Tag Archives: Psychological trauma

“It’s Not Your Fault”….I Lied….

Wow, is this powerful….The video in the link below describes a scenario that probably almost anyone who has spent a few years on an ambulance can understand.

While I don’t remember any specific time I told this type of lie, I am quite certain that I did. How can you not? “It’s not your fault…..” “It’s not as bad as it looks….” And any number of little (or big) white lies we tell to comfort the patient or the family……

And our selves……

Here’s the link to “It’s not your fault”

I do not belive I ever told the lie he describes, although I dealt with at least my share of SIDS. However, I was in a very similar situation – the only difference was that Mom already knew….and lying to her would not have changed anything……

(I have written about the emotions surrounding my experience and how it effected my for years, here, , if you are interested….)

 

 

 

Article: Pictures of PTSD

This is incredibly powerful. It is focused on members of the military, but I think any first responder dealing with PTSD can put themselves in most, if not all, of these pictures. I know I can…..

http://www.buzzfeed.com/emaoconnor/this-is-what-a-veteran-looks-like?bffb&utm_term=4ldqphx#.qkrqZapX4

Article: First-responders pay a price for saving lives

I found this to be a rather interesting article. It mostly discusses how a specific fire crew, at a specific fire department, deals with the emotional toll of the job – especially when it comes to kids. It also touches on what the fire department is doing to help the guys on the front lines.

Essentially, it seems this crew and department have a very good and productive attitude about how calls can affect the responders. According to the article, they are open and willing to talk about their feelings and emotions after a horrific call. If this is truly the case, I applaud everyone involved.

Forgive me if I seem skeptical, but this was not my experience. I was never involved in an emotional conversation after a call. It just didn’t happen. Sure, each and every crew I worked with was a very close-knit group (well, with one glaring exception – but I won’t get into that). I have no doubt in my mind that everyone on my crew would drop everything to help me – with things like moving furniture, building a fence, fixing my car……But I would have never brought up how I was feeling after a call…..

Yes, I definitely hold most of the responsibility for never asking for help. But, it was the culture. I am absolutely convinced that a big part of that culture was (and still is), lack of education. Even towards the end of my career, when I was really struggling, no one noticed. Not even me. In hind-sight, I see it clear as day, but at the time I had no idea what was happening. And neither did my crew. Or, if they did, they were afraid to say anything.

This is what needs to change. Every crew needs to be like the one depicted in this article. Talking about every aspect of a call is crucial for growth. Reviewing the technical aspects will help you do your job better. Reviewing the emotional aspects will help you do your job longer……

http://tbo.com/news/breaking-news/first-responders-pay-a-price-for-saving-lives-20140802/

 

Article: The Man Who Saw Too Much

This is a fantastic article about a guy with whom I can completely identify. Many of his experiences are very similar to mine – especially when things started coming apart for him. While I did not have the same addiction problem as he, my struggles pretty much mirror his.

It is a long article, but well worth the time. It will answer a lot of questions about PTSD and show you that there is light to be found.

http://www.outsideonline.com/outdoor-adventure/outdoor-skills/survival/The-Man-Who-Saw-Too-Much.html

 

A Look Back: The Bookends of a Career

It occurred to me last night as I was laying in bed trying to fall asleep, that this week marked a major anniversary for me. On July 30, 2000, I ran my last call……

That call was not the “worst” call of my career – far from it. But it was quite memorable. Intense.

I spent 20-ish minutes in the back of an SUV that had been broadsided and rolled onto the passenger side, trying to protect and treat a young woman while the rest of my crew cut the vehicle apart around us. As I tried to start an IV (yes, I was successful)  and administer oxygen, I remember her repeatedly trying to punch me in the head – she had a significant head injury – and all of the dust and debris blowing through the car as Flight for Life landed on the road behind us ….Oh yeah – she was also seven months pregnant.

As we watched the helicopter fly out, the A/C on scene gave me shit about not shaving that day. I told him to F-off and then told him I quit, but agreed to finish the shift. Of course, he knew it was my last shift anyway, so we all laughed. Then went back to the station for lunch.

That was my last call…..

