I have been an avid listener of Medic Mindset Podcast from the beginning and had the honor of being Ginger Locke’s guest on Episode 12: The Beauty to Death Ratio of her amazing podcast. She is thoughtful and kind, and really allows her guests to express themselves in such a way that make us feel safe and brave enough to share our thoughts and experiences. Back in 2017, Ginger had one of my favorite guests on, Dr. Tania Glenn, who was described as a “Warrior Healer,” and, as Ginger states in her bio, “She’s a leading clinician in the identification and treatment of PTSD and specializes in caring for emergency responders.”
To be honest, this appleaed to me for so many reasons. The first – and if you’ve read any of my posts on mental health – is that this job almost killed me. Well, the stress of it did. I was so young when I started as a paramedic; my first day of medic school was my 21st birthday, which was the earliest we could start back then, and I was on the street by July of that year. I grew up in a really safe family, and a really safe area, and went to work in a major urban area, where everything from culture shock, to seeing so many things for the first time, especially the violence and trauma, and then having a really dark black cloud especially as a new medic, really shocked me. If I’m honest, I had none of the coping mechanisms that I would need to survive long term on the job. Flash forward a few years, and some senior medics pulled me aside and, for all intents and purposes, did an intervention with me. This was probably around October or November, and that January, I quit. I wasn’t sure I would come back. I was drinking heavily, depressed, and actively planning my end. Shortly thereafter, one of the paramedics that I worked with who shaped me so much in my style, street smarts, and teaching ability, killed himself. Andrew and I had worked together for almost three years, and it was an awful, horrible blow.
I chose to live because of the love and care of my family and friends, and coworkers who never gave up on me. I ended up taking about a year and five months before I went back to work. Thankfully, my management understood what was going on in my head and heart and really looked out for me at the time. Since then, I’ve lost so many other friends to suicide. When I heard Dr. Glenn the first time she was on Medic Mindset, I thought it was one of the best episodes I’ve heard, and probably one that I share with people more than any other. When I saw that she was on again in a recent episode called, “Tania Glenn, Back Again” I was so excited to hear more from her. I started listening and I had to stop early on. It was like she was reading a journal of my career and my thoughts, and I had to take the episode piecemeal in order to get through it. I am so glad that I did. These are the ideas that from her comeback episode that have captivated me, or that are so in line with my antecdotal experience, I need to talk through them, and where better to do that but here?
My first suggestion would be that people would look to watch the documentary that she and her colleagues produced entitled, “First Responder Resilliance: Smashing the Stigma.” Its on YouTube, and if you click on the title, the link will take you to it. Its 45 minutes long, and absolutely worth the entire time it will take you to watch.
Tania talks about how “career longevity starts in the early days,” when we are young and in academy or on probation. I couldn’t agree more. She says that “we train resilience and instill that in [new people].” That is true. We spend so much time as instructors in class, in clinicals, on the training ground, in high fidelity scenarios, and in field training. I think that how we teach is something that desperately needs work. I can’t remember where I heard it, but the quote was, “Training is a sacred trust, and if you do not look at it that way, you should not be teaching anyone to do anything.” The idea of a sacred trust in training also resonates with me, because in the process of teaching resilience, we, as instructors, mentors, and FTO’s, need to not only teach resilience and skills in exams, firefighting, or investigations, but we also need to model attitude. One thing that drives me absolutely bonkers is when I see training officers teaching shortcuts that are inappropriate, and I can usually tell which FTO’s that will be because they are also the one’s with their boots not polished or unzipped, their uniform unwashed, and their attitude just piss poor. I then see this behavior mimicked by new hires, because they look at these “crusty” old timers that have been there and done that, and think that this is how they are supposed to dress and act. Before you can blink, they affect the same attitudes, patterns of speech, and cynicism. I remember a new medic standing in front of a nurses’ station one day, being the most salty person I’ve ever seen. I pulled him aside, and called him on it. I knew his preceptors well, and knew they had tried to talk with him about this. I finally told him that we could all see through his attitude, that my boots had run more calls than he had in his entire career, that he needed to change, or the reputation he had would follow him forever, and no one would want to work with him. He was shocked that someone would be so blunt with him. It was a hard lesson for him, but he took it to heart. Next time I saw him, he had gotten a haircut, shined his boots to a spit-polish (he later told me that it really was spit polish, just like his time in the army!). It was a dramatic change. Everyone noticed the difference. He went from being a pain in everyone’s butt, to being an asset to all the crews he worked with. His humility shone, and his professionalism was outstanding. He eventually retired from his fire department as a captain, and now works as a state fire investigator. He knew resilience. He was competent and well trained as a paramedic. In the ensuing years, we talked a lot about that night, and I personally believe he would have torpedoed himself if he had continued to emulate the burned-out medic trope. I think that because someone intervened early, he was able to find the introspective strength to make the changes he needed to to and become a leader himself. I share this story because its his and mine, and we have both used it to teach one thing: Its so critical that we choose good mentors. Its so critical that supervisors and management hire good people to run academies, be preceptors, and FTO’s. I don’t hold it against new people, but I will pull them aside and talk to them. I think that the responsibility here is solely on us senior people who have the sacred trust to instill a positive attitude, in addition to the resilience, because one without the other is so much less effective that they synergistic effect of the two together. We need to change the culture.
