trauma

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A Death, And A ‘Changed Life’: Traumatic Births Take Toll On Health Workers Too

Sarah Jagger and midwife Stephanie Avila were together when Jagger's son suffered a brain injury during labor that led to his death. Here, about a year later, in 2013, Jagger and Avila share a moment of gratitude after the safe arrival of a healthy baby girl. (Courtesy of Orchard Cove Photography)

Sarah Jagger and midwife Stephanie Avila were together when Jagger’s son suffered a brain injury during labor that led to his death. Here, about a year later, in 2013, Jagger and Avila share a moment of gratitude after the safe arrival of a healthy baby girl. (Courtesy of Orchard Cove Photography)

Everything seemed fine until the little boy was born.

He wasn’t breathing, but his heart was strong, recalled Stephanie Avila, the midwife attending the baby’s birth at a Rhode Island hospital back in 2012. But it soon became clear that the boy had suffered a brain injury during labor.

Eleven days later, after an MRI confirmed the severity of the injury and the family withdrew life-support, the child died. His official diagnosis: hypoxic ischemic encephalopathy, a brain injury caused by oxygen deprivation.

“I was prepared to stand by the family through this trauma,” Avila said in an interview. “But I fully expected I’d get sued — and it was going to get ugly, or uglier.”

Of course, the little boy’s family was devastated. “I just went into my own world,” said his mother, Sarah Jagger, speaking about the loss of her son.

But Avila suffered too. “I was a wreck,” she said.

Immediately after the birth, Avila said, she remained on call overnight at the hospital, Women & Infants, in Providence. “I retreated to the call room and curled up in the fetal position and prayed that no other people in labor would show up. I cried, had the worst headache I’ve ever had in my life, and felt like I’d vomit. For days I felt emotionally and physically terrible. I’d be walking down the street and suddenly could no longer move.”

At the time, Avila had two small children of her own. “And whenever my 2-year-old would do this cute thing, I’d think, their baby will never walk around in his mother’s high-heeled shoes. I’d get these terrible thoughts and I’d never know when it would strike.”

The Psychological Toll

After a traumatic birth — or any traumatic medical event — attention, rightly, turns to the grieving family. But research has been mounting in recent years that health care providers, sometimes called “the second victims,” also sustain long-lasting emotional damage following such a trauma.

A new study published by Danish researchers underscores the phenomena: Midwives and obstetricians who experienced a traumatic birth — one involving severe injuries or death — report that the psychological toll of such an event is deep and long-lasting.

More than one third of those surveyed said that they always would feel some sort of guilt when reflecting on the event, researchers report. Nearly 50 percent agreed that the traumatic birth had made them think more about the meaning of life. “This tells us that health care professionals are affected, not only professionally, but also at a personal and even existential level,” said Katja Schrøder, the study’s first author and a Ph.D. fellow at the University of Southern Denmark.

‘Changed My Life Forever’

This was indeed the case for Avila. “I feel as though that day — even to this day — changed my life forever in many ways,” she said. And while the “acute” nature of the trauma has passed, she said, the enormity of it continued to grip her, sometimes unexpectedly and at random times.

In the Danish study, published in Acta Obstetricia et Gynecologica Scandinavica, a journal of the Nordic Federation of Societies of Obstetrics and Gynecology, more than 1,200 Danish obstetricians and midwives responded to a survey on the aftermath of a traumatic birth. Of those respondents, 14 were selected for a followup interview.

Many of the providers spoke of not being able to shake the trauma, whether they were blamed for the bad outcome or not. “Although blame from patients, peers or official authorities was feared (and sometimes experienced), the inner struggles with guilt and existential considerations were dominant,” researchers report.

From the paper:

One mid-wife explained that even now, 12 years after the event, she would still think about that particular mother and child when passing through their town…

Most participants described having spent many hours agonizing and wondering whether they could have prevented the adverse outcome. One midwife said that her sense of guilt would never disappear because she knew that the parents would have to live with the consequences of her handling of the delivery.

