COUN 8333 – Vicarious Trauma and Compassion Fatigue

Trauma-Response Helping Professionals Gallery

Michael Wilkinson

Sailor in the US Navy

My name is FC-1 Michael Wilkinson.

I'm in the U.S. Navy, and I've been in the U.S. Navy for 13 years.

I enjoy being part of the military because it's serving my country. Uh.. when I first came in, I really didn't understand the whole process of-- concept of serving your country. And as I've stayed in, I've become more proud of what I do uh.. knowing that I'm here defending my country, my friends, my family.

Some of the reasons that my job is a high-risk job is-- one, you never know what's gonna happen. Uh.. a good example-- the USS Cole. They were pulling in to a port for a nice vacation time there in Yemen. And all of a sudden something-- they got hit by a suicide bomb. You don't know what's gonna happen. So at any time something can happen. Uh.. engines can blow up. Things on the boat can go wrong-- uh.. fires. And you're contained right there-- one vessel, and you have to be able to react to that. If you're not able to, then you can lose life, uh.. the crew, the ship. And you can be just out there on your own.

On my first deployment uhm.. back when I- I think it was '99-- 1999. Uh.. we were on-- in the Persian Gulf doing our normal stuff and uh.. one of the aircrafts was coming in for a landing and as it landed went off the side of the- the deck-- off and uh.. crashed. The two pilots ejected out of the aircrafts. Uh.. we went out-- sent out a-- our rescue helicopter to get them. And uh.. unfortunately, those two pilots passed away. Uh.. the next cruise I went on, which was in 2002, we had another aircraft. It was sitting on deck ready to get launched, and as they were getting launched the catapult system, which launches the aircraft with the help of its engines, ripped the nose cone off the plane. And that plane went-- crashed into the water, too. And we lost that pilot.

So when they lose somebody it- it hurts like a family. And those guys-- you saw people just- just distraught-- upset and just taking it really hard sometimes. And you can just see their attitudes. They- they kept- kept to themselves a lot. They wouldn't talk about things. It was just more like they were hurting inside.

They were able to continue on with their job, I believe, with the support of everybody around them. That's the thing about being in the military. You have support. You have-- between just your- your buddies that you work with from everybody else on the ship-- from the chaplain-- you have-- you have a support system there that uh.. helps you through hard times.

Off the coast of San Diego, we lost five sailors in a helicopter crash uh.. from the USS Nimitz. We were out there just doing routine operations like normal. Uh.. they took off to do their- their helicopter runs into- into uh.. Coronado and they never came back. Nobody knew what ever happened to 'em. It was just-- they were there one minute, and they were gone. That hit the crew pretty hard. Uh.. me personally, I didn't know too many of 'em uh.., but I did feel since we'd been on three deployments with these guys that they're part of our family. And it upset me a lot. Uh.. that was probably one of the one times while I was on the ship that I really had a hard time especially during the funeral ceremony-- that it really hit me hard.

What I was feeling was it was a shame that we lost five young people who were just doing their job, and nobody knows why. And a lot of them had families uh.. and that kinda got to me, too, because I'm thinking at the same time now that I'm married and have a daughter and uh.. if this happened to me, what would happen to my family?

After I got married it was more difficult to go away for the six months at that point compared to when I wasn't married and just going on deployment. Uh.. I had no-- nothing to worry about at home-- didn't really care what was going on back home. It was more I'm out here enjoying myself just living life the way anybody else would. And then once I did get married, all I wanted to do was be at home with the family. So it made it a little bit more difficult, but I still enjoyed going overseas and experiencing the different countries and the cultures and the food and stuff like that, but always in the back of my mind was my family back at home.

Ruth Moore

Private Practice Counselor

I'm Dr. Ruth Moore and I've been in private practice for 10 years. My job responsibilities have included counseling children and adolescents, counseling families, counseling individuals who have experienced a variety difficulties – abuse, trauma, depression, anxiety. So, pretty much I have worked with a variety of clientele with different difficulties, emotional, behavioral difficulties.

There are so many challenges in dealing with this type of work in this type of population. I would say it's sometimes feeling overly responsible for your clients, wishing you could do more to help them. You're working with the judicial system that unfortunately doesn't always protect children. So you have to go home and try to sleep at night knowing that even though you did all that you could do, it might not have been enough to have an impact or to make a difference or to protect the child from the abusive environment.

I've had several clients that really have hit home or really spoken to me I guess in the sense of feeling their trauma, experiencing their trauma. One was a- were two little girls, actually sisters. They were, one was five years old and one was three years old. And they both disclosed that their father had sexually abused them. The five-year-old made the comment about her father's penis and she called it a penis and said that it stuck straight out in the bathtub like a hot dog. And then she disclosed that the three-year-old, that her father made her sit on his face and that she urinated on him and then the five-year-old and the three-year-old were sexually acting out. The five-year-old was perpetrating the three-year-old and three-year-old corroborated the same, the same story as the five-year-old. And when you hear a five-year-old use that type of language and when you – and I'm a visual learner - and so when you hear someone share their experiences and for me you almost do a visual, you, you feel what they're saying, you hear what they're saying, and you see what they're saying – it really impacts you. And for me, I found that to be very, very disturbing and found myself having intrusive thoughts about that for quite some time.

