Volume 43

December - 2023

 
 

By: Jon Gaddis

Cover: Clay's Ferry Bridge en plein air

I'd always painted inside as a therapeutic outlet, but in the last year have taken to painting solely outdoors. Combining my love of nature with painting has been an absolute game changer in wellness and burnout prevention.

 
 

Cultivating Post-Traumatic Growth

By: Jonathan Warren, MD

Emergency medicine is a demanding field, not only in terms of the sheer amount of knowledge to understand, but also due to the common and routine exposure to traumatic events and high-stress situations. Frequently we want these to go well with the optimal outcome, but all too often we are confronted with negative outcomes, consequences, and a desire to bury these experiences in the past. Post-traumatic growth (PTG) is a less-explored topic in wellness, but similarly important as other topics targeting burnout and stress. There is the possibility for positive psychological changes in the aftermath of traumatic experiences and we hope to outline strategies for you to foster resilience and grow following these harrowing events.

Calhoun and Tedeschi were the first to describe PTG in 19951 and it has recently has been refined with Tedeschis’s paper in 2018, detailing it as a “positive psychological change experienced as a result of the struggle with trauma or a highly challenging situation”.2 Importantly, it is not an alternative, but a parallel process that may happen with the negative effects of trauma. That is, the same event may result in negative effects for one person and positive effects for another. Typically these changes are in self-perception, relationships, values, or philosophy.3

In an interview, Amy Canevello describes PTG as a “trauma [that] shatters your worldview and disrupts your core beliefs. And post-traumatic growth, at least theoretically, is the result of you trying to put your worldview back together in a way that incorporates that traumatic event.”4 Anywhere from 30–70% of people experience PTG to some degree.5

To allow a metaphor, it is like Kintsugi, a Japanese technique and art of repairing ceramics that requires highlighting cracks with gold or other precious metals. When we experience trauma, we can undergo PTG and become something new, a sum of both ourselves and the experiences. It is not pretending that the traumatic experiences did not exist.

You may be thinking, what about post-traumatic stress disorder (PTSD)? That similarly can be caused by stressful, life-altering events. And yes, you are right, and appears to be an area of ongoing research in the current literature. Some studies have suggested that PTSD may be correlated with PTG in that the former may drive the later, but only to a certain point.6

So how can we work toward developing PTG from those traumatic experiences we deal with in the emergency department?

Emotional Regulation:

  • Learn to practice and regulate your emotions. Instead of allowing a spiral of stress and anxiety to overcome you, observe your emotions, acknowledge them for their truth, and then proceed with forward thinking, recalling your success, and preparing for the future. Breath work, exercise, and mindfulness may provide a venue for you to focus and direct your thoughts.
  • It is important not to practice experiential avoidance- avoiding these complex emotions of fear and failure. This will prevent you from taking further steps and can reinforce the insecurity that comes from these life-altering events.7

    • Cognitive Exploration

  • One key factor of those who are able to transform stress into growth is the ability to think about and explore our feelings surrounding an event. Curiosity allows us to pursue new pathways of thought and find meaning in what would normally feel meaningless. It requires being comfortable and regulating your emotions, and being okay with sitting in discomfort.
  • You may suspect this seems like rumination, constantly thinking and focusing on the same event- and that would not be wrong. Studies have shown that with practice, ruminative (previously intrusive and negative) thoughts can become organized and positive for growth.8
  • One way to explore this is through Narrative Reflection or Reconstruction. Journaling or discussing the events surrounding the traumatic experience or sharing with trusted mentors or colleagues can allow you to interpret your emotions and develop new perspectives on the situation.8

    • Service

  • Consider channeling your anxiety toward the benefit of others. This is a large step to make, but you can use your experiences and history to support those who may be experiencing grief or going through similar experiences.
  • If you are not yet ready to channel and share in the experiences with others, you may utilize the same vigor to improve hospital or EMS policies and regulations that may prevent negative outcomes from happening in the future.

    • It is important to note that PTG is different from resiliency. Indeed, those people who may have more resiliency at baseline may have less of a significant impact of post-traumatic growth (that is, their core beliefs are not disrupted as significantly). However, PTG can lead to greater improvements in resiliency, with the person having a renewed sense of purpose and connection.

    Are you interested in writing an article for Art of Emergency medicine?

    Reach out to us through our contact form and we would love to work with you to make this a reality!

    By: Fardis Tavangary, DO

    Post residency international musings

    My partner and I took a 3 week long post-residency (and fellowship for her) international trip through Singapore, Bali, and Thailand. These were some of the shots I took during our travels. For me, photography allows me to take a few extra seconds to appreciate the beauty of whatever it is I’m looking at. It’s been a creative outlet for me ever since I bought my first camera, a good ‘ole Canon Rebel T6, post 6 of the hardest weeks of my life studying for step 1. My art allows me to look back at fleeting moments in life and make them blissfully eternal.