Still, the researchers found that for many providers, “the traumatic childbirth had given rise to personal development opportunities of an emotional and/or spiritual character …for instance by achieving a more humble and profound understanding of both professional roles and of life as a whole.”

A Meaningful Meal

About a month after her infant son’s death, Jagger did something unusual: She asked Avila to meet for lunch. Up until then, the two women had been in touch — Avila had called to check in often, offering to help out and attend followup medical appointments with Jagger.

But the lunch date marked a turning point, the women agreed. First, it became clear that Jagger didn’t blame Avila for the boy’s death, and did not want to focus on the tragedy going forward.

“We had this little boy who had a such a short life,” Jagger said. “I didn’t want his life to be clouded in anger. I wanted his life to be about love…and not focus on the horrible part.”

But the meeting also underscored the growing bond between the women. When it was over, they walked outside and Jagger posed a question: “I said to her, ‘If I have another baby, would you deliver it?’ And I think she was horrified. But I think because I trusted her so completely, through the birth, and his death, and her calls and the followup, I felt like she was there with me, like this was our loss, it wasn’t just my loss.”

The Danish research paper quotes Donald Berwick, a pediatrician who served in the Obama administration and is also a patient safety guru of sorts. In a 2009 interview published in the Journal of Patient Safety, Berwick speaks about those “second victims”:

Health care workers’ egos can be big. But believe me, their superegos are a lot bigger. You carry into work — as a nurse, or doctor, or a technician or pharmacist– the intent to do well. And when something goes wrong, almost always you feel guilty, terribly guilty. The very thing you didn’t want to happen is exactly what happened. And if you don’t understand how things work, you feel like you caused it. That creates a victim. My heart goes out to the injured patient and family, of course. That’s the first and most important victim. But health care workers who get wrapped up in error and injury, as almost all someday will, get seriously hurt too. And if we’re really healers, then we have a job of healing them too. That’s part of the job. It’s not an elective issue, it’s an ethical issue.

In the past decade or so, various institutions and nonprofits have emerged with tools and systems to better support medical professionals who have endured a traumatic event.

One of those groups, MITSS, or Medically Induced Trauma Support Services, based in Massachusetts, provides trauma tool kits used around the country.

Linda Kenney, the founder of MITSS, was herself the victim of an anesthesia error that nearly killed her. She said that for her, connecting with the anesthesiologist who caused her injury (he called her afterwards to express his regrets) and creating the nonprofit to help others, helped her heal.

But for health care providers, sometimes talking to peers at a hospital, or others in the institution, isn’t enough and can actually feel isolating, Avila, the Rhode Island midwife, said. Because of the omnipresent fear of lawsuits, and also due to patient privacy laws, she said, “there are very few environments where we can freely discuss what happened.”

A Second Chance

In 2013, a few days shy of what would have been her son’s first birthday, Jagger went into labor with her second child, and she called on Avila to attend the birth. By that time, Avila was no longer working for the same midwifery group, but the practice arranged for her to have insurance during the birth, and Avila left a family gathering on Block Island to get to Providence on time.

Jagger’s little girl is now a healthy 2-and-a-half-year-old who considers Avlia her “auntie.”

“It was this amazingly cathartic experience for all of us,” Jagger said.

Avila is now a family nurse practitioner and attends births less frequently as part of her work. These days, she and Jagger are extremely close: They’ve vacationed together, bake each other birthday cakes and talk almost daily.

“I never would have expected our relationship to evolve to this point,” Avila said. “But despite how close we are now, I would sacrifice it in a moment if I could change the outcome of that first birth.”

Related:

Narrating Medicine: The Long Lasting Impact Of Child Abuse

One day when we were in first grade and sitting on a rickety wooden bench under a large oak tree in her backyard, my best friend’s mother called her to come inside.

A few minutes later, I heard wailing like an animal being gutted. Squinting my eyes and looking perplexed, I turned to my friend’s younger sister who was sitting beside me. She whispered, “She’s just getting beat.” Beat? What’s that, I wondered. She explained. Depending on the severity of their perceived wrongdoings, they were administered one of three levels of physical punishment: a stick, a belt or a big slab of wood. Their parents had moved from Ireland to our small suburb in New Jersey.

