The Care That Makes Care Impossible
The Care That Makes Care Impossible
Medical PTSD, Patient Autonomy, and What Happens When Healthcare Becomes a Barrier to Care
By: a.d. elliott | Take the Back Roads - Art and Other Odd Adventures
This last year has been a whirlwind of medical adventures, and I need to file a complaint.
I've noticed a particular irony to medical PTSD: eventually, the very places designed to keep you alive can become places your body is convinced you must escape, and worse, it seems the system has been engineered to keep it that way.
Let's unpack medical PTSD, shall we?
Medical PTSD is not simply disliking hospitals. It is not being squeamish about needles, nervous about test results, or irritated by waiting rooms. It is what can happen when your nervous system learns, through experience, that medical care means pain, helplessness, confinement, loss of control, fear, and sometimes very real danger.
And I know exactly where mine came from.
I've written several times about "The Accident." What followed included about twelve hours of emergency triage, then weeks in the hospital.
It was terrifying. And it needed to be.
There is an important distinction here because I am not accusing the doctors and nurses who treated me then of cruelty. Quite the opposite. People were desperately trying to keep me alive. They were treating significant injuries under extraordinarily difficult circumstances, and sometimes doing what was medically necessary meant doing things that hurt, frightened me, overwhelmed me, or required me to surrender control over what happened to my body.
Sometimes good medicine is traumatic medicine, and unfortunately, we don't like to talk about that.
We tend to judge successful medical treatment by whether the patient survived, whether the surgery worked, whether the infection cleared, whether the bone healed, whether the scan was completed. We rarely ask what the patient's nervous system learned along the way.
I should mention that mine learned a great deal, and I have very specific medical triggers now.
Claustrophobia, particularly anything enclosing my head.
An oral aversion that can make dental procedures feel frighteningly similar to choking on blood.
Certain pain medications are difficult because the sensation of being "high" is itself triggering.
I can become combative when I wake up from sedation.
I frequently experience significant medication side effects, and medicine has not been comfortable since that day.
And then there is the emergency room. I cannot make myself walk voluntarily into one. That is still a problem I haven't figured out how to solve and will, perhaps, one day be the death of me.
For many years my solution to all of this was fairly straightforward:
I stayed away. I received basic routine care. I did what seemed necessary. But I generally avoided medical care that wasn't obviously essential because navigating medicine had become harder than simply tolerating whatever was wrong with me. That isn't ideal healthcare behavior. It is, however, predictable when receiving healthcare itself has become a source of distress.
Unfortunately, this year occurred. The labral tear of June 2025 put me on crutches and forced me back into a medical system I had spent years successfully avoiding.
One of my early encounters involved an urgent-care nurse practitioner in Salem, Virginia, who decided that my unwillingness to go to the hospital for pain management meant I was "not acting in my best interests." She told me, in essence, that she wished I were in a state where she could force me to go.
I dared her to try.
That may not have been my finest diplomatic moment, but it illustrates one of the problems medicine has when dealing with traumatized patients. "I don't consent to that treatment" is not the same thing as "I don't want medical care." "I don't want narcotic pain medication" does not mean "I don't want my pain addressed." "I don't want that injection yet" does not mean "I refuse treatment." "I want to know what is wrong before we start putting things into my body" should not be regarded as an act of defiance. And yet medicine still creates corners where patient autonomy seems perfectly acceptable right up until the patient says no.
Pain medicine practitioners have been particularly difficult for me in this regard. There seems to be a tendency in some practices to cycle rapidly toward medications and injections: steroids, nerve blocks, Cymbalta, whatever the next intervention happens to be. Those treatments can be entirely appropriate. I am not arguing otherwise. But sometimes the patient is still standing there saying: "Could we please establish what is causing this first?" And when that patient hesitates, the hesitation itself can become the problem. She is difficult. She is resistant. She isn't following recommendations.
Perhaps.
Or perhaps she has spent enough time inside medical systems to understand that every intervention has consequences and she would like to participate in deciding which consequences she is willing to accept.
Then I encountered the orthopedic office in Fayetteville, Arkansas.
I arrived already physically struggling and encountered a waiting room where several other patients were visibly distressed. One was crying while trying to complete the electronic intake process.
Meanwhile, office staff chatted about their weekend.
While there is nothing inherently wrong with employees talking about their lives at work, the environment matters. When several hurting, frightened people are struggling directly in front of you, and the atmosphere communicates that nobody particularly notices, patients notice that too.
My own appointment left me with little more confidence.
I felt considerable pressure toward injectable steroids before I believed we had established a clear diagnosis. Later, when I reviewed the clinical notes, they seemed substantially different from the conversation I remembered having. Trust is important in medicine. Once it is gone, it is extraordinarily difficult to recreate.
I have also experienced stranger failures this year.
At the *other* facility (having lost confidence in the other one) in Salem, Virginia, I once received a mammography report that appeared so inconsistent with my known history that my immediate reaction was essentially: "Whose breasts are these?"
You see, Henry, I have residual findings from my accident that routinely appear on mammograms.
