Not long ago I noted a certain older patient's name on my schedule. I really dreaded seeing her. It's not that I dislike her--in fact she's one of my favorite patients. It was just that I hated the prospect of seeing her looking as poorly as I knew she would. She'd been through so much: an accident resulting in devastating injuries followed by painful surgeries, and, worst, in the middle of
all that, the death of one of her adult children. Surely she'd be in awful shape, psychologically, if not physically. I mean, how much can one person take?
A lot, apparently.
The woman came in neatly and fashionably dressed as always, feisty as ever, eager to fill me in on her progress. Though she had many complaints and concerns, she also smiled and laughed a lot, as she always has.
How can she go on? I wondered. Not only go on, but thrive? How does anyone go on after experiencing so much pain?
I've thought about this woman often in the last few days as I've contemplated what lies ahead for the victims of the Boston Marathon bombings, their families, and also the first responders and witnesses at the scene. Some will, no doubt, have post-traumatic stress disorder (PTSD), a serious condition characterized by anxiety and depression that can become disabling.
But not everyone who is traumatized gets PTSD, and even for those who do, PTSD is not the whole story of their experience after trauma.
There's post-traumatic strength, too.
Yes, some people are more resilient than others. But trauma itself can bring strength, even to people who weren't very strong to begin with. Every nurse and doctor I know can tell you about a patient who was toughened by an illness or injury one might have predicted would crush them. I remember, for example, a very anxious patient who told me many times that she was terrified of developing a fatal cancer. Her fears, unfortunately, were realized. She spent her final months in a state of calm and good humor that inspired me as much as it surprised me.
President Obama called Boston a "tough and resilient town" after the Marathon bombings. It's true that there's something--perhaps rooted in our Puritan origins, lousy weather, and inscrutable traffic patterns (I've lived here over 20 years and still don't understand why you take 93 North to go south)--that makes us hardy. Bostonian and best-selling author Dennis Lehane captured this aspect of the Boston character brilliantly in a recent editorial, "Messing with the Wrong City." Lehane wrote:
I do love this city. I love its atrocious accent, its inferiority complex in terms of New York, its nut-job drivers, the insane logic of its street system. I get a perverse pleasure every time I take the T in the winter and the air-conditioning is on in the subway car, or when I take it in the summer and the heat is blasting. Bostonians don’t love easy things, they love hard things — blizzards, the bleachers in Fenway Park, a good brawl over a contested parking space. Two different friends texted me the identical message yesterday: They messed with the wrong city. This wasn’t a macho sentiment. It wasn’t “Bring it on” or a similarly insipid bit of posturing. The point wasn’t how we were going to mass in the coffee shops of the South End to figure out how to retaliate. Law enforcement will take care of that, thank you. No, what a Bostonian means when he or she says “They messed with the wrong city” is “You don’t think this changes anything, do you?”
There were, surely, certain aspects of the events of the past few days that had a distinctly Boston flavor. Who but a local, for example, could fully appreciate the news that the Dunkin' Donuts outlets in Watertown stayed open during the lockdown on Friday, April 19th, to fuel the cops on duty?
But, much as I would like to claim that my adopted hometown has a unique resilience, I have to think that Chicago, Seattle, Atlanta, or--especially--New York would now have come up just as big under similar dreadful circumstances. That's because as Americans, we've been through trauma before--on 9/11.
Like so many of my patients, we know something we didn't know before the blows came: that we can survive them.
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