The "Ghosts"

I can't really explain what happened today. It was supposed to be a fun day for me to venture out at 4am to drive to an EMS conference 3 hours away to learn about the whiles of emergency medicine with like-minded service providers. I look forward to conferences and seminars and other various classes. So, why, today, did I find myself in my truck half-way through an afternoon session, shaking uncontrollably and fighting off tears?

I recently read an article in which a seasoned EMS blogger wrote about the "ghosts" he carries with him from horrors of past patient encounters. I read the article in earnest, knowing that emotional burnout is one of the leading causes of the end of an ambulance career. However, I generally consider myself very good at containing my emotions and not letting the horrifying things of this world to scar me. Granted, I remember my first cardiac arrest clearly and the first time I told a family their loved one was dead. I remember stab wounds, gunshot wounds, psychotic patients, patients with grotesquely twisted limbs, pediatric seizures, etc. In fact, given enough time, I could probably relate to you at least some details of every EMS call I have ever been on. If you actually showed me the subsequent reports that I wrote for those said calls, I may be able to recite to you a full biography of the patient. But there is a huge difference in remembering call details and carrying around "emotional baggage" from those calls. Inevitably, however, there are situations which are impossible to walk-away from without having some permanent emotional impression left behind. Likewise, there are life events that creep into our minds while we are on a particular call or studying a certain topic that cause an overwhelming emotional response. That is what happened today.
The topic listed on our agenda for this afternoon's session was "Bodies Found in Water". No big deal. Right? I mean it's not pediatrics or death of a partner. But it cut me open like I had no idea was possible.
Last summer, we lost a dear friend in a drowning accident in one of the rivers near where we live. I was not on duty that day and, therefore, did not respond to the call. In some ways, I am thankful for that fact...in many others, I wish that I would have been there. Our friend had been out inner-tubing with some other friends. When his tube was damaged, he independently floated downstream, holding onto the cooler they had brought. After passing through a bend in the river, the group noticed that one of them was missing. They quickly clambered from the water and backtracked upstream to find our friend who had somehow become wedged under a log in the deep, swift-moving water. The events that followed are the ones that haunt me every day. Some friends tried in vain to free him from the log's deadly hold while others called for help. Arriving emergency crews launched rescue boats and, after a treacherous rescue due to debris in the river, our friend was pulled from the water...30 minutes after the 911 call had been made.
You do not need to be a medical expert to know that the likelihood of our friend surviving was tragically low. I have chosen not to ask about any resuscitation efforts that may have been carried out after he was pulled from the water. I wonder if it will make me feel better. On the other hand, I wonder if I would criticize the rescuers or become angry they didn't save him.
I have often pondered the terrors which may have traversed our friend's mind as he struggled to free himself, the final thoughts of his beautiful wife and precious little girls, the desperate moment when he realized his time was through. I only hope that when that moment arrived that it came quickly and painlessly.
The pain for the survivors, however, has never really gone away. There are times when I talk to his wife and wonder what terrible burdens she carries. Or I see him in the eyes of his sweet girls. I wish he could watch them grow up. For the last 15 months, I have pushed those feelings deep down and tried to be a strong support for his family that is left to carry on. I am glad they didn't see me today.
The conference presentation started out like any other. Some routine case reviews and scenarios. Then, the speaking doctor launched into the etiology behind drowning and every detailed pathophysiology that occurs from beginning to end. It was too much for me. Every slide had our friends face on it. I started to envision the horror that was his final moments and the cascade of events that happened from the time he became pinned. A tear trickled down my cheek but I quickly wiped it away. My stomach knotted. I debated making a beeline for the restroom but I quickly did a mental count of how many people I would have to walk past to reach it. So, I held my ground and stared at the table. A few slides more and I knew I couldn't hold it in. The exit directly outside was about a 20-foot sprint with only a few tables of people to climb over. I made up my mind and bolted. (I am not sure what everyone nearby thought of a "big bad paramedic" racing out crying but at that moment I no longer cared.)
Once outside, I figured I would crumple into some fetal position in a corner...I didn't feel like my legs would carry me much further. Simultaneously, my pride would not let me unfold emotionally in a public place. Trying to keep from running, I made my way toward my truck parked across the parking lot, trying not to draw anyone's attention as I tried to slow my breathing. Once inside the truck, I buried my head in my hands and let my emotions flow. I don't know how long I was there. I debated waiting outside until the session was over but I knew that would only let the "ghosts" win. So, at some point, I squelched my tears and tried to convince my eyes not to look so bloodshot. But I couldn't stop shaking no matter how hard I tried. Finally, I decided some cool air would help so I crawled slowly out of the truck and tried to soak up the chill of the late November afternoon. It helped some and eventually I decided I could join the crowd back inside.
I wish I could say that this afternoon's breakdown wiped my emotional slate clean, at least for a little while but I confess to you that I have shed many tears whilst writing this. Here is what I want you to understand though: My friend will always hold a special place in everyone's memory and heart. I will probably always see aspects of him in his amazing children. I will never not think of him without some pain in my heart. I may always wonder about the details of that tragic day. And, the next time I have a drowning patient, it will be a tough day for me. However, I will do the best I can and hope that whoever my patient is shares a different outcome than our dear friend did.