Saving My Life

I need to hear that shrill tone. The one that pulls me from my day and thrusts me into that of another’s. The one that orders me into my little car, and sends me to the station. The one that sits me on the bench of the ambulance, soaking in the smell of plastics and chemical cleaners. The one that captivates my attention for an hour or two.

I need the illusion that I belong. That what I do matters. To justify my reason for being. I need the excuse to keep me here another day. I need the time to think about something other than whether I should stay or go. Other than if my mistakes of yesterday outweigh my possibilities of tomorrow.

I need to feel like I’m part of something bigger than just me. Bigger than the emotional storm clouding my thoughts, raging in my head and my heart. I need to be given a few hours where I can stop worrying about yesterday and tomorrow. Where the only thing that matters is right here in this moment. The only thing that matters is the person whose hand I’m holding; the life that I’m caring for.

I need that tone to go off. Just one more time. I just need one more day to figure this out. Just get me through today.

EMS is saving my life. Hopefully, one day, I’ll be able to say it’s saved my life.

Healing Is Not A Linear Process

I’ve learned plenty of things as an EMT. I’ve learned what the top and bottom numbers of a blood pressure mean. I’ve learned how to splint a fractured bone. I’ve learned the proper way to talk on the radio. I’ve learned how to start an intravenous line. I’ve learned that real life is nothing like the textbook. In the textbook, you see calm, cooperative patients, neatly packaged in controlled, well-lit environments. Ask anyone who’s ever run an EMS call, and they’ll tell you the real world is nothing like that. But, there’s a quieter, more subtle difference between the textbook and reality; one that might not be realized right away. Once you experience it, however, you’ll never forget it.

You see, there are no pictures in the textbooks of EMT’s lost in thought, laying wide awake at night. There are no images of paramedics waking up with nightmares. There are no illustrations of providers crying, or torturing themselves with “Why?” and “What if?” These things are mentioned, though. But in real life, you only hear about it quiet whispers, if at all.

I’m willing to bet that most EMT’s and paramedics who truly love their work, and have some time under their belt, have had at least one call that stays with them. It could be a nasty trauma. It could be a medical call that got out of your control. It could be subtle details in an otherwise routine call that trigger something else. We don’t talk about it too much, though. Maybe we’re afraid, or we think we’re alone. Maybe we’re embarrassed. Maybe talking about it just isn’t helpful for some.

Everyone deals with their demons differently. Go do whatever you need to do to help yourself. Talk about it. Meditate. Write. Lift some weights. Paint. Run until you can’t feel your legs anymore. Shoot some targets. Spend time with loved ones. Play with your dog. Do whatever it is you need to so you can help yourself.

But, what if you’ve done that? What if you’ve done everything you can think of?

This is the other thing I’ve learned in EMS: healing is not a linear process. There are good days, and there are bad. You reach your peaks, and you think everything is fine…and the next day, you wake up to find yourself in a trough again. It doesn’t mean you are broken. All of your work is not undone when you find yourself hurting again. The ups and downs of your progress aren’t as important as the direction: forward. You may be down today, but you are further forward than you were yesterday. A straight line may be the quickest way to get from “unwell” to “well.” But there’s a reason why it’s called the “healing process” and not the “healing race.” There will be days where you will soar, and there will be days that you will falter.

Trust me when I say that you will have good days. You will have calls that make you smile, fill you with pride, and lift you up. These troubles that bother you so much now, will one day serve to strengthen and teach you; not haunt you. We all have those calls that we will never forget, but I promise you, they will not always cause this kind of pain that worries you right now.

 

Are You Taught To Hate Your Field?

Why on earth is the healthcare provider education system so hell bent on burning people out before they’ve even got their license in hand?

At least that’s the way it seems. Maybe it’s just a regional thing. Maybe all the schools in my area are teaching using similar techniques, and all the teachers subscribe to a similar mindset. Or maybe I’ve officially lost my mind (I am certainly not ruling that out).

This post is going to mostly be about nursing school, because that’s what I’ve experienced. But, any new-grad paramedic I know has talked about similar problems.

For any of you that actually read my rambling, babbling, nonsensical drawl, you know that I am unhappy in nursing school. Yes, I do feel absolutely miserable. Every week, I find myself up in the wee hours of the morning on the verge of a mental meltdown. Every drive to school is filled with anxiety, and every drive home is filled with discouragement. It feels almost like a trap some days. The further into the program I get, the worse I feel, but the more obligated I feel to finish it. At my worst, I find myself panicky, physically sick, unable to sleep, and waking up with horribly graphic and disturbing nightmares. Sometimes I start wondering why I ever decided to go into nursing. In my stress, I start to look for other careers I could do. Maybe I’ll find my calling in something else. In the past, I’ve considered going to paramedic school. Currently, I have some wild aspiration to go into law enforcement…which I’m sure would be greatly discouraged by anyone who actually knows me. I have to stop and wonder if these aspirations are real, or if I’m just looking into them because it’s something other than what I’m going through right now.

