by Jackie Tomasini | Jan 8, 2023 | Mental, Trauma
That day encoded itself in my memory as an example of why trauma nursing doesn’t only refer to the patient’s trauma. It’s a shared experience to everyone involved, like a bomb explosion, affecting first responders who initiate resuscitation efforts – they witness the wreckage first-hand with accompanying smells, sights, and sounds. Next in line is the hospital personnel. Lastly, it’s the family and loved ones who absorb the final waves of the blast – trauma doesn’t ask to fit itself neatly into their calendar. It’s a disruption that obliterates safety and trust in the normalcy of life leaving behind a wound.
The situation was deemed a “traumatic code” meaning the probability of mortality was high
This particular emergency department work shift buzzed with high acuity and volume of patients, coupled with a staffing shortage. Doctors, nurses, and techs huddled around a radio call from the helicopter medics who were bringing in a man, approximately in his 20s, pulled from a car wreck, and they were ten minutes from the hospital’s rooftop. The situation was deemed a “traumatic code” meaning the probability of mortality was high. We knew it was bad and only had ten minutes to prepare the trauma bay. Our training and instincts kicked in. Blood was ordered STAT (immediately) as he’d likely need many infusions for survival. We were going to fight death for this young man the best we could.
The rest is a blur, quite frankly, except for specific moments. The trauma bay was full of more medical personnel than needed because this was a teaching hospital, so interns and students were eager to watch and learn. Urgency laced with hope overshadowed the surroundings as only a miracle would save him, and everyone wanted to see a miracle.
I stood to the left of the patient, as the primary nurse, and vividly saw his insides
Thoracotomies are surgical procedures that give access to organs in the thoracic (upper chest) area. They are fairly rare occurrences in the setting of the emergency department (ED) because it’s something that should be done in a controlled, sterile environment of the OR (operating room). They are considered a last-ditch, heroic effort when utilized in the ED. Some tactics in a traumatic code include manually squeezing the heart because it won’t beat on its own, or removing pressure from blood and fluid around the heart due to injury. For these reasons, it was decided this man needed a thoracotomy.
The trauma surgeon made the cut from the left lateral position. I stood to the left of the patient, as the primary nurse, and vividly saw his insides. In a moment he’d been opened up in hopes of granting him back his life. All other attempts had failed including the multiple IV lines of fluids, blood infusions, life-saving drugs of epinephrine, and other vasoconstrictors to get his deadly low BP up to a sustainable number. The surgeon reached into his chest, pushed his lung aside, and squeezed the man’s heart at approximately 60 beats per minute. Blood flowed down from the bedside and pooled onto the floor by my feet. Meanwhile, replacement blood got pumped through an infusion machine at 1 unit per minute. About ten minutes of this excruciating procedure had passed, but it felt like a lifetime.
Then, the lead trauma doctor “called” it. We had to accept this man’s fate.
Everything went silent in my mind. I felt anger born from deep sadness. There were about thirty masked people in the room, their eyes mystified, scared, anxious, filling in the blanks of how each other felt. I suppose some pictured one of their own on the table. I had to exit the room, leaving a dead man behind, as I had done many times before.
The memory of watching the color fade from his body stuck.
This is part of trauma nursing where you turn off emotions to process them later (if you can even dig them up) and chug on to the next patient. I had signed up for this. The memory of watching the color fade from his body stuck. I noticed a blood drop on my shoe, a physical reminder of the experience which I held for the rest of my shift, and years after.
One minute beads of sweat are rolling off my forehead as I shout orders like, “I need an 18 gauge! More saline! How is the IV? Is the fluid running ok?”, and the next minute I’m taking a report from a medic for a patient with knee pain! Trauma nurses are expected to remain present, compassionate, and happy to serve without signs of frustration, grief, or anger. We aren’t supposed to have regular needs like bathroom breaks for hours on end, or lunch.
His own rift and deep loss moved me, like a vacuum of utter finality – where second chances vanish forever.
