Jungian Psychotherapy with Medical Professionals

Healing the Healer

Suzanne Hales

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000509564
• Edition: 1
• Topic: Medizin
• Subtopic: Pflege

Jungian Psychotherapy with Medical Professionals guides therapists, clinicians, and healthcare workers through the transformative healing process of Jungian psychology, demonstrating how the new spirit of medicine will originate from the relationship between the healer and the healed.

Through extensive experience and scientific research gathered over the past four decades working closely with physicians, Suzanne Hales presents the telling of their stories that have been historically hushed or hidden away. Hales offers a lifeline for healthcare workers as she weaves together the stories of physicians and their patients with gripping honesty, presenting an intimate glimpse of what happens in the lives of healers and the healed. The book offers support to the healer in need of healing, provides hope for wholeness and restoration, and advocates for those who spend their lifetime advocating for others.

The book is of great interest to Jungian analysts, therapists, and trainees, and it is essential reading for anyone working in healthcare, including physicians and healers of all kinds in the landscape of modern medicine.

Chapter 1 We are alone

DOI: 10.4324/9781003144502-1

It is a strange thing that all the memories have these two qualities. They are always full of quietness, that is the most striking thing about them; and even when things weren’t like that in reality, they still seem to have that quality. They are soundless apparitions, which speak to me by looks and gestures, wordless and silent—and their silence is precisely what disturbs me.

Erich Maria Remarque, All Quiet on the Western Front

The bleeding began an hour after the baby was born.

Dr. Rhea's patient went to the hospital for induction of labor at 40 weeks. The induction went well, but after her patient had been completely dilated and pushing for three hours, Dr. Rhea made a decision with her patient for a C-section. Due to a lack of adequate staffing and an OB emergency, the patient had to wait another three hours to get into the operating room. The C-section was uncomplicated.

Dr. Rhea was called at home. The patient was bleeding. She responded to the charge nurse by ordering multiple rounds of uterotonic medication, but the bleeding persisted. Four hours later, the hospitalist (a physician who is employed by a hospital) called for Dr. Rhea to come immediately. As soon as Dr. Rhea saw the patient, she knew they had to go back into surgery. Urgently, Dr. Rhea called for a massive transfusion protocol. The patient was losing blood, and fast.

The patient coded on the operating table and the caregivers started CPR to keep her alive while Dr. Rhea and the hospitalist did an emergency hysterectomy. Scalpel in hand, Dr. Rhea opened the abdomen, while at the same time the patient was being shocked to restart her heart. Dr. Rhea had never experienced anything this severe. Quickly, she called in a gynecologic oncologist to assist. Dr. Rhea knew gynecologic oncologists experience more abnormalities than regular OB-GYNs. Once there, to Dr. Rhea's relief, the older, more experienced oncologist surgeon concurred with everything that was being done.

The patient's status did not improve, and she continued to lose pulse. The intensity of the operating room was suffocating. The staff kept shocking and performing CPR. This had been going on for over an hour and 20 minutes and Dr. Rhea was worried not enough oxygen was getting to her patient's brain. She put her hand on the patient's aorta and concluded she had expanding retroperitoneal hematoma. Dr. Rhea and an expert surgeon called in to assist did not think they could safely do a hypogastric artery ligation to stop the bleeding. In addition to the already mounting crisis, a massive amount of bloody fluid was coming out of her breathing tube. The patient's life was hanging by threads. The gynecologic oncologist didn’t want Dr. Rhea to continue resuscitating. He assured her nothing more could be done; the team of healthcare professionals including physicians, nurses, and technicians had done enough.

Dr. Rhea and the anesthesiologist did not agree. Dr. Rhea responded, “She is still viable.” Unwilling to give up hope, they decided to pack her to temporarily stop the bleeding so her family could say goodbye while she was alive as they moved her to the Intensive Care Unit (ICU).

Dr. Rhea met the frightened and anxious family in the family waiting area. She explained every measure they had taken to save her patient's life, but even if the surgery saved her body her mind might be permanently affected.

The patient went to the ICU where her blood count continued to drop. At this point she had received about 140 units of blood. She was too unstable to leave the ICU for surgery, testing, or treatment, so Dr. Rhea called together the gynecologic oncologist, trauma surgeon, and vascular surgeon to convert the ICU into an operating room. They agreed and unpacked her abdomen and performed the gastric artery ligation.

For the first time, the patient's blood count slowly stabilized. From the eyes of the physicians, it had seemed an eternity waiting for some sight of hope, waiting in the darkness of unknowing for some sign of a turnaround. The waiting seemed endless, merciless.