I’m in an associate’s degree program, so it’s only 2 years long. Most paramedic programs are about that long as well. It’s a short amount of time in which to learn a lot of important things. It’s not like earning a typical degree…after we get out of school, our decisions could greatly impact the lives of others. The stakes are very high, and it’s incredibly important to learn as much as we can in the short time that we have. Maybe these programs are just too short to be reasonable. I find that students in these shorter healthcare degrees/certification programs are just so stressed out and inundated with schoolwork that they find themselves discouraged or disliking the career they are about to enter. It’s heartbreaking to work so hard towards something, and then to be almost directed to hate it.

Maybe I just don’t love my potential career enough. Maybe I’m not dedicated enough. And like I mentioned before, maybe it’s purely a regional thing. Regardless, something should change here. Maybe it’s just me. Or maybe it’s the healthcare system. Or perhaps something in between.

Are any of you having problems similar to this? Or did I really just plain old lose my mind.

The Shards Buried In Our Skin

I’m going to take a chance and throw this out there, and see what I might get back.

At times, I find myself worrying and believing the things others imply…that if you can’t handle the emotional toll of our calling, then you’re weak, and you won’t last. I hope that’s not true. I try to reassure myself, but in my hours of insecurity, those reassurances are fleeting and superficial.

I’ve been finding myself having moments where it will suddenly hit me; the awful things we have to see and deal with so regularly. We see so many life-shattering events. And then one day you realize there are little shards of these events that are buried in your own skin. There are so many things we can’t un-see, cries we can’t un-hear. In quiet hours, I sometimes ask the veteran paramedics that I trust, “How do you deal with this?” Time and time again, regardless of who it is, the answer is a resounding, “Take care of yourself. Everyone handles stress differently. Work out. Write. Make art. Listen to music. Go hunting. Fly a kite. Play with puppies. Do what works for you.”

Oddly, none of that is helpful. I don’t know what “works for me.” Other than writing, I suppose. But even then, I find myself trying to edit and make my writing more appropriate and appealing for others to read. No one wants to read some whiny kid moaning and complaining all the time. I don’t know if not knowing how to handle or react to stress is simply age-related…maybe it’ll get better as I get older and figure myself out more. But maybe it is something I should know now, something I can learn somehow.

I find myself doing what (probably) most are doing: shrugging away the memories. Not looking at the shards of lives embedded in our skin, the splatter of sorrow stained on our clothes.  Just like what we tell victims with gruesome injuries, “Don’t look at it.” Looking at it makes it worse. It makes it uncomfortable. It makes it too real. Ignoring it, leaving it to the backs of our minds, makes it a dream. Something that can be shaken from our minds like an Etch-a-Sketch, and written off with a light, “Whoa, that we weird. Anyway. Back to reality.”

But it’s not a dream, is it? It’s real. It’s all too real. It’s only a matter of time before that catches up with us, isn’t it? Maybe it’s only a matter of time for those like me. Those who aren’t sure how to handle it all; how to officially put those nightmares to bed. Can you even do that? Should you do that? Do these demons serve a purpose after all? To prove we still have empathy and emotion? That through it all, you’re still human and have a heart that beats and feels, interacts and reacts with everything? Is to silence the demons in our heads to become catatonic? Unresponsive? Cold? Without empathy or passion? Without any of those bittersweet, double-edged attributes that make us human? Should we live with the recurring pain to remind ourselves that we still care? Or should we numb it to allow us peace, but at the risk that we stop feeling anything at all?

There’s Something In The Air: 911 Calls for Depression

I’d rather go to fifty 3 a.m. 911 calls for depression and suicidal ideation than respond to a single untimely secondary to suicide. I’ve been to far too many of the latter lately, and it’s starting to take its toll.

The depressed patient I can help, in some small way. I can be a nonjudgmental ear. Or a shoulder to cry on. Maybe just provide the social contact that we as humans need. Just giving her a ride to the hospital and removing her from house can be helpful.  To go somewhere different, where the walls are not splattered with sadness and there is company other than her depression, can be the first step on the road to recovery. Having a medical professional evaluate her depression can help validate her. This isn’t something she should just “shake off.” It’s not that she’s weak or stupid. An evaluation, and the associated validation, can help her feel she’s not alone and unheard. From there, the decision to send her to a psych facility, the encouragement to speak to her primary care physician, or the suggestion to seek help from a mental health specialist, are all more stepping stones to healing.

Have you ever responded to the residence of a person who called 911 for depression and just felt that something wasn’t right? As if the pictures, the carpets, the clothing, the furniture, just absorb the patient’s sorrow? Maybe I sound a little crazy for saying so. Sometimes when on these calls, it’s almost like there’s something in the air. You can just feel it in that 6th sense that has no name. You just know that the patient is emotionally hurting and feeling helpless. But, depression is treatable. Depression can be beat. Maybe that’s part of why some people don’t take these calls seriously.

Have you ever walked into the scene where someone committed suicide? There’s still something in the air; that near-palpable sadness. But there’s this terrible electricity to it too. There’s a true helplessness felt by all those in the room. Something was done that can’t be undone. There is no “back” button. There is no eraser. The permanence of what happened hangs heavily in the air. It seeps through and saturates the family and friends. The frantic horror, disbelief, anger, and hurt in the eyes of the loved ones is harshly unforgettable. That is by far the worst part of these calls. There’s something about that emotionally charged air that sticks with you, even after you clear the scene.

