“When the waves wash over me, I dive down and fish for pearls.” --Masha Kaleiko

In my last post, “Can Setbacks Really Set Us Up For Comebacks?”, we talked about post-traumatic growth. I first learned of this powerful concept about a year after my malpractice litigation ended when I began to engage in public speaking on the impact of unexpected adverse outcomes and medical malpractice litigation on us as healers.

Research clearly shows that those experiences are associated with adverse outcomes in us, including post-traumatic stress and even PTSD. What I didn’t have words for, however, was my sense that there are also positive outcomes that potentially may emerge for us as human beings from these disruptive and disturbing experiences. When I ran into the term “post-traumatic growth,” I knew immediately what it must mean, in part because it so perfectly encapsulated my own experience of growth and recovery after a painful, adverse patient outcome and malpractice lawsuit.

As I wrote two weeks ago, “post-traumatic growth” simply refers to desirable changes in ourselves which might emerge, often unexpectedly, as a result of our struggle with a difficult, disturbing, or even life-threatening event. Yes, that description sounds academic. Behind it, though, lies this rich, earthy reality I want us to explore.

Poet Masha Kaleiko hinted at that reality when she wrote, “When the waves wash over me, I dive down and fish for pearls.” What ARE the pearls? Let’s take a look at 4 signs of post-traumatic growth.

1. New Possibilities

According to the Post-Traumatic Growth Research Group “Sometimes people who must face major life crises develop a sense that new opportunities have emerged from the struggle, opening up possibilities that were not present before.”

After an adverse outcome or malpractice litigation, what might those new possibilities be? Where a diagnostic error has occurred, a calling around prevention of a particular error might emerge. Or perhaps making improvements in team communication becomes central.

I experienced a new drive to abandon perfectionism. Learning to embrace failure as inherent to the human experience -- my human experience -- was an unexpected outcome, one which has enriched my life and my relationships in countless ways. (Read more about that here.)

Physicians I speak with often tell a similar story. Our culture and depth of commitment to our patients frequently drive us to hold ourselves to a standard of perfection, even at times around things well outside our control. Like many, my struggle with feelings of guilt, shame, and self-doubt led me down paths of self-examination. Along the way, life reframed my understanding of the search for excellence in terms much more humane to everyone, not least of all myself.

2. Valuing Our Own Strength

“That which does not kill us, makes us stronger.” — Friedrich Nietzsche

A shift toward a fuller acceptance of ourselves in all of our glorious complexity is an important sign of post-traumatic growth, according to Professor Stephen Joseph . “People change their views of themselves,” as a result of their struggle with difficult life experiences, he writes. Recognition of our own “wisdom, personal strength and (the fuller blossoming of) gratitude (may be) coupled with a greater acceptance of (our) vulnerabilities and limitations.”

Survivors of traumatic experiences often develop a newfound sense of their own deep strength. For many, this manifests in an astonishing capacity for fearlessness. The heart seems to reason, “If I can come through that, I can live through anything!”

3. Enhanced Relationships

When trauma causes the emotional and spiritual ground under our feet to shift, those shifts can induce changes in our relationships. Research indicates that in some instances, people come to experience true intimacy and value particular individual relationships more deeply. Although we physicians tend to be independent-minded types, post-traumatic growth may teach us to lean on others for support in ways we never had before. Post-traumatic growth may also result in a reevaluation, perhaps even a pruning, of relationships which do not serve us well. And in nearly every case, our time of struggle has the potential to amplify our sense of human connection by deepening our compassion for those who suffer.

4. Renewed Spirituality and Love of Life

By their very nature, startling and traumatic events often heighten humans’ awareness of the fragility and preciousness of life. As a result, many who grow after a difficult event describe a deeper love for life and in some cases, a deeper sense of connection to all that we understand and all that we don’t. While some “experience a deepening of their spiritual lives,” says the Post-Traumatic Growth Research Group, ”this deepening can also involve a significant change in one’s belief system.”

Professor Stephen Joseph attributes this to a “rebuilding of the shattered assumptive world” inherent to recovery after a difficult or threatening event. “Those who try to put their lives back together exactly as they were,” he writes, “remain fractured and vulnerable. But those who accept the breakage and build themselves anew become more resilient and open,” sometimes to an entirely new way of being.

I can’t speak for everyone, but to me, the fact that something so beautiful might emerge from such difficult circumstances seems nothing short of miraculous. Join me next time, when we’ll explore steps toward post-traumatic growth.