I ran my first call on January 19th, 1988. A commercial plane crash. I was a college student who had signed up for the county search and rescue team so I could learn how to rock climb. I obviously had no idea what I had really signed up for…..

I was studying for an accounting exam when I got the call. It was about 830pm and we were in the middle of a “mild” blizzard. The plane simply hadn’t shown up at the small, mountain airport as expected. Radar had it until just a few miles out. So, we did not know exactly where to look – only a general flight plan to go by and a lot of unpopulated mountainous terrain to search.

So, here I am…..a college student with no clue, snowshoeing through the wilderness, in the middle of the night, during a blizzard looking for a plane crash. We found it – thanks to footprints left by a survivor who literally hiked out to a nearby farmhouse. Over the course of just a few minutes, the scene went from dark and quiet – only the sound of a handful of rescuers trudging through the snow and their headlamps – to a level of commotion and controlled chaos that I had never before experienced. Flood lights and generators appeared very soon after, followed quickly by all the tools of the trade – axes, pry bars, the “jaws of life”……

We worked through the night extricating people. Half the people on the plane survived – the other half did not. Only one of the survivors was seriously injured – the rest pretty much walked away from it. Literally and figuratively.

After many hours, the first crew on scene, us, was relieved by the next crew. I sat down in the snow with a few others not too far from the plane, but out of the reach of the lights. We ate sandwiches that had been brought in…..Then we hiked back out. About two miles, if I remember correctly.

The trip back was again dark and quiet. But, as we crested the last ridge, we were inundated with noise and light. As the first group out, we were immediately attacked by TV reporters looking for a story.

By lunch time the next day, roughly 5 or 6 hours after leaving the plane, I was back in class listening to classmates and professors recount the stories they had heard on the news about the crash. None was very accurate. I passed my accounting exam – but only just barely…..

Both of these calls shared one very obvious characteristic – surreal. I think most of the really “bad” calls share that trait. Surreal. Many times I remember going straight from an especially nasty call to the grocery store to get food for the next meal……..Just 30 minutes earlier I had someones life in my hands and now I’m standing in line to buy lunch meat……Surreal. Towards the end of my career, the surreal-ness of it all became more and more apparent. Impressive even. Towards the end, it even bothered me at times. How could we move on so quickly from the most horrific things imaginable and get back to a normal day? I just pronounced that guy in his living room and had to tell his wife – but man am I hungry! Oh hi old friend who I haven’t seen in a couple of years…..What’s new? How are you? Oh, and by the way…..your mom and your dad are both upstairs in their bed – both dead. Looks like one shot the other but I can’t tell which one did it….But it’s great to see you…..

Yes, that actually happened. No, the conversation did not go exactly like that….but, believe it or not, it was very close. Surreal.

Maybe, as things became more surreal, I should have noticed and realized something was happening. Something was changing. Maybe that was a sign.

I think it is quite safe to say that my struggles with PTSD started with the plane crash. I remember going back to my dorm room and trying to get some sleep before class…..All I could hear was the very loud hum of the generators and tools. And all I could smell was the jet fuel that had been spilled all over the mountainside. I won’t go into what I saw when I closed my eyes….

My struggles however did not end with my last call.

During the years between my first call and my last, I saw and dealt with things I could never have imagined. The kids are what really got to me. I don’t know if I saw more pediatric horrors than any other medic – several medics have told me I did – but I did see more than I could take.

As I look back at that part of my life, at that career, it was an amazing experience. Every moment of it. I loved it! And I learned more about myself in those years than I ever would have had I pursued any other career. However, it did take its toll. I continue to work every day to win the battle with PTSD. I am succeeding. Everyday.

My only regret – I did not recognize the signs that something was wrong before I left an incredibly rewarding career that I loved. If I had known, if someone I worked with had known…….I would probably still be doing the job.

What do I want you to take away from this post? It all adds up and compounds starting with the very first call you run. And every single one of us is susceptible to PTSD.

Every. Single. One.

So, pay attention to yourself. Pay attention to your co-workers. Learn about the signs of PTSD and don’t be afraid to talk about it. Share what you learn with your co-workers. If you see someone who is struggling, step in and help. Most importantly, be open to others helping you.

The career you save may be your own……

 

Would you meet with the family??