We went to court over that case to try to restrict visitation in a chancery court hearing and the judge right when we walked into the courtroom, he said, before I hear any testimony, I'm going to tell you that I'm giving this father visitation with his daughters. And- and there was medical evidence that there was abuse, there were disclosures, there were all that and he said, but because they were three and five, the court didn't feel that there was, that they were credible enough to take this seriously. So there was no- there were no criminal charges and so the judge said I'm not here to decide whether he's guilty or innocent, I'm here to decide whether or not this father gets visitation with his daughters. And he said and I believe that all fathers deserve visitation with their children, so I'm giving him visitation. And the attorney representing the mother said will you at least hear what Dr. Moore has to say. And so he did allow the testimony and with that we were able to – I call it buying time. We were able to limit the amount of visitation, start off with supervised visits and transition into a more liberal visitation policy. But he eventually got overnight visits with the daughters and all of that. So, in with the court system, that's an example of sometimes where you feel that the court doesn't protect children, it's there to protect the rights of adults and it can be very, very challenging.

Another case that comes to mind, I had a four-year-old little boy that I was working with and they found him at his home with his brother that was 12 and the mother had been murdered. It was a murder/suicide. The mother's boyfriend murdered her and then killed himself. And the 12-year-old was upstairs asleep while this happened and the four-year-old was there but they weren't sure what he saw or what - they weren't really sure what happened. So the police were there trying to put pieces of a puzzle together to figure out what had happened in this case. And so the father had not been involved in the child's life because of some difficulties with the mother, but all of a sudden, they placed this four-year-old with this father that he didn't know. So, the father brought the child to counseling and he was four years old. And the police were hoping that maybe by him coming to therapy and being in play therapy that he might be able to disclose some things or convey what he had experienced. And so in his first session, he came in and all the toys in the room and he found the toy gun he started chanting - the gun, the gun, the gun, the gun, the gun, the gun. And then he started saying the blood, the blood, the blood, the blood. And and all of his verbalizations were in chanting but you could tell his anxiety level would increase and you really could feel his his anxiety as he was chanting this. And as he tells this story, you can basically – it's very choppy, very fragmented – but it basically with that he he heard the yelling and he came downstairs and he walked into the room and then saw the gun, the gun, the gun. And then the boyfriend shot the mother and that's when he aid the blood the blood the blood. And, so, he ran upstairs to wake up his brother, and when he, when he tried to shake his brother, his brother wouldn't wake up because he started saying wake up brother, wake up brother, brother, dead, brother dead, brother dead, brother dead, momma dead, momma dead. And the brother then woke up and so he realized that the brother was asleep and not dead. And so then he came down and then that's when he started chanting about the gun and the blood. And so what we pieced together had happened was that he had gone down and he was back and forth and just so anxious and not knowing what to do. And it was a very, very powerful – a very powerful disclosure. And when you're doing play therapy especially with young children and they reenact their trauma, you see it. I mean it's as if they are, they are demonstrating it. The toys are their words. And so you really, really feel that experience. You know, I had another child as well that was three years old and had been sexually abused. She came into the play room and found a doll and it was one of those dolls that drink and wet, so there was an opening in the - in the, between the legs of the doll. And she found some of the art supplies. We have different kinds of craft sticks and toothpicks and things like that. And she took some of the toothpicks and started inserting them into the opening between the doll's legs and she started saying hush, hush, I'll be through in a minute, I'll be through in a minute, I'll be through in a minute, hush, hush. And she just kept repeating that over and over. And so you knew that that's what she experienced and though she couldn't tell me – it's not going to be a disclosure like what an adult would give, but you certainly can - you feel their anxiety when you're in the room with them.

As a counselor, I think I'm impacted the most by hearing so many stories and though they're all different, there are similarities as well. I think the- I think in some ways, you become cynical and as much as you hate to say that, after you hear a variety of them, you almost start feeling like okay, you've heard it once, you hear it again. But it still affects you because then you start to mistrust other people, you say gosh, is there any good left in the world. And I think that's been a challenge for me in working with trauma and I try to make sure that I take care of myself because you do start feeling like there's no good left in the world when what you're hearing is one trauma story after another, and especially when you feel like that if there's not, if no steps have been taken to protect the child.

Whenever I have a client – whether it's a child or an adult survivor of abuse - in handling my own emotions with that, I've learned to try to keep that in check. I noticed that my stress manifests often in somatic symptoms, so I'll get headaches and back aches, neck aches, and those types of things. So, sometimes I have to be aware physically what's going on in my body, and when I feel that, I know you're taking on too much. Some of what I've had to do is to limit the number of cases that I know that with severe abuse cases because of the court involvement and the stressful nature of that type of work. And so it's limiting the number of cases that I would take so that I didn't feel the emotional and physical effects of vicarious trauma.

To deal with my stress with this population, I exercise. I found that that's a great escape for me. It allows me to if I need to really get, work out some aggression. It's a great way to do that. It's also a way to clear my head. It's my time at the end of the day to be able to decompress and that's much needed. Also I try to do regular, have regular massages. I mentioned earlier that my body, the stress tends to manifest in somatic symptoms and so regular massages and just taking a break from all of the stress is a good way for me to just get some relief from that.

When I began working in the field, I didn't know what vicarious trauma was. I just knew that my head hurt. And I just knew that I wasn't sleeping at night and I just knew that I couldn't, I couldn't look at a hot dog anymore without thinking of a five-year-old's disclosure about it. [02:22:00] And that I thought this can't be normal, and then I became educated and the more that I read and learned about vicarious trauma, then I thought okay, I'm not alone, and I'm not crazy. And this makes sense to me.