However, that night her right hand and forearm turned black and blue. Over the next week she developed ischemic necrosis—tissue death due to loss of blood—in all her extremities. The orthopedic surgeons had to amputate her right forearm, her left fingers, and both her legs below the knee. To Dr. Rhea, it was a continuation of the nightmare: The bleeding under control but new complications beginning. The patient continued to live, while incurring more and more losses. Losses that Dr. Rhea was helpless to stop.

Thankfully, when the patient finally gained consciousness and was extubated, her mind was completely intact. Upon awakening for the first time the patient had no knowledge of the battle for her life that she had gone through or that her limbs had been amputated or that she was unable to be with or hold her baby. No amount of medical training could prepare Dr. Rhea for the emotional trauma before her. Her patient continued to have complications: kidney failure, heart failure, hemorrhaging, an inflamed pelvic hematoma formation, and pneumonia. The patient met her baby for the first time more than a month after the delivery. Dr. Rhea followed her daily for six months and is currently following her weekly rehabilitation.

This was a deeply personal and tragic experience for the patient. What should have been the happy birth of a child turned into a nightmare for the mother that will affect her entire life. She will never physically recover fully from what happened and it will likely be a lifelong struggle to heal her wounds mentally, emotionally, and perhaps spiritually.

The trauma of medicine

However, I wish to turn from the patient to the doctor. I want to talk about the trauma the physicians experienced. Dr. Rhea did her best to save this patient's life and mitigate the cruel, seemingly unavoidable damage. The trauma I am talking about is the emotional trauma experienced by Dr. Rhea. The guilt, shame, anger, fear, anxiety, sadness, depression, despair, and often helplessness that can latch onto a healer doing their best, and how they don’t have the teaching or resources to deal with it. The emotional aspects of such an experience go unspoken. Treated as if they don’t exist, these emotions become ghostly hauntings of unanswered questions to the soul. All of Dr. Rhea's training told her to push the experience away and move on. But how could she?

Calling on the tenets of depth psychology, it was Jung who proposed: “Real liberation does not come from glossing over or repressing painful states of feeling, but only from experiencing them to the full” (Jung, 1968, para. 587). There would be no peace found in pretense. And there was no training for the present.

***

I studied family systems in my graduate training. We were taught that the child presenting for therapy or that has been brought to therapy is often the strongest member of the family. Often this child will be identified as the child who carries the family pain. I view the climate of medicine and the life of the physician currently in that same light. The family system of managed care, pharmaceuticals, insurance companies, and medical training are the parents who are taking the very life out of our healers, young and old. Who and when will these entities be held responsible for their part of the disheartened, discouraged, and disillusioned physician? Yes, the physician has to learn how to take care of themselves just like a child in an unhealthy family system. The physician has to learn ways of navigating the system in order to survive. The physician has often been identified as the problem in the culture of medicine. I do not agree with this viewpoint.

A witness

Dr. Rhea called me the day after the initial surgery. Her voice was quiet as she stated, “I need you to help me.” She belongs to a group of physicians with which I meet, and we already had a therapeutic relationship. She began telling her story, pausing only to gather her tears and catch her breath.

We met and she recounted the trauma of the previous night. She recalled the vast amount of blood on the operating room floor, on the physicians and nurses, and on herself. I could see the paralyzing fear in her eyes and the state of devouring sadness encompassing her soft face. She recounted walking out of the operating room and becoming aware of the horrified faces of her colleagues. She remembered the haunting silence of their looks and their voices. What was their silence saying to her? She remembered the lullaby that was playing in the background suggesting another baby somewhere in the hospital had been born. Lullabies and happy melodies that previously elicited feelings of warmth now seemed especially cruel considering what just happened. Sights and sounds now imprinted themselves terrifyingly into her psyche as she fought an inner desperate demon for her heart not to freeze but to stay open to almost insurmountable pain and anxiety. She left the hospital that early morning unsure of what had just happened. Alone.

