Trauma-Informed Thinking

So, I'm not a therapist, but I do delight in sharing the new things I have learned in therapy, the psychoeducation component of those sessions.  This is an invaluable part to my care, to understand and learn more about my condition and my situation through that professional, unbiased perspective while also learning the right vocabulary and names for different elements.  It's how my brain works.  And then I can apply those same concepts elsewhere, drawing further connections and ultimately reframing parts of my understanding into a healthier structure.  

In other words, I enjoy exploring concepts discussed in therapy to further my own understanding of myself and patterns that I also see in others.  And my blog is a safe space where I have enjoyed these explorations.  

So today, I want to talk about trauma-informed thinking.  I knew that one of the angles my therapist employs is CBT, Cognitive Behavioral Therapy, but I confess that I didn't really know what that meant until I was further in my Mental Health and Psychiatric Nursing class this term.  Essentially, how we think about things informs our behavior and sometimes those patterns become "programmed" in ways that need "reprogramming."  For example, someone that is highly anxious might assume that someone is canceling plans on them because the other body is angry with them--there are many reasons why someone changes plans, but the programming does not allow the individual to consider the other reasons in that moment.  Sometimes, we need another perspective to point out the other options.  

In my case, I have a fair bit of fear regarding planning for when (not "if") my body breaks down again and guarding my body from potential concerns.  This means that when I'm considering, say, taking a trip, I'm running a complex risk/benefit analysis first before being excited about the trip, considering the nearest hospital and what my insurance might cover before whether I want to go snorkeling on the first or third day.  Sucks some of the fun out of it straight away.  Or when I'm thinking about leaving a good job to start nursing school (*cough*), there's the question about what kind of security blankets I will have in place (building up the HSA fund, specifically) before things like applications and transcripts.  This can also be a freeze response in situations that "normal" persons wouldn't have a freeze response, such as when a dog jumps up and places their paws on my abdomen, only a few layers between their nails and my intestines.  

The look of a potential threat

Sometimes these pathways are very much something that I have to do, that I have to advocate for myself and know what tools I have.  Other times, it's excess worry and grief or other cognitive pathways that I don't need to go down.  In either case, I recognize that some of these first impulses are trauma-informed thinking.  The trauma that I have gone through frames how I respond and think about certain spaces.  It's not always a "logical" response or a "normal" first response, but it is a response that has been trained at least tangentially from a specific traumatic experience.  

When I encounter a reaction from myself that seems off for whatever reason--based on my own discomfort or the apparent discomfort of someone else--I am practicing to pause and run a systems check:  "is this a reasonable response or a trauma-generated response?"  That systems check gets faster the more practice I put in it, but that doesn't mean it's always a quick answer.  The real trick, though, is not judging the answer.  Both answers are valid--my feelings in those spaces are valid--and now I have a better idea of how to go about resolving the issue.

There are some cases where I can see the same process happening in someone else, noticing a particular reaction and thinking, "I bet there's some conditioning/history there."  This isn't always the case--everyone's brains work a little differently--but at the least it's a moment where I can pause and explore with the individual what's happening for them, to seek clarity or make space where it may be needed.  

Awareness builds intentionally.  Running a systems check at different intervals in the day has been a great first step for me, to keep asking myself those questions even when things are going "well."  It's revealing over time to attempt to reconstruct how and why one thinks the way they think.  I'll never get to the bottom of it, but I will at least start to understand patterns given enough time. 

The Organ Recital

When I was at my lower points of illness, when sitting up in the chair for a while was enough to send my heart rate thumping like I was swimming a mile, there were many, many points where I was frustrated with how weak my body was.  When I was twelve, when I was eighteen, when I was twenty-one, when I was twenty-five, all flares had moments where I felt betrayed by my body--someone that age wasn't supposed to be like this.  

I found at different aspects of recovery from each flare, each surgical step, that later I could sit and hear the symmetry of frustrations from an elderly companion, someone recognizing that their body simply wasn't what it used to be.  A significant difference between my companion and myself was that it was possible and even likely that their body wasn't going to get back to the place it once was ever again while for me there was a lot of unknowns to sift through yet.  Even though I had a different level of optimism about my day-to-day condition, there were no guarantees, but I could still empathize with what we were both feeling in the moment.  

