Trauma

Nothing ever goes away until it has taught us what we need to know. – Pema Chodron

Below is a story that is very personal, and I didn’t have the courage to post it until now.  By posting this, I am hoping it can shed some light to the families who are trying to understand what their loved ones may be going through during such a difficult time in their lives, and for those who are going through CIS (Critical Incident Stress) or PTSD themselves, that you are never alone.  Everybody’s story is different, everybody’s trigger point is different, and each story is unique.  Here’s my story:

—————————————————————–

This is the year, I can feel it, I feel that I have finally found myself again, the me that I’ve lost two years ago.  That day on January 2012 still haunts me on occasion but at last inside me I can taste the optimistic, driven, passionate individual that once resonated from me.  I can feel the hunger for paramedicine again, the drive to learn, to push myself towards the goals I set back in 2009.  It is as if I have found the light inside me once more, and I can finally harness and access it.  It is an amazing feeling to have, something I cannot describe in words.

It hurts when I think about that night, it still brings tears to my eyes.  Sometimes he just pops into my head and I re-live that night, how I found him on the highway, the mangled car lying upside down, the feeling of helplessness, the long 45minutes in the back of the swaying ambulance as I tried to comfort him, to help him, to keep him alive.  He told me of his family, his wife, his kids… the desperate look on his face.  He struggled to tear off the hard collar, get off the clamshell in efforts to breathe.  I knew he had a collapsed lung, but there was only so much I can do in the field.  All I could do was talk to him, calm him down, to keep the oxygen on, to help and assist him to breathe.  I tried an IV line but it was impossible with him struggling in the back.  I prayed the ambulance would go faster.  His face was so pale when we arrived at the hospital.  I held his hand, I told him to hold on.  He says he can’t breathe, with despair in his eyes.  I spoke gently to him, that we are doing everything we can.  He couldn’t breathe, we couldn’t get an IV line to give anesthetics, there was no time.  We cut him open and tubes were pushed in to drain the blood from his lungs, to help his lungs inflate again.  Next we drilled a hole in his leg, down and into his bone for fluids and medications in efforts to keep him alive.  No anesthetics.  It was not pretty, I felt slightly barbaric even, but we were trying to save his life.  I was next to his head, helping him breathe, talking to him, and hoping somehow my voice will keep him from the reaper’s grasp.  His eyes connected with mine, seconds turned into minutes, he looked straight at me as if trying to say something.  Suddenly I saw a sparkle in his eye, a “Thank you”.  Then the spark disappeared, his eyes dilated and turned dull.  He became lifeless, his spirit floated from his body.  Inside I screamed in desperation and a hint of anger, “NOOO!!  Don’t you dare!”  I pounded on his chest, performing CPR.  The whole timing begging him, “Come on, come on!”  I thought about what he told me:  His kids, his wife.  I remembered his words in the back of the ambulance to me, “All I wanted was to get home to my family.”  I knew it was too late, but I refused to believe it.  45 more minutes passed, pounding on his chest until the doctor called it.  And there he laid, naked, covered in blood, tubes sticking out of him.  There was no dignity in death.  I stepped out of the trauma bay, covered in blood.  I washed my hands at the sink, my partner asked if I was ok.  “My friend killed himself this morning…” I told him in a shaky voice and I broke down into tears.  My hands trembled.  I left the ER.  I couldn’t look at the doctor, the nurses nor the police.  I sat in the ambulance as the world crashed down on me from inside.

There is no saying whether a proper CIS (Critical Incident Stress) defusing or debriefing would have saved me from the nightmare that followed.  I can only hope that it would have been better if it was done right, and to hope that others will not have to follow the path I got thrown into.  My supervisors called me after the incident, and advised I call the CISM (Critical Incident Stress Management) line.  I did call the CIS line after much thought, but I was not provided with a defusing which needed to be done within 24hrs of the incident nor the debriefing within 72hrs for it to be effective.  I met with a colleague from the CISM team for a debrief one week later, way past the 72hr mark window.  I felt better after talking to him.  I did not realize a few months down the road I will be on a roller coaster ride.  I felt okay at the time, I was upset which is natural, but after another few more weeks I felt that I was all good.  Little did I know, I was not.

As many people know things often come in waves.  2012 proved to be a rough year for me, the following block after that call, I attended a call in which a man’s head was run over by a semi-truck and my patient who wasn’t at fault witnessed the whole incident, then I got called to a victim that was turned into a crispy critter from a fire.  In that same fire I heard 10 dogs burn alive, their piercing yelp sending chills down my back, we managed to only rescue five.  The next work block after, I went to a code 4  (code 4 refers to death) where a fellow paramedic’s father had passed away.  Then I watched another terminal patient pass away before my eyes as we were to take him home.  I then got into a car accident which could have easily taken my life like it had that patient of mine, but I got lucky.  I escaped with just a sore neck.

It was a month or two after that nightmare call that signs and symptoms began to emerge, my emotions were a roller coaster.  At times I find myself paralyzed.  I would suddenly burst into tears, thoughts of the call will emerge from nowhere and eat at me.  I have never remembered feeling so heavy, tired and lost.  My body will heat up randomly, I would get tremors and I would shake.  Any small emotion, especially sadness will tip me over the scale.  My glass was full up and it continued to spill with every small bump I encountered.  I found I lost the raving passion I once felt for paramedicine, I found myself pushing it away.  I could not watch ER/paramedic related shows on TV which I used to love, I could not read about paramedicine nor write in my blog, I could not get myself to volunteer with St John Ambulance, I even resisted the notion of merely talking about prehospital care outside of work.  I felt that if I even so much as dabbled in paramedicine on my spare time, I would spill that cup that was already brimming at the top.  It was all I could do to go to work in one piece and come home.