Kristin Wilkinson

Social Worker

My name is Dr. Kristin Wilkinson. I've been in the helping profession for 20 years. Eight of those years, I was in community mental health as a social worker, and the remainder of the time, I've been a guidance counselor in the public and alternative school systems.

As a community mental health social worker I worked with adults that had dual diagnosis with mental illness and substance abuse or mental illness and exceptionalities. So, part of my responsibilities were go into their homes, their apartments or into boarding homes that they lived in. I provided intensive case management services, if they were homeless, I would try - part of my responsibilities is to help them look for housing, connecting them with food stamps and just things that they needed to be able to survive. And for the substance abuse, I also try to get many of them into substance abuse counseling or treatment. So my whole entire day consisted of being in the community.

The most rewarding parts of the job of being a social worker, a community mental health social worker was that you felt like you could really make a difference, being able to help other people when you know somebody really needed some help. It was difficult because sometimes they didn't want help, sometimes they didn't want you to be around. So, but it was also part of my responsibility and my job to see them. So, when I was able to establish a relationship with them, I felt like I was making progress and that I was able to help them in a lot of different ways - getting them services, getting them stabilized in the community.

There are many challenges in dealing with this type of work when you're working in the community. One of things was working independently. I would have to go out into the communities and I was- I was assigned to Atlantic City region in New Jersey. One time I went into go see a client of mine, and lived in an apartment that was in kind of a rundown neighborhood. And as I was going down the hallway, I showed up a day after a murder happened and there were still the body lines that were in the hallway and blood was still all over the walls. So, you know you're kind of walking into some potentially dangerous areas. I had been propositioned many times. And you have to learn how to conduct yourself in a certain way. So you don't look as though you're afraid or that you are intimidated, but you also have to be open and willing to accept people that you're going to see. But you have to know how to walk and get along in some of the communities, when they're not so accepting of outsiders.

Some of the other challenges were also being on-call 24/7 and doing this particular kind of work was generally responding to crisis interventions for psychotic episodes. So, if somebody had a psychotic episode in the middle of the night, as opposed to doing a phone call and trying to talk someone down during a phone call, it required me to travel and be in some high risk areas in the middle of the night or have to show up at a hospital at the crisis unit for an evaluation. And I would have to accompany my clients to those areas. And just being 24/7 on-call can be very stressful and very, and very exhausting, mentally exhausting, physically exhausting because you're always worried about something happening and it limits what you can do as an individual.

So many people need assistance - between children, adolescents, families, people with mental illness, dual diagnosed. And being out in the community, you have to find these folks. They're on your caseload, you're assigned 50 to 80 clients at a time. But it's not easy because you are faced with a lot of things that most education programs aren't going to tell you. And you learn a lot when you're out there. And you have to learn how to be creative. For an example, I had one client that she was, had quite an extensive abuse history. And she had been raped but she was also had gotten into cocaine and gotten into crack. And she had no family and she was living in a boarding home outside of Atlantic City or inside Atlantic City. She was also diagnosed with schizophrenia. And I needed to try to facilitate her to have medication and also get substance abuse counseling and treatment. It was very difficult to find her because every time I'd try to show up at the boarding home, she wouldn't be there. We also knew she was at a critical stage because she was bordering on being psychotic at times. So, I found out that she would hang out underneath a steel pier in Atlantic City where a lot of other people that did drugs would hang out. Our relationship started because I would take her lunch and go hang out under the steel pier, and we would engage in conversations, developed enough of a relationship that I was able to draw her out from underneath the steel pier. And we then started going out to – out to get a burger or a sandwich or something. And then I could start bringing her into some services - until one day, I go and try to find her and find that she had died of an overdose. So, those are the kinds of things that can be very difficult because that was shocking to me. At the time, it was very early on in my career and that hit me pretty hard, I had another client that went into another boarding home and he had been diagnosed with schizophrenia and he also had AIDS. If he was angry or psychotic and he didn't want to see me or he didn't want to see anybody else, he would cut himself and threaten to expose me to his blood. Okay, you obviously don't want to see me today, that's fine, you let me know when you want to see me. But we had to keep checking on him because he'd get psychotic and injure somebody else in the community.

I had a client who again had schizophrenia and after a couple weeks had stopped taking her medication and she destabilized and became psychotic and I found her running in the neighborhood. And I had called the crisis units so I wasn't the only one to try and engage her. She became very, very angry, very agitated. So we had to contact the police. Well, the police arrived and it was one police officer and we were explaining to him that she was psychotic. And at one point in time, the cop was trying to talk to her and he just happened grab her arm. Well, somehow and I'm not even sure how she really did it – but somehow she twisted underneath his arm and grabbed his gun with the intention she was going to shoot us all. In the meantime, I had intervened because it was only one cop, he's trying to hold her but he's trying to keep the gun from coming out. The other woman tried to hold her from behind and tried to pull her off the cop. I had gotten my hand underneath between her hand and the gun and I was able to just to get my fingers wedged in there enough to loosen her grip so she let go. But in the meantime, she had grabbed my hand, bent my fingers all the way back and displaced one of my fingers. And then we were able to get her into the police car and then into the hospital. And at one point in time after that, I kind of started feeling do I, can I really do this, do I really want to do this anymore. I questioned whether I had done something wrong, that I couldn't make a good enough difference and questioned whether I should even continue in the work.

And I and I did decide to leave community social work. I think if you're going to do that kind of work, you need to do it when you're young because it takes a lot of physical and mental energy and the physical demands of it are very high sometimes.

