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Retired emergency department nurse Amy Dinaburg discusses her article “Lowercase PTSD: Why emergency staff are still hypervigilant.” Amy reflects on the relentless pressure of the COVID-19 pandemic where nurses were forced to override their nervous systems to keep patients alive. She describes the concept of “Lowercase PTSD” as the result of prolonged exposure to death and uncertainty rather than a single catastrophic event. The conversation highlights how the “hero” narrative often masked a survival mode that many staff are still struggling to turn off years later. Amy explains that healing requires small recalibrations, like consciously softening the body and allowing rest without earning it, to move from unconscious reactivity back to feeling fully alive.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Amy Dinaburg. She is a retired emergency department nurse. Today’s KevinMD article is “Lowercase PTSD: Why emergency staff are still hypervigilant.” Amy, welcome to the show.

Amy Dinaburg: Well, thank you so much for having me.

Kevin Pho: All right, so tell us briefly a little bit about yourself and then what led you to write this article on KevinMD.

Amy Dinaburg: My name is Amy Dinaburg, and I am a retired ER nurse. Before that, I was a scientist in research and development. I have a master’s degree in molecular biology and clinical nurse leadership.

Kevin Pho: OK, so you wrote this KevinMD article, “Lowercase PTSD: Why emergency staff are still hypervigilant.” What led you to contribute this article, and then tell us about the article itself for those that didn’t get a chance to read it.

Amy Dinaburg: I recently was seeing a therapist and he suggested I may have PTSD. I initially rolled my eyes because I have never been in a war, my parents didn’t show their love with violence, and I didn’t really think that I could have PTSD from working at my job as an ER nurse during the pandemic. Also in the culture of ER nursing, we are tough. We feel we can do anything. You can just throw it at us and we will make it work.

So when he sort of reframed it as lowercase PTSD, noting it is about being consistently exposed to all the death, uncertainty, fear, and different policies changing day to day, it was easier for me to swallow and think about. Because initially, I thought there is no way I have PTSD. So that is what made me write about it. I had to think about it, process it, and then write about it. That is what started it.

Kevin Pho: In the article, you make the distinction between capital T trauma and lowercase PTSD. Tell us more about that distinction.

Amy Dinaburg: Well, I was thinking that capital T trauma would be a catastrophic event. Whereas with lowercase PTSD, it was more day to day. It involves things becoming normal that weren’t normal and just readjusting. When you are exposed to somebody dying or somebody being intubated, or just the chaos of the ER on a day-to-day basis, you can’t process those emotions because the next ambulance is coming in. The next person dying is coming in. You just have to keep rolling with it. There was no real decompression time.

Of course, I don’t want to get into the hospital system and the short-staffed issues. I am just talking about what we had to deal with on a regular, everyday basis that just became normal for us. It is really hard to turn that off even after the crisis is over. It has been years since that crisis, but those coping mechanisms that kept us alive during that pandemic don’t automatically turn off when the crisis ends.

Kevin Pho: Give us some examples of some of those coping mechanisms that you are mentioning, especially those developed during the pandemic now that you have had some time to reflect on that.

Amy Dinaburg: I am always looking for where the fire is that I have to put out. It is very hard for me to sit and just play with Legos with my kids without thinking about what needs to be done. I think that this needs to be done, that needs to be done, and we need to be ready for this. Sitting and being silent and still is a challenge. I have had to relearn how to do that. It wasn’t until I retired that I realized that I am still doing it. I am not working anymore, and yet that way of thinking still happens.

Kevin Pho: And what were you like before the pandemic and before becoming an emergency department nurse? Were you always like this or is it just the events from the pandemic and the job that changed you?

Amy Dinaburg: That is a good question. I feel like I have always loved to jump in the mix, be a team player, and make things happen. But before the pandemic and that whole event, I could sit and be with myself and be silent and quiet. I may have been bored, but I could do it. I also feel like I had more compassion for little things. If someone had a stomach ache, I would be sympathetic. Now it is more like: “Are you dying?” But that might just be with emergency nursing in general.

However, I feel like I have developed an intolerance for people not doing what they are supposed to be doing. In the ER, if we are not all functioning well, the team suffers. I feel like every single one of us was an organelle in a really high-functioning cell. When anybody slacks, we can pick up the slack a little bit, but if somebody doesn’t do what they are supposed to do on a regular basis, the whole team suffers. Now I have brought that home with me. If my children aren’t running like a high-functioning trauma bay, I might lose my patience a lot faster than I used to.

I used to have more patience and curiosity. After the pandemic, it looked more like competence without the ability to soften. Everything has to be done a certain way. Even things like when the kids don’t put their shoes where they are supposed to go, it is not just a minor irritant. It can be destabilizing.

Kevin Pho: For this lowercase PTSD idea, now you left the field of emergency department nursing. What were some of the reasons behind that? Was it because of a little bit of this lowercase PTSD?

Amy Dinaburg: Yes. I love nursing. Well, really, I love helping people. I love being in contact with people, being there for them in their most vulnerable moments, and helping them find peace or stability or what they need. My goal now is to get into the more spiritual side of patient care and treating the whole person rather than making sure they just survive.

