Emerg Services Ethical dilemma, claim process

[scout86]

When I get to the part where I have to explain the call that "caused" the ptsd, what the hell do I say?

I don't think it always works that way. There may not BE "that one call that caused it". I can't give you one, specific incident. I had a good friend who came back from 2 tours in Iraq & one in Afghanistan with PTSD. I think he had it when he came back from Iraq the first time, but he wasn't diagnosed until much later. There wasn't one incident, but the place he was at was called "the mortar capital of Iraq". He argued for a long time that "nothing all that bad happened". :rolleyes:

I'm glad your T gets the honesty thing and is going to help you with this! This is kind of why they're thinking there's a such thing as "complex" PTSD. Not one bad incident, but a lot of chronic stuff & there you go.

 

[gealach]

I don't think it always works that way. There may not BE "that one call that caused it". I can't give y...

They seemed to want one call, with all the gory details, and then general other badness, like co-worker suicides, to add to it. It would be really nice, and a relief, if it doesn't have to be that way.

 

[scout86]

That's something maybe your T can explain to them, but, really and truly, you can't always accurately pin it down to one thing.

The first time I saw my T, was kind of had an idea what I thought caused my PTSD, but I didn't want to talk about it. He set about asking a bunch of questions to try to help pin it down. Turns out, I've got a bunch of Crit A stuff that I consider "funny stories". (It's all in how you tell it.) I don't know if any of that had anything to do with it or not. I kind of doubt it, because I can tell those stories all day long, no problem. It's the stuff I DON'T want to talk about that's the problem. But, I'm guessing, to most people, it would seem like it should be different because what I don't want to talk about isn't that big a deal. (Except that, clearly, it is, or I wouldn't be refusing to talk about it.)

If the only way you can get the help you need and deserve is to lie, IMO that's because the system is totally f*cked up. In that case, maybe they don't even deserve the truth.

 

[gealach]

I just want the whole f*ucked up process to be done, treat me, and get me back to work.

 

[Friday]

WCB today hinted that if I want my claim approved, I need to focus on the ugly parts of patient care, and the paramedic suicide epidemic here, and stop talking about the bullying and harassment I experienced. The problem is, I'm not bothered by the "ugly parts" of patient care. Patients experience horrible shit, sometimes they live, sometimes they don't. I always give my best effort, ewhether it's a hangnail or a gunshot wound, so their outcome doesn't bother me.

Think of it this way:

The ugly parts SHOULD bother you, & the bullying/harassment SHOULDN'T. That they're reversed? That harrowing life threatening trauma is just normal life, and normal life is end-of-the-world-no-f*cking-way... Is super PTSD.

Gross oversimplification? Yep.
Entirely accurate? Nope.
A way to reconceptualize? As in how to phrase for idiots who don't see massive trauma as normal and normal as massive trauma >>> Exactly.

Meaning, if they want examples that will curl their hair? Give them that. Save the stuff that TRULY bothers you for therapy and tell them exactly what they're asking for. What were your worst calls? What would make "normal" people puke their shoes out their noses? Whip those out for them, honestly, as asked. And feel free to call them f*cking morons in your head for as long as the day is.

 

[gealach]

Think of it this way:

The ugly parts SHOULD bother you, & the bullying/harassment SHOULDN'T. That they'...

@Friday your posts seriously always make me snort laugh :roflmao::hilarious:

I can come up with hair curling, nasal shoe barfing calls.... no problem. We whip those out on the way for coffee in the morning, for giggles, then rock, paper, scissors for who's gonna pick the clots of our bootlaces today. Meh. But only with each other. IDK why I'm reluctant to use those for the assessment, why it seems dishonest. Need to work on that I guess. That's gonna take a while.

 

[Freida]

Is the wall up so high that I'm even fooling myself into thinking I'm okay? I don't know, I just don't have any emotions around patient care, none.

Yep. I was in training for years and I can bet you don't realize that you were trained to do that. We teach you to stuff and compartmentalize during the emergency because someone has to keep it together. You are expected and trained to face whatever weird thing is thrown at you, deal with it, hope you did it right and move on to the next call. Dead baby? check CPR on a 15 year old heroin addict? check. Guy gets his penis stuck in the vacuum? check. You HAVE to keep it together and tell people you are fine because you have a job to do.

the problem is we forgot to teach people how to let that wall of "I'm fine" come down. We teach and encourage that it is a good thing, we mark it as a badge of honor, and we do it over and over again. WE teach you to hide behind that wall. We forget to teach you how to come out. Once you stop caring about the patient, once they are just another annoying babbling bag of skin that you have to deal with before you can go home, yea, that's compassion fatigue. Now add cave day - that first day off when you hid from the world? Yeap - that is cumulative stress. Now add a life threat and voila! ptsd.

Dont be worried that you don't know which call caused it. There are probably several in there. Just be willing to look at it from this angle -- did your ptsd actually come from the horrific things you dealt with every freeking day for how many years, then the assault? Your job now is to let the professionals help you. You are not ok. And that's ok - because now you can get help. Follow their lead instead of making them follow yours.

Turns out, I've got a bunch of Crit A stuff that I consider "funny stories".

