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A wave of Post Traumatic Stress may await health care workers and first responders on the COVID front lines | Column

Heroes are humans, too, and here are some ways for them to deal with the stress, writes an author who knows what it's like.
Bob Delaney arrives in 2009 at Camp Marez, Mozul, Iraq, and is greeted by Gen. Bob Brown (who recently retired as Pacific commander of the Army). Gen. Brown (left) and Maj. Patrick Husted (right) greeted Delaney on what was his first visit to Iraq. [ Provided ]
Updated Aug 10

It has been more than a decade since I shared my diary in these pages about my experiences visiting military troops around the world, counseling them about how to handle the trauma they faced daily in the line of duty. All these years later, one moment I chronicled still stands out vividly. During the summer 2009, I was embedded with the 25th Infantry Division, Camp Marez, Mosul, Iraq — led by then one-star (and now retired four-star) Gen. Robert Brooks Brown.

Gen. Brown would have me visit soldiers throughout Iraq and one such visit was to the Camp Diamondback base hospital. While on a tour conducted by a medical staff member, we entered the emergency room. I was introduced to the attending doctor and after a short conversation I asked: ‘'Who is taking care of you?” He responded with a smile and had me follow him to the rear of the hospital. We walked through a back door and there in the middle of the desert was a Zen garden, complete with a small patch of grass and a fountain.

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It was a place of solitude, a place where doctors and nurses could clear their heads and emotions, a place that made the ugly facts of war — the traumatic events they were facing everyday — fade away for a period of time. The garden gave the doctors and nurses an inner peace that rejuvenated them. It was a crucial part of the healing process.

The late Kobe Bryant chats with then-NBA referee Delaney. Bryant was called for a foul by Delaney, and while TV announcers said Bryant was arguing the call, he was actually asking Delaney what it was like to wear a wire and work undercover to expose the Mob.
[ Provided ]

Not all wounds bleed and, at times, invisible wounds cut as deep as the wounds we see. That is certainly the case with a new kind of “warrior” on the front lines of a brutal fight against COVID-19. The health care workers — doctors, nurses, EMTs, paramedics, police and more — are heroes, dealing with a constant drumbeat of death while we are asked to sit on a couch, or social distance during a driveway happy hour.

It reminds me of soldiers’ handmade signs I saw in Iraq and Afghanistan, “We are at war while America is at the mall.” The battle against COVID-19, like all past wars, carries the potential for the same kind of post-traumatic experiences faced by our combat troops. My good friend, and a true American hero, former Army Ranger Nate Self, shared the 2002 Afghanistan battle of Roberts Ridge in his book titled Two Wars, The One Abroad And The One Within. All wars are different, and all wars are the same, he explained. The COVID-19 battle against an invisible enemy will undoubtedly cause trauma for those on the front lines.

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Being aware of the potential war within is vital for self-care. For those who have been waging this new war with the coronavirus, “trauma is inescapable,” according to Dr. Richard Mollica, director of Harvard Global Mental Health and one of the world’s leading psychological trauma experts.

This past year, I had the good fortune of getting to know Dr. Mollica while participating in the Harvard Global Mental Health Trauma and Recovery Program; I spent two weeks in Italy and had six months of collaborative learning. We studied with trauma experts and learned from their experiences, knowledge and leadership skills on a global stage.

Dr. Mollica, the director of Harvard’s Program in Refugee Trauma, has received many awards for his work, published more than 160 articles on trauma over 30 years, and is the author of Healing Invisible Wounds: Paths To Hope And Recovery In A Violent World. Dr. Mollica and his Harvard Global Mental Health staff offer a “Self-Care Pocket Card” for the tool kits of all those serving in the COVID-19 fight.

Harvard self-care pocket card.
[ Provided ]
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The truth is that we are all susceptible to post-traumatic stress. It is a human condition that can be triggered by hurricanes, tornadoes, earthquakes, accidents and horrific crimes. However, those who serve are in the higher risk group because they go where trauma is. Military, law enforcement, firefighters, first responders and health care workers see what the rest of the world does not.