I think that anybody that's going into the helping profession needs to have a realistic view of what the job is. They need to have a realistic view of what they're going to face. However, realizing that you – that you're not immune to be affected by it is very important. You also have to know what you're getting into. You have to know the stressors of the job, you have to know what the expectations are.

You have to be able to practice self-care. So, some of the things that I did – one, I stopped taking on-call, I won't take a position that's 24/7. I, you know, would exercise regularly. I would eat chocolate, that I did but that would make me feel better at times. Say you know everything is cured by chocolate. Always had a thing of chocolate in my drawer. Yeah, I would take walks. I would – I would go for a run. I would take the time to spend with my family, you know, and I- I made sure that I had time set aside for me and it wasn't all about the job.

Christine Wallace

Adolescent Counselor

ÒMy name is Christine Wallace, I am a counselor by education, I have been a counselor since 1995. I've worked in a variety of situations throughout my experience as a counselor. I began as the director of an adolescent unit for a behavioral health hospital in Georgia. I also worked in a federally funded study, which interviewed women who had lost their babies in the first year of life. And I also worked in private practice as a counselor in a practice with a variety of individuals from in Kalamazoo, Michigan and working primarily with adolescents and women in transition.

Most of the children that we worked with at the behavioral health hospital had experienced some trauma in their life. It may have been that they were sexually abused or sexually molested, it could have been where they were beaten as children. I had one young man who was actually treated much like an animal, was locked in a room all the time, was given food on the floor, had to eat like an animal on the floor. Had very few social skills, was unable to really interact with other people his own age and was significantly I would say developmentally below other young people his age.

Many of the children that I worked with had been you know physically or sexually abused. So I had experience a variety of trauma. Their time in the behavioral health hospital was probably one of the safest and more structured times that they had ever had in their lives for many of them. We always thought it was funny when you'd see the behavior of some of the young people and you were wondering why, where did this behavior come from and why was someone acting the way they were, and then when their parents came, you understood it very well because you saw from a systems approach that the issues that were coming, that were themselves within the young person actually was deriving from what was going on at home. And it was very sort of disconcerting for not only myself but for my team that was working with these children to work with them on a behavioral health plan, work them to change their behaviors, work with them to restructure their thinking, and then have them go back into the same dysfunctional system that they were in before.

I was on-call at the behavioral health hospital sometimes four and five nights a week and it was not unusual for me to get a call in the middle of the night, two or three o'clock in the morning with some sort of traumatic event that occurred. A child had slit their wrists or I had a young man in particular that used to slice his skin and throw staples up his arms. And so I would frequently get a phone call at two or three o'clock in the morning with staff saying what do we do kind of situations. So, I think the you know you're at a job all day, you're working very hard, you might be working - not usually seven or eight hours but nine or 10 hours a day - and then you're getting, you know a phone call at two or three o'clock in the morning waking you up. Some cases, IÕd have to get up, get dressed and go to the hospital because these children are put in our care, we are acting as a parent and sometimes I had to go and sign paperwork at the hospital and things like that in order to get them care. So I would say that the lack of sleep, the lack of being able to get enough rest, having to make quick decisions sometimes that can affect people's lives. I think the other thing is and when I worked in the behavioral health hospital, I got beat up quite severely.

Our kids all went down to a big lunch area to eat together and they would eat with kids. And it would not be unusual to leave some kids on the unit, in part, probably because they weren't capable of being in a community setting, or they were a danger to other young people. And so it was kind of in a way, you know, a privilege and to show that you'd made progress if you go down and you could eat with everybody else. This young man could not, he was left behind on the unit. And one of my RN's had gone into the unit with a tray with hypodermic needles and he tried to grab the hypodermic needle tray from her and I intervened to make sure that he did not grab the hypodermic needles. And in that process, he grabbed me and he was a very large young man and he got me by the roots of my hair. I had very long hair at the time. And got me down on my knees and he started to beat me with his knees in my neck and my face. And beat me to the point that my scalp swelled where he had grabbed by, he had grabbed my head. But somebody eventually called a code and staff came running down and I remember at the time someone said get up, get up. And I said I can't, he's got my hair. And they had to unclutch his hands from my hair.

I think you think sometimes you're impervious to those kinds of things, like that's not going to happen to me. And when something like that happens, I think you realize how vulnerable you are. And it took me a little while to get over. In fact, I told that young man that I could no longer work with him at all. I mean he apologized and I accepted his apology, but I could no longer be therapeutic with him. And it's also knowing that, knowing that I no longer could do anything with that young man that was going to help him. And I transferred his primary care and his behavioral health plan to another person because anything that I would do would be in an effort to protect myself more than it would be to make sure that he was getting the care that he needed.

You know there is - I don't know that you can be a counselor and not have a variety of things that perhaps impact you, either personally or professionally. I always use the metaphor that I always was trying to be Teflon instead of a sponge. Whenever I was working with clients or working with interns that were maybe perhaps in the behavioral health hospital or coming into the private practice to intern. And they would be somewhat overwhelmed with the stories that people were telling them. I would remind them over and over again that as a counselor, you really need be Teflon, you really need to figure out a way to let it slide off of you so at the end of the day, you're not a sponge that's absorbed all that and then you have to take it home. And I do think that that's a very important skill to learn as a counselor. I also think that that's not something that you learn right away. I think initially it's really hard not to absorb what you're hearing.

