This piece captures something I see clinically all the time: PTSD often isn’t recognized because people imagine it has to look like flashbacks and obvious panic. In reality, it frequently shows up as identity-protecting language (“I’m fine,” “it wasn’t that bad,” “I should be over it”) while the body quietly tells the truth through hypervigilance, sleep disruption, irritability, avoidance, emotional numbing, and a nervous system that stays on high alert long after the threat is gone.
I really appreciate how you name the shame and the “that’s not me” reflex. That’s not denial, but it’s often a survival strategy that once helped someone function. The hopeful part is that the same brain that learned danger can relearn safety: trauma-focused therapy, somatic approaches, and (when appropriate) medications can reduce symptoms and restore flexibility without erasing the story.
Thank you for writing this with both honesty and dignity. For many readers, this will be the first time they recognize themselves and realize that needing help is not weakness, it’s biology!
As someone who has complex PTSD...this post made me very sad. Moral injury is prevalent in front- line workers. It's way past the time for the system to address this. You carry so much and my heart goes out to you!
I was watching a show on a streaming platform called Doc yesterday. It’s several seasons in and is extraordinarily well done. A young teenage boy arrested and died despite their best efforts and I can usually watch this stuff and it doesn’t bother me . However, the writers who did this script nailed it. The physician called it and told the parents he died. The mother and the father both screamed ;she laid her body on top of her son and the father fell to his knees. Suddenly tears gushed involuntarily from my eyes. I retired four years ago from the Pediatric ICU but pretty sure there’s a lot in my psyche that hasn’t been fully worked out yet.
Thank you so much for your posts. I retired from Emergency Medicine 5 years ago and am currently sorting through the effects of the trauma. I wish I had access to your insights when I was practicing
After 40+ years in EM, I occasionally still finish shifts in my sleep. Certain smells can be a trigger. I have a cascade of badly burned (and dead burn patients, thanks to being a deputy ME) that all come back briefly with the smell of human burns.
Again, though I’m not a physician, your words resonate deeply. As a community leader I’ve found that by surfacing my own vulnerabilities I’m often able to lead with more strength. Certainly more empathy. I imagine you do too.
Why does it take a fellow physician - a psychiatrist, no less - to state the obvious: PTSD is NOT a "self-healing" disorder. The fact is, there is limited data regarding depression & suicide among ER physicians - which appears mutually dependent - but two studies that do address the issue of suicide clearly indicate a significant increase of prevalence as >60% higher than the general population; and another study measured depression prevalence as >20% higher than the general population. I would question your "What Actually Helps" suggestions as seriously naive, and your "What doesn't" as bordering on enabling or "scorning snitching" on peers in observable stages of "circling the drain."
My final suggestion is that any hospital or regulated critical care facility without an Employee Assistance Program that does not place the mental health of valued employees under intense pressure, such as the ED, as a primary, confidential benefit of employment is simply not worth your time, or in this case, your life, regardless of salary or other benefits. Personally, it has always been the first question I ask in an interview in regard to "benefits."
Kung HC et al. Suicide Rates by Occupation and Industry Group: National Violent Death Reporting System, 16 States, 2012–2015. Preventing Chronic Disease, 2019;16(10):190020.
Schueller SM et al. The Prevalence of Depression in Emergency Medicine Physicians: A Cross-Sectional Study. Journal of General Internal Medicine, 2016;31(8):952-958.
This piece captures something I see clinically all the time: PTSD often isn’t recognized because people imagine it has to look like flashbacks and obvious panic. In reality, it frequently shows up as identity-protecting language (“I’m fine,” “it wasn’t that bad,” “I should be over it”) while the body quietly tells the truth through hypervigilance, sleep disruption, irritability, avoidance, emotional numbing, and a nervous system that stays on high alert long after the threat is gone.
I really appreciate how you name the shame and the “that’s not me” reflex. That’s not denial, but it’s often a survival strategy that once helped someone function. The hopeful part is that the same brain that learned danger can relearn safety: trauma-focused therapy, somatic approaches, and (when appropriate) medications can reduce symptoms and restore flexibility without erasing the story.
Thank you for writing this with both honesty and dignity. For many readers, this will be the first time they recognize themselves and realize that needing help is not weakness, it’s biology!
As someone who has complex PTSD...this post made me very sad. Moral injury is prevalent in front- line workers. It's way past the time for the system to address this. You carry so much and my heart goes out to you!
I was watching a show on a streaming platform called Doc yesterday. It’s several seasons in and is extraordinarily well done. A young teenage boy arrested and died despite their best efforts and I can usually watch this stuff and it doesn’t bother me . However, the writers who did this script nailed it. The physician called it and told the parents he died. The mother and the father both screamed ;she laid her body on top of her son and the father fell to his knees. Suddenly tears gushed involuntarily from my eyes. I retired four years ago from the Pediatric ICU but pretty sure there’s a lot in my psyche that hasn’t been fully worked out yet.
Thank you so much for your posts. I retired from Emergency Medicine 5 years ago and am currently sorting through the effects of the trauma. I wish I had access to your insights when I was practicing
Important article. Full of pain and brutally honest.
After 40+ years in EM, I occasionally still finish shifts in my sleep. Certain smells can be a trigger. I have a cascade of badly burned (and dead burn patients, thanks to being a deputy ME) that all come back briefly with the smell of human burns.
Great post, Mike.
Prayers.
Again, though I’m not a physician, your words resonate deeply. As a community leader I’ve found that by surfacing my own vulnerabilities I’m often able to lead with more strength. Certainly more empathy. I imagine you do too.
Why does it take a fellow physician - a psychiatrist, no less - to state the obvious: PTSD is NOT a "self-healing" disorder. The fact is, there is limited data regarding depression & suicide among ER physicians - which appears mutually dependent - but two studies that do address the issue of suicide clearly indicate a significant increase of prevalence as >60% higher than the general population; and another study measured depression prevalence as >20% higher than the general population. I would question your "What Actually Helps" suggestions as seriously naive, and your "What doesn't" as bordering on enabling or "scorning snitching" on peers in observable stages of "circling the drain."
My final suggestion is that any hospital or regulated critical care facility without an Employee Assistance Program that does not place the mental health of valued employees under intense pressure, such as the ED, as a primary, confidential benefit of employment is simply not worth your time, or in this case, your life, regardless of salary or other benefits. Personally, it has always been the first question I ask in an interview in regard to "benefits."
Kung HC et al. Suicide Rates by Occupation and Industry Group: National Violent Death Reporting System, 16 States, 2012–2015. Preventing Chronic Disease, 2019;16(10):190020.
Schueller SM et al. The Prevalence of Depression in Emergency Medicine Physicians: A Cross-Sectional Study. Journal of General Internal Medicine, 2016;31(8):952-958.