Healing Touch

Holly Kastan drove to the hospital, fearing the worst.

Her infant daughter, Sarah, had been happy and healthy, growing and thriving. She hadn't been ill or looked sick.

But for some inexplicable reason, in the middle of an October night, the four-month-old's tiny lungs stopped giving her breath.

Kastan sat in a small room with her husband as the doctor delivered the news.

Sarah died of sudden infant death syndrome.

"It's like the movies-time stopped," Kastan said. Caught in a state of shock, she was acutely aware of everything. The way Sarah looked. What she was wearing. Twenty years later, the memories still bring her to tears.

Kastan sat with a social worker for 20 minutes, who told her not to blame herself; there was nothing she could have done. And then she went home.

Kastan had walked into the hospital a mother of three and left a mother of two.

"That was horrible," she said. "You're leaving your child behind. It's just unbelievable."

Until then, said Kastan, the daughter of Mel and Lenore Schottenstein, her life had been rose-colored.

"I feel like I was in a fantasy world before. My parents did everything they could to protect us from the difficult, crazy, violent things that happen in the world," Kastan said. "I was grateful, but ill-prepared for what happened."

The oldest of four, Kastan was blessed with a supportive family, loving husband and Jewish faith to fall back on. Per tradition, she didn't leave her Bexley home for a week. Friends visited to pay their respects. It gave her a chance to grieve openly.

Although she had the structure to move forward, it didn't stop her feelings of guilt. If she had done something differently, she wondered, would her baby still be alive? That's why many trauma victims have nightmares, Kastan said-they live the event over and over, hoping to change the outcome.

That's one of many small teaching moments Kastan is adept at sneaking into conversation. With a soft and sweet tone, she tries to show her experience isn't unusual. Losing a child may be, she admits, but going through a terrible experience isn't. Studies estimate that nearly 90 percent of Americans will be exposed to a traumatic event in their lifetime.

Kastan lists her symptoms as classic: depression, numbness, sleeplessness, an alternating feeling between low energy and anxiousness.

Nancy Jeffers, a close family friend and one of Kastan's mentors, said Kastan handled the loss with grace. "She can describe how alone she felt, but I don't think that was really visible. Most people felt she did a fantastic job of moving forward," Jeffers said. "She's very strong. Very strong."

Almost immediately Kastan opened up about what a tragedy it was, and began searching for professional help.

She found three area specialists who had training, but not understanding. It was something she can't forget-trying to get help but feeling like nobody understood. It was two years before Kastan's best friend put her in touch with the head of the Jason Lutz SIDS Foundation in Boston, and she finally found the help she had been looking for. He counseled her through the hard work (a point Kastan repeatedly emphasizes-that it hasn't been easy) of dealing with her trauma.

Meanwhile, Kastan lost her father to cancer. She gave birth to her son Sam. Her life moved forward.

Raised on the philanthropic words of her father, she found healing in helping others. She continued his legacy with the Community Shelter Board he founded and chaired the nonprofit's annual benefit for five years, raising $450,000 the first year.

"She's very much like her father," said Jeffers, who co-founded the nonprofit. "He was very intense, directed and focused. He was a leader for good in this community. I see Holly cast in that same mold."

Kastan began to wonder how others get through these devastating experiences-why some move forward and others are down for the count. She wanted to understand the resilience factors. And as friends began to call her to help others work through their traumas, her desire for an answer grew stronger.

Kastan left the house in tears. She barely knew the mother, a friend of a friend, who had lost her daughter to SIDS. But she did know what it was like to unexpectedly lose a child.

She consoled as she had done repeatedly over the previous eight years, without saying a word. "I would sit and listen. I think that's the best thing I did," Kastan said. "I would just be there. It's almost like you share a common bond. It's like the highest form of communication."

Tears she was used to. But this was different. There was something in this mother's story that so closely mirrored her own. This is too important for me to not know what I am doing, Kastan thought.

"I started to think about the thousands of people every day that are coming in to hospitals and their lives are profoundly changed by an accident, an illness or an injury-maybe a diagnosis," Kastan said. "People who have had these experiences understand that there is life before the trauma and life after the trauma."

So in 2000, Kastan went back to school for her master's degree in social work at Ohio State University with a focus on clinical studies. It was then that she met Grayce Sills, a nursing professor, and Ken Yeager, a psychiatry professor.

"Holly had a passion for trauma-informed care as a student," Sills recalled. "The three of us (decided) that STAR was the next step in trying to help people respond to their mental health needs."

