Perhaps It's Just Me

"Is it really possible to have a career in EMS and be emotionally unaffected by the things we see?"

This is the question I posed on Twitter a few days ago. Many seemed to think that it's an impossible task, that, after all, we're human too. However, there were some who seemed to think it possible. To work through a career and remain untouched. Unharmed.

It seems I have joined an ambulance service where macho-ism, for all its pros and cons,  appears paramount, or at the very least, a lot more visible. Whereas in my previous place of work the male-female ratio was split almost straight down the middle, my new place of work is staffed mainly by males. Perhaps that lends itself to a culture of bravado. Perhaps having more females around allows for everyone to be braver with their emotions, whereas having fewer means that those left must be impressed. Perhaps I'm imagining it or over-analysing it. Or perhaps, as I'm beginning to suspect, it's just me.

Other thoughts have taken root. Paramedic burnout seems faster here. Turnaround is high. New paramedics are qualifying all the time, only to find that their best career options lie elsewhere, away from the front line and away from patients. Patient empathy seems less common and the emotional toll seems negligible. Maybe that's the answer. Ignore the reality around you, and treat every shift as another day on the production floor. No emotional involvement. All the while, I'm still taking calls home with me.

Questions still run through my mind. Are the hardened souls really that hardened, or do they hide their torment better than I can? Are the tougher types really that tough, their souls numb to the humanity we witness every day, or have they just learnt to compartmentalise better than I can? Are they just burnt out, their hearts and minds numbed after seeing so much, too much? Or perhaps, as I'm beginning to suspect, it's just me.

Perhaps it's a cultural issue? Perhaps I'm not quite as "at home" as I think I am? Perhaps I'm just being ridiculous?

PTSD amongst EMS staff is well documented, if not well recognised or well accepted. At least not well enough. There's too much stigma still attached. Those affected are seen as weak, not "man enough" for the job. Not strong enough. Too attached. Too emotional. Too ridiculous. 

I don't think I'm any of them. I don't think that anyone who carries these feelings with them is any of them. I think that perhaps they, we, just have a different way of connecting with our patients. Some see their patients as the latest gadget on a production line. Some see their patients as their next challenge. And some see their patients, imagining them as their very own parent, or grandparent, or child, or best friend. Not every patient, but enough of them. Enough to make the emotion raw enough, real enough, for it to affect them in the longer term.

I'm not sure whether that's a healthy thing, but I strongly believe it makes me a better paramedic.

But perhaps it's just me.

Behind Closed Doors

Midnight. The normally quiet residential street is a hive of activity, as busy and bustling as a midday marketplace. People have gathered from all over; neighbours, friends, relatives, all standing outside trying to make sense of the unfolding drama. We can see it all, hear it all from the bedroom, each of us taking turns to peek out to the street a dozen floors below as we rotate over and over again, each of us briefly the centre of the chaos, standing pumping his heart, then taking a break, a breath of fresh air and a glimpse out the window. 

The bedroom is tiny, the furniture within taking up the vast majority of the space, leaving us with very little room to work, yet somehow we all fit in. Through the closed door we can hear the sounds from the lounge. It too is packed full of people, some who heard the initial shrieks and screams for help, some who received the panicked phone-call. Some were further along the communication tree, receiving word as the news branched out exponentially. 

We know how much this means, how much is riding on our success or failure. Every call means the world to someone. Every patient needs our help equally at their time of distress, even if we don't always see it that way. It's hard for us to think that the patient who's had backache for a fortnight ranks as highly as our patient now. Sometimes we show our frustration, but mostly we treat what we see and who we are seeing as the centre of our attention, as though nothing else in the world matters now. 

Right now, however, we really feel it. Nothing else matters. In that tiny, closed room is the entire universe and all that's important within. We are fighting for a life in one room, as in the other they can only wait. Every few minutes someone goes out to update them on what is happening behind the ominously closed doors. 

It's all so different from the time before, when we worked in the lounge, watched throughout by a partner who knew she was saying goodbye to her lifelong companion. There was no noise, barely a sound uttered. Every few minutes she'd hover behind our backs and ask us if there was any change. At the third time of asking, when there was none, she calmly sat down and asked us to stop. 

This time we stopped when we saw that all our efforts were futile. We fought for over an hour, far longer than we should have done, far longer than the protocol requires of us. We fought because it felt as though we couldn't afford to lose, even when we knew we were losing. We fought until we lost. 

We sit silently behind the closed doors of the ambulance, tidying, cleaning, preparing the inevitable, intrusive paperwork. We are not quite hidden, more cocooned, yet unavoidably touched by the tragedy all around. More friends and family turn up at the scene, each showing grief in their own way. Some cry, some wail, some are silent and sombre. Some are more stoic, lending shoulders and strength to those who need it most. 

Back upstairs, behind closed doors, a mother and her young children sit stunned as the building in which they reside remains upright but the entire world around them collapses.