Over the course of the last year I have developed an established morning ritual. One piece of that is sitting down and reading a series of links for the day that include local and national news sources as well as posts from selected blogs. It helps pass the time in the morning, and it is something to do while I enjoy my coffee.
Last month, I read a very moving post by Chris Kaiser over at Life Under the Lights about provider suicide. That particular morning I was teaching at my department’s monthly educational day for one of our platoons, and one of the topics that I was tackling was stress management. The post made such an impression with me that I included it in my lecture while describing the “code of silence” and how it applies to EMS professionals.
It was a blunt reminder of the stress that each of us in this field deal with both as a provider and as a person. We are not only expected to shoulder our own problems but we are expected to tackle the problems that everyone else around us has as well. The result is us burying and burying and burying until our own feelings are so suppressed that when they do surface they are so overwhelming that they are that much harder to deal with.
Sad to say, I am seeing more and more cases of provider suicide in the field. It is a problem that is not going away. In fact, my whole reason for writing this post is because I recently learned of the passing of someone that I met a number of years ago. He was a hard-nosed paramedic who was never afraid to speak his mind. Although he was one of those people who could clearly be a thorn in your side it was obvious to me that he had his peers’ and his patients’ best interest in mind. Much like my other experiences with provider suicide, the news that I heard came out of the blue and based on what I have heard from friends, while there were some warning signs out there no one ever thought that he would take this path.
I think that is the big problem here. We look at each other as rock solid, especially when we get into this field for a considerable amount of time. The armor seems so thick and we feel unstoppable. Despite how someone might seem on the outside though, they are the only person who knows how they truly feel. I am not going to share his name in this post, but I am sure if one of his coworkers is reading this they know who I am talking about. His response to his own unfortunate circumstances is proof positive that even the toughest, hardest, seemingly most put together people can struggle too. We all need help sometimes and we just need to know where to look for it.
Part of my stress management lecture deals with an EMS World article I read a few years ago written by Captain Larry Hinds of the Sarasota County Fire Department in Florida. Written in 2004, the article summarizes a study that he did within his county in regards to stress management and how various departments were handling it. Ten years later, I think we still face a number of problems that Captain Hinds identified.
The first point that he summarizes from his article is that “few respondents were aware of or used existing stress-management services.” Captain Hinds is talking about things like Employee Assistance Programs (EAP) which offer a number of different services for those who choose to reach out to them. This includes everything from financial counseling to marriage counseling, assistance with substance abuse, or a gateway to therapy, and an outlet for someone to talk to about their problems. Every professional organization that I have been involved with has offered some sort of EAP to their employees, and if a person who needed some help asked their human resources representative I am sure that they would find that their service offers one as well.
These programs are 100% confidential except, of course, for those cases that they are mandated to report by law. They are easy to access, and they help. An EAP card is something that every EMT and paramedic should keep tucked into their pocket because you never know.
I am going to share something now that I have hinted at from time to time but never talked about in depth with anyone except for a few close friends but about three and a half years ago, I reached out to EAP. I was in a bad place. Work stress was piling with life stress, and I was finding myself getting more and more angry, jaded, depressed, and in need of someone to talk to.
I made “the call” and within a few days, I was sitting in a councilor’s office not sure what to do next. Over the course of the three visits that my company paid for I just talked. I talked and talked and talked. I talked about what was bothering me about the job; I talked about what was bothering me about life. I talked about the glass ceiling I felt that I had hit, and the fact that I did not feel I was being given the ability to contribute at the level that I knew I was capable of. I talked about the fact that I felt trapped where I was both personally and professionally.
It helped so much that I kept going for a little while until I felt that I had reached a point where I was not going to get anything else out of the experience. While my time with the therapist was short lived, I walked away with a lot of tools to help me deal with life’s challenges. It helps. It works.
