Advanced Care Paramedic Natalie Harris writes about potential ways for paramedics to care for their mental health.
It's 0600 and the tones go off an hour from the end of your night shift. The noise makes your heart jump like every other time; being woken up in this way is something no one ever gets used to. While you try to catch your breath, and convince your body that it doesn't need to use the washroom, you make your way to the ambulance and prepare for…well, anything. While you pray that it's a false alarm because every cell in your body is desperate to sleep, you hear the dispatcher say, ‘You are going to a motor vehicle collision on the highway, transport truck versus a motorcycle.’ As you pull out of the garage, you ask for air ambulance's availability, and conceit to the fact that you won't be using the washroom any time soon. The dispatcher continues with, ‘Patient is trapped under the transport truck, but speaking.’ and then you hear the statement that makes every medic cringe, ‘We are getting multiple calls on this one.’ You know it's going to be bad.
Afters what feels like days on the highway, you're not even sure what time it is when you transfer care of your patient, finish giving report to the air-ambulance crew and stroll back to your truck along the closed highway. As you walk, news helicopters fly overhead while you take in the scene. The smell of gasoline, oil and rubber, heavy in the air, will have seeped into your uniform by now. Bystanders who were on their way to work or home now line the side of the road, in awe of what they just witnessed. As you walk past them, you step over mangled motorcycle parts and blood, and finally unclip your helmet while sweat drips down your neck.
The call was bad. The condition of the back of your ambulance is undebatable proof. Blood, suction canisters, equipment and garbage litter the floor. What would look like something from a horror movie to the public, looks like just another day at the office for you. Without looking at the clock, you know you're getting hours of overtime because of extensive paperwork, clean-up, decontamination and replacement of equipment. The wishful effects of coffee are futile at this point; you are exhausted beyond belief. And besides, you just remembered that you still hadn't used the washroom yet. No coffee is a must.
While you drive home, you try to concentrate on the music you hear on the radio, but images of the accident scene, the bystanders, the media, the air ambulance landing on the highway, the recollection of procedures performed, and conversations with base hospital physicians, all cycle through your mind, sometimes without you even noticing. In a blink of an eye the lives of so many had just changed, and whether you realised it or not, yours has changed, too.
Paramedics are human beings like the patients they care for. Yes, they may be able to shoulder the responsibility of providing care in chaos when so many can't, but that doesn't mean that they have an impermeable shield blocking memories that the chaos brings from their profession. The events in all of our lives affect how we view the World and each other, and are like seeds planted in the complex wiring of our brain, growing day by day into our human psyche.
So what happens when the chaotic events paramedics witness plant too many seeds? Well, without ‘chaos-pruning’ along the way, our minds may become populated with many negative memories. I have experienced this myself: over my 13-year-long career, hundreds of chaos seeds grew in my mind, often without my awareness. Work got busier, time went by, and I didn't realise the impact of these accummulating memories. If only I had ‘chaos-pruned’ every day throughout my career, my memory garden wouldn't have been so out-of-control, and my mental health would have improved with practice, turning what at one point may have felt like work, into a healthy habit.
So what is ‘chaos-pruning’? What would it entail? Allow me to share my personal gardening tips:
Breathe. It may sound like the simplest of tasks, but while paramedics are engulfed in tension-filled, time-crunched, exhausting calls, we often don't pause to take a deep breath and give our well deserved body some essential peace. If you forget to take some deep breaths while on a call, don't worry, you can always take one or two minutes after the call to practise some deep breathing. It may give you the energy boost you need for the rest of your shift.
Exercise/participate in an extra-curricular Activity. I know that paramedics have busy lives, but this is key for their competence as well as wellbeing. You don't have to join a team or gym and spend a lot of money to get active. Even making a conscious effort to go for a walk every day can help clear your mind. Once I started walking every day, I began to finally notice the peaceful parts of life, which in turn, encouraged me to balance my chaos memories with positive ones. The smell of a BBQ or the crunch of new fallen snow under my boots also reminded me to live in the moment; something I had forgotten to do for a very long time.
Try to meditate. This does not need to be a difficult task like many believe it to be. If you are a beginner, I have two recommendations to ease your potentially skeptical mind: start with guided mediations and keep the meditation short. Mediation takes practice, because our minds are so filled with racing thoughts, so even the seemingly simple task of focusing on our breath can be tricky at times. But the good news is, any attempt at mediation is a successful attempt! You don't need to be a monk to reap the healing rewards of meditation.
Work with compassion, not attachment. A few months ago, I was amazed to learn that during my 13 years as a paramedic, I never recognised that my attachment had been masquerading as compassion. Furthermore, I used to believe that being too compassionate was what made me sick. In retrospect, I can see that it was attachment that made me unwell, because true compassion never hurts. Remember that you can hold the wish that your patients are well when you leave a call, be they in life or death, but when you pack up your bags and drive to the next call, you can't be attached to the outcome. When you've done all you can do, compassion should only bring you peace.
Limit, or omit, your use of alcohol/drugs. Again, I am speaking from experience when I say that my use of alcohol and drugs (even prescription drugs) never helped me prune my chaos garden! It only helped me ignore how overgrown it was for a very long time. If you are using alcohol or drugs to cover up your chaos garden, it will only work for so long. It's only a matter of time until your family and friends start to be affected. If you, or a loved one, has recognised that alcohol or drugs may be a problem for you, today is the perfect day to ask for help. You may wonder what how to seek help, and now comes the most important tip of all.
Talk! Paramedics are some truly amazing people. We are able to endure mental and physical trauma on a tremendous scale, and we take pride in the strength we possess to be able to do this. But not until recently has ‘strength’ been associated with asking for help when we need it. The stigma of ‘weakness’ is still very much part of the soil in which our chaos gardens thrive on, and this needs to stop. We need to trade-in this weakness with communication and understanding.
Take pride in your career, but remember that we are all human. Like I have illustrated in the call at the beginning of this article, we as paramedics need to remember that we are just as human as our patients. We bleed, cry, and hurt, and that's OK. It's important to remember that part of being human is allowing whatever emotion we feel to be felt, and then to let it pass. Stuffing our emotions behind a super-hero ego will never make us strong. We are not made of steel (to the dismay of some of you out there), we are made of flesh and bones. So when you put on your uniform, yes, it is important to be able to smile in the mirror with pride as you deserve to, but don't live in it! Remember to take it off at the end of each shift, and change into some comfortable gardening clothes from time to time.
