This Dashboard Confessional one of the shortest we have received, but one of the deepest.
“Just read your blog. I’m a paramedic – I’m not supposed to feel. I’m not feeling while operating on a bad MVC. I tell the family of a loved ones death and continue to go on to the next call. Although that is at work, I find myself doing the same at home.”
Personally, I have always worried about how we deal with the desensitization of EMS – how do you turn it off at work, but turn it on again back home. I know that I’m not the only person who has this concern.
I’ve asked a colleague work specializes in mental health issues in emergency services to comment on the topic. Christen Kishel, Ph.D., is a licensed Psychologist in Washington with an extensive background in this area. Her comments are long, but profound. Please take a moment and read to the end:
Emotional numbing is a survival skill in emergency response. If we cried with every distressed patient or family member, or screamed and flinched at the sight of bodily fluids, we would be completely unable to do the job. Like gymnasts who need to build calluses on their hands, those in EMS need to build calluses on their hearts. There is a difference, though, between having calluses and being callused. The process of building shields around the heart to be able to do the work can have the common but unfortunate side effect of generalizing to every situation and every relationship. It’s not hard to understand that when you see things like abuse, neglect, chronic illness, and acute traumas all day long, the things that distress the people in our lives who don’t work in the field can seem trivial. If anyone asked you what you value most in life, it would be your family and your job (not necessarily in that order), but the way you feel and act at home and at work is light years away from reflecting those values. Instead, you feel irritable, frustrated, fatigued, and worst yet, nothing at all. This is most frequently due to burnout and trauma. A core symptom of post-traumatic stress injuries/disorder is emotional numbing, and cynicism and apathy are common features of burnout. In fact, cynicism is so common that I consider it a job hazard. Most people experience their first episode of burnout about 5-7 years into the profession, and can move in and out of burnout throughout the course of their careers.
So, what can you do about it? Let’s start with some simple things that can help prevent, or bring you out of burnout. First is mindfulness. It’s not as “woo” as it sounds – it’s simply a matter of asking yourself, “Where am I now?” Are you in the present, in the past, still on a call in your head, checked out, or present? If you need to ground yourself to the present, take note of what you can see, hear, touch, smell, and taste. Take note of who is there with you and what is important to both them and you. If you are with a loved one, be there doing that. Easier said than done, but with practice, it gets better. If you have had a rough day or a rough call, you might not want to share all of the details. But your partner still needs to know how you are doing with the calls and situations of the day. They need to know who and how you are, even if the gore is better left unsaid so that they aren’t vicariously traumatized and you don’t have to re-live the situation before you’ve had a chance to sleep and process. They key is communication. From the very beginning, start talking about what you can say when you “aren’t ready to talk”, and discuss how much detail your loved ones can handle. Develop phrases or scripts that let that person know that you might need some alone time, a hug, distractions, humor, silent presence, or whatever best fits that relationship. If your loved ones can’t handle much of what you have to say, find peer supports or others on the job or at least familiar with the job to talk to when you need to. Find the kind of people who will listen, hear, and maybe even check on you the next day just to see how you are holding up.
It can be really helpful to create a work-to-home routine. Especially helpful is getting exercise – specifically cardio – to get the stress toxins (cortisol especially) out of the system. Follow that with water or Gatorade or something like it, and you’ll be literally flushing the system, like changing the oil to keep the gunk from building up and bogging down the engine. The work-to-home routine might involve listening to music or to a podcast, or maybe some comedy to change the channel in the brain. It might mean hugging your kids when you get home before setting a timer for 15-30 minutes during which you get to lie down and nap (research says we should all nap every day!) or otherwise “check out” for a bit before reconnecting to the family in a more fully present way.
Remember your big “Why” – why do you do this work? Do you work to live or live to work? (It’s ok if it’s both, but if the scale tips too far in the work direction it’s time to reassess!) Do you have hobbies and interests and friends? Or is it work-eat-sleep-repeat? If you can’t say that sleep is an actuality, time to get that looked at. If you can’t remember the last time you felt rested when you woke, talk to your doctor! Sleep apnea is approximately four times more common in emergency responders. And if anxiety/depression/trauma are keeping you awake, ask about a beta blocker like propranolol to help with sleep (stay away from things like Ambien or Ativan – they can increase nightmares and flashbacks, and can make things worse!).
Drink less alcohol and more tea, hot chocolate, water, etc. Alcohol is your frenemy – it might make you tired, but you’ll disrupt the brain’s deep sleep, which is the part of sleep where stressors and traumas are processed in an adaptive way. And if the numbing and callousness has been around for a while, and it’s getting in the way of fully connecting with the people that you care about most, it’s time to think about seeing a psychologist or therapist who understands the culture of emergency response and can help you find your way back to being who you really are. I have personally been working with trauma for about 20 years, developed a specialty in working with emergency responders about six years ago, and a few years ago finally decided to learn about EMDR. What I am finding is that EMDR is extraordinarily helpful in moving the traumas that get someone stuck into more adaptive parts of the brain and bringing life back into balance. CPT and CBT also help. There are options and there is hope. You don’t have to live in that numb, disconnected place. You can come back to a place where you can detach enough to do the job but not so much that you no longer feel like a part of this world. You and your loved ones deserve for you to be fully present in your own life.
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