Contrary to what EMTs and paramedics like to tell themselves, we are not immune to that which we see, treat, and deal with on the job. We hide behind humor, we don’t talk about things, we bottle up emotions (After all, we can’t show it while treating our patients…), which unfortunately can spill over into our personal lives.
Personally, I have some “demons” in my closet, as we all do. I used to not talk about them. Those patients that really got to me, both the negative and positive. Some of the negative ones are really bad. Many of us see the horrible side of humanity. I used to be amazed at what people could do to one another. Some in fits of murderous rage, others thinking that they are doing the right thing in punishing a child, who instead kill or injure that child so bad that you think death would be better. What would possess a parent to bash their child’s head against a wall for wetting themselves? How could a child stab another in the heart over a toy? Why would someone shot another, then run over them with their car? Well, they do. You see it in the news every day. What you very rarely see is the anguish on the faces of those treating the victims.
But in not talking about it (“Sucking it up”), it weighs down on us like a ton of bricks. Over the years, we have evolved in emergency medicine to discuss things. We still try to not bring it home to our families. But we talk about it more with our peers. Critical Incident Stress Management began this process for many of us. Critical Incident Stress Debriefings, Defusings, Exposed Group meetings, whatever you want to call it, gave us a no holds barred approach to working through those situations that would help us to deal with our own feelings: anger, betrayal, grief, questioning our actions (“I should have done more”, “Should I have tried ‘x’ drug?”), thinking someone got in our way, etc. Before they cause us post-traumatic stress disorder and depressive illness that is even more difficult to treat.
Recently, one particular incident in my EMS past has come back to me. It happened innocuously enough. One of my family members asked that question we all hear, “What is the worst thing you’ve ever seen?”, and I gave my stock reply, “You really don’t want to know.” This family member pressed on, and wouldn’t let it drop. I should have just insisted on them dropping it, but I didn’t. So, I took this person to a private location and told them (I didn’t want others to hear it). The look on this person’s face when I told them was akin to that “Oh my God” look we know. It wasn’t their fault.
It was a few days later that it came back in my sleep. I had not woken up in a sweat that bad in a very, very, very long time. I couldn’t go back to sleep. If I did, it replayed over. And over. So, I stayed awake. For over 2 days. I got a lot done, but it isn’t healthy, and I know it. So, I did something I haven’t done in a long time. I told a friend I needed to talk. Someone who has been through it themselves. We talked for hours. About all sorts of things, but most importantly, about that horrid day so long ago. And my friend suggested that I write it down in a journal. I had never actually ever written out my feelings about this particular incident. I wrote it out 5 times. I wrote until I physically couldn’t any longer.
And then I took this journal and I burned it. I stood there watching those pages turn to ash, and I made a promise to myself. I first of all, would not bend again to someone else pressing me to tell them about the worst thing I’ve seen. I can’t do that to myself… or to them, no matter what they think they want to know. I also promised that the next time this happens, I will call a friend to talk. Or someone who is trained to deal with post-traumatic issues. After all, this isn’t the only bad situation I’ve dealt with, or will in the future. Most are safely tucked away in my memories. But some may make their way out again.
While there are times to keep things to one’s self, there are other times that they should and need to be discussed.
If you have found yourself in a situation that you can’t let go of, whether it happened today, or 30 years ago, find someone to talk to. Ask for a CISM counselor at your place of employment, talk to your clergy, friend, family member, coworker. If you can’t talk to someone, write it down, draw it out, go out and smack the hell out of the boxing bag at the gym. Whatever you need to do… Don’t let it eat you up.