When Carol Lindsay, 32, got her wisdom teeth extracted, she knew she wanted to be completely sedated. She'd anticipated a mask, but the sedation came via a needle to her arm. When she realized what was happening, she panicked—Lindsay has a long-standing fear of needles. She cried for her partner, who was being shoved out of the room. The last thing Lindsay remembers is struggling against being held down for her IV. "Don't worry," she overheard the nurse reassuring her partner, "she won't remember any of this."
Lindsay did remember, and the experience was added to a list of scary encounters she's had in medical settings. Her fear of doctors' offices started when she was a child. The memories of being held down and physically restrained when she got vaccines sit inside of her, like a tether, holding her back every time she has to interact with a healthcare professional.
Dental phobias are extremely common, says Carrie L. Lintner, a dentist who's been practicing in Kalamazoo, Michigan for 17 years. Lintner's practice caters to people who struggle with medical and dental trauma. Patients often relay to her office staff that it has taken them up to two months just to muster the courage to call and schedule an appointment.
"The biggest thing I can do as a dentist is listen. No two patients are the same and have the same fears. It's important for me as a dentist to get to know these patients as people. Once I understand what their fear is, it's a lot easier to coach them through it," Lintner says. Her office offers nitrous oxide, noise canceling headphones, music, conscious sedation, blankets, topical anesthetic, anesthesia buffering, and emotional support by talking through the procedure or coaching them through it.
Lindsay's anxiety isn't just your run-of-the-mill fear of needles, where you joke about maybe passing out when you get blood drawn and make sure to look away to keep from feeling woozy. Lindsay has what is known as medical trauma and it deeply impacts her ability to navigate healthcare. She requires heavy sedation for routine dental cleanings, and generally avoids medical care at all costs because of the severe anxiety that she experiences.
Medical trauma is the physical and psychological responses to pain, illness, fear, or injury that a person experiences in a medical setting. Often, these responses are re-triggered in similar settings, and they can even include symptoms of PTSD. It can result from emergency, panic-inducing situations, and times where something has gone seriously wrong. But trauma also comes about from routine healthcare experiences—physical exams, childbirth, planned surgeries, and dental procedures to name a few. One bad experience sets the stage for anxiety and fear for the next, and so the downward spiral of triggers and more trauma goes.
Alison Barrett, a New Zealand-based OBGYN, says that in her 20 years of practice she regularly sees patients who have medically-induced trauma. In fact, she says, it's more common than not for people to hold some level of trauma around medical experiences.
Barrett says that births are not just linked to trauma because it can be painful and unpredictable, but also because "we still think the safety of the baby is more important than the parent's dignity and autonomy. We still think that experts should have more say in what goes on in birth than the birthing people, themselves. We say things like 'a healthy baby is all that matters.' It's not all that matters."
It only took about four weeks into her pregnancy for 29-year-old Sasha Acker to learn first-hand about that 'healthy baby' trope when she tried—and failed—to access pain relief early in her first trimester. About a month into her planned pregnancy, Acker was diagnosed with trochanteric bursitis, a painful inflammation of the hip, which left her unable to climb stairs or get in and out of her car. No one would prescribe her pain medication, though, because she was pregnant, and her primary doctor told her not to take NSAIDs, like ibuprofen, or other pain relievers. Then, around the same time as her hip diagnosis, she began throwing up five to ten times a day.
Acker spent the next two weeks puking off the side of a mattress her partner had moved to their main floor living room, and calling every OBGYN in her Michigan county. Even though she couldn't walk and couldn't keep food or water down, no provider would see her, citing office policy that patients needed to be a minimum of eight to ten weeks pregnant before their office would see her (a rule among many obstetricians).
Planned Parenthood was the only place that would see her, but their soonest appointment was another two weeks out. "I was very distressed, hungry, thirsty, nauseous, and in a ton of pain," Acker says. Desperate for relief, she began calling abortion clinics across the state. She ultimately traveled three hours to a clinic that was able to schedule her the next day for an abortion. Even though Acker terminated a wanted pregnancy, she says, "My abortion was zero percent traumatic; my very short pregnancy was extremely traumatizing."
For more than a year afterward, Acker avoided going to an OBGYN, even for a routine gynecological physical. " I hated them all. I hated them for not treating me like a human while I was sick," she says. "I felt like as soon as I became pregnant I was no longer a patient to take care of. My body no longer mattered." Before her pregnancy, Acker did not struggle at all with anxiety, but afterward, she found herself obsessing for weeks in advance about upcoming doctor's appointments.
As a mental health clinician herself, Acker could easily recognize these signs as a mental health issue. "I know how to navigate healthcare systems really well. I know how to advocate for myself. I understand physical health and mental health," she says. But following her own trauma, none of that mattered. When she finally did make it back to the doctor, she had to take Xanax just to get through a routine appointment.
Understanding trauma in a healthcare setting is particularly important because, as statistics reveal trauma influences people's everyday experiences and health. For patients of color and other marginalized groups, the trauma experienced in a medical setting can be compounded by cultural insensitivity and micro-aggressions, and race-based trauma as well.
While many providers are doing their best under high-pressure circumstances, Barrett says doctors could stand to be more introspective in how they handle anxious patients. "When a person is traumatized the most important first thing is to hear the story and believe it. So many doctors do the thing of minimizing what happened into this view that the family should be grateful for their care. And this is completely unhelpful, and damaging," Barrett says.
Subtle things in a healthcare setting can re-trigger trauma—things like lab coats, room temperature, the sound of a dental drill, the smell of rubbing alcohol and latex gloves, or being asked to disrobe can all cause unnecessary discomfort for people with medical trauma. But, if providers are more conscious, they can reduce reactions to triggers and make subsequent experiences more positive.
"Trauma-informed care is, at the most basic, building solid therapeutic relationships with people where the patient is empowered and the provider is open to being questioned and recognizes that all good healthcare is a partnership," says Cheryl S. Sharp, a therapist and consultant at the National Council for Behavioral Health. Sharp, a survivor of medical trauma, is doing the work of training providers in a trauma-informed model of care.
Lindsay and Acker are trudging through their trauma as best as they can. Lindsay has done exposure therapy with friends who do piercings or who are phlebotomists, to experiment with needles in a low-key, non-medical setting. She says that has been somewhat successful, but she still procrastinates or finds excuses to avoid medical attention even when she knows she needs it. Acker recently found a doctor that she feels okay about. But her fear of being medically abandoned has thus far kept her from moving forward with her desire to have a baby.
For patients who are struggling in the aftermath of medical trauma, Sharp suggests bringing an advocate and directly communicating about your anxiety and past trauma with your healthcare team and stating your needs. Also, seeking mental health care that focuses on PTSD treatment holds promising results. "Recognizing that one has experienced medical trauma and that it has the same impact as any other type of trauma is important," Sharp says. "Some medical trauma comes [as a result] of insensitive caregivers that need to understand they hold a person's life in their hands."
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