I still remember those places, even now when I'm in the best health I have been in ages.  And I remember the feeling of some of those conversations, to talk with someone that understood.  These tended to happen frequently at church, but also with some older family members.  We were talking frankly about our bodies--frank in our realities and honest in our complaints.  We both gave and took space.  We talked about poop; we talked about aches; we talked about stiffness; we talked about how much endurance we had for "normal" tasks; we talked about ways we had to adapt those tasks; we talked about how not everyone would allow us to talk about these things, interrupting with well-meant comments that shut down their concerns without much empathy.  

Once, I left one of these conversations and a family member asked me how the organ recital was.  When I asked for clarification, they said something along the lines of "oh, you know, my back, my stomach, my kidneys, my eyes...an organ recital."  And, yes, I think that it's an apt name for that kind of conversation.  

And thinking about it, I've experienced the organ recital in multiple ways:

1. As a child, confused but politely listening
2. As an older child, starting to get the idea that some of these things were not normally talked about in other places, but I had been in the hospital and sort of understood that frustration.
3. Acknowledging that this wasn't always a socially acceptable to continue on for long, the incorrect yet also honest answer to "how are you?" but listening politely anyway.
4. Needing to make my own organ recital because that was what was real to me when I was really sick and I fully understood the need for freedom to discuss it and feel heard.
5. Responding with empathy statements, remembering when that need was urgent and allowing them that space, regardless of social acceptability.  
6. Working in a hospital, it is FAR more acceptable to talk about these things, but that doesn't mean that everyone is practiced at it.  Sometimes, I help guide the speaker on how to talk about it with questions and encouraging their own expression.  Sometimes, I briefly mention that I have my own chronic illness, just so they don't have to re-lay the basic groundwork and can jump right to their specifics.  

Having my own experiences with a chronic illness helps me understand the weight of a new, devastating diagnosis.  I won't say that I know all of what their path has in front of them, but I know what it is to have that sense of security in tomorrow shattered.  Having my own experiences in the hospital helps me relate to patients that there currently.  I won't say that I understand their full circumstances and context, but I know enough to relate to the uncertainty and disruption in their lives.  Having a chronic illness has helped me identify with people who are aging, persons who are seeing their bodies slow.  I won't say that it gives me a full understanding, but there is still some commonality of understanding.  

The sound is similar--a genre that I know--but everyone's song is wholly their own.  The real trick is finding a space to play.  As I'm getting ready for work, I sometimes find myself looking forward to hearing another organ recital, partly because I need to know that information to help their care but also that I want to ensure that they have space where they might need it or where I could create it on their behalf.  It's an art.  And particularly with COVID restrictions on visitors, I get the feeling that patients are hungry for that space.  It can be exhausting but also very rewarding.  

The hospital creates a place where we can circumvent the normal taboo.  Advanced age creates a space, too, where we can more readily accept a dump of personal information, be it body mechanical or body emotional.  There are reasons not to talk about certain topics, such as a lack of consent, but a social taboo isn't a good enough reason to refrain from saying things that need to be said.  There's a greater need for these authentic spaces, to create them and to exist in them.  An organ recital can be a holy thing.  Connecting with other people in an authentic space, that's worth far more than preserving certain social rules.

Carrying Secrets

So, Andy is settling into his job at Rivian, and comes home frequently buzzing with excitement.  We'll catch up at the end of the day and he lights up starting to talk about something, and then stops himself.  There are a number of things, he explains, that he's not supposed to tell anyone.  And he does stop.  But I can see that he definitely still wants to talk about it, a quiet buzzing under the skin.  

This hadn't really been a problem before.  When we were both working at Skyward, we knew upcoming developments and changes together or we could otherwise update the other with a mutual understanding--not being public with sensitive information, knowing roughly where that line was, and able to at least talk about any and all scuttlebutt between the two of us.  

However, he's not the only one:  I have secrets, too.  Or rather, I've had them since I've been in clinicals.  I can't go into certain specifics about my day.  I can't share information about my patients that could link back to them.  I can talk about fascinating symptoms in the vaguest sense only.  I cannot geek out about some things until I have enough patient experiences to make up a aggregate "I had a patient once that..."  I am legally bound to keep the information of the patients on my floor.  

(Quick, relevant reminder to today's world:  HIPAA means that as a provider I cannot share your information, not that no one can ask me about mine.)

