~The Comfort Garden: Tales from the Trauma Unit ~
Laurie Barkin, RN, MS
Laurie Barkin, RN, MS’s story begins in the early 1990s on the trauma unit at San Francisco General Hospital, where she worked as a psych nurse consultant; assessing patients who had recently experienced trauma and helping them cope with their emotional and psychological reactions. During assessments, she and her colleagues heard horrible stories of untreated childhood traumas with disturbing frequency.
Like any compassionate caregiver, Barkin needed a way to deal with what she was hearing. "When you absorb other peoples' traumas, they lodge in your mind and in your body," she explains. She began to develop symptoms similar to those of the patients she was treating. "Four years into my job I started having symptoms that were worrisome to me," she says. "All of the sudden I was having nightmares...I developed this fear for my children's safety." She experienced heart palpitations and shortness of breath. "I know this was directly related to the stories of child abuse I was hearing on the trauma unit." While attending a trauma conference, she learned that what she was experiencing was called “vicarious trauma.”
Vicarious traumatization and compassion fatigue are all too familiar to many psychiatric mental health nurses. Regular exposure to other peoples' traumas can cause profound emotional and psychological impact in the caregiver and, if left untreated, ultimately result in burnout.
Barkin explores this issue in her book The Comfort Garden: Tales from the Trauma Unit. It is her personal story of suffering and recovering from vicarious traumatization. It opens with her first day on the trauma unit, during which she listens to the story of a former child prostitute who was stabbed by her pimp and is now a paraplegic. "Take good care of yourself, Laurie," a colleague warns her, "I know you’ve been a nurse for a long time, but listening to some of our patients’ stories can suck the life out of you.”
Barkin had always been an erratic journaler, and to cope with what she was experiencing while on the trauma unit, she turned to writing. "For me it was a way of working it out. The stories would get caught in my soul." Writing was cathartic, a "form of self-care."
While writing helped, it wasn't enough. Barkin did not find the "culture of processing" that she was looking for at work. Her requests for staff time to talk about what they were experiencing were denied. "I just remember thinking, 'I need to take care of myself,' so I left. And again, I started writing for release."
Writing the book was part of the healing process for her – rather than letting the stories suck the life out of her, she chose to "write them out." She refers to the research of James Pennebaker - a professor at the University of Texas at Austin who has studied how expressive writing can facilitate healing.
Over a period of nine years, her writings began to coalesce into a book. As she wrote, Barkin saw the possibilities of using her writing to raise awareness. "I wanted to counter the image of Nurse Ratched," she explains. "A lot of what psych nurses do, a lot of the skills are hidden. It was important for me to show what psych nurses really do." She hopes that other psych nurses will learn the value of self-care from her book as well. "Self-care is not an option if you're going to be effective in your job," she says. She believes that many nurses are counter-dependent; that they do not want to be dependent on anyone. She urges them to seek help if they need it: "You need to ask for what you need to do your job."
The comfort garden referred to in the title can be found at the San Francisco hospital, dedicated to staff who have passed away. It’s where Barkin would go to find relief and rejuvenation, to "counterbalance the ugliness" of what she heard on the trauma unit. It’s a beautiful garden, “enthusiastic and bursting with life,” Barkin says.
This garden, ultimately, serves as a rich metaphor for what Barkin has learned, that everyone must find balance in their lives: offset the ugliness with beauty, care for others but also remember to retreat and care for yourself, and cultivate recovery and hope not just in your patients, but also in yourself.
Barkin now works as a psychiatric nurse consultant for UCSF. For more information about The Comfort Garden: Tales from the Trauma Unit, visit her site at http://lauriebarkin.com.
Do you have a book or story that you'd like to share with the APNA membership? Contact Meaghan Trimyer at email@example.com.