Tania also alludes to, but doesn’t explicitly say, that healing is a long-term process. She states in the interview with Ginger, there is so much that takes place after a critical incident that is just survival, meeting our hierarchy of needs at the most basic levels. She also states that in the peer support model that she teaches, that there is also a place for making sure that people get professional help if they need it, and walking with them for the long haul. Healing isn’t linear. Healing is so much a cha-cha, forward and back, but ultimately, we can find ourselves moving smoothly through those transitions. In my experience, having friends and counselors who have walked with me for decades has been a lynchpin to my healing process. Sometimes, weird things trigger the nightmares or flashbacks, like a brilliant sunset in July or August. Knowing who to call, even 23 years after that call, saves me over and over. I rarely call anymore. I maybe have one nightmare a year now, if that. When they do happen though, I pick up the phone in the morning and reach out. I no longer have to explain myself or the process, and people are able to understand immediately. If you’re a peer support person, understand that this very well can be a lifelong relationship that you’re forging, and it will help you as much as it helps them. Be there, always, whenever they call.
I am also one of those paramedics who was told that I burnt out early in my career because I “cared too much.” My partner at the time told me that it was because I wanted to the death notifications. I think that the reason I’ve chosen to do this is that I learned to care about the patients in this moment from an amazing doctor, who I think I’ve written about before. He was the doppelgänger of Sammy Hagar from Van Halen. What Jeff taught me though was that caring for people, kneeling in front of them when I had those conversations, that letting people see how much it meant to me that they were suffering, was not a sign of weakness, but of depth of caring. I never let it get to the point where the family would feel that they had to take care of me. I would also suggest that before we take a patient who is critical and there is family around, such as out of their house, please make sure you introduce yourself before you leave to the family. Tell them that you have to hurry, but that you’ll find them when you get to the hospital and help them navigate the emergency department as soon as you can, and make yourself available to answer questions on arrival at the ED. Often, for safety reasons, we can’t take family in the ambualnce with us to do what the hospital does, which is have family present during resuscitation. In lieu of that, answering those questions can be so critical in allowing family members to know that everything was done for their loved ones. Again, I’m so thankful that I saw Jeff model this to me when I would bring patients to him. He truly taught me some of my best lessons, and I absolutely have to echo what Ginger said in this moment: To anyone who thinks that being there for families after we do a death notification, FUCK THAT. Be there for them. They need it.
I absolutely resonated with Tania’s assertion that in our careers, we go through a somewhat predictable trajectory, especially those who make it a long term in public safety. She puts it this way (italics mine):
“And here’s the thing: What I tell people all the time is that your love and compassion for the people you serve, that’s what brought you to this. And then we kind of go through a period where we get a little calloused, a little removed, and we get a little jaded. Usually what happens to most people who endure a career and make it to retirement, is they reconnect, they have wisdom. And wisdom is hard earned, and causes grey hair.”
This was absolutely my journey. I did start this career with the most altruistic of intentions, and a genuine desire to serve my community. I was very much a tenderhearted, innocent young kid. I went through that progression from that to the jaded and calloused, to the angry and burnt out. Thankfully, I took that time off, and my heart was reset. In that time away, my therapist reminded me of something that seems so obvious, but that I had completely forgotten. We absolutely live in a world and environment that is not “reality”, although I might argue its more real in someways than any other plane of existence. Maybe our reality needs that reminder though that for the vast majority of people, they don’t live in a world of constant exposure to trauma, moral injury, interpersonal violence, unimaginable tragedy. The fact that I’d forgotten that forged in me an us(anyone who wears a uniform) vs. them (society at large) mentality. It was hugely self-destructive. Taking that year off allowed me to remember that, as did some great therapists. When I came back, I felt the weight had shifted, that I didn’t have to own that attitude any more, and that I could carry more of the exposure of the bad stuff, without compromising my own humanity. Did that make me immune to the exposure to that badness? Absolutely not. My second shift back, a toddler drowned in a toilet. What had changed though was how I carried that burden, how I viewed that horrible scene and the screams and anguish, rage and sadness. It was present, and I acknowledged how I felt, but I learned not to carry it as closely, regardless of my proximity to it. I felt like Luke Skywalker after he had hung out with Yoda, learning the peace and calmness of the Jedi. I’m so thankful I did the hard work in therapy, because it saved my life and career. And yes, Tania is right again: The grey hair I have is hard earned, but it reminds me of what I’ve fought through to be here today.
Finally, one of the topics Ginger and Tania talked about was sharing about work with family. My therapist gave me some great wisdom about that after one of my pedi codes we were working through. It was right before a big family holiday dinner. I came home and just needed some space, and I told my mom what had happened and how I needed a little space before I reengaged with family. Instead, I was told that I probably should have chosen an easier career instead of one that would affect me so much. Obviously, that didn’t go over so well. I was telling Jim about this and he told me that he had been taught to share the emotions with family, and the clinical stuff with coworkers or friends from work. I’ve loved this model ever since. I can come home and connect with family after work and say, “Hey, I need some space right now because I had a call last night that was heartbreaking and scary, and I just need to shower and take a big breath.” They can understand heartbreaking and scary. I have my coworkers (and now Twitter friends) with whom I can actually say, “Hey, I had a pedi trauma code and I couldn’t get the tube because there was an internal decapitation, and I was scared, angry, and frustrated, and I felt helpless, and now I feel like shit.” That is something that only they can understand. Its one of those “Unless you’ve been there…” moments. I would ask your individual therapist about how to handle specific situations, but for this, and my N=1, its worked really well.
I’m so grateful that Ginger has cultivated relationships with professionals like Tania, and that we can all learn from them. This job is hard, and will take so much out of us, but it doesn’t have to destroy us. We really can, through choosing to work hard on ourselves, become mentors and teachers, showing the up and coming generations of public safety professionals how to negotiate this emotional landscape and succeed long term. In doing so, I think we will save a lot more lives of our peers, and even, might save our own.
Thanks for reading. Be safe out there and look out for each other.