[ultramar]

**** Caution for suicidal ideation and abuse ****





As mentioned here before I'm a Spanish Medical Interpreter at a large hospital (interpret at all out-patient practices, in-patient units, ED), and sometimes I interpret in situations that 'trigger' my own issues and I was wondering if anyone who has gone through this (or doesn't work in healthcare but has advice) has suggestions regarding self-care.

Most recently (and the reason for this thread): Late Friday afternoon, a teenager who was being triaged to the Acute Psychiatric Service (in the ER). I was briefed very briefly beforehand (with a series of awful acronyms) as to what brought her to the ER.

After hearing this, I took a deep breath, quite literally physically steeled myself. I remind myself: this. is. about. her. she. needs. you. She was taken into the room and we got started with a psychiatrist.

I know I did well by her. In such situations especially, a kind of protective side of me comes to the fore and I'm able to stuff down my own personal reminders, and any reaction to the awfulness the patient is going through. I'm perfectly calm, I use a comforting voice and body language.

But the aftermath, for me, can be awful. Every once in a while, I'm able to go to a bathroom to cry, I cry at my desk if no one else is around. It helps me to cry, partially. But I often don't have that luxury (have to see other patients, etc.).

If it's a death and dying issue, I feel comfortable sharing with colleagues (and they with me), we all get it, and it's very helpful to talk about it. But things like what happened on Friday, I do not feel comfortable sharing my feelings about, at all.

So I'm left feeling very alone, and in this awful and confusing limbo between my emotions having been staunchly stuffed down, yet emotions fighting to get to the surface.

I've talked about these things in therapy, and sobbed (especially dying patients), but I have my usual problem of being able to do so soon after the fact, but if my session is too long after, my defenses have stuffed it all down again (separating myself from my emotions is a big problem for me). And yet, despite my strong defenses (my therapist has called it dissociation) I do know it all builds up, accumulates.

I guess I'm looking for two things:

1) If anyone who works in healthcare has self-care strategies, or others with such suggestions.

2) Something I've brought up before in a different context: if something awful has happened in your life recently, but session is several days away and by then you've stuffed down the emotions and separated yourself from them: how do you find/feel those emotions again *while in session?*

Thanks, guys.

I work in healthcare. Talking to other co-workers at the time of the event helps a lot, because healthcare providers (and you are included in this of course) are a pretty strange bunch regarding what constitutes a "typical day" at work...frequently it involves blood, guts, death, and someone's worst day of their life.

In addition, I like to hang out with people who have NOTHING to do with my job to get some separation. Also, I have a fairly lengthy commute so I use it to listen to music, NOT talk on the phone, but just spend the time alone to get myself together and get past whatever it is that I've just had to deal with. Finally, I absolutely refuse to get involved in workplace politics because it triggers the crap out of me and makes me take everything else personally.

I have very strict work/life personal boundaries; I rarely friend people I work with on FB; for me I have to have a very distinct line of where life starts and work ends because otherwise I know from past experience that I take on everyone's problems and never really "leave" work. I almost never work overtime unless it's my choice, I don't take on extra duties because I feel what I do is enough, and I try not to enable other health care providers by being the person who answers every question and knows where everything is and how it works...instead I try to gently redirect them because if I spend my shift helping everyone besides the patients, I end up getting home late and that is also a pretty big boundary for me. Oh and last but not least, I ALWAYS take my full 30 minute lunch break with my work cell turned off, and I try to find some sunshine if possible, usually away from the unit breakroom so I can actually feel like I get a break from not only patients and families, but also co-workers.

Hope this helps!

[Miswimmy1]

Taking breaks and detaching yourself from the situation if possible... Also, letting go and finding peace of mind that you did all you could and then worry about yourself because you need time as well...

[stopdog]

I am not in the health care field, but I (in a part time private practice) have clients on death row and represent people being involuntarily committed or who someone is trying to have declared incapacitated (horrible accidents, dementia, strokes etc). Sometimes I am the one who has to refuse treatment on behalf of someone or choose hospice over treatment or "pull the plug." Sometimes over the objection of other people, sometimes with a bunch of people crying/yelling/threatening me.
I remind myself it is not about me and I did not create the problems that got them where they are, keep a sense of humor, and remind myself that death is not the worst thing that can happen to someone.

