I am often told by patients something to the effect of “I couldn’t do what you do, man” on a semi-regular basis. I don’t take an air of arrogance like some do about being a Paramedic, I checked that attitude at the door when I was hired at my current employer. I take pride in my walk in life, but I do my best not to be holier than thou. I typically just smile, and remark how the job is not for everyone. This is generally followed up with an inquiry by the patient about how I manage to deal with the horrors of my job, which in turn I respond with a joke of some nature. We halfheartedly chuckle and move on.
Paramedic school is not meant to prepare you for every situation, or facet of the world of Emergency Services like we are inclined to think during our time as students in the classroom. This reality did not take me long to discover. Really, it would be an impossible task. No one can tell you how you will react to the harsh reality of Emergency Services, nor can they easily prepare you for it. Its an unfortunate aspect of this job, and its an often ignored issue. Like many before me, I talked myself up inside about how I could handle anything this world had to offer me, that nothing could break me. I was mistaken in that. I didn’t handle my first truly bad 911 call well. Outside I shrugged it off, played it out like I was immune to the trauma.
In the immediate moments after the call I occupied myself with my charts, and shared in the time-honored practice of EMS professionals by making a few off-color jokes. To some, its a method of defusing. Others, its a facade. To my then training officer and his partner, I was fine. But I wasn’t fooling myself. I didn’t sleep well that night, all I could hear was the crying of my patient, and replayed the scene in my mind, wondering what happened. But in time, I walked it off without ever really coming to terms about what happened. I suppressed the call, and moved on. This was a habit I had acquired from my time as an adolescent in coping with depression; bottling everything up, and walking it off like I was fine. In time I began to realize this was the wrong way to do things, and was a mistake I’d been repeating for almost 9 years of on-and-off depression I had thought I’d beaten. I was mistaken in thinking that.
Fast forward from September 2013 to February of 2014. I’d been let go following a bad run of immaturity and ill preparedness at my first 911 job out in the country, and was a few months into my employment at EMS Hive. I had been through a fatality accident, and several failed cardiac arrests. Between my release from the first 911 job and what I viewed as personal failures in my many unsuccessful cardiac arrests, I was not doing well. I kept playing the scenarios back in my mind when my depression was flaring. “You failure. You’re in over your head. You don’t deserve to be here.” These were thoughts I berated myself with when I was at my worst. With each passing day I began to resent my job, my life (or lack thereof), and myself more and more.
I stopped seeing my friends. My relationship with my family deteriorated as I became more hateful and bitter. When I did see my friends we spent our time in bars, with me forgetting my frustrations on my off nights. I had no romance in my life. I felt alone all the time. When I was not lashing out at myself over the calls, and emotions I refused to seek out help for, I was growing angry at the amount of low acuity calls my system endures. Stubbed toes, tooth aches, homeless people making complaints up for the sake of working the system. I’d had it after 3 months, and began to resent putting my uniform on every day. Between what i considered my personal failures as a Paramedics, and the amount of calls I viewed as “not worth my time”, its safe to say I was burning out, and falling fast.
In my view, this was not what I wanted when I fantasized about life as a Paramedic. I felt I’d been cheated out of something. I hated being a Paramedic. Worse yet though, I hated myself. But worse yet, I still made myself suffer in silence for an irrational fear of being judged as weak, or incapable by my peers. I’d played this game with myself for 9 years, and it was coming to a head. I continued to suppress my anger and pretend I was fine on the outside. When I wasn’t at work, I continued to drink, blacking out a couple times with some friends who I stupidly believed I could not come forward to about what I felt. I started to isolate myself from people more and more.
I stopped going out with friends, except to drink. I cancelled my social media accounts. I fantasized about dying, scenarios where I died, how people would react, wondering if anyone would even care. What was more twisted though was that I thought this was normal, as if everyone was secretly suppressing this hateful attitude, this self loathing. I thought I was fooling everyone, including myself. I blamed work, and contemplated leaving for good. In hindsight, that would not have solved anything, because for years before I had already been lying to myself about what I felt. The reality was, I have depression.
Come February, I was approached by a manager of mine at work in our clinical department with a simple “hey man…you okay?” I lied, as usual, and said I was fine. But the doubt was apparent on his face. Another manager asked, and despite my lying, said I just looked kinda “off”. My poker face must not have been up to snuff that day. I let the moment pass, until I received a text message from the Clinical Education Dept Head that I had an amicable relationship with: “hey buddy, you okay? A lot of people are concerned. If you need to talk, I’m here for you.” I don’t know why, but for the first time in years I was honest about what i felt…well, mostly honest. But it was a start.
I came clean about my anger, my frustrations, my failures, and for the first time admitting that I had a problem. I sat with bated breath, fearing what would happen, recalling the horror stories I’d heard about Medics being fired for emotional problems. But what surprised me was the considerable lack of judgement, punitive action, and the reaction of someone just listening. I was asked a few basic questions about what was going on, for how long, and just what I was thinking. Nothing more, nothing less. The world did not burst into flames around me, a comet did not impact the Earth killing us all, and no one showed up in white coats hauling me away with straight jackets. Most importantly thought, I felt at ease for the first time in months. Between both of us, we came up with a plan.
I took a step down from my status as a Lead Medic to resume in a lesser position, and given as much time as I felt I needed to figure things out. In addition, I was given a contact to a 3rd party counseling source to speak to, should I elect to. No judgement, no meltdown of my little world. Nothing. Life went on. A few weeks passed. The clouds began to clear, and from the ashes a life began to sprout. I gradually began to accept things on my own with a fresh perspective. At the recommendation of a few wiser and more experienced Paramedic contacts I had developed friendships with via the internet, I made a move from night shift to days. I had not been sleeping well on nights, developing some mild shift work disorder with my sleeping patterns.
I stopped going out so much at night, and made a personal decision following a few bad episodes with alcohol to lay off. Things began to improve. My mood began to perk up again, the dark thoughts began to perish. I acquired some healthier habits. I met a girl who stole my heart in a short span of time as I began to recover. I began to live again. I am not ashamed about who I was, because that person made me who I am. I made many mistakes, but those mistakes made me who I am now. But the one mistake I wish I could redo if I could, is talking to someone years ago.
I have always had depression, but refused to face reality and admit I needed help all through adolescence and into adulthood. Its a mistake many providers make now, not wanting to be seen as weak. That mistake has proven fatal to many before me, and sadly will to many more. Its a sad reality of our profession, and one that doesn’t have to exist. The culture of depression and post-traumatic stress as being seen as a weakness, instead of our being human must go. I was lucky enough to have someone who cared enough to speak up, but often that is not the case. This must change. The silence must break. The world will not end, I promise. Someone just may surprise you, like they did for me.
– Paramedic, 3 yeas in EMS. Texas