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Illustration by Mary Kirkpatrick
Mary’s name popped up on my screen, her appointment the last of the day. A hollowness thudded in my gut. Six years ago, as her family doctor, I’d failed her and she’d left my practice. Soon after, she’d moved away to a nearby town. But her new family doctor had referred her to me for a chronic pain consult.
I took a deep breath. I promised myself to not let her down today. Since she’d last seen me, I’d learned a lot more about trauma-informed medical care.
It still surprises me where I am now compared to six years ago. In 2016, I started writing a book about South Africa and apartheid. But first I signed up for writing classes, studying technical and creative writing. The lessons I learned studying writing taught me far more than how to put words on paper.
A writing instructor mentioned Bessel van der Kolk’s The Body Keeps the Score, a book about how our bodies change with repetitive trauma. The book gave me the language to explain how stress affects our minds and bodies. It highlighted a vacuum in the traditional medical model and inspired me to turn to fields of study outside of medicine.
Mentors, university courses, and peer writers showed me a new way to listen, too, by paying attention to stories. My patients shared their stories of racism, prejudice, neglect and resilience. I learned why certain people suffer more with chronic pain than others, why they develop multiple chronic diseases and why they die young. My patients also taught me how they survive. The lessons I’d learned would almost surely benefit Mary.
She arrived on time and sat stiffly on one of the black leather chairs in my reception area. A mask partly covered her round cheeks. Her long dark hair was the same colour as her eyes. She sat hunched in the chair, her body telling the story of past traumas. Adverse child events and repetitive adult stressors had filled out her belly and robbed her limbs of muscle.
“Welcome back, Mary,” I said.
Her eyes lit up when she saw me and I immediately relaxed. She appeared to have forgiven me for my past mistakes.
Mary’s parents’ injuries imprinted themselves on her. She was further assaulted in adulthood by prejudiced and racist behaviours. When I’d seen her before, I’d underestimated the downstream consequences of racism, abuse, intolerance and hate. I hadn’t recognized my ignorance.
Writing mentors had helped me identify my residual racist thoughts, my prejudices and tendencies to stereotype people of colour or those from a different culture. I’d been humbled and spurred to study further. I learned how repetitive childhood insults and exposure to danger or unsafe situations change the body and mind. How complex post-traumatic stress disorder affects individuals, families and societies.
CPTSD sets the body’s nervous system into a state of chronic alarm, the brain and body geared to flight, fight, or freeze. In response to danger messages, inflammatory proteins pour out, wreaking havoc on our blood vessels, our cells, our fascia and organs, priming us for chronic pain, disease and early death.
CPTSD explained my own chronic inflammatory sinusitis and the reasons for many of my patients’ chronic inflammatory conditions. It explained my parents and my nature, my anxiety, depression, obsessive nature, my ADHD, and personality ‘quirks,’ my shifting moods and rocky self-image, from grandiosity to feelings of worthlessness. I now understood why I am the way I am and how I could change.
My parent’s traumas had been passed down to my siblings and me. We’d learned early how important it was not to upset them. I became a people-pleaser. My injured parents could never be pleased, their sense of self was too damaged. Nothing we did was ever quite good enough. This led to shame.
When Mary saw me years ago, I couldn’t explain her chronic pain. Neither could her new family doctor. But I have learned to decipher the clues leading to lingering unprocessed trauma, open wounds being triggered time and again, often subconsciously, producing inflammation in the body.
I now had the missing puzzle pieces but finding the tools to help traumatized patients proved harder. I live and work in Quesnel, B.C., a rural town with limited resources for patients who have chronic pain or mental illness. But I recognized how strong my patients are and I knew they could help themselves.
Using a library course, I created a website, painimprovement.com, with information about pain and links to resources and organizations where patients can find more help. Mary had Internet access. I invited her and her husband to use the tools other patients have found helpful. I shared with her my own story of shame and how these tools have helped me.
Mary and her husband both found these tools helpful. She is able to enjoy her children and grandchildren. She still has pain, and probably will always have pain, but she says her quality of life has improved and her pain is now more manageable. She feels understanding the reasons for her pain was the most helpful process for her.
If there is one thing I have learned during my writing journey, it’s the value of community. It is only through caring about each other and about learning to care and love ourselves that we have a hope of healing our injured society.
Judy Dercksen lives in Quesnel, B.C.