Before publishing The Comfort Garden: Tales from the Trauma Unit, Laurie Barkin worked in psychiatry for 22 years as a staff nurse, head nurse, educator, and psych liaison nurse. Since leaving her position as a psych liaison nurse at San Francisco General Hospital, Laurie has worked as a consultant to the University of California San Francisco, providing emotional and psychological support for psychiatric staff. She is an active member of the Bay Area Red Cross Disaster Mental Health group and volunteers at a nursing home giving end-of-life care. Laurie began her career on a surgical ICU before transferring to psychiatric nursing. After five years working on in-patient units in and around Boston, she returned to Boston University School of Nursing and earned a master’s degree in adult psychiatric nursing with a focus on psychiatric consultation and liaison nursing. Laurie and her husband have raised three children who are now all in their 20s. She is an avid walker, singer, and gardener.
It’s an exciting task to select highlights from an interview about the stories told in The Comfort Garden: Tales from the Trauma Unit. Laurie Barkin’s account of the five years she worked as a psychiatric nurse on the surgical trauma unit at San Francisco General Hospital is told against the backdrop of patients who survived motor vehicle accidents, falls, fires, fists, bullets, and knives. In larger thematic terms, The Comfort Garden: Tales from the Trauma Unit is a metaphor for the emotional support caregivers need. The stories in the book illuminate the issues of compassion fatigue and vicarious trauma that may develop in caregivers when exposure to tragedy becomes routine.
The Comfort Garden won the 2011 Book of the Year from the American Journal of Nursing and the Nautilus Award in 2012.
Here are some highlights of my conversation with Laurie:
On where the stories in The Comfort Garden occur (2:40):
4D is called the trauma unit and it’s the surgical unit that specializes in treating victims of trauma, so that’s people with gunshot wounds, stab wounds, broken bones, and blunt trauma as opposed to people who are ill. Everyone who’s in San Francisco who experiences major trauma, even if you’re Mark Zuckerberg, a new resident to our city, is whisked to San Francisco General Hospital, which is an inner city public hospital, because it’s the county’s Level I Trauma Center, which means that it’s fully staffed 24/7 to accept trauma patients.
On her motivation to write the book (3:26):
Well, to answer that, I need to tell you a little bit about my job. In my work as a psych liaison nurse at the General [the nickname staff gave San Francisco General Hospital], I consulted primarily to the trauma unit and to the AIDS unit. I conducted psych evaluations of patients and helped them cope with the emotional aspects of recovery. In the course of these interviews, not only did I hear the details of the current trauma that brought the patient to the hospital, but I also heard stories of early childhood trauma because I would ask the question, “Have you had other trauma in your life?”
But stories that I heard there just haunted me and they made me angry. There was so much sexual abuse, physical abuse, emotional abuse, and neglect in their histories. So because I’m an empathic person and because each day at work I was receiving a high dose of other people’s trauma, I developed the same symptoms as my trauma patients did after a few years. I had nightmares, intrusive images during the day, palpitations, shortness of breath, I feared for my safety and for my children’s safety, and I just had this general sense of doom.
[I wrote the book] to break through that denial, absolutely, and give a name to it. I think it was just really important to give a name to—because that was so useful to me to hear, “Oh my God, all of those symptoms have a name,” [vicarious trauma] so I wanted that to be out there and I also wanted to show how it develops.
On a patient, Hope, who fell two stories at a rave party, and why Laurie’s crisis intervention involved intervening against other staff (16:30):
In Chapter Four of The Comfort Garden, the charge nurse on your floor, a woman named Trudy, asks you if you have time for a little crisis intervention. You go to tend to a young woman named Hope, who fell two stories at a rave party and suffered some pretty serious injuries. Can you describe that intervention?
Hope was 23 years old and she had fractured her arm and leg. Trudy, the charge nurse, asked me to see her because she was sobbing uncontrollably since the physicians had seen her that morning during their rounds. When I walked in, she was hyperventilating and literally clawing her face. I noticed right away that she had cigarette burns and scars all up and down her arms. When I talked to her, I learned that she had freaked out because the trauma resident, the same one that I had described earlier, had marched into her room with a bunch of students and had just been incredibly insensitive. He didn’t address her, he did not ask permission to lift up her johnny and show people her injuries, and she got rigid, and I determined later—she didn’t tell me outright, but I talked to her therapist and— she definitely had a history of childhood sexual abuse that got triggered.
So I taught her some relaxation techniques and wrote out a treatment plan that only two people could come in a room at once and that permission must be granted before anyone touched her. The point is that we don’t know the trauma histories of the people that we’re dealing with, and the incidence of, for example, childhood sexual trauma is unbelievable, one in three to four women in the country according to the ACE study, Adverse Childhood Experiences study they did at Kaiser. One in three to four women in this country have experienced sexual abuse during childhood, and boys also, although they’re much more reluctant to admit it, but I’ve seen estimates that are as high as one in six.
On the dangers of restraints (19:00):
In the 1980s, we finally figured out that the great majority of so-called borderline patients had histories of sexual abuse and it’s just really important to be sensitive to this fact. When you restrain someone, just restraining a person can trigger these memories. One more point about that is that a restraining situation like that can also trigger our own memories of abuse, our own memories with out-of-control people in our lives, so that all comes into the situation and we have to deal with it.
On the real comfort garden at San Francisco General Hospital (20:00):
The Comfort Garden is a garden on the San Francisco General campus. It’s about 20 feet wide by about 120 feet long, and it was established in 1992 to commemorate staff members who had died, mostly of AIDS. There are several benches where you can sit and really tall trees and shrubs, flowers, roses, camellias, dahlias, just beautiful, beautiful flowers and no patterns or anything, everything just shoved in there, but it just works and it’s gorgeous. And there’s a psychedelic orange Thunbergia vine that goes the entire length of the garden, which is kind of fitting for San Francisco