I hold secrets.  It is a privilege, and it is heavy.  And Andy and I have to adjust to our own mutual circumstances in this.  We both hold different secrets.  We are bound to that secrecy for our respective company's benefit and in my case for the privacy of the patients I serve.  While we recognize that necessity, there's still pressure, the wanting to talk about it.  That means that there is a bit of a disconnect, then, between us.  A minor wall.  It will take some time to sort out how we balance in those places.  

And the goal will not be to eliminate the secrecy but instead to rebalance how we carry those emotional loads and rebalance what it means to our connection.  We can distill out the core of the important pieces that we do need to talk about and can share, yet that will require some additional emotional work to get it to that point, which also needs to fit into that recalibration.  And in time we'll find a pattern in how best to carry pieces forward.  

Revenge of the Blog (Peterson Family Update#3456)

There are lots of big and little things happening in the world, and on a local level there are definitely a number of pieces that make up our home's bigger whole.  

• I'm still adjusting to the idea that I'm not just on a break between the last term and the next--I'm starting to believe it some mornings.  There's still a niggling feeling sometimes that I should be getting back to my textbook readings, but I am steadily moving away from that particular kind of "you need to be productive!" guilt.  
• Luna is, I think, heartily confused by our new schedule.  Andy is gone on weekdays for the workday.  Mike is gone for chunks at a time on multiple days.  I am gone for less days but for a long time on those days.  We're trying to work on some habits and concepts, like how alone time in the kitchen isn't a punishment.  

• One of the last major sections discussed in one of my final courses was all about sepsis.  These sections were very difficult for me to read and process, because it put me back in those memories--all of these facets felt very familiar in some ways.  I had names and patterns for flashes of moments that pieced together into a very horrific whole, blandly stated on a textbook page.  We had a guest speaker come in that voiced her own experience in septic shock, and, while I was grateful for her voice, I also felt trapped in the class, frankly tried to think about something else for parts of it, where I needed a brief gulp of free air.  It fit in with the Seeking the Edges concept, but it was more difficult in that I didn't feel I had much choice in how/when I interacted with it, meaning that it was not my favorite couple of weeks in class.
• By the way, in case folks hadn't seen:  I PASSED MY NCLEX.  It shut off after 75 questions (the minimum, meaning I either did really well or failed it wretchedly), and I tried the trick to re-sign up, got the good pop-up.  Such a relief to have that squared away.  The ball is rolling at Bromenn, to change me over from Tech to RN in the system, work through what orientation pieces I will need and which ones I already have completed.  I got my letter affirming that I had passed and sent it back with a check to the state for my license on Saturday.  Starting to feel like a big kid.  :)  

Real picture of me in the coming weeks

• We had some nursing students on the floor lately during one of my shifts, and that day they were specifically assigned to follow a tech.  I delighted in showing my two persons around and having them try some different things with me, talking about their current course load, the NCLEX, and other random questions as they had them.  
• Andy's new job at Rivian is going well--he comes home full of excitement or tired from being excited most of the day.  There's a lot moving and shaking that he cannot get into the specifics of, but there are many, many good indicators for the company culture.  I'm excited to see how it will steadily affect the area.  
• Switching jobs meant switching insurances.  Rivian's options were much better for our situation (let's be honest, I'm an outlier in most hypotheticals in this arena) than what Carle Bromenn offered, too, which meant that all of the initial pieces for myself had to go through Andy.  And, of course, I had a couple of significant things coming up in August that had specific requirements and necessary gates to go through.  Ugh.  These had to be redone, and within roughly twelve business days.  Effectively we'll be hitting our max out-of-pocket twice within six months, since it will all start over again in January.  *sigh*  
• Andy added about six trees to our yard over the summer.  This is not to mention all of the many other small plants that were also planted around the house.  I hope spring is going to be as pretty as he imagines it!
• Now that we're on the horizon of being a dual income home again, we are starting to think about what our priorities are, for housing projects, financial goals, and what kind of adventures we want in the future.  I want to travel to Iceland late next year, for example.  There are a number of things that we cannot hash out until we have some of the basic numbers sorted out, what my general paycheck range will actually math out to be instead of what I'm guessing it might, but we can at least start some of the speculation phase.  There's hope in those spaces.  
• We're on the precipice of great change in our home, just waiting for a number of things to settle.  There are logistics and emotional facets to consider that we do not yet have enough understanding to work through yet.  We just need to ride the wave for a while.  

More adventures ahead!