The OSU STAR Program stands for Stress, Trauma and Resilience. It's the only trauma program in the country attached to a medical center that's dedicated to clinical services, education and research.

STAR hopes to eventually offer clinical care for healthcare professionals, patients and families affected by trauma. In the short term, the focus is on providing education and training to healthcare workers and creating an awareness of STAR's need within the community.

The latter is Kastan's primary role as director of planning, development and outreach. She hears the same response from the hundreds she's approached about STAR: a program like this is much needed. Under her guidance, STAR has raised more than $600,000 in its first three years.

"Through her own personal experience and professional training, she combines great insight and knowledge and is able to translate that into very practical solutions," said Dr. Steven Gabbe, CEO of OSU Medical Center, which supported the start of STAR with a $750,000, three-year grant. "That's evident by the very generous community support."

But Kastan is the first to shine recognition on others. She repeatedly emphasizes STAR's collaborative approach and the team effort that's made the program possible.

It's a quality Gabbe responds to with a chuckle. "That's Holly," he said. "But she is a champion for this cause. She's a pioneer of this program."

This program, Kastan hopes, will remove the stigma attached to mental health. "You wouldn't hesitate to get help for a broken leg," Kastan said. "But somehow people feel (with this) that they did something wrong or that there's terrible shame. Nobody chooses mental illness. Nobody chooses trauma. What we hope here at the STAR Program is that this will help open the dialogue."

Sitting in a German Village coffee shop, Kastan rests her elbows on the table. She leans forward as if hoping to absorb every aspect of the conversation. She holds eye contact, softly, just enough to convey she's listening, but without intimidation. It's what friend Nancy Jeffers called her natural empathy-people just open up and talk to her.

She bubbles and repeats the word "exciting" every time the STAR Program weaves its way into the dialogue. Then, she simultaneously smiles and tears when it circles back to her daughter. She admits she still cries every now and then. She won't say she's recovered.

"My life's not the same as it was before the baby died," she said. "To me, recovery means you're kind of back to where you were before. And I don't think I am there. I would have taken a totally different path if that hadn't happened."

Two decades after the tragedy, Kastan continues a tribute to her daughter with STAR, hoping that no one ever has to think, Getting help shouldn't be this hard.

"Everybody has sadness. Everybody has stress. It's wonderful to be able to address my healing through my work," Kastan said. "That's one of the reasons why I'm passionate about it. It felt like I never had a choice."

And while some stories can't have happy endings, they can open opportunities, Kastan said.

"That's the good part of the story."

Rising Star

There's no denying trauma is a vast area to cover. So the STAR program has focused first on treating those who treat the victims of traumas on a daily basis: doctors, nurses, emergency responders and other healthcare personnel. The goal is to reduce their stress, reduce their trauma and give them the tools to continually deal with both.

"Day after day, our staff that works in the burn unit, intensive care unit, emergency department-they are hearing and witnessing horrific things that no one should have to see and witness," Holly Kastan said. "Even by witnessing or hearing a story of a trauma you can be traumatized. That has an impact on you."

For example, Grayce Sills, a nursing professor instrumental in the creation of STAR, recalls something an emergency room doctor once said to her: If I have to tell the parents of one more 16-year-old that their kid wrapped their car around a tree and didn't make it… I don't know if I can do it or not.

The goal is to change the mentality that doctors and nurses are superhuman, or that they are weak if they feel remorse at the loss of a patient.

One way STAR hopes to help is by teaching medical staff relaxation techniques such as stretching, meditating and breathing that can be done on the job. Research due out next year shows that stress levels dropped by 40 percent in nurses who used such techniques.

Another thing STAR wants to offer is debriefings for traumatized staff. The debriefings have focused first on high stress departments, such as the intensive care and surgical units. Ken Yeager, who spearheads this effort, has trained 43 medical center employees to debrief. They can work with groups or individuals to talk through moments of an event that impact them. It's a piece-by-piece recovery that gives them a safe place to turn for help.

"On the opposite side of tragedy is resilience and growth," Yeager said. "Once you help a person work through that difficult time, they can help other people work through a difficult time. And that's what the staff is doing."

The next step: outpatient clinic treatment, focusing on victims and then their families.

"Everybody's vulnerable to trauma," Yeager said. "We want to be known as a center that doesn't just treat your family member, but your whole family."

For more on the STAR Program, its upcoming spring benefit with the Wexner Center and ways to help, contact Holly Kastan at holly.kastan@osumc.edu.