[~EnlightenMe~]

Ultramar,
I am not a healthcare worker, but I wanted to chime in. I wonder if you can ask others you work with how they handle this day in and day out, outside of the cases of dying. You don't have to be specific, but if you find someone trustworthy, maybe you can talk to him/her and see if you can find a person to talk to and be with you, if just for a short time, when you do have these triggers. I think talking maybe to the seasoned Doctors, who will more than likely understand, might help? Just a thought. It is clear that you are helping a lot of people. I hope you find a way to take care of yourself.

[ultramar]

**** Trigger for CSA ****



Death and dying is sometimes 'easier' than others. If I've been interpreting for the patient for some time and/or it's a child, it's a lot harder. I do an End of Life Family Meeting on average about 1-2 times a month, sometimes more often. But no matter how hard, I have a good deal of support in those situations, talking to colleagues (who have also often times interpreted for the same patient).

The case of the teenager on Friday had to do with CSA (I put an extra trigger icon on this as well just in case) and that's what was so difficult. And it's not something I feel comfortable talking to coworkers about -not the personal things, I'd never do that, but even the encounter itself.

In some situations (including work) I'm very good at compartmentalizing (which helps me to do my job well and I see a great deal of tragedy -it's very hard to interpret very bad news, with family members all crying around me, but I manage it, I never cry or anything of the sort in front of patients, amongst other things, it's not fair to them), but it can also be an impediment sometimes when it comes to getting in touch with my feelings, especially if the emotions are not immediate. It can make it hard to process things (in therapy or otherwise) such as what happened on Friday at work.

Thanks for all of your replies. I think I just need to continue working on getting in touch with emotions in therapy, rather than separating myself so much from them, which is only partially effective in the short-run, and not effective at all in the long-run.

[Perna]

I would just treat it like an "emergency"; generally we're programmed to deal with crisis and then "fall apart" later when it is safe to do so and it sounds like you perform well at your job. I'd just remind yourself you will be going home and can work with it then, etc.? I'd maybe ask your T if there is are some tricks to dealing with crisis that she knows and what would she recommend?

This site has "How to Better Cope" with traumatic experiences, maybe their suggestions could help? Dealing with Crisis and Traumatic Events

[ultramar]

Originally Posted by Antimatter

Ultramar,
I am not a healthcare worker, but I wanted to chime in. I wonder if you can ask others you work with how they handle this day in and day out, outside of the cases of dying. You don't have to be specific, but if you find someone trustworthy, maybe you can talk to him/her and see if you can find a person to talk to and be with you, if just for a short time, when you do have these triggers. I think talking maybe to the seasoned Doctors, who will more than likely understand, might help? Just a thought. It is clear that you are helping a lot of people. I hope you find a way to take care of yourself.

Thanks, Antimatter Sometimes I'm able to chat with one of the providers I just interpreted for briefly afterwards and that has often been helpful. Though at that stage we're still reflecting on the patient/family, not us, it's helpful nonetheless.

Interestingly, as far as 'seasoned doctors', I've been doing this for 12 years and aside from the providers who work in the ED or intensive care units, in some ways we, interpreters, deal with death and other such things more than them, in the sense that if there are any Spanish-speaking patients dying (or whatever else) *anywhere* in the hospital (and it's huge), we go there. But it would be good to get their perspective on what they do, especially the social workers who are often involved in the more awful stuff -it's a good suggestion, I'll ask.

When I worked in NY, there was a ton of 'gallows humor' and that was actually helpful to me. But the culture at the hospital where I am now is very different and I actually realized that they're more respectful here, gallows humor can get a bit dehumanizing. I've found my co-workers aren't into that either, so that coping strategy has kind of gone by the wayside. Likely ultimately for the better, though.

Our department (Medical Interpreting) actually had a workshop on Vicarious Traumatization presented by the social work department a few months ago; it was more validating than specific as far as coping strategies, though. We did discuss sharing with co-workers.

Thanks!