 Depression is a security blanket; the misery is comfortable in its familiarity. But this blanket is smothering. Asking for help and seeing things in different lights is brave. It’s scary to pull off that blanket that you’ve been holding onto for so long. But things can get better. So long as you are alive, there is always hope. There is always room and time for growth and change. The only time that stops is when you decide to let that blanket smother you completely.

If the way to start that journey to health and happiness begins with you calling 911, then call it as much as you need to, regardless of the time. I would be honored to help you fight such a tough and courageous battle. I’d so much rather be there in your hour of need than at your hour of death.

Something’s Got to Change: Part I

Considering my medical capabilities as a BLS provider, all of my inter-facility transfers are stable patients. Most of them are depressed patients (which I’m more than okay with.) The vast majority of the time, this works out well for both myself and the patient. I’ve had my own battle with depression, and I understand a lot of the emotional pieces that the patient is going through. My experience allows me to be genuine, honest, and thoroughly empathetic with them. It allows for a trusting professional relationship to develop. And when that right chemistry is in place, sometimes it puts the patient in a position to begin the healing process. Moments like that never cease to amaze me.

That kind of chemistry works particularly well with my teenage patients. I was more or less in their shoes only a few years ago. For older providers, it might be harder to relate to that particular kind of patient. Older providers have had more life experience, so they’re able to put things in perspective. Most adolescent troubles seem trivial to middle-aged EMTs, because they have survived worse. But seeing as I was in high school only a few years ago, many of those wounds–although healed–are still fresh in my mind. It wasn’t that long ago that I had my heart broken for the first time, or wondered if and where I belonged, or had fights and disagreements with friends and family. And, yeah, at the time, it seemed like the whole world was ending, because that was all I’d ever known. After spending a few years in the “real world,” I’ve gained some experience and perspective that I didn’t have in high school. But those memories aren’t so long ago that I forgot their sting and bite, given my short and few life experiences as a high school kid.

But not all of my patients are middle- and high-schoolers going through the trials of growing up. Some of them are people twice or thrice my age, with problems I can’t really relate to. Sure, we make do during those long transports in the back of the ambulance. And often, we do build that chemistry that allows the patients do talk about what’s been hurting them so badly. With teenagers, I know what to say, because I’ve been there and back. I survived the break up, the fights, the contemplating the meaning for my existence. I know things now that I wish I could tell myself then, and I’m given that chance to be there for emotionally hurting teenagers. But with middle-aged (or older) folks? I haven’t suffered a divorce. I haven’t had to worry whether putting my parents in a home was right or not. I’ve never even been pregnant, much less had to plan my own child’s funeral. I haven’t had to watch loved ones as they die. I haven’t been evicted, or unemployed, or widowed. To these, and so many more problems, I don’t know what to say. But I know “I’m so sorry,” doesn’t cut it, and “it’s going to be okay,” doesn’t mean a damn thing.

I truly believe that EMS providers can have a big impact in the recovery and healing process of the depressed. For many, you are going to be their first exposure to the healthcare system as it pertains to their mental health. They’re probably going to be a mix of sad, confused, worried, scared, angry, or any number of other emotions. And your receptiveness, your compassion, your respect–or lack thereof–could very well be their first impression of mental healthcare. And the scary part is we’re not trained in that.

Think back to your EMT class. How much time did they spend on psychiatric emergencies? If it’s anything like my program, it wasn’t much. We covered it in probably about an hour, and it all boiled down to “if they’re violent, make sure PD is there,” and “scene safety.” I’d say the vast majority of my depressed patients showed no signs of aggression towards anyone, with the exception of maybe themselves. So our education in dealing with psychiatric patients is directed towards a slim percentage of what we actually deal with*. Or at least what I deal with in my system.

We are emergency medical technicians. We are trained to deal with a whole host of possible emergencies. If a depressed individual slashed their wrists, or swallowed pills, we can address that. We can manage the physical manifestations of their condition. But we simply aren’t equipped to deal with the condition itself: mental health. In a 911 emergency setting, we can get away with overlooking that problem. But in a non-emergency interfacility transfer (particularly long ones), odds are we will have to address it in one way or another. Whether it be that we talk to the patient about what’s bothering them, or just try to be respectful of the situation and allow the patient to do what she needs to until we arrive at definitive care. And yet, all we have to draw on is personal experience. We simply do not have the training for this kind of a situation, which is surprisingly common. This worries me because this initial contact can coincide when the patient is at her most receptive and most hopeful. Depending on your actions, she can see that people are really there to try and help her, or she can feel as though she is being a burden and that she is beyond (or not worthy of) help.

So one of two things needs to change. Either our education develops to help us help these patients; or another system is created which specializes in the treatment and inter-facility transport of psych patients, complete with providers who are trained in a “first aid” of mental health. So what do you think? I’m interested in your comments and ideas.

 

 

*This being said, I in no way de-emphasize how important scene safety is. This point about ensuring your safety is incredibly important.