Finding Solace: DSS medic uncovers incidence of PTSD

June 27, 2018

Date: 10/10/2018 Description: Image from Finding Solace - State Dept Image
James Eusanio provides medical emergency support for DSS Mobile Security Deployments training in Blackstone, Va. (State Department photo)

Department of State employees who serve in high-threat environments can suffer post-traumatic stress disorder (PTSD). Just ask Diplomatic Security Service (DSS) Tactical Emergency Medical Support Program Manager James Eusanio. His symptoms began after he returned from deployment to the U.S. Embassy in Port-au-Prince, Haiti, in 2010, where he’d supported operations in the aftermath of that nation’s devastating earthquake.“Port-au-Prince was shattered,” said Eusanio, who recalled the homeless and injured begging and “corpses lying in the streets. “The city looked like an apocalyptic aftermath,” he said. 

Eusanio buried his shock and, with an Air Force Special Operations Surgical Support team, began treating people with broken bones, crushed or amputated limbs, dehydration, starvation, second- and third-degree burns, and more. The medics prioritized patients, and Eusanio worked nearly around-the-clock, only able to grab an hour or two of sleep each night.

“I got a front row ticket to some of the worst suffering I have ever witnessed in my life,” Eusanio recalled. “The horrors you see as a medic handling a mass casualty incident set me up to receive an emotional bullet that I did not recognize for a while.”

Eusanio’ wife, Erin, a firefighter paramedic, noticed a change in him when he returned stateside. She initially believed he needed time to process, but after a few weeks, he remained withdrawn, short-tempered and apathetic. She “had to walk on eggshells” to avoid upsetting her husband, who she said “continued to lose interest in things he normally enjoyed…” 

He “rarely laughed or joked, which was very unlike my husband,” she observed. Erin suggested that her husband see his doctor, but he didn’t.

“I felt like the whole world was out to get me – I was paranoid – and had a grey cloud over me that wouldn’t let me be happy,” James said. He’d been raised to repress his emotions, so he tried to push his feelings aside, but he said they only got worse.

Finally, his suffering reached “a debilitating point,” he said. “I had tightness in my chest, my heart raced, and I felt overwhelmed all the time. It was difficult to go to work, to interact with people. I was seeing everything through a negative lens.”

Date: 10/10/2018 Description: Image from Finding Solace - State Dept Image
A volunteer cradles a Hatian child as James Eusanio (back right) works with military personnel to coordinate treatment and logistics for orphans in the immediate aftermath of the Haiti earthquake in January 2010. 
Photo by Disaster Medical Assistance Team) 

With traumatic images of orphans and casualties flooding his mind, harming his memory and concentration, James found himself unable to remember simple instructions or regular tasks, like taking out the trash. He didn’t know what was wrong, and feared seeking help would hurt his security clearance and get him labeled unfit for his job. “I was told by colleagues that if someone needs mental hand-holding they don’t belong in DSS,” he recalled.

In 2014 – four years after his return from Haiti – Erin gave James an ultimatum: Go to the doctor.  Still afraid about losing his job, James sought treatment outside the Department. The doctor gave him medication and at first responded well, but after a few months, his symptoms came back. 

That’s when James turned to the Department’s Employee Counseling Services (ECS). They were “absolutely superb,” he said. “I can’t stress that enough – superb.” ECS concluded that James needed treatment that wasn’t through ECS and so it referred him to an outside licensed clinical social worker, MaryAlyce Torpy. But when he first met with Torpy, he glossed over the problem, telling her “I’m fine.”

“In the field of trauma therapy, ‘I’m fine’ is usually a deterrent that means ‘I should be over this, let’s move on,’” Torpy explained.

Date: 10/10/2017 Description: Image from Finding Solace - State Dept Image
Responding to the 2010 Haiti earthquake,James Eusanio, foreground, and other responders depart the landing zone after loading a casualty onto a med-evachelicopter headed to the comfort ship. (Photo by Disaster Medical Assistance Team)

She said James’ additional symptoms – tightness in the chest and tingling in the arms – showed that traumatic memories were still brewing, readying a “fight or flight” response.  Torpy wanted to assess all James’ symptoms before deciding the way forward, so as to “rule out an underlying medical cause before defaulting to psychological causes.”
After a thorough assessment, Torpy confirmed ECS’ diagnosis that James had PTSD, which she calls a neurobiological response to an event  not a failure to cope.

She put James on a treatment regime that includes medication coupled with Eye-Movement Desensitization and Reprocessing, a psychotherapy that allows patients to forge new traumatic memory associations and coping skills. She also called for Accelerated Resolution Therapy, which helps remove strong emotional triggers and physical reactions when thinking about the difficult experience. 

By Angela French, public affairs, Diplomatic Security Service