An ER Doctor’s Journey from PTSD to Recovery
When people think of ketamine therapy, they tend to think of it in the context of treating depression or post-traumatic stress disorder (PTSD). Ongoing wars, interpersonal trauma, and serious life-threatening experiences are three of the major factors that cause PTSD to be present in mental health settings. In our work with ketamine, this is all too common to us and therefore, discussing cases related to PTSD can go a long way in helping us better understand the importance of this breakthrough therapy.
Several years ago, I had the pleasure of working with an MD who was an ER doctor. Because of his work, he had observed numerous injuries and broken bodies as part of his daily work. While he had never experienced a warzone, his experience in witnessing the results of these tragic accidents had taken a large toll on his mental health. Working in the ER for over 10 years, he was witness to countless stories of broken limbs, cranial fractures, and other life-altering injuries to his patients. As a consequence, he began experiencing nightmares of his encounters with these individuals who were seeking care. He described it as though “ghosts were haunting him”, particularly with those patients that he was unable to save. He also was very hard on himself anytime he lost a patient, even in cases where the prospect of recovery was minimal.
Working with a doctor who is also a patient presents its own unique sets of challenges. Oftentimes, clinicians do not make for good patients. Those of us who know too much tend to overthink the procedures, expectations, and outcome just by virtue of how close we are to our work. This case was no different. Often, my patient would make demands about treatment protocols, durations, and infusion schedules instead of focusing on his treatment. Being able to bring forward recollections of traumatic events was also difficult because he continued to have patients die in his care or experience severe injuries which would haunt him and further complicated his care. We decided it would be best for him to take a leave of absence from working in the ER for the duration of the treatment to prevent further exposure that may be traumatic for him.
A week into his professional leave and taking a vacation, we continued our treatments. His focus had greatly improved; a sign that he was likely overly stressed and unable to handle the realities of his job at the time. During his vacation, his sleep and appetite improved, and his overall presentation was highly functional compared to where he was previously. It became obvious that the job was no longer for him; however, making that decision during treatment was not something we believed would result in a net benefit because it would be highly disruptive to his thinking. It was decided this would be something that would have to occur after his treatment was completed.
The vacation came around the time of his third infusion and for the next several sessions, he was able to tap into the realities of his work, trauma, and treatment. It dawned on him that his profession was taking a severe impact on his personal life, as he was in his 40s and had never married due to the realities of medical practice. He had an epiphany during the fifth session where he realized that his work was not the only important thing to him. He completed the sixth infusion of the series and left his job in the ER to work in a different clinical environment altogether.
Shortly after this shift in his work, he reached out to tell me that his life had changed significantly. He found a loving partner and his nightmares had decreased. The ketamine therapy provided a significant benefit to resetting his life and viewing it from a perspective that offered more clarity and awareness. All in all, my patient no longer met the criteria for a PTSD diagnosis based on post-treatment measures.
Ultimately, it came down to his own imposed quality of life. His passion for helping people was the thing that was hurting him the most. Ketamine allowed him to break out of his ego in a way that allowed him to make meaningful changes in his life. Had he not pursued treatment, he may not have had the courage to make these essential changes.
U.S. Department of Veteran Affairs, PTSD: National Center for PTSD
National Institute of Mental Health, Post-Traumatic Stress Disorder