I think as far as training for counselors as they finish their programs, I think it's very difficult sometimes no matter hard you think about it and write about it and even through the very beginning of your practicum in your internship, I don't think you really realize sometimes day-to-day, day after day when you're make your living as a counselor and you're really dealing with the wide range of problems that might come into your office. And so you don't know long-term what the affects of hearing people's most intimate moments of their life and in many cases, some of the most horrible moments of their lives, over and over again can have on you. And so I think I would say first of all not scoff at what the long-term affects of vicarious trauma might be in your life. I think the other thing is to – I'm going to quote my old Chinese professor, which I do frequently. And he used to say to me balance in all things. And I really used that when I was a counselor. And that is you need to, you know, work hard, play hard, take breaks, pray, read something that has nothing to do with the profession sometimes just for fun, spend time with family, not forget your friends. And you need to somehow find a way to do a little bit of all of that so that you end up that your whole life isn't just about counseling and your whole life isn't just about other people's lives and other people's experience.Ó

Eric Huber

Emergency Room Nurse

ÒI've been a nurse for little over five years. Uhm.. my initial area was critical care ICU. I did that for a number of years and then went into emergency medicine.

I'm an emergency room nurse, uh.. we just opened a- a new patient tower there so it's fairly large uh.. for an emergency room, it's like a hundred beds plus divided into different- different segments, you know adult population, pediatric population and a psychiatric population. Uhm.. I typically serve the adult population, sometimes uh.. go into the pediatrics uhm.. typically average patient flow uh.. for a day is 300-350 plus patients a day, uh.. so it's fairly-- it's- it's one of the largest emergency rooms in the State of Maryland seeing over 100,000 patients a year.

I had one patient, you know, obviously on some sort of substance come in, I don't know what it was, it was PCP or Angel Dust, one of- one of the drugs and was hallucinating, thought his baby was the devil and decapitated his kid, and brought him in to the emergency room. I mean that's, you know, how do you deal with that, you can't- you can't separate yourself from that. It- it's just horrible. Uhm.. wow, and I- the- the kids are the toughest part to deal with and that's, you know, it's just tough to separate yourself from. Uh.. and I mean you have to, you have to show compassion to the- to the family, to the- uh.. the patient, but it's hard to- it's hard to build up that wall and move on to- to the next person, I think that's real difficult to do. You want to empathize with the patient and you can't really show too much uh.. for them but you don't want to be totally dead to it,

I think one of the things that impacted me while I was working was the passing of my father and that- that- that I would say impaired me a little bit, but- but brought back a little bit more compassion. Uhm.. in that dealing with the elderly, you know, elderly population. Uhm.. one thing that that- that a nurse uh.. gave to me, one of my mentors, uh.. was that, this was in the ICU environment you have these elderly- elderly patient come in, they may have family but they may not be there and they're dying, and in a matter of what, jeez like they may be- they may be passing on but never let them die alone. So I- when I've had a patient that- that's passing, no matter what- whatever my- my other load is, uhm.. I'll- I'll stay with that patient until they're- until they're gone, just because I never really want them to die alone. Uhm.. as far as other traumas uhm.. that have impacted me uhm.. suicide's really hard to deal with, especially obviously the unsuccessful- unsuccessful ones uhm.. in that uh.. wow uhm.. just to- I can't- I can't really bring myself to- or put myself in that person's shoes. You try and do that uh.. to try and feel what they're feeling or- or think of how you can provide better care for them but uh.. a mental disease is kind of hard to uhm.. rationalize uhm.. it's- it's- it's like dia-- think of it as- as like diabetes, you're very sick, but you don't feel it. Same thing with psychiatric illness, you really don't feel it so then it's hard to uhm.. visualize that uh.. and- and- and help bring the patient around, maybe- maybe that's not my specialty but it's just one thing that's hard for me to deal with.

You separate yourself from- from- from the patient, but yet not too far. Uhm.. and that- that becomes the most I think difficult balancing act to do. Uhm.. and whether or not you're successful or not during that day, you really can't tell until your day is over, when you actually get time to sit down and- and- and think of how your day went. Uhm.. and that's when it hits you, uh.. it really may not hit you at work, but after that uhm.. after that day uh.. when there is time to slow down and think about it that's when it really, really impacts you. Uhm.. except of course for- for the major traumatic events when they- when they bring in- they actually do have a crisis intervention teams that can come in and then talk to staff at times uh.. just to help them uh.. through an extremely difficult time if there's a major catastrophe or anything like that uh.. you know we had one incident that a uh.. one of the team members was fairly- fairly traumatic that- that kind of, I think, brought the whole place to a halt which uh.. is uh.. as someone there kind of uh.. was backing out of their driveway and- and ran over their child and they brought them to the emergency room, that was- that was a lot to deal with and, I mean, not so much for- for you, I mean you want to care for that person, it was more of uh.. at least for- for- for those that weren't directly impacted just- just uhm.. coaching for us to help support you know them, and I think that's- that's a good point.

