When someone is having the worst day of their life, I get called out. When their world is being turned upside down, I have to be the solid force that tries to right the situation. When I get called to help, I don't have the choice to fall apart emotionally.
Don't get me wrong, I have shared an untold number of tears with grieving families. But, there are many circumstances in which I find myself that I am left with no choice but to “hold it in”. Every situation is different. Everyone handles death and tragedy in their own way. There is a distinct point at which a victim's family or friends are ready to face their grief. It is then, and only then, that I allow myself to grieve with them. Up to that point, when they are angry or hysterical or still reeling from the incident, it is up to me to “keep it together” and maintain some semblance of order amidst the chaos.
When I am in “go mode” and simply running on adrenalin, I find it physically impossible to cry. If am doing CPR or breathing for someone who cannot or pumping medications into a failing body, the best thing for everyone is for me to stay focused and throw all emotion aside. It is later, when the call is over, that you may find me in the back of my rig, bawling my head off. I am not ashamed to admit that I cry. You will, however, rarely see me do it. I, also, am not afraid to talk about my feelings, whether they be anger, sadness, frustration, disappointment, elation or pride. However, my tears are a private matter and I will usually only let them out when only I can see them. So, the next time you see an emergency responder who is not crying after helping an injured child whose parents didn't take the time to buckle him up properly, know this: They are dying inside, they just don't have the privilege of being able to express it quite yet. At some point, somehow they will.
Granted, there are those situations that some think is a dire emergency that really isn't. A recent study found that only about 10% of all 911 calls are true emergencies. I'm not here to tell anyone NOT to call for help if they need it. But we, in emergency medicine, have a fair share of calls that we respond to that really don't require an emergency response. If you call me at 3 a.m. because you stubbed your toe and it really hurts, I will take care of you and I will be nice about it. Heck, I may even take you to the hospital if you REALLY want me to...and probably give you something to help with the pain along the way. However, I won't be moved to tears...even if you tell me it is the worst pain you have felt in your life. I have seen bones sticking out of places they weren't meant to and I have seen foreign objects sticking into things that they weren't meant to. Honestly, (and this is the part that makes me seem coldhearted) a stubbed toe, even a broken toe, ranks pretty low on my scale of traumatic injuries. In other words, in the grand scheme of all that I have handled in my few years of EMS, some things I just don't phase me emotionally. It is not because I don't care,. It is because I must pick and choose my emotional battles wisely if I am going to survive in this profession.
Everyone talks about burnout in EMS. The average EMT makes it only 3 years in this profession before they throw in the towel. If you make it beyond that, you're probably going to still be doing this gig when you retire, as long as some debilitating injury doesn't prematurely end your career. The one and only factor that plays a difference in whether you let EMS break you is your own coping system. We all have triggers, those little or big things that overwhelm us emotionally and, at times, can cause us to act irrationally. How we deal with those triggers is entirely up to us individually.
I'm not saying we have to go at it alone. But we have to recognize when we have reached our limit, put our pride aside and be willing to take steps to bring ourselves back to baseline. Whether that means taking a personal day and curling up at home in front of the TV or going out with friends or going for a long run or just simply talking it out with a close confidant, we have to take the time to just do it. Hopefully the method of venting is a constructive one. I can guarantee that those who turn to alcohol or drugs or other forms of risky behavior, will eventually get themselves into trouble that will invariably lead to the end of their careers.
If we ignore the fact that we are suffering emotionally, we can't be there to provide adequately for those who call for our help. And most of all, we won't be there to provide for our friends and family. Critical Incident Stress Debriefing (CISD), also called Critical Incident Stress Management (CISM), was inducted several years ago to help rescuers cope with the stresses that are inherent with major calls, ranging from mass casualty incidents to patient death and death of a co-worker (whether on or off duty). Many “paragod” types scoff at these opportunities to do a call review and “talk about their feelings”, especially in a group setting. (There are also options to have private CISD sessions.) Admittedly, these sessions are not at the top of my list of fun things to do. They are, however, pretty high on my list of important things to do. I don't care how proud you are or how long you've been working in emergency services. We all, at some point, find ourselves in a situation that hits one of our many triggers. And, for whatever the reason, we can't independently shake it and get back on track. That is the point at which we must reach out and get the needed help before it tears us, and those around us, apart.
So, here is the take away message from preceding aberrations: Emergency responders are human too. We have emotions like everyone else. We just are very stringent on when we express them. If we didn't care about people and their problems, we wouldn't be working in the profession that we are. We cry. In fact, we probably cry more than the average person, simply because we witness far more harrowing events than the rest of the general public.
Everyone you and I meet is fighting some type of battle. Emergency personnel are no different. But, rest assured, the next time you need us, we will be there and, no matter what we've been up against that day, or even that week or that month, we'll do all we can to keep it together emotionally for both you and ourselves.
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