However, the report I received from that facility seemed so disconnected from what I knew about my own body that I questioned whether I was even reading results from the correct imaging. Of course, this mammogram came with complications. I had undergone it on crutches, and during the appointment, I also found myself repeatedly questioned about why I had not undergone a colonoscopy.
I wasn't there to discuss my colon. I was there to talk about my breasts. And quite frankly, after the disaster with my mammogram, I was most certainly not allowing this facility to send a camera up my bum.
There is something peculiarly unforgiving about healthcare's occasional assumption that once you enter a medical building, every aspect of your body becomes available for discussion whether you consent to that conversation or not.
It doesn't.
Finally, this year, I had an MRI scheduled in Springdale, Arkansas.
This one matters because it demonstrates something I wish healthcare administrators understood much better: Stress is cumulative.
It had been roughly twenty-seven years since anyone had seriously imaged the injuries left from my accident. Now, as I get older, and as the postural problems I've lived with since the accident have deteriorated further following the labral tear, it was decided that, despite the difficulty involved, I needed imaging of my head, cervical spine, and thoracic spine. Claustrophobia and stress were obvious concerns. I said so. Repeatedly.
My physician actually ordered the MRI with sedation because we already knew this would be an extremely difficult test for me. However, when I called scheduling on August 20, I waited more than ten minutes before speaking with someone.
I was then told that arranging sedation would require coordination between imaging and anesthesiology, along with an ongoing health form my physician would apparently need to maintain during the scheduling process. At some point during the conversation, the process of getting sedation approval seemed more intimidating than attempting the MRI itself. So, despite my doctor's original order, I agreed to try oral anti-anxiety medication instead.
Then scheduling ran into a roadblock because I have surgical clips from a previous gallbladder surgery and tubal ligation. Imaging was needed to determine whether it was safe for me to undergo an MRI. Fine. Whatever. Safety matters. I waited. And waited. Nobody called.
Finally, on August 31, I called them.
I waited another fifteen minutes to reach someone. I suggested that Northwest Medical Center may not be able to accommodate my complicated medical history and that I should seek care elsewhere. Miraculously, clearance arrived while we were talking. We scheduled the MRI. Again, I explained the claustrophobia and anxiety.
On September 8, I received a text instructing me to register online. I completed registration a few days later and again disclosed the anxiety and claustrophobia.
On September 14, I completed more demographic information and received payment information. At no point did anyone tell me there was a problem with my insurance.
Then I arrived for the MRI. I checked in. I waited approximately twenty minutes. And then a registrar approached me, wringing her hands over an insurance problem.
I need to say something here because I don't blame this woman.
She did not design the hospital's intake system. She did not write my insurance policy. She did not create the coordination problems between scheduling, imaging, registration, billing, and whatever corporate office had made a decision that suddenly became my problem. When I snapped at her and she explained that this wasn't her fault, I knew it. I wasn't asking her to accept blame. I was asking the institution to stop making its systems problem mine.
I told her plainly that I have PTSD, that this process had already been incredibly stressful, and that we needed to make it less so.
If insurance was the problem, fine. Take insurance out of it. Here is my credit card. I will pay for the MRI myself. Just please stop adding stress.
It took several more minutes of conversation before the system finally found a way to accommodate that.
Eventually I went back to the waiting area and tried to calm myself.
Then a man, apparently trying to arrange an emergency ultrasound, was told he needed to call scheduling. So he did. On speakerphone. In the waiting room. Loudly, and to the distress of everyone present.
I'd already taken oral anti-anxiety medication. Two Valium, in fact. It wasn't enough.
Because this is the thing healthcare systems repeatedly fail to understand: Human beings do not reset between administrative encounters. The phone call counts. The fifteen minutes on hold count. The missing callback counts. The insurance surprise counts. The paperwork counts. The crowded waiting room counts. The uncertainty counts. The person having a crisis three chairs away counts.
The nervous system does not distinguish between stress produced by a medical procedure and stress produced by the bureaucracy surrounding the procedure. It simply accumulates.
By the time I reached the MRI machine and saw the narrow bore enclosing my head, I was finished. I couldn't do it. Afterward, the MRI technician told me: "Next time ask for sedation." Which very nearly earned the response: "I did, you dumb ass. That was my first request."
That's how this entire process started. My doctor had ordered sedation. I had backed away from it because navigating this hospital's process for obtaining it was so unnecessarily complicated that taking a couple of Valium and hoping for the best appeared easier. Then, when that failed, I was advised to request what I had asked for in the first place. There may be no better summary of my modern healthcare experience this year.
A day later, the hospital called and asked whether I wanted to reschedule.
Absolutely not.
I did, however, spend time talking to the woman who called. I assured her that I understood this was not a "you guys in intake suck" problem. It was a hospital administration problem. The people answering phones and checking patients in did not invent the systems they were being forced to operate inside. I asked her to make sure her supervisor understood that distinction.