The Catholic schools the parents had attended as children in Ireland were very strict and the nuns reportedly beat them until their knuckles bled. Here, as parents in New Jersey, they told their daughters to strip naked and mercilessly receive corporal punishment. (I learned this from her sister, and over the years, from my friend.)

This was not a onetime event. These were repeated, deliberate acts. Continue reading

Commentary: When Sexual Violence Survivors Give Birth, Here’s What You Should Know

By Sarah Beaulieu
Guest Contributor

Sarah Beaulieu (Courtesy of the author)

Sarah Beaulieu (Courtesy of the author)

It shouldn’t have been a surprise that childbirth would leave me traumatized.

In retrospect, it seems obvious that when a survivor of sexual violence feels pain in her vagina caused by a strange being inside of her, the experience might trigger memories of an earlier trauma. But what wasn’t so obvious were the many ways that the childbirth and medical professionals didn’t prepare me for these unexpected and painful emotions related to giving birth.

With 20 years of therapy under my belt, I consider myself to be a fairly confident survivor with many tools in my resilience box. None of these tools prepared me for what happened during the birth of my son. After 12 hours of relatively peaceful labor in the hands of midwives, I dozed off, preparing for a long night. I woke up with at least two sets of hands inside of me, alarms ringing and a sense of panic in the room. My son’s heart rate had dropped dangerously low, and I needed an immediate C-section.

This experience — traumatic for even the healthiest woman — wrecked me, surfacing old post-traumatic stress disorder symptoms and pulling me into depression and anxiety. With the help of a hospital social worker, I emerged from my emotional dark place a few months later, and immersed myself in learning more about birthing as a sexual assault survivor. My experience was scary, but it couldn’t be that uncommon, I thought. After all, 1 out of 4 women share a sexual abuse history like mine, and U.S. women gave birth to nearly 4 million babies last year.

My research led me to Penny Simkin and Phyllis Klaus, two legendary birth educators who compiled much of the existing research into a single manual, “When Survivors Give Birth.”

I learned that, in fact, there were approaches to childbirth that were especially helpful to survivors of sexual violence. Not only that, but it was fairly common for pregnancy and birth to re-trigger memories and emotions related to past sexual violence. Yet despite this, the topic of sexual violence wasn’t typically covered by my midwifery practice, recommended childbirth literature or my natural childbirth class.

First and foremost, health care providers can adopt a trauma-informed approach to care for laboring mothers. Knowing that 25 percent of patients in labor and delivery will have a history of sexual violence, there is a benefit for all staff to be educated about sexual violence and its impact on birth. There are medical reasons too: Childhood trauma, including child sexual abuse, is a documented risk factor of postpartum depression and anxiety, which impacts 10 to 15 percent of new mothers — and their babies and families — each year.

Knowledge starts with screening for a history of sexual violence on standard intake forms and first visits. It also means creating a health care environment where survivors feel comfortable disclosing such histories. In my midwife’s office, there were pamphlets for every possible pregnancy complication, from gestational diabetes to heartburn to exercise during pregnancy. So, why not a pamphlet on giving birth as an abuse survivor?

Cat Fribley, an Iowa-based sexual assault advocate and doula whose practice focuses specifically on sexual violence survivors, describes trauma-informed care as “supporting the whole person with collaboration, choice and control, cultural relevance, empowerment and safety — both physical and emotional. This requires making certain adjustments to the way they work with survivors, acknowledging both the challenges that arise from sexual trauma, as well as unique coping skills — such as dissociation — that may help the survivor through the process of childbirth.”

