Trauma Doesn’t Define Us: A Journey to Healing Through Trauma-Informed Care

The following essay is the runner-up from this year’s annual Section on Pediatric Trainees (SOPT) Essay Competition in Pediatrics. This year the SOPT Advocacy Campaign was titled, “HEADSS Up!” and we encouraged trainees to reflect on the HEADSS domain of adolescent mental health.I still remember the quiet click of the door closing behind me as I entered the adolescent medicine clinic on that autumn morning. Seated in the softly lit room was a 15-year-old boy whose eyes tracked every movement I made—his name was Eliah. The clinic nurse had prompted me about his previsit PHQ-9 scores, which indicated a score of 18. The nurse also noted that the mother had informed her that Eliah was a recent immigrant who had been displaced by war and survived bombing raids, during which he witnessed one that took his sister’s life, and was separated from his brother during migration.As I introduced myself, Eliah failed to make eye contact. His shoulders hunched inward, and he looked barely larger than the 12-year-olds I often encountered in the clinic. I didn’t rush to ask about his symptoms. “Eliah, tell me about your journey; what happened?” I said. He spoke haltingly about missing home, about nightmares that pulled him into where his sister had died, of chests tightening like iron traps whenever the wind rustled through their apartment’s blinds, and of a dark loneliness that he barely recognized when he looked at the mirror. In his stories, I recognized reflections of my own experiences. I felt an old ache stir within me—the same hollow ache I once carried through nights of terror back in Nigeria.During my youth service in northern Nigeria amid the terrorist insurgency, I felt as though the universe tested my resilience in many ways. I experienced fear like never before—I could taste the metallic tang in my mouth whenever mortar shells exploded nearby and frequently worried about my family losing a son. That same year, while grappling with the unbearable grief of losing my sister,1 I suffered damage to my cochlea from a blast injury, leading to an insufferable tinnitus and hearing loss that resulted in severe panic attacks, anxiety, and depression. I remember my hands trembling so uncontrollably during a panic attack while providing medical care to families displaced by disaster that I couldn’t hold a stethoscope. After losing my sister, I recognized that no words or actions can fully capture the magnitude of the absence of a loved one in our lives. Navigating the evolving nature of my grief meant moving through certain days in a fog of guilt, expecting the floor to collapse beneath me at any moment.I had once believed these feelings made me weak, not just as a man, but as an African—where emotional pain is too often swept beneath perseverance and prayer, leaving little room for vulnerability or therapy. But that narrative is gradually changing.2 As I listened to Eliah tell his story and struggles, all that echoed in my heart was “trauma-informed care.” I encountered trauma-informed care (TIC) for the first time during my advocacy rotation. I learned that trauma is not just a footnote in a patient’s history—it is often the root cause of their present. TIC doesn’t ask, “What’s wrong with you?” It asks, “What happened to you?” It represents a profound paradigm shift—one that promotes healing rather than retraumatization.3 I also realized that my survival hinged on a single thread: the presence of safe, stable, nurturing relationships—my family, friends, mentors, and religious community. The presence of a physician-mentor, who sat with me in silence, allowed me to cry openly and gently taught me grounding exercises to ease the tremor in my body—created a space where I felt seen, believed in, and supported. It was in that space that I began to reclaim my future.Mental health disorders among adolescents in the United States are rising.4 TIC is a clinical approach focused on fostering safety, trust, collaboration, empowerment, and cultural humility while considering a child’s past trauma to provide appropriate and comprehensive mental health support.3 Most adolescents in America, including immigrants, have experienced at least one potentially traumatic event early in life, many of which have been adversely exacerbated by poverty, immigration, and racial unrest.5,6 TIC acknowledges that many children face adversities that can significantly impact their development, behavior, and mental health, often with long-lasting effects.3,7 As pediatricians, we are expected to be knowledgeable about trauma physiology and are uniquely positioned to identify trauma and support recovery in our interactions with our patients.3,7 Symptoms can vary widely, including alterations in eating