East of Eden: Tom Hamilton and the Second Victims We Fail to See.

There are many reasons why John Steinbeck is a Nobel prize winning author, but for me at least, East of Eden is his Magnum Opus. I could talk about this book for hours and hours; for the reflections, insights into the human condition, and lessons it provides throughout this incredible text. There is clearly more than one article’s worth of content, but for now, I want to focus on the tragic tale of one of the side characters that illustrates a heartbreaking (but not unusual) story of ‘the second victim’.

If you haven’t read the book and plan on doing so and don’t want a spoiler or two… please go no further. But for the rest of you, please proceed. Here is a little contextual background about the character of Tom Hamilton and a refresher.

Tom Hamilton: “Born in a Storm and Lived in Lightning”. 

Steinbeck describes Tom as, ‘born in a storm and lived in lightning’ to articulate his constant internal battle with his potential for greatness. Tom is intelligent and innovative, demonstrated by his designing a vast number of marvellous inventions that never get the credit they deserve (a repeat of his father and the patent battles he continuously had). He shares this intensity and inclination with his beloved Father Samuel, who also recognises the potential in his son and even remarks to other characters ‘he’s wrestling with greatness’.

Tom is one of many children in the Hamilton family, all of whom have a mix of merits within them, but he seems to be the one closest to his father and also the one with the largest potential but is burdened with feeling a huge deal of pressure to live up to those expectations.

A Tragic Attempt to Care for His Sister. 

When Tom’s father passes, it is a massive blow, and he intensely struggles with his grief. One of his only siblings who seems to also share in his agony with grief is his sister Desi. Desi decides to move into the family ranch with Tom to be with him through this time, but unbeknownst to anyone, she is struggling with a serious abdominal pain that she tries to conceal. After a short time, Desi’s agony can no longer be hidden and in his innocent ignorance, Tom tries to help his sister by giving her a family recipe of salt water to help with stomach issues. Unbeknownst to Tom, Desi actually had an appendicitis and the salt water led to it rupturing, killing Desi as a result. Tom is so utterly defeated and riddled with inconsolable guilt that he decides to take his own life by shooting himself in the head, but not before staging a few things to make his mother believe it was a horse accident in a bid to protect her from the truth.

Why Tom Hamilton Made Me Reconsider the Second Victim. 

In my many ponderings and musings on this book, I kept coming back to the concept of ‘the second victim’ in relation to the character Tom Hamilton. I wanted to re-explore this in more detail. However, as I began gathering up my sources and reference material, I began to get increasingly more frustrated and admittedly a tad cross. So, let’s now dig into why that was the case.

What Does “The Second Victim” Mean? 

There are a few definitions available of ‘the second victim’ out there, but a commonly adopted definition is; ‘Healthcare providers who are involved in an unanticipated adverse patient event, a medical error and/or a patient related injury and become victimised in the sense that the provider is traumatised by the event. Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, second guessing their clinical skills and knowledge base.’ (Scott et al, 2009)

Dekker’s 2013 book ‘The Second Victim’ gave a new slant, where he pulled it specifically away from healthcare as an industry, but there still remains a focus on professionals. ‘A practitioner who is involved in an incident that kills or injures another person and for which they feel personally responsible.’ (Sidney Dekker, 2013). Whilst Dekker’s definition of ‘The Second Victim’ is indeed an improvement on the first one by Scott et al, because it is broader, I actually find both examples reductive and limited with the undertone of one must be considered a ‘professional’ in order to experience it. From my perspective, that simply is not true.

Does the Definition Exclude Too Many People? 

Let’s go back to the example of Tom in ‘East of Eden’. He was neither a healthcare worker nor a professional practitioner of any sort within the context of his example. He was a brother trying to provide care to his sister in their family home when she was sick. He believed he was doing the right thing, and he was trying to help. Yet the action he took had a catastrophic outcome whereby he was so deeply traumatized that he felt unable to live with it. A tragedy indeed and from what I can tell, he should absolutely fit the criteria of a ‘second victim’, yet the examples above would exclude him.

The Overlooked Experiences of Family and Unpaid Caregivers. 

Tom, while he may be fictional, his experience is not unique. A lot of the literature on this topic focuses on the healthcare side and the literature is much more limited on broader industries such as other emergency services (police, fire, rescue etc), who will surely have ‘second victim’ experiences. But beyond that, this psychological trauma has so many broader implications. Consider the vast swathe of caregivers (many of them unpaid) who undertake huge responsibilities and with the best of intentions, have made decisions with significant consequences that harm (or have the potential of harm even when it doesn’t materialise). These people must then either reconcile with what has happened or become traumatised by their experiences.

My Experience as a Parent and Caregiver. 

As a parent of a child with a complex medical condition, I can say first hand that there have been times where I have taken medical decisions that seemed perfectly reasonable at the time but have turned out to be the wrong thing with real life consequences for my child, and they haunt me terribly. For clarity on that, I have a child with type one diabetes and as a main caregiver, I administer his insulin for the food he eats. If I inadvertently miscalculate the volume of carbohydrates he is consuming in a meal, he could end up either hypoglycaemic or hyperglycaemic and both of these make my child feel very unwell (as well as other potential implications). I also apply his medical device regularly, and a slip in my application of it can render the equipment significantly less effective. This introduces a second, often painful application of the device, as well as him feeling unwell due to ineffective insulin delivery. As his mother, I absolutely do not want to be the cause of his unwellness. I only ever want to help and support. Any errors caused by myself in my child’s care make me feel incredibly guilty amongst other painful emotions that take a good deal of sorting through.

Psychological Safety Must Extend Beyond Professional Care. 

Psychological safety matters here because people need to feel able to talk honestly about mistakes, uncertainty and unintended consequences without immediately expecting blame or condemnation. This applies not only to healthcare professionals, but also to parents, family members and unpaid caregivers carrying significant responsibilities without the formal structures of support available in professional settings. 

Compassion for the Second Victims We Fail to See. 

Revisiting ‘East of Eden’ gave pause to reflect on how significant ‘second victim’ experiences are and also how may people out there fall into this category but never share the impact of their trauma. Classic literature that stands the test of time more often than not explores ‘what it means to be human’ and as someone heavily invested in the field of Human Factors, these stories remind me over again how important it is to have compassion in the world but also that so many of these experiences are rarely unique to a particular field or industry and moreover ubiquitous with the human experience.