Here’s an example: At one birth Fribley attended, “the birthing mother became visibly upset when new and unknown staff would enter the room while she was laboring. A simple sign on the door asking people to knock and announce themselves before entering helped make the birthing mom feel more in control of her environment — and the exposure of her body.” Continue reading

How Trauma Brings Fear, Yes, But Also More Nuanced Reactions

A woman breaks down while paying her respects at a makeshift memorial near the Inland Regional Center Friday in San Bernardino, California, where several people were shot and killed by two shooters on Dec. 2. (Jae C. Hong/AP)

A woman breaks down while paying her respects at a makeshift memorial near the Inland Regional Center Friday in San Bernardino, California, where several people were shot and killed by two shooters on Dec. 2. (Jae C. Hong/AP)

By Mary C. Zeng, MD
Guest Contributor

November and December have been months of trauma.

The Paris terror attacks and the American shootings in San Bernardino and Colorado Springs have taken a heavy toll on both survivors and witnesses. Media coverage depicting scene after scene of carnage has also generated painful and lingering emotional reactions by secondhand exposure. A recent New York Times article describes “a creeping fear of being caught in a mass rampage has unmistakably settled itself firmly in the American consciousness.”

It’s true that trauma breeds fear. Those who were directly victimized in the attacks are, of course, likely to develop both short- and long-term fear reactions. But even indirect victimization, such as through the media, can be psychologically damaging. One study of New Yorkers after Sept. 11 found that people who watched more news coverage were over three times more likely to develop post-traumatic stress disorder (PTSD), a hallmark disease of fear.

However, if we are to truly understand and appreciate each other’s emotions during these troubling times, we must talk beyond fear. Failure to do so would be a disservice to those who are suffering.

A variety of responses is expected, and normal, in the aftermath of trauma. Fear is only one of several emotions that may arise — one of a cluster of experiences collectively known as peri-traumatic distress. Other feelings in this cluster include helplessness, sadness, grief, guilt, shame, anger and horror. Certain cognitive responses, such as a worry about fainting or dying, are also common, as are physical sensations such as loss of bowel or bladder control and shaking, sweating or a racing heart.

Another common response immediately following a trauma is peri-traumatic dissociation: a state of disconnectedness from oneself or from reality, memory loss, reduced awareness or time distortion that is triggered by a traumatic event.

Both of these sets of responses are normal short-term reactions to trauma. They may be experienced with varying levels of intensity, depending on how directly or indirectly someone was exposed to the trauma. They are expected to phase out, or extinguish, for many people over a course of weeks after the traumatic event.

It is when these reactions do not extinguish that the long-term and potentially crippling effects of trauma begin to show in individuals with a genetic predisposition. Peri-traumatic responses then turn into PTSD, a psychiatric illness affecting 7-8 percent of all Americans over their lifetimes. The classic signs of PTSD, aside from exposure to a traumatic event, include intrusive memories of the event; avoidance of people, places and situations associated with the event; negative mood and cognitions; and hypervigilance and hyperarousal.

In the same way that a veteran who saw IEDs in Iraq now sees IEDs everywhere, the mass shooting survivor forgets how to feel safe even on the home front. The world turns into a permanently dangerous, uncontrollable place.

Besides peri-traumatic distress, peri-traumatic dissociation and PTSD, which are widely researched because they can lead to psychological disability down the line, a whole range of emotions is possible in light of the recent tragedies. Numbness, bewilderment, resignation — there is no one right way to react to trauma. Traumatized individuals are also at higher risk of developing psychiatric disorders other than PTSD, such as major depression and substance abuse.

But positive adaptations to trauma have also started to receive research attention. Continue reading

Outpouring On Beloved Prouty Garden Continues: Traumatized Kids Need It

The fountain in Prouty Garden at Boston Children’s Hospital (Jesse Costa/WBUR)

The fountain in Prouty Garden at Boston Children’s Hospital (Jesse Costa/WBUR)

News this week that the Prouty Garden at Boston Children’s Hospital can be bulldozed continues to draw impassioned pleas to reconsider the garden’s fate. Here, Dr. Elliott B. Martin, Jr., a psychiatrist at Newton-Wellesley Hospital and Assistant Clinical Professor of Psychiatry Tufts University School of Medicine, adds his thoughts. (This is the second powerful letter we’ve received from defenders of the garden. We also welcome letters from the other side.)