    Ode to the white coats


    Doctors fight for life, in every possible way,
    Through sleepless nights and tough bleak days,
    Standing tall, like shining beacons amidst life's haze
    In crowded halls of hospitals or emergency bays.

    With compassion as our cape, its power magnified,
    Beneath the white coats, true superheroes reside,
    Navigating the storms with an unwavering might,
    Will never broke, shining through the darkest of nights.

    On the battlefield of diseases, we keep marching on,
    We are the keepers of health, undeterred and strong.
    Gaining skills and expertise, being a serene light,
    Bringing comfort and solace to those in plight.

    A gift from God with the lives you pave.
    For in your hands, lies the power to save,
    Stay strong, dear doctor, for your work divine,
    Inspires hope in hearts, and gives strength to shine.

    Image generated by Craiyon

    By: Rida Jawed

    Doctors are the gateway to the hospital and beacon of hope and health for all those walking in through the doors of the hospital. But at times, its tiring physically and emotionally for the care providers as well. This poem is a reminder of our strength and courage during the times we lose motivation.

    By: Jonathan Warren, MD

    The Light at the end

    Do you want to see your art shared with the community? Don’t forget to submit today!

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    References:

    1. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471. doi:10.1007/BF02103658

    2. Tedeschi RG, Shakespeare-Finch J, Taku K, Calhoun LG. Posttraumatic Growth: Theory, Research, and Applications. Routledge; 2018.

    3. Dell’Osso L, Lorenzi P, Nardi B, Carmassi C, Carpita B. Post Traumatic Growth (PTG) in the Frame of Traumatic Experiences. Clin Neuropsychiatry. 19(6):390-393. doi:10.36131/cnfioritieditore20220606

    4. The complicated truth of post-traumatic growth. Accessed December 15, 2023. https://www.bbc.com/worklife/article/20220311-the-complicated-truth-of-post-traumatic-growth

    5. Linley PA, Joseph S. Positive change following trauma and adversity: a review. J Trauma Stress. 2004;17(1):11-21. doi:10.1023/B:JOTS.0000014671.27856.7e

    6. Kleim B, Ehlers A. Evidence for a curvilinear relationship between posttraumatic growth and posttrauma depression and PTSD in assault survivors. J Trauma Stress. 2009;22(1):45-52. doi:10.1002/jts.20378

    7. Kashdan TB, Kane JQ. Posttraumatic distress and the presence of posttraumatic growth and meaning in life: Experiential avoidance as a moderator. Personal Individ Differ. 2011;50(1):84-89. doi:10.1016/j.paid.2010.08.028

    8. Cann A, Calhoun LG, Tedeschi RG, Triplett KN, Vishnevsky T, Lindstrom CM. Assessing posttraumatic cognitive processes: the Event Related Rumination Inventory. Anxiety Stress Coping. 2011;24(2):137-156. doi:10.1080/10615806.2010.529901

    9. Jirek SL. Narrative reconstruction and post-traumatic growth among trauma survivors: The importance of narrative in social work research and practice. Qual Soc Work Res Pract. 2017;16(2):166-188. doi:10.1177/1473325016656046

    This Months Featured Artists:

    Fardis Tavangary, DO

    EM physician who bought his first camera as a present to himself post step 1 exam. Have loved being a hobbyist photographer ever since. View more of his work on instagram.

    Jon Gaddis

    My name is Jon. Prior to EKU's Emergency Medical Care program, I'd always taken an interest in fine arts. I currently work as a paramedic in the Emergency Department (I'm also a current student), and my sense of peace has always been tied to outdoor pursuits; those interests led me to volunteer as a Wilderness Paramedic for RedSTAR in Kentucky's Red River Gorge - which had been a source of inspiration for some of my more recent artwork. The experiences I've had over the years in emergency medicine and the lessons I take from it compliment all areas of my being; I am always learning and growing from them. My art (primarily traditional acrylic on canvas) and my interests across the many disciplines might capture some of the moments on my journey, or reflect upon them. I have found great joy in painting and it has translated positively in all areas of my own life - and hope you can find joy in your own art.

    Rida Jawed

    I am Resident Year III at Emergency Medicine department at Aga Khan University Hospital. I have a passion for writing since childhood and being a strong believer in stoic philosophy, I cherish every opportunity to write from my heart and soul. Entering medicine 13 years back, my writing has become even more heartfelt and deep over the years.

    You can learn more about the artists featured in this and other volumes at our contributors page!