It was all very confusing.  I knew that I did everything I could have on that call.  I knew that no matter what I did or what anybody else did he was going to die.  But here is the funny thing, it doesn’t matter what I knew was real, or that I did everything I could, it doesn’t make the feeling of helplessness or despair go away.  I couldn’t make the emotions go away.  It clung onto me like a child would to a mother.

After another month, the signs and symptoms got worse, I knew there was something seriously wrong.  I wasn’t getting nightmares, but there will be days where my boyfriend comes home to find me crying in my bed.  He’d distract me, and hold me till my shaking stops and my body relaxes.  I knew this can’t be a long term solution, I knew I had to do something.  I decided to see a counselor.  It was a move I desperately did not want to take, because it means telling the whole story all over again, re-living the nightmare once more in more vivid details, and this time opening my most vulnerable chapter to someone I don’t even know.  But the need to know why these eruptions of feelings are getting worse, and why over the last four months it has not gone away, was enough motivation.

The counselor told me what I am experiencing is normal.  That I just needed more time.  He didn’t give me any coping mechanisms or techniques to deal with the intrusive thoughts, he didn’t ask how I was feeling, or investigate how long ago this incident happened.  He only asked if I was still working, which I answered yes.  To him, that meant I’m okay, I’m coping enough to work, what he didn’t know is that I’m coming to him because I’m grasping at the end of my straws.  I’m falling apart.   I don’t know what his reasoning was, perhaps to him, having the responsibility of someone’s life in in your hands, spending 45 minutes alone trying to save them and then having them die in your care, looking into your eyes isn’t traumatic enough for him to deal with, that “I’ll just get over it with time”.  He didn’t suggest for me to come see him again, he said I have PTSD symptoms, and he just sent me home with a prescription:  Boyfriend to provide lots of hugs.

I was devastated.  This is normal?  It sure doesn’t feel normal.  I never stepped back into that counselor’s office, I was too broken, he had no idea how much courage it took for me to step into his office and tell him what had happened to me, to make myself vulnerable.  I couldn’t make myself go through something like that again, I didn’t try seeking another counselor.

And so I went home to live my life, to wait for time to heal things.  I was very vulnerable emotionally and struggled with minor depression.  Stressors such as moving stations and working away from home for five days a week did not help with the stress, nor did the constant commuting.  Neither did my gnawing question of why I am so affected by this particular call get answered.  I felt that it had to do with my friend killing himself the same day and my patient dying, but I could not see the true link behind it all.  I tried to move on, but the bumps in the road constantly opened up the scabs, like having my car broken into and having my camera equipment stolen after a trip full of amazing photos (at the time photography become my therapy when I was away from home at work).  These bumps as well as financial stress, long commutes, and days away from home constantly pushed me back down the abyss I was trying to crawl out of.

I only ever told a few people about what had happened.  It seemed the advice was to go talk to someone about it.  The only problem was, every time I talked about it, it just reopened the wounds that were trying to heal and made it raw again.  One day my boyfriend told me to try something different, he told me to get this workbook which will later become my bible – Mind Over Mood:  Change How You Feel by Changing the Way You Think by Dennis Greenberger, PhD & Christine A. Padesky, PhD.  It is truly this book that slowly gave me back my strength and to help me crawl out of the mild depression I was getting myself into.  Every time I hit my low, when I feel like my glass of water is tipping over, I worked on the book and it helped me refocus and change the way I looked at situations.  Over the span of several months, the book helped me keep track of my mood, helped me truly understand my feelings, and allowed me to identify automatic thoughts, and create an alternative or balanced thinking.  The beauty of the book for me was that it helped me regain some of the control I lost, it empowered me, and allowed me to heal without having to constantly reopen my wounds by re-living the event to others.

A year and a half later, when I was talking to a colleague of mine about the call I had, I think I may finally understood why that night hit me so hard.  I’ve always felt that there was a connection between my friend’s suicide and the loss of my patient, but I never truly understood what the link was.  I realized that day after my conversation with my friend that perhaps I subconsciously, without knowing it, was trying to save my friend through saving my patient.  I did not just lose my patient that night, but in some ways my patient and my friend were one and the same.  Logically I knew they were two separate beings, but emotionally and subconsciously they were one.

During those months as I slowly climbed out of the abyss, I wondered how people were able to be at TEMA conferences and talk to people about their journey through PTSD.  I do not know if I have PTSD, just PTSD symptoms (according to that counselor), as I was never formally diagnosed, but even then it was very difficult to even write about, let alone talk to a group of people about.  To me, those people are truly admirable.  Like them, one day, I wish to be able to share with others my experiences so others can gain a better insight and feel that perhaps what they are going through isn’t so abnormal after all.  It took over two years before I was able to write this down.  Even now as I write I am not sure if I will have the courage to post it, as it is such a private story, and touches my heart in such a delicate way.

There has never been a day that has gone by that I wished to not have been there on that call.  As painful as it was, I also see it as a blessing.  That patient now lives inside me through my memories, he has taught me more than the last 100 calls I have done.  He lives through me as a lesson, and what he has taught me that night has helped me in many calls afterwards.  I still stand by my post back in June 2011: The Honour to Witness.  I was glad to be there for this man in his last moments, for him to share with me his love for his wife and kids, and to be the one holding his hand and offering comfort in his last moments.  There is no greater honour than that, and if asked, I will do it all over again.

I am still on the road to healing, it still hurts, but I’ve come far out of the darkness, a darkness at times I felt impossible to penetrate.  But it is possible.  It just takes a lot of baby steps, determination, hugs, and time.  Don’t give up.

 “You won’t realize the distance you’ve walked until you take a look around and realize how far you’ve been.”