived.
Taking care of people with PTSD - if it even really exists as a "disease" - ain't nothin compared to that kind of work.
And that kind of medical work ain't nothin compared to combat.
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...standing on the mound, look of puzzlement on the face. A strapping left hander, veteran, been kicking around in the minor leagues because of wildness for some years. And now, at a critical moment, gone wild. Walked three straight hitters, Flynn is leading down off third base, Blake off second, Cooney on first....BD out to talk to the pitcher trying to get back in the groove again. There's nobody warming up in the bull pen. This will be it all the way. It has to be. Pitched four days ago against Boston, and tonight's the night. The crowd has grown uneasy...Now, the batter coming up, a big right-hand hitting outfielder from Florida, and he can run like a deer. Pitcher is ready to go. Infield is in. McCormick at first. Frey is at second. Myers is at short. The third baseman is Riggs...and here's the pitch...Strike!!! That was a high fat fastball, right in his wheel house, and it's a called strike! He just stood there with the bat on his shoulder...the crowd is stunned...Now he's walking away?!?
Tim, I think I read his lips...He turned to the ump and I believe he said "Just too damn easy"...
PTSD - if it even really exists as a "disease"
I take it that's a joke. Nobody who ever spent time around doctors could seriously claim that post-traumatic stress doesn't exist.
From The Master Sniper by Stephen Hunter
(Excerpt from concentration camp after liberation. Shmuel - prisoner)
Shmuel drew back as the man’s breathing deepened into regularity. He was aware that a dozen guant faces stared down at him, death masks, and he didn’t care for the sensation. And undertang of DDT, from a recent delousing, hung heavy and powdery in the close air, causing his nostrils to flare.
Shmuel stepped to the door and out. Cool air flooded him, smooth and sweet. Above, an abundance of stars rose in their tiers, like the eyes of the men in the bunks.
There: a metaphor, drawn from the camps. :Like the eyes of the men in the bunks.” Only a Jew would see stars blurry and infinite in bands from horizon to horizon and think of the white eyes of men at the point of death. Would he continue to draw on the camps for metaphors, was that how deep they’d been driven into him? Did the Germans own his imagination, a final, subtler purchase, one that would seal him off from human company, the metaphorical Mussulman, forever?
Yet as he in despair realized the answer was Yes, he realized also that the problem was as much literary as psychological. And from that there followed immediately the recognition that he was, for the first time in many long years, thinking of literature again. He thought he ought to write about the camps, and that sometime, perhaps in a year or so, when one would not confuse zeal with excellence, passion with brilliance, he might in fact, if only as a private exercise.
As he walked down the street, between the mute rows of barracks, he realized what an awesome task he’d so slightly just evoked; perhaps even an impossible one. It was enormous in a thousand ways: had any man the right to try and spin stories from a tragedy so huge? What of people of ill spirit who would read such accounts purely for the extreme sensations they caused, which of course was not the point at all? What was the artist’s responsibility to the gone, the lost, the unheard, the forgotten? And he saw also that in a certain way the imagination had been forever altered. The boundary of evil had been pushed back beyond the horizon on the one hand, but on the other, the capacity of the individual to withstand and triumph over the murderous intentions of the State had also been pushed back. A new form would have to be found, something that would encompass these new boundaries and at the same time convey the immensities of the act of Murder: a new esthetic for the post-atrocity world. Again, the problem of metaphor thrust itself upon him. In the camps, metaphor was everywhere: life was a metaphor, death was a metaphor. How could art be spun from a reality already so charged with elemental symbolism, the vision of hell the Germans had labored so mightily to construct on this earth: satanic sparks, the flames, the awful stench, the dogs straining on their leashes, fangs glistening? Perhaps it was beyond the reach of the artist.
You’d have to concentrate on something small: a parable; panoramas were incomprehensible. Concentrate on one man: how he lived, with as much dignity as the times permitted, and how he died, senseless perhaps, one more sliver of ash in a whirlwhind dank with clouds of ash, but convinced somehow that his life had had some meaning.
- - -
An immense pleasure spread through him. Look at me, he thought, I am thinking again.
Nah.. JOY BLISS ... "ain't nothin."
Some misunderstood me.
1. The symptoms of "PTSD", many of us think, are the natural reactions of some people who go through difficult experiences - rather than a disease.
2. I did not say that those symptoms "ain't nothin." I said that taking care of them is not difficult for the doc. We all do it, often. These people are easy to help out.
"These people are easy to help out."
No doubt, Doctor Bliss, you ice them down with the admonition to grow up. What could be easier?
As you do not appear to know what you're talking about, PTSD is extremely difficult to treat. In fact, in many cases, treatment consists of hope. Perhaps ER work instead of psychiatry would have been more suited to your attitude.
a disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury
D i s o r d e r. It fits.
"These people are easy to help out."
Sorry, but I find that a major presumption. According to what standards I'd first ask. Second, could you please give a hint as to your treatment styles as last I heard there was no treatment, only palliatives, good wishes, and hopes for the best.
'Natural reactions', yes, I can buy that. But past a point aren't certain centers in the brain effectively neutralized or 'disembodied' in a sense. Real organic damage in other words.
Luther, No physical change/damage in the brain though some areas appear smaller than in someone without PTSD. Work in this field continues apace, and the memory 'triggers', once thought to reside in the hippocampus - the filter, and the amygdala, are now found all over the brain. PTSD, complex PTSD, are thought disorders of intense anxiety triggered by memory/memories. It would be nice to neutralize those triggers, and a very inexpensive blood pressure medication seems to work for some to ameliorate much anxiety: Propranolol. Any disembodiment usually comes from dissociation which is a hallmark of severe PTSD. Although 'disembodied' is not often used, the feeling can be just that.
"These people are easy to help out."
Really? I'd like to hear their side of it. Did they find it easy? I doubt it. Trauma is trauma (whether from the horrors of war suffered by a brave soldier or abuse inflicted on a child). What helps? Compassionate care, empathy, time, and a hard working doctor. Good care, like classical ballet, only looks easy. After hours and hours and hours of work on each step...
Aeschylus described it:
"And even in our sleep, pain which cannot forget falls drop by drop upon the heart,and in our own despite, against our will,
comes wisdom to us by the awful grace of God."