That morning when she returned home, she was flooded with sadness and anxiety. As she held her own infant son in her arms, she felt guilt as she wept and began wondering if the newborn baby would ever be held by his mother. She battled within her own mind on why she had the privilege of this moment and her patient did not. She held the unanswerable questions inside of her own body: What had happened? Could she have done anything differently? What would happen? Over and over the questions came like an angry, restless sea pounding against the shoreline. But the pounding was now in her heart, pounding with a silent cold rage, a rage demanding of voice, to words that were unspeakable… Her heart was breaking. Since she was a little girl, she had wanted to be a doctor; the innocence of that call and the oath to do no harm were in conflict with the reality she now faced. The paradox of innocent idealism responding with her heart to a call to help others. Now she would stand alone. No one could take this suffering from her. It was hers. She had stood in the face of tragedy, did everything she knew to do, and yet could not find peace and quietness within her own soul. At this point she was standing between the two worlds of life and death. Here is a critical moment for the physician. She was equipped to respond to the physical obstacles. This is not why she presented in my office. She was here in my presence because she was in great conflict with her feelings. Because of the relentless questioning, the never-ending images that appeared in her mind, her emotions were screaming for relief. Her outer world and inner significance were tumultuous. Would she be able to stand in the presence of such a tragedy and know she did the best she could do? Regardless of the outcome?

I asked Dr. Rhea, “Could you see yourself standing in the operating room? Can you see yourself doing all that you were trained to do, realizing that the outcome is not what you wanted it to be?”

“Yes, I can’t get away from it, but I don’t know how to respond to it. What else could I have done?” There was silence.

She responded, “I did all I knew to do.”

The conflict was to endure regardless of the outcome of the patient's life. This journey was now Dr. Rhea's. The abiding question to be lived was: Could the outer events and the inner response come together in a meaningful way resulting in a sense of wholeness and holiness amid this relentless hell?

The following morning, Dr. Rhea boarded a plane with her family for their long-awaited vacation while her mind and spirit were still in the operating room. She was going on a family vacation which seemed viciously ironic to her now. Dr. Rhea called me from the destination. We spoke often. Sometimes she spoke with emotional flatness and other times stopping to focus and trying to breathe as the emotions were so overwhelming. Her mind spun with questions about what had happened and why. She talked to the patient and the hospital doctors every day on her vacation. She was unable to detach from the experience that was now clawing at her mindful resolutions, living with only the questions and no answers, a place of acute anxiety.

The journey of survival

She came to my office the day she returned home. Dr. Rhea was filled with emotion but no words. The emotional impact was still overwhelming to her brain. She was in survival mode as her amygdala was firing in her unconscious mind letting her know of a constant and abiding threat to her emotional well-being. She had been traumatized. Bessel van der Polk, in The Body Keeps the Score states, “Trauma, by definition is unbearable and intolerable” (2014, p. 1). A brilliant young dedicated physician was being forced to go into an unknowable path, alone.

When I am in the presence of such intense and acute pain, I offer more experiential forms of therapy. I was intuitively aware there had to be more than talk therapy to release the emotions that were held prisoner in her body. She had come in on the weekend and we had the entire space for ourselves. I was glad as the vastness of the office was needed for her pain to be expressed.

The daunting images would not be silenced

As she began recounting the story, I could see her body was writhing with energy. I decided to ask her to wait a moment as I left her presence and went to a colleague's office to borrow the punching bag for her. It was big and heavy. She kicked and punched and screamed. She had no words, only guttural instinctive sounds. And yet with every blow, the bag continued to bounce back. It was like her mind. No matter how hard she hit it, it came back. She could not conquer it. She hit and hit and hit. Screaming and crying before surrendering in complete exhaustion. She was traumatized, and I suspect everyone who had been there that day in that operating room had been traumatized as well… We now know that witnessing a trauma has the same impact, sometimes greater, in that the observer often feels helpless to do anything. I wonder about them. Do the images reappear? Does the mind take them back to review the bleeding, the intubations, the manual CPR while being opened? What did they see and hear and touch that sits silently within?

The question of soul

In her physical and emotional exhaustion, she said to me, “I don’t know if I want to stay in medicine. I don’t know if I want to be a doctor.” There was no path for her to follow regarding this confrontation of not knowing. The first 40 years of her life were about knowing logos. The development of her ego. As a physician she was trained to find the source of physical pain, diagnose it, treat it, and bring the problem to a productive end. This development and training are absolutely necessary; however, it is simply not enough to deal with this kind of suffering. There was a question at hand much larger than her ego.

It was a seemingly timeless moment with no answer. Would she stand in the presence of such horror and would she choose what she chose as an innocent child who wanted to help others? Would she respond to her call or would she leave her calling because it was asking too much of her? It is here, I think, that we must provide additional training for physicians’ well-being.

“I know I have to go back. I don’t know if I can bear it. Seeing the OR… even thinking about it, my heart speeds, hearing the lullaby played in the waiting room took me right back to the hours of the morning of this nightmare. How will I ever be free from it? Will I ever be my normal self again? Can I find any kind of peace in this moment of hell? Will I always be a prisoner of the...