Some time ago I wrote about one of the most horrific calls I ever responded to as a paramedic. (The Overwhelming Burden of Empathy http://wp.me/p2CkoS-1i)  It is one of those calls that lives with you forever. In the years since this tragedy, I have very often wondered about the family. How are they now? Did the marriage survive? How are the other kids? Was Dad able to recover. These questions still haunt me.

A few nights ago, as we celebrated the life of a fellow firefighter/paramedic who took his own life, I had a conversation with one of my former ambulance partners: my partner on this particular day. He told me that this call is at the top of his list of  “three calls that I will take with me to my grave”.  He seemed to want to talk a lot about the call – which brought up a lot of emotion for me, but I figured it was therapeutic for him too, so we continued to re-hash the details of how the call ran and who did what. I teared up several times, but manged to keep it together. Eventually he shared with me his real reason for brining up this particular call…. Through a long string of coincidences, he has found the family……

He wasn’t really trying to find them – it just so happens they live, in the same house as they did at the time, very close to a good friend of his.  The connection was made this past Christmas when my former partner was visiting his long time friend. My partner noticed a large pine tree in the neighborhood park was decorated for the holiday. My partners friend explained that this was done by a neighbor in remembrance of the son they lost to a tragic accident many years ago. It did not register immediately for my former partner, but as he left the neighborhood he realized where he was……When he spoke with his friend again, he asked more questions, and has all but definitely been confirmed that this is the family.

My partner tells me that, according to his friend, the family is doing quite well. The marriage survived – which is a real shock to me, but great news.

After allowing this to sink in for a few minutes and giving me a chance to get myself together, my partner then offered to for us to meet the family – if they are willing, of course.

This threw me for a complete loop. I never in my wildest dreams thought I would see them again. I was completely speechless. Frankly, I still am  and really don’t know what to do…..

I saw my therapist for our regular appointment a couple of nights later. Of course, this a the major topic of the entire hour.  At the end of our time, she told me that she thinks meeting the family would be incredibly therapeutic for me. She advised that I give it some time – maybe a couple of months – to prepare myself emotionally and then meet the family.

I can’t say that I disagree with the therapeutic aspect of the meeting – assuming the meeting is positive. My greatest fear is I will learn the family does not feel we did everything we could or even did our best and, to some degree, blames us for the outcome. This would be devastating. Almost as troubling is the concern that meeting us would take the family back to that horrific day – bringing back all the pain and suffering they endured that day and in the following weeks and months. Also, I am worried about the effects such a meeting would have on me – especially if it does not go well, but maybe even if it does go well. Obviously, it will bring back all the memories and emotions I have fought so hard to get under control. Could meeting the family actually diminish some of the progress I have made in the last couple of years?

So, what would you do? Would you meet the family with the optimistic belief that it will be, in the long-term, a positive and therapeutic experience? Or, would you take solace in knowing the family is still together and strong, and simply move on without meeting them?

I truly do not know what I am going to do….

A Disturbing Realization and the Resulting Question: Was it Worth it?

I have not posted anything recently because I simply haven’t had anything to say. Which is actually a good thing. My anxiety level has been very low. And I haven’t had an emotional “episode” in months. I’ve cut my therapy sessions from every week to every other week and, in fact, between my schedule and my therapists schedule, more appointments have been cancelled in the last 3 months than attended. As I said, this is all really good. It means that I have made progress. I can go several weeks in a row without a therapy session and survive.

Unfortunately, I’ve had a setback…….

In the last week, I’ve had a couple of fairly minor emotional episodes. One triggered by a news story that set me off before I could hit the button to change the radio station while I was driving. I was able to work through it quickly and move on. (Proof of progress!).

The second was triggered by a song on the radio that caused me to snap at my son for no good reason. (For the full story on this particular song, see my previous post: On the turning away….A trigger, a flashback, an incident at church, a sermon, and a Pink Floyd song…Update: Recently I had a great conversation with the young man mentioned in the post. This was the first time I had seen him since. Of course he did not remember me from the incident but was very appreciative of my help when I told him about it. He is happy and as healthy as he has been in years.) I have not been able to listen to this song since the episode described in the post. On this particular evening though, I was in a great mood and feeling really good. I was busy doing something around the house and the radio (actually Pandora) was playing in another room. I noticed immediately when the song came on but quickly decided that, since things had been going so well, I should be able to handle it and went about my tasks, without really paying attention to or even thinking about the song. Part way through the song, my son interrupted what I was doing to ask for help with something. I snapped at him. It was at that point that I realized the song had effected me. I noticed then that my entire mood had changed. I apologized to my boy and went to help him. But the fact that the song had effected me really bothered me for the rest of the evening.

