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PTSD

 

I attended a critical incident stress debriefing (CISD) a few years ago. I thought I had been invited to an informal get-together of folks from another service who I had been on a upsetting call with the day before. Had I known it was a formal CSID debrief, I wouldn't have gone, as I had always avoided them in the past. Not that CSIDs don't help some people, they are just not for me.

 

I have been in EMS for thirty years now, and I have been on traumatic calls. This one ranked up there, but since I wasn't the first medic in, I didn't catch the brunt of it. For me the worst calls are not always those that make the news.  I take it hardest when my patient dies in my care, when I have to witness a sudden deterioration and  feel helpless to stop it or feel like maybe had I done things differently I could have possibly affected the outcome for the better. Other calls where the patient's fate has already been settled before I arrive are less taxing to me than they used to be.  This was such a call.

 

Each of us processes trauma and stress differently. When I was new, it helped to have an experienced person (another medic) guide me through what I was feeling. In time I learned where to put these calls. It's not like you don't think about them  — you wouldn't be human if you didn't — but you soon understand what the job is, and you understand that tragedy and, in some cases evil, are a part of our world.

 

At this debriefing a team member told those assembled, "You gotta let it out, you gotta let it all out or it'll eat you up inside." I didn't want to be disrespectful because I felt I was a guest at someone's house, but I disagreed. If you have a way of dealing with trauma by yourself and it works for you, then that's good. Go with it.  I found hearing what others had seen and felt on the call was more traumatizing to me than actually going through the call myself. Their details (a cell phone, music playing, a family member's response) recalled details from past calls I had done. They triggered an explosion of what I had kept contained. When it was my turn to say what I found most vivid about this particular call, I passed. I didn't want to burden someone else with the images that were in my memory of the call. I found in the next twenty-four hours, that little box where I kept past traumas had been ripped open and all these ghosts from the past swirled around me. I suddenly vividly remembered calls I had long ago forgotten. It took me two sleepless nights to put them back in their proper place.

 

I have friends who have gone through traumatic calls on a scale larger than my own — calls that could shake a priest's faith in God. They struggled with what they experienced. Some talked with peers, others sought professional help, still others went it alone.  Most found their peace.

 

I know peers who have found great consolation with service dogs (I will likely be writing about this topic soon). Others have gotten medical marijuana cards (although I suspect some of them just like to be able to smoke legal weed). Tell the doctor you are an EMT and have nightmares. That and a $100 fee get you a diagnosis of PTSD and a card you can present at the dispensary. While I enjoyed smoking in my youth, and sometimes long for those times, I am a father and a busy person, and just can't see toking my evenings away. I don't even drink beer much anymore, but when I did, I avoided it in troubled times because I always wanted to be clear minded as I sorted through what challenged me.

 

I know there are some members of our profession who will be broken, who will endure as long as they can, and then end up on the wrong end of the bottle or even the wrong end of their own gun.

 

I guess you have to ask yourself how you are dealing with what you have witnessed, and if you feel like you are having a hard time, then find someone you trust to talk to or seek professional help. There are people out there who will help, and there are methods you can be taught to help you deal with what you have been through. If you don't feel like talking about it, don't. If you do, then talk about it. You are not more or less of a person for seeking help.

 

If you see a brother or sister in EMS struggling, let them know you care. Most organizations have confidential employee helplines and have people trained to recognize who may be suffering. Some cases may be obvious, other too subtle to see.

 

Sometimes it not that big call that does it, it is a quiet long accumulation of common sights that leads to despair.  If you sense someone you know is down, if they seem incapable of joy, ask:

 

"Are you okay?"

 

Three simple words with great power. Don't hesitate to use them, even if you know the response:

 

I am, appreciate your asking.

 

Be vigilant.

 

Stay safe out there, and at home.

 

Take care.

 

Calm

When I first became an EMT, a friend asked me why I liked the job so much. When I come through the door, people look at me like I am an angel, I said. What is it like driving lights and sirens? Another friend asked. Awesome — I feel all powerful. I hit wail and the cars part for me like the red sea parting for Moses.

 

If you asked me then if there was anything wrong with what I described, I would have been seriously puzzled by the question. I didn't quite understand the true nature of the work.