I gazed down at the “knee pain” report and noticed the blood drop stain dried on my shoe. I had no time to wipe it off, accepting it as just a normal part of my day at the office. My anger at the “system” surged. Trauma nurses were set up to fail with inadequate support and understanding. Yes, we were angry and grumpy moving from one bloody battle to the next without expressing our true emotions. Yet we learned to cope with the type of sarcasm that only a “seasoned” trauma nurse knows – proof you had been in the death trenches many times.
But even worse than death, is the aftermath. I saw for a brief moment, while performing the rounds in between one crisis and the next, the father of the young lifeless man slumped over his son in the trauma bay, crying. His own rift and deep loss moved me, like a vacuum of utter finality – where second chances vanish forever. No more “I love you”, and no more “do-overs”. It was the beginning of his grief marked by the completion of a chapter with his son.
That night I lay in bed with adrenaline flooding my body. Trauma nurses don’t clock out when their long shifts end. They often go home to replay the day’s scenarios with no off button. Some scenes linger for days, or months, as though hard-wired on the brain. “Just relax” becomes an annoying pat phrase that rolls off the tongue of someone ignorant to the weight of it all.
Trauma may even affect our physical appearance like the deformity due to an accident
That blood stain never fully washed off my shoe leading to many perspectives and perceptions. Many of us carry memories of trauma in our lives, often forgetting one for the next while the physical signs stay with us in the form of unprocessed emotions. Trauma may even affect our physical appearance like the deformity due to an accident, exposing evidence of a past hardship begging to be dug up and given its proper attention. Trauma nurses often drag strainful experiences to the next room, patient, job, and everything else. We work hard to put on a face and still act professionally, like having a casual conversation with someone in front of us, while under the surface wanting to scream, “Don’t you see the blood? Is what you are saying really as important as this blood?”
With a lot of grace, compassion, and willingness to sit in these spaces with others we find that we all have the “blood drop” of anguish to one degree or another. Although I didn’t see it on that horrible day, I realize we don’t have to die or be near death for one person’s hardship to elevate above someone else’s. Pain shapes how we see death and creates a new tolerance and threshold for stress. We grow, change, gain new perspectives and learn our limits. When your perspective becomes relative to knowing the love of God you know that all people matter to him equally.
Christ understands trauma, perfectly. I imagine as He hangs on the cross, a blood bead rolls through his brow, down his nose, landing on my shoe. He doesn’t erase the memory of the patient but shares it with me in this present time, allowing me to silently remember how He allowed His own death for our salvation. Stillness comes in the act of His one blood drop.
by Jackie Tomasini | Dec 18, 2022 | Mental, Trauma
Here she lays in the dragon’s lair overcome with spirit shrunk back and ashamed of her cowardice. She’s shell shocked because the one she loved is so deceptive and willingly coerced her here. She’s angry, self-loathing, and self-disrespecting at her own weaknesses. She re-frames the situation to fit a more acceptable, less painful reality. Justifications and minimization mount. Truth and reality are edged out and the size of the dragon grows.
As long as she keeps the peace, doesn’t challenge the dragon, then it sleeps. On days of strength, days she stands up for herself, he awakens and it singes her with his intimidating, fiery breath that smells like death. She’s conditioned to keep the ‘peace’. She re-frames her perceptions to fit the dragon’s narrative and make it more bearable.
She knows the one she loved became an idol that grew in power over her. She is caught in the thorns of idolatry.
She’s angry in her pleas for everything to be made right, but under the layers of the words, it’s clear to her she’s communicating her desire to be free and frantically looking for the road back. In fact, that road has been hedged. She is led to the scripture Hosea 2:6-7 that says, “Therefore I will hedge up her way with thorns, and I will build a wall against her, so that she cannot find her paths. She shall pursue her lovers but not overtake them, and she shall seek them but shall not find them.”
She knows the one she loved became an idol that grew in power over her. She’s caught in the thorns of idolatry. The life she knew is gone and this reality is too much to bear and grieve. She can’t adequately articulate her pain to convey the extent of the loss. She knows she is punished with the consequences of going after her lovers and for forgetting the Lord (Hosea 2:13). She believes God has turned against her.