I am writing in hopes of continuing the narrative around the fate of the Prouty Garden at Boston Children’s Hospital. I have been involved now for several months in the effort to save the therapeutic space, and the letter yesterday from Ms. Ellen Gilliam has inspired me to build upon her story, in hopes that others will add their own chapters.

I, too, have worked at Boston Children’s Hospital, as a physician, specifically as a psychiatrist. Until recently, the best kept secret at Children’s Hospital had been that there is in fact an inpatient psychiatric unit there. At any given time the hospital cares for some of the most grievously traumatized children you can imagine. These are kids, ranging from seven to seventeen years old, who have suffered ungodly physical and sexual abuse, at times since infancy. These are kids who have suffered from neglect, at times to near death. These are kids with profound depression, who have tried to commit suicide, very often many times over.

Therapeutic options in such cases are extremely limited, often amounting to time, containment, support, and most importantly, love. Many, if not most, of the physically ill children at the hospital at the very least know the love of their families. For the psychically wounded there is precious little love. As we would often observe on the inpatient unit, very few people sent get well cards to the psychically ill. The clowns never came there. The celebrities, on their visits to sick children, were carefully shuttled past the double-locked doors designed to be disinviting.

In this environment two therapeutic modalities stood out as having had immediately tangible, positive effects on these children. The first was the weekly visit from the therapy dog, and the second were the daily supervised excursions to the Prouty Garden. For kids otherwise confined day and night to a tiny, cordoned off piece of hospital property these fifteen to thirty minute trips were their only connection to the greater world, the ‘world outside’, as one horrifically abused seven year old boy once described it to me. To see these kids playing in the garden one might even mistake them for “normal’ kids. To see them interact with children in wheelchairs, with children wheeling IV poles, with children sentenced to die and whose parents had nowhere else to cry, one might think they were even more than normal, that they were, at least for a few minutes, special. Continue reading

Bomber Trial: How Do You Talk To Children About The Death Penalty?

In this courtroom sketch, Assistant U.S. Attorney Aloke Chakravarty points to defendant Dzhokhar Tsarnaev. Tsarnaev was found guilty and now faces the death penalty. (Jane Flavell Collins/AP)

In this courtroom sketch, Assistant U.S. Attorney Aloke Chakravarty points to defendant Dzhokhar Tsarnaev. Tsarnaev was found guilty and now faces the death penalty. (Jane Flavell Collins/AP)

Killing is the ultimate bad, right? That’s what we teach our children. So how do we talk to them about the very real possibility, splattered across our screens and newspapers, that we may put a young man to death for his crimes?

“I think he should die,” said my 9-year-old child when I raised the question leading the news this week: whether Boston Marathon bomber Dzhokhar Tsarnaev should be sentenced to death or life in prison. “If he killed [four] people and injured hundreds and ran from it he should have a very serious consequence.”

“Life in prison is worse,” said my older daughter.

The conversation then turned to what kinds of people commit crimes and why, and by the end, my young daughter was not so sure about the death penalty. Needless to say, it’s complicated.

Earlier this month, Tsarnaev, 21, was convicted on all 30 counts against him and was found responsible for the deaths of three spectators at the 2013 marathon as well as the fatal shooting of an MIT police officer.

Today, defense lawyers are making the case for life in prison for Tsarnaev, rather than the death penalty. The public, is seems, is also leaning in that direction: A recent WBUR poll found that only 31 percent of Boston area residents say they support the death penalty for Tsarnaev.

So how do we talk to our kids about all of this?

Shamaila Khan, Ph.D., is director of behavioral health at the Massachusetts Resiliency Center, a program of Boston Medical Center, and has been attending the Tsarnaev trial regularly, providing support for survivors at the courthouse. She was a responder on the day of the marathon in 2013 working with families and individuals brought to BMC. She has also worked closely with families affected by the bombing and its aftermath, including people in Watertown who were impacted by the hunt for the Tsarnaev brothers days after the bombings.