 

When I became a paramedic I quickly learned to be a circus ringmaster, barking orders to partners, other first responders and even bystanders. All eyes were on me as I orchestrated getting vitals signs, med lists, moving furniture, putting on oxygen, getting an IV, delivering medicine, extricating the patients, even determining who could ride with us to the hospital. Eventually I brought that same leader of the band approach to running cardiac arrest (compressions, shocks, IV access, drugs, intubation, post-ROSC 12-lead, dopamine to support blood pressure, all seamlessly timed. I felt like a rock star. Driving home, I would go over in my head how well the calls went, how impressed people must be with me. Even if a call wasn't critical, I still strode in like I owned the world. I bantered with the other responders while making my way to the patient. How's the wife and kids? How about that car accident yesterday? Hope the Sox win tonight. I was a big city medic. Living the dream, as they say nowadays.

 

Of course, over time that changed. Work the streets long enough and you can't help but see the job for what it truly is. It isn't a TV show. It is not a play in which you are the star. It is just a system for getting sick and injured people to the hospital in the safest, calmest, kindest way possible.

 

My old teacher Judy Moore used to say the emergency ends when you arrive. It took me awhile to understand what she meant. But I learned. When you come through the doors, you don't bring the cameras in with you. The patient should be the center of attention, not the paramedic. Don't suck up all the energy in the room. Cut the theatrics, the commotion, and the self-importance. Converse with the patient. Reassure them. Be professional. Do what needs to be done without fanfare.

 

I see my old self in a few younger providers, but I don't say anything. They will learn. Even if they came first for the adventure and the lights and sirens as I did, if they stay long enough, they will stay for the human contact.

 

I remember when I was a young EMT at a car accident, doing my best to seize control. An older medic arrived in the second ambulance, and without saying a word, smiled wryly and somehow managed to make sereneness out of my chaos.

 

You don't need a cape to do this job. Drive carefully, speak softly, act calmly, be competent, be kind. Be a paramedic.

Tidying Up

 

Twenty years ago when I was looking to buy my first house, my realtor didn't understand why I did not like the home she was showing me that seemed to meet all my specifications: price, location, size. She did not understand that just two months before I had worked a cardiac arrest there. I could still see and smell the man and all his bodily fluids in the cluttered living room where he collapsed. If I bought that house I would have to live with his ghost. Not for me.

 

Home hunting is hard when you are in EMS. You walk in thinking as I always think when I enter a home, how am I going to get the patient out of here? A stretcher will never fit in that bedroom. Spiral staircase, forget it. Even if you didn't do a cardiac arrest in particular houses, you did arrests or memorable calls in houses with the same design. You remember the mother screaming in the bedroom. You see patients wedged between the toilet and the sink. Blood drips down the stairs.  You see all the crap that was in your way that you had to move to get the patient out to the ambulance.

 

I ended up buying a newer house that was empty with freshly laid carpets and big windows that let in the sun.

 

Today when I go into houses, I am depressed by hoarders, not just the ceiling to the floor appear on TV show kind, any kind of clutter. It bums me out seriously.  Dark apartments with dust particles visible in the air and rooms with dirty carpets and boxes of crap and untidy overflowing shelves — it weakens me.  Maybe it is because my own empty house is now more cluttered than I would like. We can only fit one car in our two car garage there is so much stuff in it. Of course I no longer live alone. I share my house with my wife and three daughters, and all their accumulated and still accumulating possessions.

 

The sun bothers them.  Every time I come in the living room I open the shades. Let some light in here. When I am old, I want to live in a spare space with lots of light so when the angels (or the devil) comes for me, I will ready to go. Leave nothing behind but a few heirlooms for the kids and some money in the bank to help them make their own way without me.

 

I am, hopefully, many years away from that day, but I don't want to be caught off guard. I want things tidy.

I went to a hoarder's house once. The neighbor had noticed newspapers piling up at the door and mail overflowing the box. We had to break in. This was a major hoarder. The house had newspapers stacked to the ceiling making rows in what were once big spacious rooms with high ceilings. We went all through the house wandering through the maze until at last I found her. A stack of papers and boxes had collapsed and her legs stuck out from underneath them like the wicked witch's legs stick out from under that tornado blown house that landed on her in the Wizard of Oz.

 

I did another presumption recently where the room was dank and filled with boxes. The man sat dead in his chair by the window, the curtain pulled just enough so he could look out. A neighbor in fact had noticed his face in the window, unmoving, mouth open, not responding to the neighbor's frantic raps on the pane.

 

I need to sort through my stuff. I have boxes of books, and records and VHS tapes in the garage, but I will buy the book, music or movie again digitally with the tap of a button before I will go down to the garage to look for what I know I already own.