Truth is re-framed – reality distorted. She’s no longer looking at her image in a clear glass, it’s like fun-house mirrors at a circus. The walls of the dragon’s lair are covered with wavy self-reflections. She dreads walking by them for fear of catching a glimpse of herself. Her own reflection is unrecognizable and disproportionate. She’s embarrassed by her appearance and cowardice. She’s enraged that the one she loved was willing to overpower and conquer her. She feels duped and lost trust.
There are some who willfully choose evil and even enjoy inflicting pain
The lair is cold, dark, musty, draining. Her smile is replaced with a scowl, representing her spirit. Instead of walking free in a land of vibrant streams and tall, shady trees, she’s traumatized by psychological land mines the dragon has proudly planted. While he enjoys watching her navigate the mine field, he gets irritable when she cries with pain after stepping on one. Nowhere is safe to walk, as there’s always something hidden, dark, and sinister that will break her heart.
She’s learned a hard lesson about those who choose evil and enjoy inflicting pain. The smirk on the dragon’s face shows it all. There’s no remorse, concern, nor intent to protect. He’s turned on by his power over her. Naively, she prays, “this isn’t him, he doesn’t know better”, “he just needs God to heal him”. She commits to him and tells herself anything in hopes the dragon changes back into the man who once had light in his eyes, love, and admiration in his heart for her. They shared a common fear and awe of God at one time.
Occasionally, she hears Him clearly only to lose the signal again to static white noise
She doesn’t know it now, but will learn it later, that she’s bonded with the dragon. She makes excuses and feels sorry for it, but he doesn’t return the favor and has no appreciation for her attempt to help cast out his rebellious nature. So she goes back into hiding; ashamed. God’s voice has become unclear, as though the radio towers were demolished causing the frequencies from God to be scrambled. Occasionally, she hears Him only to lose the signal again to static white noise. Her disconnection keeps the dragon feeling powerful, as he abuses her with deception, intimidation, and at times, brutal force. Hatred grows in her heart – a bitter root replacing a past deep love.
She realizes hope is actually nothing more than magical thinking. No one is coming to help get her. She yearns to describe her insides and convey what it’s like in the lair, but even she believes the lie and convinces herself of having high expectations.
But one night, she has enough, and while he sleeps, she runs deep into the forest until the sight of that awful castle is gone and she never looks back. God shrinks the dragon back to the size of a typical man and vanquishes the fight in his heart. He realizes it’s all over when he awakens to see she’s gone.
She still feels the tension in her muscles and is instinctively on high alert, looking for land mines
She starts over. The dragon gone, but memories of his hot breath linger for some time. At times, she still feels the tension in her muscles and is instinctively on high alert, looking for land mines. She’s afraid others will smell remnants of stench from the lair, or her appearance may seem distorted or disgusting to the world. She’s vulnerable, yet taking risks and wanting to see herself without misconceptions, justifications and minimization.
She wants truth in all things and love above all. She is reminded of I Corinthians 13 and knows love is the answer. Not the worldly, soulish kind that’s based in emotion. No, what she craves is the love that comes from God that is peaceable, pure, cleansing, that instills hope, trust, respect and dignity. She wants the love that protects, leads and guards with a watchful eye. She responds to love. Her spirit opens wide to love. Her eyes are cleared and ears opened in response to love.
She knows it is time to accept her part, to wash off the stench, to change her clothes
The relationship with the dragon is gone, but it is love and God’s Spirit that break the remaining mental bondage to heal and re-frame the memories. The way of love is the path to healing for “Love is patient and kind; love does not envy or boast; it is not arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice at wrongdoing; but rejoices with the truth” (I Cor 13: 4-6). She knows it is time to accept her part, to wash off the stench, to change her clothes and agrees with the words of the Apostle Paul who says that “When I was a child, I spoke like a child, I reasoned like a child. When I became a man, I gave up childish ways. For, now, we see in a mirror dimly, but then face to face, Now I know in part; then I shall know fully, even as I have been fully known” (I Cor. 13: 11-12).