and sleeping patterns and mental health problems.3Efforts to incorporate TIC into pediatric primary care clinics are growing. Shoptaugh et al implemented a virtual, TIC symposium, followed by longitudinal learning modules, which significantly improved pediatric clinicians’ knowledge of trauma and the application of TIC principles into their clinical routines.8 Similarly, Marsac and colleagues described an institutional transformation model that embeds TIC into pediatric health care networks through system-wide cultural shifts, including staff-wide education, workflow redesign, and standardized language use that minimizes retraumatization during clinical care encounters.9I told Eliah about my sister, the grief, the anxiety—and how I began to heal when I leaned into the supportive arms of my loved ones. As he listened attentively, head tilted, as though trying to catch each quiver of my voice, I asked him, “Does it help to know you are not alone?” His reply was a slow nod, the barest flicker of relief crossing his face. His eyes lifted for the first time when I reinforced, “You’re not alone.” I validated his experiences, normalized the panic attacks, and framed therapy as an act of courage rather than weakness. As the mother waited outside, I explored other areas of his social history with the HEADSS framework using trauma-informed principles. I paused and offered grounding techniques, such as deep breathing, aware that my questions could trigger a panic attack. We finally decided to start small, focusing on his strengths, meditation, journaling, and hobbies that make him happy. When my team referred him to the adolescent psychiatrist and connected him to a culturally aware support group, he asked, “Is it okay that I’m scared? Do I need to talk about my fears?” I told him, “Absolutely. And we’ll walk through the fear together. Also, your mom is here for you—it is okay to talk to her when you feel anxious.”From medical education to clinical practice, TIC should guide how we communicate and advocate for our patients. Training programs have started integrating trauma-informed principles into residency education.10 The PATTeR curriculum—a relationship-based, interdisciplinary model—used case-based learning and reflective practice to teach residents trauma screening, narrative validation, and family-centered care.11 A condensed version delivered during interns’ developmental-behavioral rotation significantly improved residents’ confidence in recognizing and responding to trauma.12 Similarly, a standardized patient workshop enhanced trainees’ communication and resilience counseling skills, with most residents reporting an intent to apply TIC principles in their clinical practice.13 These innovations reflect a shift toward making TIC an essential clinical competency in residency training.TIC is also centered on relational health care, emphasizing the importance of forming and maintaining safe, stable, and nurturing relationships (SSNRs). SSNRs help to buffer stress-related adversity/traumatic events.3,14 Pediatricians can utilize a two-generation approach, focusing on caregiver-child attachments to bolster emotional regulation and resilience in children.3,14,15 For instance, I tell my patients, “Look around you—there are people who care and believe in you. You are not alone in this journey.” These gentle reminders of connection ground them in safety and help rewrite their internal narratives.15Eliah’s transformation over 6 months was profound: fewer panic attacks, more stable sleep, improved eating habits, a better mood, and a renewed curiosity about art. He told me, “Hearing your story made me feel like I will be okay too.” That moment is engraved in my memory, revealing why our stories matter. TIC has the potential to transform lives.3 As pediatricians, we carry the privilege and the responsibility to shape narratives of resilience. Self-disclosure is one tool physicians can use to build patient trust, and, perhaps more importantly, help patients see that they are not alone. When adolescents learn that they possess the tools—their stories, their voices, their cultures—to navigate mental health challenges, grief, and fear, they internalize an unshakable belief in their own capabilities. In my case, when my patient saw a physician who had once trembled in terror and depression yet still stood before him as a healer, it reminded him that survival could be more than just endurance—it could be a pathway to purpose.I thank my family, mentors, friends, and the Commonwealth of Zion Assembly for their love and support during the most challenging periods of my life. I extend my gratitude to one of my mentors, Andrés S. Martin, MD, PhD, and close friends, Maureen Uzoewulu, MD and Antonio Yaghy, MD for their invaluable feedback on this essay.