BOOK EXCERPT: Damaged: Childhood Trauma, Adult Illness, and the Need for a Health Care Revolution

The following is an excerpt from Damaged: Childhood Trauma, Adult Illness and the Need for a Health Care Revolution by Dr. Robert Maunder and Dr. Jonathan Hunter. –––––––––––––––––––––––– “I was having a shower and felt this lump” is the beginning of a conversation most doctors recognize. It comes with urgency, fear, and uncertainty. The silent communication: “I don’t know if this is really a thing or not. I need you to tell me to take this seriously or to relax.” It leads quickly to a physical exam – nothing else matters as much as the lump. Isaac found a lump in his armpit. He knew that the medication he was taking for Crohn’s disease can cause lymphoma, so he was worried. He immediately called his family doctor and took the first available appointment, even though he would see a resident instead of Simon, his own doctor. It was better than waiting. At the appointment, the day after he found the lump, it had already gotten smaller and harder to find. The resident was still training but she knew what she was doing. She reassured Isaac: “Bad things don’t go away.” That’s where Isaac started when we met the next day. “‘Bad things don’t go away.’ She doesn’t know how right she was about that.” “It’s like a one-sentence description of your life: bad things don’t go away.” We shared the relief of a lump transformed from the only thing that matters to nothing at all. And then we took a moment to pay attention to his response to the danger sign, which was a timely, appropriate, and effective request to see a doctor. Read: Book review: Fighting despair It wasn’t always like that. When Isaac was twelve, his mother took him on the long bus ride to the doctor their family had been seeing since before he was born. He hadn’t been to the doctor for three years. Unless the school insisted on a vaccination, it never seemed like a priority. His fear grew as they sat on the bus. He was thinking about the young man next door and his threats. If Isaac ever told anyone what the young man did, the man would kill Isaac’s mother. Isaac believed the threat, but even worse was the shame and the terror of being discovered, his sense that he was implicated in a terrible act. He sat silently on the bus thinking that somehow the doctor was going to figure out what had happened to him. He’s going to know. He will know. He didn’t know how the doctor would figure it out, just that somehow it would be obvious to him. He will know. When they got off the bus, his mother turned toward the doctor’s office and Isaac took off at full speed in the opposite direction. He was out of his mother’s sight in no time at all, and she had no idea where he went. Eventually she just went home. Isaac didn’t return home until late that night. His parents didn’t ask him why he had run or where he went. His dad yelled at him. He was in big trouble but he didn’t care. The punishment couldn’t compare to the shame averted. Read: Book Excerpt—Steady: A Guide To Mental Health Through and Beyond the Coronavirus Pandemic He didn’t see another doctor until he had his first operation a decade later. About four years later, Isaac needed braces. That’s what the dentist said, so his parents sent him to an orthodontist. He lay back in the chair. He was used to the routine, but the orthodontist was new to him so Isaac was wary, checking out the scene. Isaac always knows where the exits are. The orthodontist said nothing but “open your mouth.” Isaac opened his mouth and the man put something into it – a piece of equipment, his fingers, an instrument – Isaac had no idea. Whatever it was, it felt shocking, unexpected, overpowering. Maybe it was something in the man’s manner or the command. Maybe it was something about the feel of the thing in his mouth. Isaac still can’t figure it out. Almost fifty years later he still gets anxious telling the story. He jumped from the orthodontist’s chair and ran from the office. They were probably yelling at him as he left. It’s all a blur. Isaac didn’t see another dentist until he was thirty A year or two after starting therapy, Isaac was preparing for surgery. Another resection, another foot of scarred and twisted bowel needed to be removed. At the pre-op clinic, swabs were required to see if he carried any bacteria that would put other patients at risk. The nurse did not explain this. She just said, “I’m going to stick this up your nose.” “The fuck you are. Give it to me. I’ll do it.” The next swab was of the skin in the crack of his buttocks. The nurse said, “Drop your pants.” Isaac said, “Stick it up your own ass,” and left. Once again, he was “a difficult patient.” At times like that you can’t see his fear through its thick veil of anger. The recent story of the-lump-that-went-away is an excellent exception to a lifetime of running away from health care. Isaac has worked hard to achieve it. He needed help, asked for it, and help was given. As an extra bonus, something bad appeared, and then it went away. Excellent exceptions are the footholds of change. Excerpt from Damaged: Childhood Trauma, Adult Illness and the Need for a Health Care Revolution by Robert Maunder, MD and Jonathan Hunter, MD (2021: Aevo-UTP, University of Toronto Press).

BOOK EXCERPT: Damaged: Childhood Trauma, Adult Illness, and the Need for a Health Care Revolution

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