I'd say, there's-- your- your novice nurse is just coming into the- the- the practice, what they would need to do, or what I would tell them if I- if I mentor them through something like this uh.. as far as dealing with a traumatic event would be don't- don't be afraid to seek help. Uh.. don't try and take the burden alone. Uhm.. yeah it's- it's- it's tough, I mean you want to, you obviously want to care for you know somebody else but who's going to care for you? You know, you can't care for yourself by yourself, there- there's plenty of people there for uh.. for help and direct them toward those resources. And your- your closest people are going to be you know whoever you work with. Uhm.. I- I- I don't know, I had a mantra, I donÕt know whether it's good or not, but I'm at work pretty much to work, but not- not to make friends but they- they wind up being your friends uhm.. and uh.. you know there- there's the friendship and there- and then there's the professional side uh.. at work. Uhm.. and when you need support uh.. kind of uhm.. uh.. rely on the professional side and the friendship side of your coworkers because they do care for you. You're going to have to find your own way that works for you. Uh.. but take all the advice you can and- and sort through it and figure out what's going to- what's going to work for you.Ó

Barbara Bennett

Emergency Room Nurse

ÒI am an ER nurse for the last three and a half years.

Our typical duties is you know to process a patient through triage first, and then they come into a room, we'll start an IV or whatever if they need to be done, and any orders that the doctor give, and- blood work, that kind of thing. Take care of the family, take care of the patient, any aspect that they need.

The most rewarding part of the job is not always saving the patient, but helping the family get through it, I think that- that's the biggest part that I love about my- is the whole family aspect of it. They come into the ER, they're stressed, they've got, you know, they're scared, they don't know the process and helping the family through the process of the ER is probably the most rewarding part.

Uhm.. some of them can be very stressed and they tend to take it out on the nurses and they don't always mean to, and half the time they apologize later but it is stressful.

Couple weeks ago I had a patient uhm.. whose family member had a GI bleed and she was actively vomiting and- vomiting blood and he just wouldn't stop being in front of us, he was almost in the way and- and cussing at us, screaming at us. We had to remove him from the room and once she passed away, about a half an hour later he did apologize to everybody. He realized that everybody was in there working trying to help her but it was- you know, he just added to a stressful situation, didn't realize it.

Our average at our ER is about 125 patients a day, after a holiday it's even more uhm.. the other day we had a 193 patients that we process through the ER in 24 hours.

You got trauma patients coming in, you're pulling people out of rooms, and you never really- some days you donÕt get your head wrapped around what's going on and just- it's just the volume of it. So many people go to the ER for everything these days that you just can't always help everybody

On days that it's high volumes I feel like some days I walk away and I didn't do my job and like I felt like I didn't make an impact because I didn't get to really take care of that patient. You know, it was- I felt like I was just kind of processing them in, processing them out without, you know, the care aspect isn't always there and it can't always be there when you have the volumes like that.

There is that realization that you can't help everybody and if you walk away thinking that you can help everybody you're not going to last long in the ER because not everybody can be helped by the ER.

I think because I have family and good backgrounds so I have good support at home so that stuff doesn't stay with me and it doesn't affect me. I'm able to walk away and go home from my job and leave my job at home. Not to say that I don't think about it and, you know, when we have bad days, but you know my couch is my friend when I go home

There are some days that some things like, you know, the- you have- like I've had family members die of certain things, so you know when you have that patient come in, your heart goes out to them a little bit more. So like my cancer patients kind of are- go to my heart because I've had two family members die of cancer so I tend to give them a little bit more attention so I would say that- from that aspect that does affect me.

The nurses that I've worked with at both hospitals are really good. They all work well, when you become nursing, you become friends and you guys end up supporting each other, so you go through the same things together. So it ends up being a good support group.

If there's a bad trauma we can- the support systems come in and they kind of have a debriefing. They'll bring in like the minister or, you know, they have a safety, you know, liaison that'll come help walk us through, make sure that we knew we did everything. The director of our ER's really good about that, and when we have bad days, they know we have bad days, and they try to support us.Ó

Donald Gerkin

Police Officer

I'm Donald Gerkin Jr. I am a police lieutenant in a major metropolitan police department.

I've had various positions in the police department stemming from working on the street and patrol, answering 911 calls to supervising the folks that do that as well as taking a command position over the supervisors that supervise the folks that answer patrol calls. I've also had investigative assignments in narcotics, street crimes and surveillance.

In 2003 I was involved in a shooting where someone pointed a gun at me and obviously wanting to preserve my own life I shot at him before he shot at me. Because of the situation I actually missed him. However, it caused him to drop his gun. So I can't speak to you about the stress of knowing that I've wounded somebody or potentially killed somebody 'cause I know it has happened to people but I didn't realize it 'til a few days later. When I was a training class with the Maryland State Police I saw uh.. uh.. a video where on film a trooper pulled out his gun uh.. at a suspect and I froze. I was sitting in a class and just cold chills went through my body and I realized that, you know, maybe I needed to take a step or two away from work and- and put my thoughts together because even though on the scale of police-involved shootings what happened with me was relatively minor, nobody was hurt even though I did fire my weapon, uh.. it still had an impact.

I managed to cope with that. At this point it's probably 7-1/2 years old and it's probably the furthest thing from my mind at this point. I came to peace with it years and years and years ago and basically it took being removed from the situation uhm.. for a little bit to actually realize that hey, you know, I signed up for this, I knew this- that this could happen, I prepared myself as best I could, you know, mentally, physically, emotionally to win and I won that day, so that's a plus.

