Amid trauma and burnout, it ‘takes courage’ to reflect on mental, emotional well-being
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Editor’s note: This is the fifth in a series of five stories from ASCO Voices, a session during ASCO Annual Meeting that focused on the human side of oncology.
In many ways, the scene mirrored yet another typical day in health care for William E. Rosa, PhD, MBE, MS.
The behavioral scientist and palliative care nurse found himself in a busy psychiatric ER, listening to a woman describe her preadmission suicide attempt while another patient discussed the domestic violence attempt that had landed him there.
Yet Rosa was experiencing these circumstances from a vastly different perspective than he was accustomed to.
On this day, he was on a stretcher, dumbfounded by his own predicament. He had just been admitted to the unit, and all he could think was: How did I get here?
“A few minutes earlier, my husband and parents had walked me right to that unit entrance. Just before I could hug them goodbye, a latched steel door slammed shut, separating me from the people I love the most,” Rosa recalled during his presentation. “Then the guards ordered me to change into scrubs and surrender my belongings. All of a sudden, the words that people had used to describe me my whole life — words like ‘capable,’ ‘resilient,’ ‘strong,’ and ‘brave’ — no longer seemed to fit.”
‘My time to have a nervous breakdown’
As Rosa waited in the ER with his fellow patients, he began thinking of many less empowering adjectives to describe his current state: helpless, debilitated, fragile and deeply afraid.
“I was really scared,” recalled Rosa, who specializes in palliative and end-of-life care, health equity and LGBTQ + inclusive care at Memorial Sloan Kettering Cancer Center. “A few hours later, I was discharged home and referred to a psychiatrist for a next-day appointment. That psychiatrist felt that my 30s were simply my time to have a nervous breakdown.”
In retrospect, it seemed inevitable.
Although Rosa had accomplished a great deal by that point, he also had endured more than his share of trauma.
“After a childhood of round-the-clock, nonstop bullying for being the gay kid, I moved to New York City for college just in time to watch that second tower collapse on 9/11,” he said. “As I became more independent, I tried on all the addictive and numbing behaviors that any kid with internalized homophobia and a broken sense of self tries on.”
In his early 20s, Rosa enjoyed success as a classically trained dancer, but that career came to an abrupt halt when he fractured his hip, leaving him immobile for months.
Ironically, Rosa’s injury rehabilitation provided the spark for his next career.
“I was inspired by that injury rehab to serve others,” he said. “Now I’m 15 years into a career in palliative care and oncology nursing that I love so much.”
His new career became a source of meaning and passion, but the same powerful emotions that motivated him were sometimes a source of anxiety and despair. Rosa’s empathy for his patients often left him with feelings he couldn’t simply leave behind at the end of the workday.
“Ever since then, the dying patient and the grieving caregiver became ever-present,” he said. “All the while, I was just absorbing these gasps of terminal dyspnea, the nuances of existential distress and the shockwaves of a pain crisis at an almost cellular level. Eventually, all of this accumulated angst became too much to bear.”
‘We are all suffering so much’
A few months before his admission to the psychiatric ER, Rosa began having nightly panic attacks.
He would wake up with his heart pounding and his chest tight, drenched in sweat and convinced of his impending death.
Even worse, the medications he was prescribed to manage the panic attacks caused Rosa to suffer severe, alarming suicidal ideation.
“The morning of the psych ER admission, I was standing in my shower, just hearing the most gruesome advice to kill myself,” he recalled. “I was sure I was losing my mind, and I really did stop functioning altogether.”
The ER admission was the beginning of Rosa’s wake-up call. His body had generated this paralyzing anxiety to let him know something was wrong, and he needed to take time to address it.
“It quickly became clear that, in a time where nowhere felt safe, my first task was to learn how to feel safe in this body,” he said. “This rubble that had been the target of all that abuse and brokenness was actually the exact temple I had to enter to heal.”
A few months later, Rosa found himself sitting on a panel with hospital colleagues, describing “the emotional impact of taking yet another patient off the ventilator at the end of life.”
“My voice caught me off guard. All of a sudden I just blurted out, ‘I need a break,’” he said. “As soon as I said it, I knew it was true. Why was I so afraid to say it out loud?”
After that session, several colleagues approached Rosa to commiserate. Many told him that they, too, very much needed a break.
“I thought, ‘Wow, we are all suffering so much in this work,’” Rosa said.
Value of trauma-informed care
Rosa began to realize that in the stressful, devastating situations he and his colleagues faced daily, there was much to be learned from the principles of trauma-informed care.
“This is the idea that cultivating an awareness can prevent us from re-traumatizing ourselves and others,” he said. “I think it starts with reflecting on — and telling the truth about — our mental and emotional well-being. That takes courage.”
In acknowledging the emotional scars, brokenness and vulnerability that comes from tragedy and loss, individuals can begin to heal a lifetime of stored and unresolved trauma, Rosa said.
“As a workforce, you and I see unacceptable rates of suicide, burnout, moral distress and attrition,” he said. “It’s time that we come to safe and supported terms with our trauma — not just as individuals, but as a collective, not only for the patients and families we serve, but for us to survive.”
Looking back today on his psychiatric ER visit, Rosa realized he never did lose his mind. However, he was extremely tired and traumatized, and he didn’t know how to ask for the help he needed.
“It turned out I’m not a machine like I once thought,” he said. “I’m a fully functioning human being. I’m a husband, a son, a friend and a nurse, and I live an unpredictable, fulfilling and sometimes really hard life.”
Rosa has since realized that, as he sat there in the psychiatric ER, convinced that the positive adjectives once attributed to him longer applied, he actually was embodying those qualities by having the courage to seek help.
“This story of mine, so much of it traumatic, is exactly what makes me all those words people use to describe me my whole life — capable, strong, resilient and brave,” he said. “Because I am.”
For more information:
William E. Rosa, PhD, MBE, MS, can be reached at rosaw@mskcc.org.
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Rosa W. Trauma informed. Presented at: ASCO Annual Meeting; May 31-June 4, 2024; Chicago
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