She knows love does not coerce, nor provoke, or cause confusion through a deceptive tongue. Love doesn’t smirk nor over power. It does’t yell or intimidate or try to control. It holds loosely and points to God. It removes obstacles to God, doesn’t create them. It points the way to right relationship with God. Love creates opportunity and increases the land and seizes the inheritance of God in humility and with a heart of gratefulness.
Yes, she is determined to re-frame her mind; to align her perceptions with truth, in love. To look at herself in a clear glass, no longer seeing herself dimly in the funhouse mirror. She is on a road to knowing God fully and being fully known until she sees her true reflection; the one that reflects how she was created in the image of God, until the mirror tells her she is a friend of God (John 15:15), a citizen of heaven (Philippians 3:20), a new creation (II Cor. 5:17), a chosen people and God’s special possession (I Peter 2:9), cleansed from unrighteousness (I John 1:9), purified, clean and washed whiter than snow (Psalm 51:7), pardoned (Jer. 33:8), redeemed and zealous for good deeds (Titus 2:14), sanctified and justified in Jesus and in the Spirit of God (I Cor. 6:11). For, her worth does not come from man. She looks to God to fill her cup. The scowl is gone, the smile returned.
The dragon wars for her mind, but she looks into the face of love and experiences kindness, mercy, and the gift of freedom. She remembers Hosea chapter 2 again and how God has spoken of this passage so often to her, “’I will go and return to my first husband, For then it was better for me than now.’” (Hosea 2:7) and her God responded saying:
“Therefore, behold, I will allure her, Will bring her into the wilderness, And speak comfort to her. I will give her her vineyards from there, And the Valley of Achor as a door of hope; She shall sing there, As in the days of her youth, As in the day when she came up from the land of Egypt. “And it shall be in that day,” Says the Lord, “That you will call Me ‘My Husband’ And no longer call Me ‘My Master’…”I will betroth you to Me in faithfulness, And you shall know the Lord”…”Then I will sow her for Myself in the earth, And I will have mercy on her who had not obtained mercy;…” (Hosea 2:14-16, 20, 23).
And, so she sings…
by Ivo Tomasini | Dec 17, 2022 | Mental, Paranoia, Spiritual
In a world dominated by an incessant drum beat of “us vs. them”, we must ask ourselves – who are “them”? Who are we fighting? How well do we know them and how defiant is our stance against them? Today’s economically sensitive culture is ripe for picking an enemy and blaming it for whatever obstacles lay in our path to winning that bonus, chasing that dream, or freeing ourselves from addiction.
You realize the true battle suddenly lights up with picture perfect clarity – it is “you vs. you”
On the other hand, if we can stop to think as individuals, to wipe away the mental blur induced by an arbitrary antagonist, one can put into focus the critical obstruction keeping us from attaining our goals. Like the face staring back at you in the mirror, you awaken to the unflinching fact that the villain in this game is actually you. Once you step away from the hype spun by the media machine, hearsay, gossip, politics, news, talk shows, etc. – you realize the true battle suddenly lights up with picture perfect clarity – it is “you vs. you”.
The manufactured formula for swaying human emotion is powerful, and worth billions of dollars to those who control it. People almost always fall for the contrived notion of a hero saving us from the evil “them”. Our minds effortlessly take comfort in placing the full blame of our problems onto an external bad guy…eventually allowing all possible solutions to gradually slip further into the distance of an after thought, separating us from the present state of reality.
According to the bible, ¹ everyone is in need of redemption. Our natural condition was characterized by guilt: “all have sinned and fall short of the glory of God” (Romans 3:23). Christ’s redemption has freed us from guilt, being “justified freely by His grace through the redemption that is in Christ Jesus” (Romans 3:24). The word redeem means “to buy out.” The term was used specifically in reference to the purchase of a slave’s freedom.
