The Road to Resiliency: A Case Study

  • The Road to Resiliency: A Case Study

    by Dr. Tina S. Brookes, MSW, LCSW, Ed.D. and Jama Brookes

    The emphasis of Critical Incident Stress Management (CISM) has to be on the management of stress, not on the stress itself.  It is easy to fall into the trap of sharing ‘war stories’ when speaking to those in crisis in an attempt to underscore many of the unique ways stress presents itself following a critical incident or trauma. Some use this method as a way to validate themselves in the field while others simply inadvertently get caught up in talking about their own stories with the ones in crisis.  Yet, stressful stories told to stressed-out people can often compound the trauma by having the exact opposite of the desired effect.  People in a crisis simply have no emotional reserve to hear someone else’s crisis story. However, when the greatest emphasis is placed on the management of stress with a sincere desire to foster growth and resiliency, real healing and change can occur with lifelong positive implications that impact not only the individual in crisis but their family, friends, and peers as well.  

    This article focuses on the road to resiliency by examining three pertinent phases of the journey: live it, heal it, and embrace it.  It features a case study written by the subject herself.

    Live It:  

    Oftentimes people find themselves on journeys they did not choose, or could even have imagined. CISM offers an opportunity for them to first “tell their story” by inquiring about facts or details of what happened. There is great power in this process because as the individual recounts the journey it is often the first time they have reflected on the whole picture which can offer a concrete validation of just how much they have encountered and endured. CISM support providers can then build on that information as a means of encouragement, “look at what you have lived through and how you found ways to cope and even grow”.  It is a sacred gift to listen to others share their experience without cutting them off or jumping in with platitudes of comfort like “but you are OK now, right?” or “well, that is all behind you”.  A great deal can be learned from the simplicity of listening to the lived experience:

         In 2012, I went from a very active, healthy kid to being deathly ill, diagnosed with Crohn’s, and on a systemic immune suppressant medication within a month. After two years of living medication-to-medication, my colon almost disintegrated inside of me.  I had a total colectomy, which resulted in peritonitis, adrenal failure, and an ostomy bag. Eight months after being discharged from the hospital, I received another surgery to takedown the ostomy and reconnect my intestines. Though this was supposed to mark the end of my medical journey, the surgery failed and created a domino effect to many more issues. In 2015, I was in and out of the hospital for a total of 200 days dealing with a blockage, hidden and superficial infections, extensive scar tissue, each fallopian tube filled with 1/2 cup of fluid (hydrosalpinx), and a hole in my bowel connected to my skin (fistula). By August 2015, my surgeon was frustrated he could not fix my many complications, so, he released me. From there, I transferred to Johns Hopkins where it was decided I needed three more consecutive surgeries. My first surgery in October 2015 consisted of a six-hour operation to remove the fistula and scar tissue, make a new ostomy, and clean the infections. In April 2016, I had an eight-hour surgery to remove the rest of my rectum and both of my permanently damaged fallopian tubes, and create a “J-Pouch” for a makeshift rectum. In August 2016, I had my final surgery to take down my ostomy and allow my bowel to function as normal as possible.

    Heal it:
    In our culture strong individuals have a tendency to gloss over crisis and trauma with a hurry-up mentality to just get through it and get back to normal. It’s like somehow if they don’t think about the incident then it didn’t really happen or have an impact on them. And while it may seem counter-productive, true healing cannot happen unless the experience, is well, experienced. It has to be lived, felt, and processed before it can be healed. It is like a wound on a child after a bike wreck. The wound is full of grit, dirt and gravel. It must be cleaned first by removing the debris and washing it with antiseptic cleanser before it can be stitched and bandaged.  CISM service providers participate in this healing by taking the time to listen as reactions to the trauma are recognized, examined, and expressed: 

         I lost control of my body, the one thing I thought was controllable. And, by losing control of my body, I lost control of my life. Though I desperately worked to stay in school, in the end, my medical condition won. I was forced to remove myself from school, soccer, ballet, and marching band. By losing school, I lost my friends, and by losing my extra curricular activities, I lost my future aspirations to be a professional soccer player, ballerina, and valedictorian of my high school. The simple longing to learn in a classroom surrounded by my peers now seemed like an unreachable goal.  The greatest emotional hit I took, though, was the feeling that I had let everyone down. Due to surgeries scheduled only a month in advance, I had to back out of a ballet performance that relied heavily upon my role. Due to extensive, never-ending hospital stays, I had to pull out of my school activities like Model United Nations and Mock Trial at the last minute. Since I was the only who was trained, they had to scramble to find a potential replacement. Due to long episodes of pancreatitis, my soccer coach was unable to know which days I could play and which days I simply could not. So, she stopped counting on me to be on the field. To make things worse, since my medical issues were an ongoing problem, I placed each group in a terrible position more than twice. I had become a wild card. I was that sick kid that could not be relied upon with important roles due to the intensity of her medical condition. So, I had to grieve the loss of my own reliability.

    Embrace it:
    Once the wound has been cleaned and the healing process has begun, then it is time to talk about the Lessons Learned gained from the experience and to discuss the “new normal” that lies ahead. One technique to use is the “Growing Through Crisis” Questionnaire (Tina S. Brookes, 2012) that includes three simple but poignant questions: 1. Did you learn something from it? 2. Did it make you stronger? And 3. Is there anything you learned you can now use to support others in crisis?  “Growing Through Crisis” empowers individuals to identify their personal strengths and label their lessons learned. Individuals often report increased confidence and poise as they answer the empowering questions that focus on resiliency and growth.  True healing occurs as they find the purpose in their pain:


         In the beginning I was constantly trying to become my past self, but I had to embrace the fact that I had shattered the mold of the person I once was and it was impossible to put the pieces back together. So, as I gained new contents of knowledge, I began building a new mold. Days spent advocating for my medical care and taking care of my ostomy became my new normal. I did not find happiness in the same places I once did. Rather, my new joys were simple ones that were found in a smile of a nurse, loving heart of a mom, and a laughter-filled hospital birthday. My accomplishments went from winning a soccer game to being able to ride in a wheelchair around the hall. And, with each new day, I grew a stronger appreciation for simply waking up alive. I realized as my reality was shifting, so was my purpose. I stopped seeing the hospital as defeated ground and instead saw it as my mission field. On the days I was not paralyzed by pain, the Child-Life workers asked me to speak to other young girls about ostomies. While I stood in front of each girl telling them to not be afraid to clean their emotional wounds and to believe in their strength, I grew a great deal of passion for supporting those around me.  Instead of letting my illness destroy my life, I let it strengthen my heart and spirit. I knew my life could never be the same again after walking this journey, but I believed it had transformed into so much more. I finally understood that resiliency is not about bending back into the person you were, it is about bending forward into the person you are becoming.              Jama Brookes