Post-traumatic stress has been with us forever. Sophocles wrote about the warrior not understanding emotions after coming home from battle. After the Civil War, we called it Soldiers Heart. Then came World War I, when it was known as Shell Shock. The World War II term was Battle Fatigue, while the Korean and Vietnam wars had the “flashback” terminology. Today, it is Post-Traumatic Stress Disorder. It became a diagnosis in 1980 and, from my view, we have over-medicalized the issue ever since, pushing people away from the conversation due to the stigma attached.

The COVID-19 pandemic will create similar post-traumatic stress experiences for front-line medical workers. Allow me to share the similarities between them and our amazing men and women who have served in Iraq and Afghanistan.

In presenting to members of the military, I quickly came to realize that the title of PTSD Education and Awareness caused some in the audience to react defensively because of the stigma associated with the term Post-Traumatic Stress Disorder. So I decided to rename it “Operational Stress Education and Awareness.” Words matter. Military, law enforcement, firefighters and first responders relate to operational responsibilities, and using a term that sounded “less medical” allowed for more honest discussions.

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Those in military uniforms like to think they can leap tall buildings in a single bound. But we can never lose sight of the fact there is a human being wearing it.

The uniform called “scrubs” does the same for the health care professionals. They also serve, protect and save lives. Similar to soldiers, they see death, however, not at the rate they are witnessing due to COVID-19. They are in a fight where they can feel helpless at times yet steel their personal emotions in order to do their job. They have learned to repress feelings and emotions, and being immersed into their work protects them for a period of time.

I share this analogy regarding emotions. I ask folks to imagine I am holding a large balloon in front of the room and ask how can we get the air out. More often than not the words “pop it” are said and yes, we can take a pin and pop it to get the air out, but we no longer have a balloon. We can let it go and it flies all over the room and goes out the door never to see the balloon again. Or we can turn the balloon upside down and let a little air out at a time — it will make a noise we may not want to hear, a noise that hurts our ears, yet at some point we will get the air out and we will have a full balloon we can use again one day. We need to get the air out of our “balloons.” However, more often than not, we push things down, one after another, and if you take that analogy to its fruition at some point the balloon will burst.

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The largest window in a car is the windshield because it allows us to see where we are going, and the small rear-view mirror gives us the opportunity to see where we have been. We need both to navigate the paths we take, and it is no different with COVID-19. We have learned trauma lessons from past battlefields, and we need to prepare for the future care of COVID-19 front line health care warriors. This pandemic shadow will be with us for a time; however, we should never fear a shadow because if there is a shadow that means there is light nearby. It is our responsibility to ourselves, and each other, to get to that light — and it starts with self-care because heroes are human.

Bob Delaney is an author of two books, “Covert: My Years Infiltrating the Mob,” and “Surviving the Shadows: A Journey of Hope Into Post-Traumatic Stress,” with Dave Scheiber, and has been a post-traumatic advocate for more than four decades who presents worldwide. He is a former New Jersey state trooper who went undercover and infiltrated the Mafia in the 1970s. His healing journey with PTS brought him back to the game of his youth, basketball — leading to a 30-year career as a referee in the National Basketball Association. He is an NBA Cares Ambassador and advisor to the Southeastern Conference. He has received numerous national awards, including the President’s Volunteer Service Award from President Barack Obama and the NCAA’s highest award named after President Theodore Roosevelt. His story has been told by numerous media outlets and has been a guest of Dr. Sanjay Gupta on CNN.

It has been more than a decade since I shared my diary in these pages about my experiences visiting military troops around the world, counseling them about how to handle the trauma they faced daily in the line of duty. All these years later, one moment I chronicled still stands out vividly. During the summer 2009, I was embedded with the 25th Infantry Division, Camp Marez, Mosul, Iraq — led by then one-star (and now retired four-star) Gen. Robert Brooks Brown.

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