The former slave gains because he sees the real fight for what it is
The former slave, like an addict who drops the drinking habit, gains back his full potential when he himself changes – or asks to be redeemed, without waiting for an elusive enemy to fall, or for some phantom hero to rescue him. The former slave gains because he sees the real fight for what it is – an actionable change that starts by asking for redemption.
The next time you’re brushing your teeth, stop for a moment to face yourself in the mirror and ask, “God, what can I do today that will help me find peace, even if it’s a tiny action?” Then spit, rinse, repeat every day, and know that with a little faith, things will begin to change and the enemy will fall.
References
¹Gotquestions.org
by Jackie Tomasini | Aug 14, 2022 | Trauma
She’s stuck. The mud, the rain, the night; this same scenario repeats over and over like a loop set on re-play. Each day she gets out of the wagon, walks around to the back, driver side wheel, drenched in the night rain, and sees the wooden wagon wheel in the huge pot hole. The task of getting it out and moving onward just seems to be too much. She is cold, shivering, alone, lost and wonders where she is even heading. So, she kicks the wheel, curses the mud, cries in frustration and waits for her will to return and for a helping hand to get her out.
It’s not so much that she feels sorry for herself as it is that she just doesn’t see the point… and….that she is lonely. Hope has been traded for mere instinctual survival. What’s the point in re-playing this scene over and over only to get out of this pot hole to then get stuck in another one? She looks up and sees the street signs and the signs are all around. They all seem to mock her with words like “there’s no point”, “the never-ending road”, “the road to nowhere”. Dizzy with confusion, sadness and despair she slouches down, covered in mud- head to toe. She does so more in despondency than self-pity, remembering what it felt like to love, what it felt like to hope, to be secure, to dream. But, now this loop, this dreary scene, plays over and over in one way or another.
It’s not that she’s lazy, or not trying, or stupid. She’s lost. Her identity got buried and her feelings have overwhelmed her like a tsunami that hit years ago leaving her homeland devastated, still looking for life amongst the ravaged land.
A thought comes over her. She realizes she can leave this old, outdated wagon behind. She can choose a road and start walking but which one? This seems like a circle of never-ending choices and each road seems to lead back to this loop and mocks her and all her hard work. Her hopes, her wishes; they’ve become like ghosts that mock her, like wispy beings that laugh at her. And, she feels silly. Silly for dreaming of feeling clean and warm and pure and on course. Silly for dreaming of feeling like she belongs somewhere, like she can actually reach her destination. It’s as though a finger of the devil himself put his nail through her back and is mocking and taunting her. It’s not that she’s lazy, or not trying, or stupid. She’s lost. Her identity got buried and her feelings have overwhelmed her like a tsunami that hit years ago leaving her homeland devastated, still looking for life amongst the ravaged land. But, there was none.
Today is the day and now is the time to leave this wagon that represents a false way of thinking; a mental pattern that leads to a pot hole or a ditch.
So, she packed and left, not really knowing exactly where she was going but happy to go away. Anything had to be better than that place. And, here she is- stuck.The journey has been painful; grueling at times and at times joyful with breaks of light. But, here, this place is different. It’s like a time warp. Everything seems skewed; time, people, herself. Everything seems warped with long shadows cast over everything. Today is the day and now is the time to leave this wagon that represents a false way of thinking; a mental pattern that leads to a pot hole or a ditch. She decides to leave on foot and walk away from here- free from those clunky wheels. She decides to travel light and chooses what to leave behind. Though she doesn’t fully understand, she knows this journey was started in faith and her God has provided all her needs thus far. For some reason this particular place has sucked her in but she is reminded that “even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me”…She wants to make it to her destination because she knows of Him that “He prepares a table before me in the presence of my enemies; You anoint my head with oil; my cup overflows. Surely goodness and mercy shall follow me all the days of my life, and I shall dwell in the house of the Lord forever” (Psalm 23: 4-5).