These two incidents really bothered me. They really were not a big deal compared to many of the emotional episodes I have experienced, but it did feel like a set back. Last night during my first therapy session in a few weeks, I talked about the episodes and described the feeling of taking a step or two back. My therapist pointed out that I was able to process them and move past them quickly without letting them “take over”. She told me what a great indicator this is of the progress I have made over the last two and a half years. I commented that I had hoped I had moved beyond these types of episodes and that I was “over it”.

Her response: This is all part of your story now. You cannot change this – it will always be a part of you and who you are…..

Her comment hit me like a ton of bricks. I had the very sudden realization that my PTSD will never go away. I will never get over it. Of course this makes complete sense and I think I probably knew it at some level. However, I had never consciously thought about it in this way. I think I expected that at some point, it would not longer affect me. That after “X” number of therapy sessions I would no longer have to worry about a song on the radio or a news story that has nothing directly to do with me or any of my experiences; That I would be able to go to a party and not have to be concerned that someone might say something or ask me a question about my experiences that I was not prepared to answer…….

Apparently, this is not to be…….ever.

Sitting in my therapists office, as this sunk in, I broke down. It hit deep and it hit hard. Later, watching a TV show with my wife, the point was driven home even more dramatically. The title character, talking to another character whose girlfriend had just been killed, ended the show by saying: “The pain you are feeling will never go away. It will always be with you. It will be the first thing you think of every morning when you wake up. But, some day, it will be the second thing.”

Wow. I now understand that this is my life. This is who and what I am – who and what I will always be. To some degree, PTSD will define me for the rest of my life.

Of course, I completely lost it. I haven’t lost it like that in a long, long time.

During my meltdown, a very powerful question came to mind: Was it worth it?

Was it worth it to spend more than a decade of my life responding to and dealing with the most horrific things anyone can imagine? Was it worth it to work so hard to save people who could not be saved? Was it worth sacrificing my mental health and, to some figurative degree, my life?

Today……I’m not sure……

 

PTSD Is Not A Disorder: Remove the “D”

This is an interesting perspective. I think I agree. Although I am not quite convinced that removing the “Disorder” from the diagnosis would eliminate the stigma……..

http://tv.msnbc.com/2013/08/30/ptsd-is-not-a-disorder-says-medal-of-honor-winner/

 

What do you think?

 

By the way, this is how a true American hero looks and acts……..

 

A New Focus on the “Post” in Post Traumatic Stress Disorder

A body of evidence suggests that your social environment immediately after a traumatic event can, at least to some degree, dictate the long-lasting effects. I find this extremely interesting and definitely believe there is something to this theory. Certainly, I think there are others factors, like the nature of the event itself, that play a bigger role, but I do see the connection.

For me, my “social environment” immediately after an event was interacting with the fella’s back at the firehouse. Not exactly a supportive and nurturing environment to express your feelings after being directly and intimately involved in a horrific situation. In fact, it was the exact opposite. It’s like the Tom Hanks line from League of Their Own: “There’s no crying in baseball!” Substitute firehouse for baseball……

It seems to me that by raising the level of awareness in first responders, and thereby changing the environment, we can prevent a significant number of PTSD cases. Would this have helped me? I’m not sure…..I think I have some other contributing factors that would still have dictated some degree of PTSD. However, I do think it is plausible that the effects might have been less – maybe dramatically less. It certainly would not have made it worse…..

Here’s a link to an article:

http://www.nytimes.com/2012/12/25/science/understanding-the-effects-of-social-environment-on-trauma-victims.html?pagewanted=1&_r=3&smid=tw-share

 

On the turning away….A trigger, a flashback, an incident at church, a sermon, and a Pink Floyd song…

Written just over a year ago, this was my first “urge to journal” and the result of a major breakdown – the worst in years. Several separate events came together to create a perfect storm of emotion. In the middle of Christmas Eve church service. Let me paint the picture, then I’ll share the writing.