I also asked her to pass along something I was including in my formal complaint:
At this point, I believe that in an actual emergency I would be more likely to bleed out in this hospital's parking lot than successfully navigate its intake process and receive care. That isn't a complaint against an employee. It indicts a healthcare system that has made seeking care there feel less tolerable than the medical emergency itself.
And I am now having the MRI performed somewhere else. Maybe. If I can find a facility that can truly accommodate medical PTSD. I am looking for a wider scanner in a smaller, less chaotic imaging environment. I am prepared to self-pay.
Which brings me to insurance.
I pay approximately $600 every month for health insurance. That is roughly $7,200 every year before deductibles, copays, coinsurance, and whatever else I may owe when I actually receive care. I understand the purpose of insurance. I understand that I am purchasing protection against catastrophic expense, not simply depositing money into a medical savings account. But there is something profoundly wrong when the product I pay thousands of dollars a year to maintain becomes an obstacle between me and receiving proper medical care. When paying cash and removing the insurance company from the process makes healthcare simpler, something has gone badly wrong.
None of these institutions exist in isolation from the others.
The specialist recommends treatment. The hospital performs the test. The insurer determines payment. Scheduling controls access. Registration handles intake. Billing handles money. Each department can plausibly say: "That isn't our fault." And perhaps individually they are correct.
But the patient experiences all of them.
Somewhere amid billing structures, insurance requirements, compliance systems, corporate efficiency metrics, and departmental responsibilities, healthcare has forgotten that only one person stands in the middle of all those systems while simultaneously being sick, injured, frightened, or in pain.
The patient.
Healthcare has effectively made patients the unpaid project managers of their own medical care. That arrangement becomes particularly absurd when the patient's medical history specifically includes trauma caused by medical treatment.
And I know I am not an easy patient. I have unusual triggers. I have strong medication reactions. I have difficulty with sedation. I don't tolerate confinement. I ask questions. I sometimes refuse treatments. I need physicians to explain why they recommend something before I agree, and sometimes what I need will make care more complicated. I understand that. But being complicated does not make a patient unreasonable. And trauma-informed care cannot simply mean entering "PTSD" into a medical record.
If knowing that a patient has medical PTSD does not change anything about how that patient is moved through the system, what exactly has been accomplished? A traumatized patient should not have to repeatedly relive the trauma to qualify for accommodation.
And now let's talk about the elephant in the room that health practitioners refuse to acknowledge.
Medical treatment is often inherently traumatizing. Sometimes there is no alternative. Emergency medicine can be frightening because emergencies are frightening. Surgery hurts. Needles hurt. Being restrained because moving could cause catastrophic injury is frightening. Being intubated is frightening. Having strangers expose, examine, cut, inject, manipulate, scan, restrain, or medicate your body can be frightening even when every person involved is compassionate and competent. Sometimes healthcare has to ask extraordinary things of patients to save their lives. That reality should make healthcare institutions more careful about the unnecessary burdens they add, not less. If medicine must occasionally impose necessary fear, pain, indignity, and loss of control, then hospitals have an obligation to eliminate as much unnecessary fear, pain, indignity, and loss of control as possible.
The administrative burden is not separate from patient care.
The waiting room is not separate from patient care. Scheduling is not separate from patient care. Billing is not separate from patient care. Insurance coordination is not separate from patient care. Patient care begins with the first phone call. And every unnecessary administrative burden consumes some of the patient's capacity to tolerate the medically necessary burden that remains.
I have written before about illness, injury, chronic pain, and the difficulty of navigating healthcare.
This incident has now joined that body of work.
And perhaps this essay is the beginning of a new category:
Reasons Hospitals Don't Care About You.
I acknowledge that title is deliberately unfair. Of course people in hospitals care. I have met extraordinary nurses, physicians, therapists, technicians, and support staff. Some have cared for me during the worst moments of my life. Some have gone far beyond anything I could reasonably have expected from them.
The problem is that caring people can work inside systems that behave as though they don't care at all.
A system can be efficient on a spreadsheet and brutal to the human being required to navigate it. A policy can satisfy an insurance requirement and prevent a patient from receiving treatment. A form can satisfy a compliance requirement and consume the last bit of emotional capacity somebody needed to make it through an MRI. A clinician can recommend appropriate care and still destroy the patient's trust by refusing to hear the word no.
Eventually those things have consequences.
Patients leave. Patients avoid treatment. Patients pay somewhere else. Patients stop trusting. And sometimes patients become so thoroughly alienated from a healthcare institution that they find themselves thinking something objectively ridiculous: "I would rather operate on myself than walk through your doors again."
No hospital should hear that from a patient and wonder which department was at fault. They should be asking how their patient got to that point and what in their system needs to change before another one does.
Stay healthy, my friends, because I don't feel like we can count on our hospital system any longer.
a.d. elliott
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About the Author
a.d. elliott is a wanderer, photographer, and storyteller traveling through life
She shares her journeys at Take the Back Roads, explores new reads at Rite of Fancy, and highlights U.S. military biographies at Everyday Patriot.
You can also browse her online photography gallery at shop.takethebackroads.com.
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