Preston Gorman, PA-C is no stranger to infectious disease epidemics. In 2015, while volunteering in Sierra Leone to care for patients infected with Ebola, he contracted the lethal virus. His harrowing journey to recovery included nearly a month of isolation, testing the limits of his body and spirit. The experience led PA Gorman to face his own mortality, and advocate for the importance of trauma-informed care. Doximity had the opportunity to speak with PA Gorman and glean insights that can be applied to the ongoing COVID-19 pandemic, and beyond.
Doximity: What would you like clinicians to know about the experience of isolation?
Preston Gorman, PA-C: Isolation can have far-reaching effects on your psyche that can be difficult to navigate. Isolation — especially the degree of extreme isolation I went through — really makes you feel separate from the rest of humanity. It makes you feel like you don’t belong and makes it hard to relate to others’ life experiences. No one could relate to my experience and I couldn’t relate to them; I had no one to compare notes with. My suspicion is that isolation has impacts on our neurobiology and neurotransmitters. For example, the fact that we can have this conversation right now, that’s engaging our neurotransmitters and both you and I are — on a second-by-second basis — adjusting what we are saying, and even more so if we were in person, you would be watching my body movements and I’d be watching yours and we would sort of play off one another. But when you’re in isolation, you have none of that stimulation and those neural connections begin to atrophy. An analogy is an athlete that is used to playing a sport and then stops for a couple months — those skills begin to atrophy. It’s the same for human relations.
You have no control in isolation. I couldn’t leave the hospital nor do much for myself. My muscles were so atrophied and I was so weak; I even had nurses rolling me over in bed. You lose your autonomy and your ability to connect with others meaningfully. Part of our humanity and what helps us cope in life is people connecting to our experience. When that’s suddenly removed, that is a form of trauma. You could probably [similarly] look at prisoners of war or people who are incarcerated. Someone may look at my experience and not be able to relate and even withdraw from it. I’ve had to overcome things that most people will never have to overcome.
Dox: What does trauma-informed care look like to you?
PG: It’s being able to honor, respect, and validate someone’s emotional subjective experience. It’s educating the patient and their loved ones on the signs and symptoms of post-traumatic stress. In my experience, no one even told me that what I went through was trauma until two years after. It’s helping people identify that what they went through is a major deal, and that they may need some time to process and recover. Like soldiers coming back from war and going through an intense ICU admission, your body goes into scramble mode. When a person comes out of that intense experience, it’s actually a mistake to put them right back into civilian society. Their body and mind needs to decompress from that trauma. There’s a sort of de-escalation process that the body, mind, and soul need to go through to get back to baseline. And just like how people have different [physical] pain tolerances, people also have different emotional pain tolerances.
Dox: How has your experience surviving Ebola informed your current patient practice?
PG: It’s made me more aware of trauma and its effects, and now I approach patients differently. There are times when a patient’s physical or mental health complaints could arise from previous trauma. Mental illness is prevalent in the student population where I work. My experience has given me a lot more compassion and empathy; it might even be asking an extra question or two that I now know to ask because of my experience. It affects my history-taking; I try to connect with where the patient is at and validate what they’re feeling and their subjective experience.
Dox: What has been your experience so far during the COVID-19 pandemic?
PG: Professionally, it hasn’t had as much impact as one may think. In my clinic, I’ve stayed in the urgent care section and I really don’t see a lot of the COVID-specific patients. Early on [in the pandemic] it was a little triggering being in the midst of PPE again and the changes in protocol. Over time, I’ve grown used to it. It’s not so triggering anymore.
Dox: How can clinicians take better care of their mental health during COVID-19?
PG: That’s a really hard question. I think physical exercise is paramount. Moving the body is a big deal. And staying connected with loved ones is also important. In this time of COVID-19, everyone is isolated and it’s wreaking havoc on our mental health and our sense of self and society. As much as possible in your own households you need physical touch from your loved ones. Period.
Dox: What is a technique from therapy that you use for yourself?
PG: Journaling was really helpful for me. Also, I did visualization exercises like imagining different outcomes. Personally, I would visualize certain aspects of my trauma and ask myself, “Where was God in that scene? Where was He taking care of me during those bad things that were happening?” And, honestly, letting myself cry. Letting myself shed tears over my grief. When I finally gave myself permission to let the tears out when they came it was actually freeing. A sort of dialectical behavioral therapy technique I learned is being able to hold two truths at the same time. I did go through hell and I did lose a lot. But at the same time, there’s been a lot of good to come from it. I’m literally alive and walking around. People can get caught in two traps — the grief cycle or being in denial and focusing only on the positive. And I don’t think that’s honest. You have two things — the pain of loss and whatever your new life is after.
This interview was conducted by Angelica Recierdo, MS, BSN, Doximity Editor.
Illustration by April Brust