I spoke with Khan about how to help parents talk about these tough issues — life and death, justice and punishment and revenge — with children. Here, edited, is some of our conversation:

RZ: So, as a parent, how do you begin to talk to children about these complex issues?

SK: This is a very controversial topic. It’s hard enough for adults to talk about it, let alone children. Children respond differently based on their developmental level — depending on what age they are and where they are developmentally. But there are three basic things to consider: listening, protecting and connecting.

RZ: OK, can you give some more detail please?

So, first, listen. Ask the children if they’ve heard about this, and what they know. With social media, there’s so much information available and often children know more than parents think. If they have heard about this, listen to what they have to say. Often, our tendency as adults is to start explaining — first let the children tell you what they know. Once you know that, you can figure out how to answer their questions, and find out what they are curious about. If they are expressing opinions at one end of the spectrum [like my daughter], offer them another point of view, maybe something like, ‘Who knows why this person did this?’ and give them more information. Help them to think about it in a more complex way, highlighting the variation on the spectrum. But remember, sometimes not telling the whole truth is important.

Like if a child, say up to 12 years old, asks how exactly does the death penalty get carried out, you might want to explain it in a way that demonstrated how it’s done with the individual experiencing the least amount of pain. You can be kind of vague and abstract. I’ve given examples of a pet that needs to be put to sleep: It happens in a way that doesn’t hurt them. So, a little abstract and not giving all the graphic detail unless asked. You can explain the death penalty by saying, for example, there’s a process in place, and different ways that it can be done. They try to figure out the least painful method, maybe medication or an injection. They used to do worse things but they don’t do that any more. Just keep it simple and abstract.

So you also said “protecting” is important. How does that work in this context?

Children, no matter what you’re talking about, they think about their own self and safety: Where is this person? Can this person get out of prison and hurt me? Is he in the same town where we live? Is he chained up? What kind of person does this and can there be anyone else around to do this to me? So the child’s own sense of safety is triggered. As parents you want to make sure the kids are feeling protected and safe. So just reassuring them is important.

And “connection” — where does that come in?

Connection is about making sure their support system is in place. You make it clear that you are there as a parent or parents, and other people are around, teachers, family members and others. You make sure there are other people and systems in place and say, ‘If you ever want to talk, there are people around to talk to.’ Often children stay curious, and if talking is not what they want, offer them activities that give them other ways to address their feelings: write a letter — What would you say to this person? — write in a journal, create a drawing… Continue reading

Related:

A Boxer’s Brain And The Evolution Of Sports-Related Head Injuries

(don's athletics/Flickr)

(don’s athletics/Flickr)

(This post originally appeared on Boston University’s Research News website as “Head Examiner: Neurologist Ann McKee Talks About Battered Brains, Tangled Tau, And The Future of Sports“)

By Barbara Moran

For Ann McKee, every brain tells a story. And sometimes it’s a tragic one. McKee, a professor of neurology and pathology at the Boston University School of Medicine (MED), is the director of neuropathology for the Veterans Affairs New England Healthcare System, and also directs BU’s Chronic Traumatic Encephalopathy Center. Chronic traumatic encephalopathy (CTE) is a degenerative brain disease found in athletes with a history of repetitive brain trauma. McKee first identified its telltale mark—tiny tangles of a protein called tau, clustered around blood vessels—in the dissected brain of a boxer who had been diagnosed with Alzheimer’s disease.

Although most people associate CTE with professional football players, McKee has found it in the brains of soccer, hockey, rugby, and baseball players as well. Her research has alerted the public to the long-term dangers of repetitive hits in sports and raised tough questions about safety. McKee was invited to speak about this growing public health concern at the annual meeting of the American Association for the Advancement of Science (AAAS), the world’s largest general scientific society, held in February 2015 in San Jose, CA. She told BU Research the story behind her discovery of CTE, and what it might mean for the future of sports.