This is meant to be walked through- not around. To be felt, not analyzed. This is a place to be comforted
She realizes she is looking at the unhealed memories and they stand in front of God who is light. That is what creates the shadow of death that looms over the land before her. And, it becomes clear. This is a place of grieving and sorrow; where worldly sorrow becomes godly sorrow, where the past gets traded in for a future. Where loss is released in tears. This isn’t the end. It is a beginning. This isn’t a prison sentence, it’s a cocoon. This isn’t punishment. This is love. This is rest. This is meant to be walked through- not around. To be felt, not analyzed. This is a place to be comforted- a place to have her well dug out and filled. She wants this place yet she also fights against this place. “What if the pain is too great?”, “What if I’m alone?”, “What if I never find my way out?”, “I don’t know where to start”. She falters, yet, she walks. Trepidaciously, she walks.
This time is different. This time, getting up, she doesn’t walk alone. There are others to ease her loneliness. There are others designated to comfort her when she cries, to encourage and speak truth when she falters, to just be with her and listen as she releases all the pent-up years. This time she won’t push away. She’s done saying she is fine. She’s not fine. She’s done doing it all by herself. She is through with lonely. She’s done believing she is a burden and that she’s unlovable. This is her time to receive, to be comforted, as she has often done to others. She knows that “Blessed are those who mourn, for they shall be comforted…” Matthew 5:4 and that this is her time on the road to somewhere great.
by Jackie Tomasini | Aug 13, 2022 | Trauma
“People who laugh the most have experienced the most pain” – Unkown
The first time I saw this picture I thought to myself: “Oh my God, that’s me!”. It stopped me dead in my tracks and burned its image in my mind. It connected with the “me” that learned long ago to protect myself with some things I saw as assets, such as humor and analytical thinking, in order to survive the life I was living.
It is safety and connection that I believe we all crave. When those needs are not met we are faced with choices- “How will I fill this need?…eat?…drugs?…alcohol?…sex?
The names Robin Williams, Chris Cornell, and Chester Bennington all invoke sadness and questions. Did they each struggle to connect with others as I have? Were their sensitivities and views of life just too hard to articulate? Is this what ultimately drove them to a point of not seeing a reason to keep living? I am only speculating. One thing I do know is that depression is blinding, like a thick black fog, consuming everything on the ground and taking away all perspective, and covering all the beacons of light. It is safety and connection that I believe we all crave. When those needs are not met we are faced with choices- “How will I fill this need?…eat?…drugs?…alcohol?…sex?…..end the search?…”
I find that making connection is not difficult to do. To me, the pain comes in not being able to maintain it. Some relationships last a week, a few months, years, or a lifetime. In all my relationships I can only be accountable for myself as the common denominator in all of them. That person inside my head sometimes retreats and ruminates over careless and sharp words spoken, and of things she wishes had been spoken. Rather than trying to erase uncomfortable memories, I find that acknowledging and letting those thoughts breathe, is how I find peace, and change into something better.
I learned to use laughter as a defense mechanism to get me through tough situations. Unfortunately, the hard feelings got tamped down, giving me a false sense of safety and validation.
We all need the same thing – someone willing to sit with us in those dark hours without answers. It is in the sitting and the being there that provides the answer.
I find some of my saltiness and defensiveness from the past no longer serves me well. Instead, humility and humanity are things to share with others who have my best interests in mind and who don’t make me feel like hiding, but rather acknowledging the person behind the defenses for who they really are. To see with compassion, understanding, and a willingness to connect.
I wish I could’ve talked to some of those who committed suicide, who decided life had no hope, or light, and were exhausted from laughing on the outside, but crying on the inside. That is an unsustainable task. Sometimes we all get to a point where all feels lost. I can’t imagine the loss some have experienced and the amount of grief that it generates. I know we all need the same thing – someone willing to sit with us in those dark hours without answers. It is in the sitting and being there that provides the answer.
What is the difference between the day I first saw that picture and now? I acknowledge I was the one crying on the inside, but only felt safe to show the laughing “me” on the outside. I sometimes feel overwhelming waves of truth mingled with tears melting away denial and excuses – a relief that lightens my load. I’m not ashamed of who I was or who I’m becoming. Eventually, it will all be made whole and I’ll see a portrait instead of an unfinished puzzle and maybe you will too….
