My gut churned, a burning rose into my chest as I read the email. It’s happening again repeated on a reel in my mind, followed by  I need to leave this job. But I wasn’t quitting. I was triggered. It was years after I’d had the rug pulled out from under me at an institution where I’d spent decades working, but sometimes my nervous system sent me right back there.

I was a palliative care doctor — an assistant director — when it happened to me. I had just moved into the cancer center where I consulted on patients before they were admitted to the hospital, or put on life support in the intensive care unit.

The hospital was revamping our palliative care program. Data was showing palliative care involvement with very ill patients decreased the “total cost of care,” which was music to hospital administrators’ ears. For me, it was the proverbial “win-win.” In palliative care, we got to do the right thing by focusing on quality of life, and we were getting institutional support to do so.

One day I arrived at our usual staff meeting to find an “org chart” projected on the large white screen at the end of our ovular table. We sat together: nurses, social workers, dieticians, and doctors, as the brand new head honcho, whom I’d interviewed for the job, directed our attention to the typical graphic depicting who reports to who in a workplace. His name was at the top.

Things were being rearranged, and he was in charge. The next three staff meetings started the same way. His name bolded at the top of a cascading tree of his underlings. That was, until the meeting where he started with a video of himself speeding in race cars “so we could get to know him better.” Soon after, he asked to meet with me.

He welcomed me warmly, made space on a chair. He was unpacking books which were scattered all over. A photo of his wife and kids was framed on his desk. I remembered him from the interview. Then he’d seemed guarded but curious. I was encouraged by his friendly demeanor.

“It’s nice to see you, Eve,” he began, “Tell me, how long have you been doing palliative care?”

I started fidgeting with a pen in my coat pocket. The tone seemed to have changed.

“I took my boards after taking courses from leaders at other institutions, adding to my own experiences from decades as a doctor. I learned tips about managing difficult symptoms. Then I spent a year covering consultations in the hospital with my palliative care colleagues here,” I explained with enthusiasm. But I was starting to wonder why I felt like I was defending myself. I added: “It’s going great down here. Oncologists are sending lots of patients. Everyone’s happy!”

Pause.

“I was thinking it might be good for you to go spend some time with some seasoned palliative doctors — masters in conversations about life and death. Don’t you think that might do you some good?”

That was the first time I felt that sinkhole collapsing in the center of my chest—the prickling of the nerve endings on my skin.

“Um. OK. I hear you but … I’m not sure I understand exactly what you’re saying.”

He wasn’t backing off:

“Just think about it, Eve. It would be a good opportunity. We all have things to learn.”

“Of course … uh … I have a patient to see,” I quickly muttered and rushed out feeling like a water balloon had been lobbed at my gut at close range.

But this was only the beginning. The questioning of my judgment, the second guessing of my knowledge, continued after this initial one-on-one conversation and led me to leave the institution that had raised me as a doctor without reaching out for help.

I left the place where as a teenager I followed my dad on rounds. Where, as an intern, resident, and fellow, I became a real doctor. Where, as an attending physician, I honed the skills allowing me to deserve that title. And where I got letters of love from patients, excellent performance reviews, and donations in my name.

As one article on workplace trauma put it, these interactions are hard to address when a power differential is at play, and even harder to shake long after they occur:

“… in hierarchy-driven workplaces, workers may find it especially challenging to complain to supervisors…A lack of communication can become even more of a problem when gender, race, or age dynamics are in play … These dynamics can combine to make trauma more acute and longer lasting — a major problem for workers of all stripes, no matter the “severity” of their individual experiences.”

For people of color, LGBTQIA+, differently-abled, neurodiverse, the frequency of these incidents is exponentially higher. Coupled with prior trauma, the effects may be all the more devastating with long-term effects.

In the time of COVID, the term workplace trauma provokes more disturbing, more profound, images than a cocky man posting, and reposting, the org chart with himself at the top; or playing reels of his manly exploits, or even of conversations meant to belittle charges who may feel like a threat in some way. Now we see images of overrun emergency rooms, understaffed intensive care units, and sick health care workers. Add to that the trauma of living where expertise is denigrated, science likened to opinion. There is no doubt of the traumatic implications of what we face now.

For me, after the crushing blow in a workplace I loved, I grew as a leader. Most importantly, I tried to prevent others from similar traumas. Where I work, we talk openly about emotional issues. And I’m not afraid to say that my own emotional healing is not done.

Eve Makoff is an internal medicine physician.

Image credit: Shutterstock.com