BU Research: You’re a world expert on tau protein, which has been implicated in Alzheimer’s, CTE, and other brain diseases. Have you studied tau your whole career?

McKee: Yes. I love tau.

Why?

It’s beautiful, the way it collects throughout the nervous system and just sort of fills up the nerve cell. It’s always been quite lovely to look at, visually captivating. I mean, how crazy is that? But it’s true.

When you started studying tau, you were studying Alzheimer’s?

I was interested in Alzheimer’s, but I also worked on PSP (progressive supernuclear palsy), and something called corticobasal degeneration.

Those are not so famous.

No, they’re not so famous. But I got very involved in defining what these individual diseases looked like. It’s like being at the Smithsonian and being really interested in one collection of pottery or something. And once you start understanding it, you start seeing all these differences, and it’s like “Whoa!”

Brains with CTE show a distinct pattern of tau protein, seen here in brown. The two slides on the bottom come from the brain of a 66-year-old ex-NFL player. The slides on top are from a 65-year-old man without CTE. Photo courtesy of Ann McKee

Do you remember the first time you saw a brain with CTE?

Yes. It was phenomenally interesting. The first case was Paul Pender, a professional [middleweight] boxer here in the Boston area. He had twice been world champion. That was my first time seeing it under the microscope. I looked at the slide and it was like “Oh my God! This is so amazing. I’ve never seen anything like this.” It just blew my mind. That was 2003.

How did it look different than, say, a brain with Alzheimer’s?

Alzheimer’s disease has these beta amyloid plaques that look like small puffs of smoke throughout the brain. Continue reading

How Art Can Re-Order A Harsh, ‘Deformed’ Childhood

Artist Evelyn Berde was born with congenital scoliosis in 1950 and spent many years in and out of Massachusetts General Hospital, confined to a bed for months at a time.

Her art, she says, is informed by her experience living with her “deformity,” as it was referred to back then, and her childhood growing up in the old West End of Boston, a low-income neighborhood near MGH and the Charles River, which was razed in the late 1950s, displacing many residents.

It wasn’t an easy childhood: Alcoholism ran in the family and Evelyn’s brother drowned in the Charles River when he was nine and she was just six. Evelyn was subjected to numerous surgeries and procedures for her scoliosis — some that now seem barbaric.

But art, she says, “has the ability to lift us out of one place and take us to another.”

Here, you can listen to Evelyn talk about five of her paintings and tell the stories that helped shape them.

Artist Evelyn Berde's "Shame" (Courtesy Berde)

Artist Evelyn Berde’s “Shame” (Courtesy Berde)

Artist Evelyn Berde's "July 12, 1956" (Courtesy Berde)

Artist Evelyn Berde’s “July 12, 1956” (Courtesy Berde)

Continue reading

Beyond Carb-Cutting: Resolutions After A Trauma — Sleep, Play, Love

(katiebordner/Flickr)

(katiebordner/Flickr)

By Rachel Zimmerman

A friend, trying to cheer me up over the holidays, suggested I find comfort in this fact: “The worst year of your life is coming to an end.”

In 2014 I became a widow, and my two young children lost their father. Needless to say our perspective and priorities have shifted radically.

Last year at this time, my New Year’s resolutions revolved around carbs, and eating fewer of them. This year, carbs are the least of my worries. My resolutions for 2015 are all about trying to let go of any notion of perfection and seek what my mother calls “crumbs of pleasure” — connection, peace and actual joy on the heels of a life-altering tragedy that could easily have pushed me into bed (with lots of comforting carbs) for a long time.

As a mom I know with stage 4 cancer put it, when your world is shaken to its core, your goals shift from things you want to “do” —  spend more time exercising, learn Italian, make your own clothes — to ways you want to “be,” knowing that your life can shift in an instant.

So, with that in mind, here are my five, research-backed, heal-the-trauma resolutions for 2015:

A Restful Sleep

Yes, at the top of my list of lofty life goals is a very pedestrian one: sleep. Lack of sleep can devastate a person’s mental health and without consistent rest, the line between emotional stability and craziness can be slim. (See postpartum depression, for one example.) In my family at least, to ward off depression and anxiety, we need good sleep and lots of it; more Arianna Huffington and less Bill Clinton.