 

There is a new show on Netflix called Tidying Up. A young Japanese woman helps people declutter their homes.  Marie Kondo is the author of the book The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing that spawned the series. I thought about buying a hard copy of the book, but instead bought it electronically on my Kindle. This weekend, I am ready to put her plan into action.

 

She advises starting with your clothes. You take every item of clothing you own and put it in a pile in one place, and then you go through it. Rather than deciding what to throw away, you decide what to keep. You hold each item and ask yourself if it sparks joy in you. If it does, you keep it. If it doesn't you thank it for its faithful service, and then put it in the throw or giveaway pile. I have uniforms from past EMS services I worked for. I will never wear them again. I don't need them to remind me of the old days.  A ti-dye tee-shirt  made by my daughter with my name on it and a smiling sun stays.  An old torn Bruce Springsteen concert tee-shirt from 1984 goes, after being thanked for years of service.

 

Next you do your papers. She advises you throw them all away except for those that you are required to keep (wills, birth certificates, tax returns etc.) and those that need attending (bills, correspondence). I will keep my recent CME certificates, which I am required to keep for three years, but I will throw out my handouts from classes taken decades ago, as well as all those old ECG strips I kept. Seen one v-fib, see them all. I don't need them to remember what it felt like to shock all those people with sick, and often dying hearts.  For those rare few, I don't need the strip of the resulting sinus rhythm to remember the feel of the pulse beneath my fingers or the warmth with which their family hugged me when we later met.

 

When it comes to books, Marie Kondo says you shouldn't own more than 30. A book lover, I might dispute that, but the over one thousand I own are mainly in boxes, and the ones on shelves, I rarely take down. Better me sort them now than a grandchild have to haul them off to a tag sale. I will keep a select few (The Iliad and The Odyssey, Moby Dick, The Great Gatsby and The Old Man and The Sea) as well as a box of my books (Paramedic and Rescue 471) to give out from time to time because that brings me joy.

 

You work your way through everything you own, finishing with the personal mementos and sentimental objects.  I will keep a wooden carved Don Quixote, a small brass Bengal tiger given me by my father when I was five, and a single baseball card of Tony Conigilaro, my childhood hero. 

 

The principle around all of this is stuff takes up space and energy. If you are going to have possessions you should be surrounded only by what brings you joy. I can have a garage filled with boxes or I can have space where my eleven-year-old daughter and I can dribble basketballs on cold snowy nights, working on our crossovers to see who's is better (hers).

 

I can't wait to get started.

 

When the day comes when the medic calls the time on me, I want him to think what a beautiful clean well-lit room this old gentleman passed away in, the morning sun on his face. And I want him to look at my spare surroundings and see only the things that brought me joy (pictures of my family on the wall), the Grateful Dead's "Ripple" playing on my Amazon Echo, and to think what a life well lived. And as I journey up toward heaven (again, hopefully as I have tried to be kind), I want to look down and feel I have left a good impression and not a cluttered mess.

Balance

 

December 8, 2018: This weekend, I am in Worcester, Massachusetts at the New England Short Course Meters Masters Swimming Championships as a member of the Connecticut (CONN) team. Last year, we shocked many of the other teams by taking first place. Points are awarded based on place finish in individual and relay events. Each swimmer is only allowed to swim a maximum of six events a day or 13 for the entire meet. Friday evening is distance day (800 Free), Saturday and Sunday are for the relays and the main swimming events. Last year I scored 119 points swimming 12 events despite having a pretty severe chest cold. I also swam in three of the four relays. I came in second in the men's 55-59 200 Meter Butterfly and earned 15 points for it. I was second out of 2 swimmers. Last year I finished 25th in the nation in that event in my age group. 25 out of 25. Still I was proud as it is a difficult event, particularly for someone who did not know how to swim the stroke five years ago. I am swimming it again this year, and if all scheduled swimmers swim, I will likely finish 5 out of 5, but maybe some of them will scratch (drop out) as it is the last individual event. Last year I swam the full 200 meters without stopping. This year I may hang on the wall and catch my breath at some point along the way. I have not trained as much this year as last. My best event is the 50 free, but I will not come close to my best time of two years ago. Again, lack of training time and intensity. Plus Father Time sapping some of my strength.

