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Selfless Caregiving May Heighten Vicarious Trauma

Cultivating insight can help caregivers build resilience to loss.

Key points

  • Emotional identification with someone who experiences trauma can increase the likelihood of vicarious trauma.
  • Victims of vicarious trauma may minimize their own experience and lack insight that they too have been traumatized.
  • Vicarious trauma can increase susceptibility to grief and depression.
  • Cultivating insight about one's reactions to caregiving can help caregivers build and maintain resilience.
Soultwins1/wikimediacommons
Source: Soultwins1/wikimediacommons

Melissa and I were similar in many ways: the same age; fiercely independent; betrayed by our bodies. We used the same coping strategies: kept busy to quell our anxiety, sought companionship for comfort, relied on chocolate to self-soothe. She had a powerful sense of humor that made us both laugh; I have a powerful spiritual faith that kept our hope alive. We were sisters. Not biological sisters, but soul sisters.

As Melissa’s strength faltered, we went to cancer research hospitals: first for a consult about any new chemo (nope), and then a couple of months later for a last-ditch about surgery (nope again). In between those trips, I stayed with her, keeping loneliness at bay. One night, we had to go to the rural hospital as she seemed about to die.

As Melissa attempted to stand at the registration desk in the emergency room, she suddenly cried out, “Help me! I’m having a heart attack! Help! Help! Help!”

I got behind her as she wobbled, ready to catch her if she fell. After what felt like a year and might have been a full minute, the security guard arrived with a wheelchair, which Melissa slid into, weeping and whimpering. A nurse came through the door to the ER examination room and the medical staff took over.

Melissa continued in great distress, crying out periodically as her heart rate spiked to 170 beats per minute. “Help me!” I seemed to be the only one listening to her. The nurses and the doctor were busy trying to figure out what was going on with her heart. We realized that they didn’t know; a wave of panic ran through me as the telemetry showed the irregular rhythms and high speed of her heart, her face showed her fear, and the doctor exuded no confidence.

On and on, the alarming diagnostic procedure went. While the staff kept looking at changing patterns on the screen, I kept moving around the gurney, holding Melissa's hand, touching her shoulder, resting my palm on her sweaty hair. Contact seemed essential.

“Am I dying?” she whispered at one point.

None of the professionals answered. She and I both took their silence to mean “Yes.” I leaned over her. “I’m here with you, Melissa. You are not alone.” She grabbed my hand and held it tight. One of the nurses said briskly to me, “Excuse me. You need to go to the other side of the bed so I can get at this IV.” I walked around the bed as they gave her medication that briefly slowed her heart. For a moment, Melissa was back to her calm and capable self. We all relaxed. And then, boom! The pulse climbed and the arrhythmia returned. Tears leaked from her eyes, and she cried out, “I can’t do this again.” And then, "I don’t want to die!”

I stood beside the gurney, out of the way and close to her, holding the round metal side rail with both hands. I suddenly needed to tighten my grip—my vision blurred, darkness—

I woke up on the floor, confused, questions pounding me from the doctor and nurses. I was eased off the ground and guided to the gurney next to Melissa's as my head swam. “Elizabeth, are you all right?” The head nurse’s voice was loud, clear, kind. But she was supposed to be paying attention to Melissa! I lied and said thickly, “Yes. I just need to lie down. Melissa needs you.”

One nurse moved from Melissa to me, and the rest of the team returned to full focus on her. Melissa was silent, glazed over, out of her body. A wave of fear rolled through me. I whispered, “She’s not dead, is she?” My nurse laughed. “No, she’s right here with us. We’re taking care of her. Let’s get you set now, okay?” and she slid an IV into my arm.

Eventually, the medication they were giving Melissa calmed her heart; her pulse and rhythm returned to normal. I got normal too, my blood pressure stabilizing and my blood sugar rising. The staff went away to decide what to do with her.

I looked over at her gurney. I could only see the back of her head. “Melissa,” I said quietly. She seemed far away. “I’m sorry,” I said.

“I was worried about you,” she said. “I told them that you were going down, and the doctor thought I was talking about myself, and I said, ‘No, she is,' and down you went. The doctor caught you right before you hit the floor.”

Shame blushed up my face. “I can’t believe I did that.”

She laughed, a welcome sound, turning her head to me as much as she could, so I could see the side of her face. “It’s a good story,” she said. And then disappeared into her inner depths again.

“What’s going to happen?” I asked in a while.

“I think you’ll be sent home. I hope they admit me. I’m exhausted, and scared that the rhythm might get off again.”

“Yes, I understand.” I thought of her consult with the doctor at Dana Farber just 18 hours earlier, with the dashed hope that she might qualify for a drug trial. Then the terror of the arrhythmia. The absurd concern that I was ill. And now waiting.

“It’s been a crazy day.” She lay back and stared out into the room. “I’m just glad you’re okay.”

The doctor discharged me. I should drink water and be careful driving home.

“Stay at my place the rest of the night, okay?” Melissa asked.

“Of course. But what about you?”

“They will figure it out.” As she spoke, the doctor arrived and said, “We’re trying to find a place for you. I guess you could go home.”

He sounded doubtful, and Melissa immediately said, “No. No, I can’t. I’m too weak. And scared.” He nodded. I realized he was scared too.

“The nurse is trying to get you a bed at University Hospital.”

“Why there?” I asked. It was 2 hours from her home and 40 minutes from me.

“Because they have a cardiology department,” he said simply, “and we don’t.”

“That’s fine,” Melissa said. “That’s good. I want to see a cardiologist.”

Eventually, I slept in her bed with her cat. At 5:15 a.m. I got a text from her: “At Uni, waiting for a bed.”

That crazy night, I didn’t know that I had been traumatized by Melissa's near-death experience, her grueling decline, her ongoing withdrawal into herself. I prevented myself from acknowledging the shame of having fainted at her bedside. I failed to recognize that I was pierced by anticipatory grief. I couldn’t tolerate the fact that although she didn’t die this time, she was rapidly moving toward death. I couldn’t let myself see that I would lose my soul sister soon.

This lack of insight is, of course, common in vicariously traumatic situations. My case was classic: My strong emotional identification with Melissa increased the likelihood of vicarious trauma occurring. Being so focused on her experience prevented me from attending to my own reactions. And as often happens, the vicarious trauma eventually became problematic for me, especially in the context of the death of my dear friend. Months after Melissa’s death, I made a series of aberrant decisions leading to problematic behavior that evolved into an episode of severe depression.

Being present with Melissa was a choice, and one I will make again with people I love. But next time, I’ll be present with myself too.

Royak77/wikimediacommons
Source: Royak77/wikimediacommons

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