My point of sharing this, while therapeutic for me, is to let everyone else out there who might be reading this know that they are not alone. There is no shame in asking for help. No one is so tough that they can be expected to handle every single challenge that life throws at them.
I don’t expect comments from this. I don’t expect stories or confessions. Just do me a favor, if you are reading this and it has any effect on you or you start thinking, “maybe I need someone to talk to” do it. Reach out and make a call. Find out what your employer offers for EAP and put a flyer up on every bulletin board that you can find. Announce it at a union meeting, or an employee meeting. Send the information out by email “just because.” Make sure every person around you knows that help is available. You never know, you could save a life.
Recently someone in my
organization came to me and said he had suddenly developed panic attacks. He
had no history of psychological issues and he could not understand where they
came from. Like so many people, both EMS professionals and lay people, he was
embarrassed by the fact that although he “knew” there was nothing
physically wrong during these episodes, they just took control over him and he
felt helpless. I told him I suffered from the same thing for years until I
found the right combination of medication and a lot of therapy. He said that
like many colleagues when he previously responded to calls involving
psychological issues, especially panic attacks, he believed the person was either
faking it or just looking for attention. He now looks at those calls in a
completely different light. I have found over my 20 plus years in EMS that
providers view suicidal people in the same way as someone suffering a panic
attack. Responses of “He’s just looking for attention.” or “If
she really wanted to do it she would have done it.” or perhaps the most
devastating “Next time why don’t you do it right.” Like many of us, I
have been touched by suicide professionally but I also have a first hand insight.
While my financee was going through a divorce her estranged husband took his
life. At the time, their only daughter was 16 years old and a junior in high
school. I watched both of them go through hell dealing with the initial
feelings of grief and anger and the years of trying to recover from the ordeal.
It has been over 10 years since the suicide and they are functioning quite well
at this point but every now and then the old thoughts of “I should have
seen it coming and I should have done something to stop it” come creeping
back in. Although I do not condone helping someone with an advanced medical
condition such as end stage cancer or Lou Gehrig’s Disease, hasten the
inevitable, I think people can understand it because it is the result of a
physical illness. However, when we cannot see the emotional pain that someone
is suffering we choose to believe it is not there or not as real and painful as
a physwical ailment. I am not sure if giving additional time to mental health
issues during our training would change the profession’s view of psychological
illnesses, but I think it is kind of like chick soup, it certainly would not
hurt. Please heed the old adage of “Physician, heal thyself.” if you
feel burned out or emotionally overwhelmed. If a colleague thinks less of you
because you seek help, then that person’s opinion of you must not have been
very good in the first place.
Scotty, or anyone else, PLEASE read Surviving The Shadows by Bob Delaney. Its one of the best books I have ever read, and in the top 3 that made me take a look at myself, my coworkers, friends, EMS/Fire/PD, as well as military community. The author is a former undercover officer who for years was embedded in organized crime, and his difficulties after. He is now an NBA ref. He goes through the disciplines, speaks of resources which are very silent—theres actually 2 in the nation from the same survival treatment organization for PD/medical practitioners/EMS and fire, one actually in an anonymous spot and the other is out west. They do not cost anything and are a retreat. He also speaks of military history with coping sqq soldiers in WWII came back with less stress because many came home on boats that took a couple weeks to arrive, and them being together “decompressed” them. Now, they come home in a day or two, and are immediately back to work. Its why the Army is trying to do peer-to-peer counseling. I honestly read the book in 2 days. He goes into animal therapy, the cutting edge stuff they’re doing for managing stress, and he touches on a few people who did not seek help, their downfall and eventual death. (He has a chapter about the soldier that was on every newspaper and magazine cover running with the Iraqi child, I don’t know if you remember it.). He committed suicide years later and it wasn’t covered. We’ve had 4 suicides here in under 4 weeks. They were not made public. People are afraid to reach out. Its the hardest but bravest thing you can do.
The anonymous spot I wrote about is surprisingly in western MA.