 

Joe Frazier used to say. "If you cheated on that (your roadwork) in the dark of morning, you're going to get found out now, under the bright lights." I have no cold this year, but I am a year older, and not in the shape I used to be. That lack of training is likely to be apparent. Still I am here as part of a thirty person contingent of people who I have come to call my friends over the years. No matter how fast or slow I swim, i always get high fives and good jobs. I doubt we will win this year. Charles River Masters, who we upset last year, showed up loaded with more swimmers. My goal is to score more points for my team than last year, which will be a little easier as I am swimming one additional event and I have moved up in age to the 60-64 division.

 

Here's why I writing all this on my EMS blog.

 

I was talking the other day with a new medic trainee and we were talking about a number of the old career medics who were around when I started, and I told her of how many of them ended up broken. Here's a roll call. Overweight, fired for poor behavior, dead of a heart attack. Fired for violating policy, seen a few years later in a nursing home with jaundice, dead not long after. Retired unceremoniously, dead within months of lung cancer, obit posted on the operation's wall. Fired for undisclosed reasons, shot dead by police in a standoff — suicide by PD. Left for undisclosed reasons, found dead in bed a few years later, obese, uncertain of heart attack or overdose. Not a lot of happy stories. Many say that the job will leave you bitter in the end.

I used to say that I wanted to stay at this until I am 72 when my youngest daughter is targeted to graduate from college. I don't know if I can make it make it that long. I am hoping to at least stay full time until my middle daughter who is a freshman at college graduates. My goal is to get her through without any debt. In addition to my medic job, I also work as an ems coordinator at a local hospital. Between the two I am scheduled for 64 hours a week, but I often work longer. I try to keep Saturdays as a day for my youngest daughter and I to do things together.

 

My youngest is very into sports, and unfortunately, tomorrow, she has her first basketball game of the season, and I will miss it because I am here at the meet. She is playing in two leagues this winter, one with Saturday games and one with Sunday. Other than today, I will be at all her Saturday games, but because I work Sundays, I will only be able to see the Sunday games if I take off work. A part of me wants to go part-time on the ambulance so I can be free to see all her games, but with the middle daughter in college, I can't really afford that yet. I debated not going to this meet, but last year I skipped several meets to see her games. The fewer meets I do it seems the less I train. This is the one big meet of the year, so I expected if I skipped it, my identity as a masters swimmer would pretty much slip away, and I am not yet ready to give that up. I need athletic competition to keep me healthy and maintain my image of myself as an athlete and a man still in prime health.

 

All these conflicts.

 

I used to never miss an ambulance shift. I prided myself on always being on time and always being there if my name was on the books. In twenty-five years I have only had to go home sick twice, and only called out sick about the same number. I have only been late three times, twice due to a time change and once due to my alarm not going off. I take days off fairly freely now. With my seniority, I get a ton of PTO, so I use it. I took off for Zoey's soccer championships and I will certainly take off for her basketball championships if she makes those. My next swim meet is Superbowl Sunday and I am planning to take off for that, but only if it doesn't conflict with one of her games. I'll take that game over the local meet. Hopefully, I'll be able to do both.

 

I enjoy my swimming friends, as I enjoy my EMS friends. And of course, I enjoy my family most of all. Between the three I hope to be able to maintain a balance that I have not always had. I don't need to be on the ambulance everyday or at every swim meet or at every single one of my daughter's games. I just have to do my best to be there whenever I can, and ensure that I am healthy, and happy. I want to be there for the long run.

 

Postscript:

 

We came in 3rd in the meet. I had the eighth most points of any male in the competition, points mainly accumulated because I was one of a few who swam 13 individual events. I finished the 200 Butterfly only a few seconds slower than last year, and captured 3rd place. Out of 4.

 

My daughter won her game and scored 8 of her team's 14 points. Hearing her recap of the game wasn't as good as being there, but it was still great. Nothing much of interest happened on the ambulance that day, according to the guy who filled in for me, nothing unusual. I didn't miss out on anything exciting.

 

The meet renewed my enthusiasm for swimming, so I have been hitting the pool hard this week. I saw my daughter's game yesterday and it was great. They won and she played well, scoring 10 or 12 points in the win, including making both her free throws. Not bad for 10 years old.

 

I am at work now, posted on a street corner in the December rain, drinking hot tea with honey.  I am hoping the next call will be an interesting one.  I hope that I get out on time so I can swim at the pool.  I hope that when I get home, I will sit in my armchair and have a cold glass of water, while my wife sits on the couch and laughs at Will Ferrell in the Wedding Crashers in a way that brings warmth to my heart.  I hope that my daughter will be dribbling her basketball back and forth between her legs.  I hope that she looks up at me and says "Dad-Catch!"