A trigger and a flashback: The last Christmas I worked before “retiring” was horrible. I’ll spare you the details, but imagine responding to a brand new parents worst nightmare. On Christmas morning. Needless to say, Christmas has been rough ever since. Always very emotional for me. Always just a trigger away from a flashback and an emotional event.

An incident at church: I am not much of a church-goer, but my wife’s family has been going to the same church for decades. Through my wife and in-laws, my kids are very involved. I go any time they are performing or have something special occurring during a service. And Christmas Eve service is a must. both of our entire families go – we must have 15-20 people there.

The Sunday before Christmas my kids were singing with the choir, so I was there. One of the regulars at church is a young man with severe physical issues – very bad epilepsy among them. He has a seizure every couple of hours. Usually we are seated too far away for me to be of much assistance, but on this particular day, I was seated directly in front of him. When he had his inevitable seizure, I helped his care giver get him out of the chapel and stayed with them until he had fully recovered. No big deal. Until Christmas Eve.

At the very beginning of the service on Christmas Eve, the pastor announced that the young man with the seizure issues had been in ICU all week. There was no word on when he would be released or for that matter, when he would be moved out of ICU. The pastor told of a visit he had with the young man a day or two earlier that week. The pastor basically told the young man it was too bad he would be spending Christmas in the hospital. The young man said: “At least I get to enjoy Christmas – even if I am in the hospital, it is still Christmas.” For some reason, this hit me really hard and the flood gates started to leak.

A sermon and a Pink Floyd song: After delivering the news about the young man, the pastor started his sermon. It was an extremely unique sermon because it was based on a Pink Floyd song. He started by playing the entire song, then delivered his message. I’m not quite sure what his message was because I was lost in the depths of my own emotions. (I think he talked about not turning our backs on others in need).

The song: “On The Turning Away”. I’ve heard the song a million times and I have never really listened to and thought about the lyrics. This time, the lyrics  hit me like a bus. I completely fell apart. Left the chapel in the middle of the service in tears. Had to squeeze past every one in the aisle to escape – my wife, my parents, her parents, my kids…..I left the building and spent the rest of the service balling my eyes out in the side yard of the church. I was an emotional wreck for the next several days until my next therapy session. That week was my 3rd session I believe – very tough session.

For me, this song brought up all of the emotion surrounding the lonely 15+ years I spent hiding from my PTSD. It was not about turning my back on others – it was about turning my back on myself and hiding from my emotions and struggles. Reading this now, a year later, I see that I have made a tremendous amount of progress. I am no longer hiding and fighting alone. I still have a long road ahead, but today, I know there is hope. For the first time in more than 10 years, Christmas this year was bright and happy – not dark and sad. The memory is still there. It always will be. But I have come to terms with what happened and accepted my role. I have started to move on….Finally…….

Here is what I wrote:

On the turning away…..

He says we should not turn away…..

He says it all matters….

He is half right…..It all matters.

But sometimes, there is only turning away….

“It’s a sin that somehow light is changing to shadow”

If this is true, then there is only turning away.

Light quickly becomes the shadow

If you don’t turn away fast enough…..

“And casting its shroud over all we have known”

The darkness is there – over all we have known.

The emotions are coming….

The pain is here……The memories.

The flood is here…..

If you don’t turn away fast enough they will see.

The kids will see.

The wife will see.

The parents will see.

If you don’t turn away fast enough, they will all see….

Sometimes, there is only turning away.

“We could find that we are all alone……”

There is only turning away….

But we are all alone…..

“In the dream of the proud”

There is no turning away…..

There is no more pain…..

There is no turning away……

“From the weak and the weary”

Is this who is turning away?

“Is it only a dream that there’ll be

No more turning away?”

There was no turning away.

Now there is only turning away…..

“On the turning away…..”

Then comes the guilt. The shame.

Rushing to turn away

Instead of pausing to remember.

Turning away is so selfish. So weak. Cowardly.

You should stand up. Face it. Be strong.

But there is only turning away.

ThePatientTeacherRN

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