You know, strangely enough it's not so much these exceptionally traumatic things that happen or could happen to you that uh.. impacts you professionally on a daily basis. It's just the- the never ending flow of things that are happening to people day in, day out, you know, in this jurisdiction where people are getting robbed or getting raped, shot, killed and so forth it's a- a meat grinder of uh.., you know, crime coming in. And there becomes a point in time where it takes the wind out of your sails is the best way to put it. Uhm.. Certainly, you have to be careful because it's easy to become complacent and say, "Wow. This place is awful. It's been awful for a long time and it's gonna be awful, you know, 'til the day I die so w-, you know, why does it matter?" But when you get to that point especially when you're out in the street and so forth, you know, that's a safety issue. You could end up gettin' yourself uh.. hurt, somebody else hurt and so forth, but I do see that it's- it's exceptionally easy to become complacent just because you're inundated with all this bad if that makes sense.

I think you have to involve some sort of self-care whether it be physical, emotional or both strictly from a point of self-preservation. Uhm.. I am active, you know, at a gym. Uh.. I-- I am probably at the gym four times a week. Uhm.. Obviously, there's the natural benefit of going to the gym but it also is a good way to release anxiety. I uhm.. haven't figured it out, don't know why, but there's something about getting your- your tail kicked at the gym and, you know, leaving tired and sweaty that makes you feel a little bit better, uhm.. and I found that that's actually been relatively important. Uhm.. Emotionally, uh.. mentally I think at least for me, and I can't speak about how other folks might do this, uhm.. you need to prepare yourself long before you're ever in this situation or a situation where all

this stress is coming at you uhm.. to know that A) the day is gonna come when it does happen and B) like this is how you deal with it. Uhm.. Does that necessarily

make it easier? I-- You know, I don't know but I think if you wait until you're in the middle of a fairly hectic or stressful situation and then start thinking or wondering whether or not you're prepared for it you've probably lost that battle. So I found just, you know, from time to time what would I do here or what would I have- what would I have done differently in that situation that maybe would have worked for the best, and I think thinking about things, acknowledging that it exists and that you're gonna have to respond to it in- in some fashion uh.. makes it easier to deal with.

There's a lot of uh.. bravado in law enforcement. You know, there's- there are a lot of divas in law enforcement. There's a lot of folks that think that they are it and there's a culture in law enforcement that you know, we're the police department, we handle problems but we aren't affected by these problems. And it's a tough culture to break from the outside, you know, having a- a counselor come in but also as a young police officer coming in I think sometimes we do these guys and girls a disservice because this atmosphere exists and here they are thinking that this shouldn't affect me because if it affects me it means X, Y and Z. Well, it affects you and even if it affects you it doesn't mean a thing at the end of the day, and I really think that you know, given all of the- the pulling that happens there from different directions and all the stresses that- or the stressors that can sit on someone's shoulder <clears throat> don't be afraid to utilize the things that are in place. You know, the agency provides these things for you and there is no-- I've talked to a coworker who was having some problems outside of work and it wasn't anything arguably significant like when you talk, you know, a group of guys like okay, you know, I understand, we all go through this, but it was bothering him and so be it. And he told me that he went out and he spoke to some of the guys, uh.. one of the psychologists at- uh.. that service that the agency provides, and he felt much better, and my response was "That's fantastic." However, I think culturally there would probably be a little bit of a- like a locker room razzing like oh, you had to go talk to somebody 'cause your delicate little feelings are hurt, that kind of, you know, uber-macho high school football locker room stuff, and at the end of the day, you know, you know, r- it's a bunch of nonsense. You had this expectation as a police officer to be as sharp as possible and uh.. there's a lot thrown at you, many different distractions, and this is just one thing, you know, one of many, you know, the- these stresses that can eat away at that sharpness and not only can it affect your performance, your job satisfaction but I think as I alluded to earlier it's a safety issue. If you become complacent or you become apathetic, then it's not gonna matter to you whether-, you know, what happens and you're gonna go out, do the same thing you do, maybe not pay attention to the guy around the corner of the 7-11 that's hiding behind the Dumpster with a gun and, you know, sure enough you find yourself in a bad position where you might get hurt or- or so forth. It's exceptionally hard in this job to stay aware for eight hours at that level uh.., you know, the level at which they expect police officers to be aware of what's going on in their surroundings. It's a difficult task to ask of anyone and with these things that can erode away at that awareness and just your general, you know, well-being so what if you have to go talk to somebody and, you know what, so what if you saw something awful happen and it affected you. I would argue if you're telling me that you don't that there's something wrong with you so you know, at the end of the day I would say, "Look. You know, it is kind of a macho job. I get that- that stigma that's placed on law enforcement but you're a human being. Don't be afraid to- to- to use these services, that's what they're there for, and unfortunately I think many officers-- You know, it's typical to go after work and go drinking with your buddies and so forth, which is fun, but then when it becomes a replacement for dealing with your mental health then-- I mean police officers have well-documented problems with alcohol abuse, drug abuse, divorce and so forth and that's part of the reason why because instead of uhm.., you know, using the avenues that are in place uhm.. certainly drinking 'til four in the morning or doing some of this other stuff is not the way to handle it. So I would advise these young guys and girls to use it; it's there.Ó

Mat Morgan

Red Cross Disaster Responder

My name is Mat Morgan and I am an international communicator with the American Red Cross. I deployed as a delegate to the Haiti operation in the very early stages of the operation and provided communication support, explaining to the American Public and to other publics what the Red Cross was doing and explaining our decision making process.