Kevin Pho: So when the therapist said that you had PTSD and you had time to reflect on it and think about it, tell me what happened next in terms of how you dealt with that and how that has affected your life today.

Amy Dinaburg: It has been really illuminating. One of the other things as a nurse that you have to do regularly is justify why you do what you do. When you are in a situation where your resources are so thin and there is no way that you can be on time for 60 patients in the lobby, you have to prioritize. You have to make sure they all get medicated. That is what it was like. You either had four patients in a zone who were all actively dying, or you had the triage area where you had 60 patients who were triaged as not critical, but it could all turn on a dime.

When your resources are so thin, you have to make sure that your priorities are correct and that you are doing what you are supposed to be doing for the people who are the sickest, while also taking care of everybody else too. With that mentality of always trying to justify why I was doing what I was doing, I found that in processing if I have this PTSD and if I am carrying these coping skills into my life today when the pandemic was years ago, I realized I am constantly justifying everything that I am doing because I am afraid somebody is going to tell me I am doing it wrong.

That has been illuminating because I realize I don’t have to fight anymore. One of the other things besides that thought habit that I am working on is being able to rest even when I feel like I don’t deserve it. Before, if I needed to rest, I would just rest. Now I feel I have to earn it. I have to make sure that I am a part of the team and I do my fair share before I can earn the privilege of resting.

That is another thing that I have realized since this diagnosis of PTSD. It is just being able to rest and not having to fight to make sure everyone knows that I did the right thing. Learning to recalibrate my nervous system so I can sit still and be silent is important. I remind myself it is not an emergency and I don’t have to make a decision right this second. I can think about something for an afternoon before making a decision. Before, it had to be done and it had to be done right now or yesterday.

So far as how my life has changed since that diagnosis, it has really illuminated a lot of the behaviors that were coping skills I needed at the time but are not serving me in the kitchen of my house.

Kevin Pho: There are thousands of health care workers, of course, that are still working even after the pandemic. What are some of the dangers if we don’t address this potential PTSD that they developed because of the pandemic? What are some of the repercussions for these health care workers?

Amy Dinaburg: Disillusionment and, of course, burnout. But I feel like burnout also needs to be reframed as well, because I was in burnout for sure. I feel like when you are really entrenched in that burnout, you know you are burned out and you don’t care. It is just life. When people offer you resources or say you should do this to help with your burnout, you have just accepted your fate. You don’t think anything could help. If it does, you feel it would only help for a second. It is hard to describe now that I am on the other side of it.

I feel like especially for people on the front line, but also people in the ICUs or people who really see critical patients on a regular basis when resources are spread so thin, more needs to be done. We need to address health care workers so that they keep the joy in their heart and their passion in helping these folks who are sick. Towards the end it was just asking if they are dying, and if not, moving on to the next person who is. That is not where I began. I love connecting with people and helping them. Where it ended was if you are not dying, I need to move on to the next person who is. Even with my children, instead of being present with them, I am always wondering what more important task needs to be done.

Kevin Pho: What kind of advice do you have for your fellow emergency department nurses or other health care workers for that matter who may be listening to you and wondering whether they have undiagnosed PTSD? Tell us the advice that you have for them.

Amy Dinaburg: Go to a therapist and discuss it. Just discuss it and have a conversation. You may not have it, and that is fine too. Anyone who goes through an event like that which lasted for years with all the political implications and the constant stress is going to carry something. You are dealing with your neighbors, people wearing masks, Facebook, and all these things coming from all different angles.

I had a patient one time who said he didn’t believe in COVID as I was putting the nasal cannula on his face. Any sort of event like that is going to leave a mark. Even if you don’t have PTSD officially, lowercase or uppercase, there is decompression that needs to get done. That is honoring your humanity. It is not admitting weakness, which is one of the things that I was afraid of. We consider ourselves tough broads in the ER.

Just have a conversation. If you find yourself unable to be silent or unable to be present in moments that make life worth living, sit down and talk with a professional about it. It doesn’t have to be a big deal. Just have a conversation.

Kevin Pho: We are talking to Amy Dinaburg. She is a retired emergency department nurse. Today’s KevinMD article is “Lowercase PTSD: Why emergency staff are still hypervigilant.” Amy, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Amy Dinaburg: The take-home message is that the coping mechanisms that kept us alive during the pandemic don’t automatically turn off when the crisis ends. Our nervous system and our physiology have changed after prolonged exposure to that sort of environment. Turning around and being the person that you were is hard to do. So be cognizant of that. Think about that and see if there is help that you can find or conversations that you can have that would help others. Other people might mention that they are suffering from similar things. I would really recommend anybody on the front line just to have conversations about how they are feeling right now, pre-pandemic and post-pandemic, and see if there is any help that they need in finding peace.

Kevin Pho: Amy, thank you so much for sharing your story, your time, and your insight. Thanks again for coming on the show.

Amy Dinaburg: Thank you so much.