Play, Sing, Dance

The beautiful thing about children is that despite tragedy and loss, they remain kids; they are compelled to play, climb, run and be active. Resilience, as the literature says. In their grief, they can still cartwheel on the beach, play tag or touch football in the park. Shortly after my husband died, I tried very hard to play the games my kids liked, which often felt like that scene in the “Sound of Music” where the baroness pretends to enjoy a game of catch with the children. Soon I learned to broaden my definition of play — really anything, physical, or not — that serves no other purpose other than to elicit pure joy. Continue reading

Elderly Man (Me) Found In Snow With Punctured Lung But Still, At 79, I Ski

Author Ralph Gilbert, who suffered a punctured lung in a ski accident, and his son, Keith, his rescuer (Courtesy)

Author Ralph Gilbert, who suffered a punctured lung in a ski accident, and his son, Keith, his rescuer (Courtesy)

By Ralph M. Gilbert
Guest Contributor

Traumatic pneumothorax: the presence of air or gas in the pleural cavity, which impairs ventilation and oxygenation, caused by a severe trauma to the chest or lung wall. Symptoms are often severe, and can contribute to fatal complications such as cardiac arrest, respiratory failure, and shock.

Every time I tried to lift my head the sky began to spin. Then I felt the nausea. I knew that I had to get up out of the snow but after a few attempts, I just lay back, exhausted. Suddenly, a spray of powder was kicked onto my face as a young ski patrolwoman executed a hurried skid stop. She bent down and put her cold face next to mine:

“Sir,” she said looking into my unfocused eyes. “Are you all right? Do you know where you are, sir? Where are you, sir?”

“Huh?”

I realized that she wasn’t asking a particularly hard question, but I just couldn’t come up with an answer.

“I don’t know,” I replied.

She helped me to my feet.I looked around and saw the other skiers.

“I’m skiing…right?”

She radioed for help. The next thing I knew, I was being leaned back into a toboggan. Fighting the nausea and afraid that I would have to throw up, I asked to be tipped over momentarily before they restrained me to the sled for my ride down.

I regained consciousness in a strange hospital ER.

A young woman was standing over me. She asked: “Do you really think, sir, that a man of your age should be skiing alone in the glades?”

I hated that question. I found it particularly humiliating. As an intrepid, former U.S. Army trooper, I didn’t want to be talked to that way, especially by a woman who asked me the same questions my wife often asked.

Tests indicated a concussion. Upon release, I was told to buy a new helmet (each helmet can absorb only one crash), and not to ski for a week. I took only one day off, which I thought was plenty. I then purchased a new helmet and two days later I was back up on my skis again.

My next accident a few years later was to be worse, much worse.

Age denial? Not So Much

Before I tell you that story, I’d like to note that I’m not in total age denial. Now 79, I spend less and less of my après-ski time trading embellished ski stories with my buddies in smoky bars. These days, when we go on our annual ski trip, I can be found at night alone in my little room, carefully applying ice packs and winding compression bandages around my ill-treated joints.

I reject the idea, however, that I am suffering from any age-related diminution of muscle tone, balance or endurance. My ski dreams are still intact even if my body is not. I do realize that I should avoid the super steep double black diamond trails that I once traversed. But I just can’t resist.

Why? By story’s end, I’ll try to explain.

Male Bonding

Each year, twelve of us, former army buddies at Fort Bliss, Texas go on a ski trip together. We had trained as Nike Missile crewmen back in 1958 during the Cold War. Our job was to join with others to protect the City of New York.Stationed in a darkened radar van, we were to monitor our radar screens for Russian bombers. Our Nike Missiles were buried in concrete shafts near us. Our vantage point was Spring Valley, New York, which otherwise is known for kosher chickens and Hassids. If we saw any Russians in the air we were to electronically challenge them, then shoot them down. Continue reading