Haiti was unique in the world of disaster response. The capital city demolished, 250,000 people, you know estimates vary up and down but a great number of people passed away but then a number much greater than that were homeless and lost friends and family. So being on the ground in the first month of disaster responseÉI think in the first week or two I still had a very na•ve view of what was happening on the ground. It was my first disaster response so I was more interested in learning what the Red Cross was doing, how it was functioning and learning about the nuances of the operation. And that change from the gloss of it being my first time came when I began to focus much more on our beneficiaries. Now that I could explain to the public how the Red Cross was working it was much more appropriate to start showing the stories of people that had survived the earthquake and were asking for, and in many cases receiving aid from the American Red Cross or the Red Cross Societies.

The first instance I think that stands out above everything else is an 8-year-old boy in a hospital in Port-Au-Prince who had lost his mother, had broken his leg when his house collapsed on top of him and left him trapped there for quite some time. This was indicative of the fact that his world had been turned upside down and thatÕs when I realized that what we were experiencing in people and what theyÕre were dealing with and then multiplying that by 1.5 million people in a capital city that did survive and it quickly became overwhelming what we had experienced. And I spent days after that trying to put into context what I had experienced and trying to push forward with the same enthusiasm and the same general commitment to work with the idea in mind that the situation was a lot more grim that I have sort of allowed myself to understand in the very beginning.

Working for the Red Cross you believe that everything you do makes some measurable impact to alleviate the conditions for those on the ground and I canÕt underestimate the importance of feeling like you are part of the solution when you are in a situation thatÕs so grim, you know, and so devastated. I think being a communicator actually helped in many regards because folks who were on the ground as part of disaster response teams did have the opportunity to help but our roles as communicators were to speak with everyone in the operation and then really internalize that and be able to adjust it for another audience. And as tough as that was – just the act of talking about it and writing it or putting it into video or audio interviews helped you know and I think it took a while to become comfortable talking about some of these things. I would say time helps and not to say that any of us were comfortable with the fact that we were becoming, I think – the only term that is coming to mind is deadened- but really desensitized to what we were experiencing and just focusing because you just knew that it was part of the landscape and just push forward. Lastly I have to say that coping mechanisms do come into play here and IÕll speak generally – disaster responders do drink more than other situations. I think that thereÕs just an acceptance that what people are experiencing sort of lends itself into the need to de-stress afterwards and blow some steam off. I donÕt think it was ever irresponsible but it was notable that every night people tended to engage with that.

It was also important to stay in touch with friends and family and the Red Cross does a great job before you go down there to let you know about different ways of coping with the stress and coping with what you are likely to see and experience on the ground. And among thing they mention the importance of keeping those connections with family and bringing things down that remind you of them and other things in your life and making sure that the outstanding issues that youÕre experiencing before you deploy in the field are resolved so you donÕt have that additional thing to worry about and having something to think about other than disaster response in your part.

I think one other thing to mention is that you canÕt do that thing indefinitely. You can burn out very quickly and they work into the Red Cross disaster response model that you can only be down there for four weeks. In the case of Haiti they were only having people down there for three weeks at a time and people that were there for the early response were only there for one or two weeks just recognizing the scope of the devastation they have seen.

We received a lot of calls for help from people who were trapped under buildings and had access to mobile phones and there was nothing more frustrating than not having action, your inability to act on that. And I would say thatÕs very demoralizing and oftentimes tough to sort of push that out of your mind in the context of everything else that you have to work on. There are certainly long hours that we have to pull in major disasters. I would say, in major disasters, we probably work maybe 16 to 18 hours a day, jump in a taxi, get some sleep, jump back in a taxi and come straight back here and work, hammering out again. And adrenaline keeps you going but it can be a lot of work. I think everyone is here for the work. Everyone loves it but you see burnout too. ThereÕs some really high turnover in some of the really stressful positions, because as much as people want to make an impact, there are limits to what people can do.

The experiences in my professional life have impacted by personal life. The story that comes immediately to mind is coming back from Haiti and taking the subway from the airport to home. I had been in Haiti for seven weeks at that time. I had been extended longer than I was supposed to have been down there for because they couldnÕt find a replacement and seven weeks is a long time to be down there in the very beginning stages of an operation of that scale. So I came back and I was on the metro for the first time with people who had not been in Haiti for two months and I felt angry and I felt frustrated. I am not an aggressive person by nature but I wanted to fight someone on that metro. There was this general sense that how could you be here, laughing, living your life (and every had seen the news for weeks by then) as if nothing was happening so close to the U.S.? I think talking to friends and family during and after the experiences, I think I feel disconnected sometimes from them. Right now its not as difficult because IÕm learning from the experience but thereÕs no way you can encapsulate what you have seen, what youÕve felt, and what youÕve done in an environment like that. And people ask questions. How was it? Is Haiti getting better? And the answer is much more complicated than you can fit in a short response and I swear to God no one wants to hear more than a sentence. You know, itÕs the moment you launch into a serious response that people shut down because they donÕt want to hear it or just canÕt understand what youÕre going to say in response. And you know, my family is great and they made a very honest effort to listen to my experiences and I told them in great detail what I have seen. My friends were very good about trying to understand but even then, I think there is a limitation to what they can experience. And sometimes even more frustrating people just sort of pop off the question you know ÔWhat was it like?Õ and youÕre still sort of living with that emotional tinge about what you just lived with for the last two months. So it was tough sometimes trying to articulate that even knowing that sometimes they didnÕt necessarily want to hear it.

You need to experience a disaster to know if its something that youÕre capable of handling. I know there are people who worked here who deployed that thought they would be doing better than theyÕre doing and some didnÕt have the same level of confidence in them but stood up down there and served to come up with some incredible results down there despite being under the circumstances they were in.