Oh I am so right there with you! I think half my traumas are hysterically wrong place/wrong time funny. Oddly the rest of the world doesn't agree...hmmmmm

 

[gealach]

Follow their lead instead of making them follow yours.

ya, I trust them about this :stop: much. It hasn't exactly been a helpful experience up to this point. Issue #502 on my list of issues to be fixed.

 

[Justmehere]

I think you are overthinking it a bit. (I do that myself!)

When I get to the part where I have to explain the call that "caused" the ptsd, what the hell do I say? Uhhh, Uhhh, Uhhh isn't gonna cut it. Right now, I can't name one. But I have to. I can talk about calls that could be considered bad calls, but that feels like lying to me, they don't feel like anything, much less a bad call.

Is a mental health professional going to do this assessment? It would of be very strange if they sat down and said ok, which singular call caused the PTSD?

They would be more likely to ask about symptoms now, and past trauma. And when they do - you can list all the trauma, regardless as if you believe it caused anything or not. The more gory and specific the better.

They seemed to want one call, with all the gory details, and then general other badness, like co-worker suicides, to add to it. It would be really nice, and a relief, if it doesn't have to be that way.

Why would it be a relief?

IDK why I'm reluctant to use those for the assessment, why it seems dishonest. Need to work on that I guess. That's gonna take a while.

You are not being dishonest to tell them about these traumas. They are trauma. Period. They may not be on your mind now, or ever, but it is trauma none the less.

The fact that you feel like it’s lying to say a trauma is a trauma... strikes me as a defense mechanism.

If it really wasn’t anything, you probably would not resist so much.

When someone I know committed suicide, it didn’t seem like it affected me. I was stuck on things that were more like the bullying and harassment you describe. I thought the suicide didn’t phase me. When I had to go through a couple of assessments, I told them all about how it happened and what the person did to die and etc. I also was clear, I can’t say which trauma has had what clinical impact. All I can say is what I went through, all the trauma even if I thought I was fine about it, and what I’m going through now.

About 5 years later, the suicide kicked my butt. I finally had the safety and ability to deal with it.

You don’t have to predict what is going to pop up for you later. They are not asking for that.

They are asking you to list the trauma of the past. So describe it all. It’s not lying. It’s actually very honest.

 

[gealach]

I think you are overthinking it a bit. (I do that myself!)

Is a mental health professional going t...

yup, the assessment is going to be done by a psychiatrist. And I've been given a heads up that at some point I'll be asked to write about the trauma that's bothering me the most, give details, describe how it's effecting me, etc. This is supposed to be "the call". This is the part I'm really struggling with. I know some paramedics have that single, well defined horrible call, my work partner did, and others have the slow drip of multiple calls over time, and our system is struggling a bit with that concept.

I meant that it would be a relief if I could just describe some of what I've seen, without having to then also focus on "the one".

If they want to hear about "bad" calls, I can do that. I don't think of the calls that way, but I have time to prep, so I can figure that out. But to describe the call that's bothering me the most (or the calls).... that's not what's bothering me the most.

What's actually bothering me the most is being threatened by a much larger, ragingly angry, paramedic while I was already injured and not really able to defend myself. I've seen what pissed off can medics do, and this guy was really angry. I've been in some scary situations, some where I was reasonably sure I wasn't walking away without injury, but I wasn't injured yet and I could defend myself, and I wasn't really that scared. In this case though, I've never been that scared, and that sure that I was about to have the tar beaten out of me. If they need "the one" during the assessment, this is it. At the very least, this is the thing that finally pushed me over the edge. If this had happened on a call, and it was a patient instead of a medic, and I was trapped in the ambulance and not in the corner of an office, there would be no argument. So, in my literal, no imagination, brain, passing something else of as being more traumatic (for me) because that's what they want to hear, that equals lying. This what I'm having trouble reconciling.

I have time to prep, and that's what I need to wrap my brain around how to do this.

On the funny side, I had a nightmare about all this last night, and my pants were literally on fire during the assessment. OMG I seriously need a new brain.

 

[LuckiLee]

My guy is a veteran so he's being treated through the VA and Vet Center but he has said he's "had to play their game". Tell them what they want to hear.

J had an abusive childhood, you think he's gonna tell them that? Nope. No way. Why? So they can deny the military had anything to do with his mental health. F that!

Don't you think you had PTSD prior to the physical altercation? I would think that experience filled your stress cup and exacerbated your symptoms. IMO.


Good luck.

 

[Friday]

I've seen what pissed off can medics do,

Since you have time to prep, I'd suggest categorizing some of your calls into different groups (you know, the heartbreaking, the haunting, the needs 6 showers / burn your clothes and STILL finding bits of people in surprising places, the needs prophylactic medication, the hates humanity evil motherf*ckers, etc., to break through the lying barrier IE you aren't saying these calls gut you, but you are giving an accurate overview of gnarly)... AND ...making sure this is one of them. Times when people you trust and depend on lose their shit.

If it's someone you halfway trust? Then you transition immediately from that category to "Everything seemed to hit me all at once when I was a patient, trapped in a corner, situations totally reversed & the people Intrusted and depended on lost their shit on me."

There's a way to make that really poignant. When "the" call? Where everything came crashing down? Was your own.

But it'll have to be worded carefully to have it be work related.

AKA the huge list of hard calls, finishing with your own... And THEN looping into / transitioning from that into colleague suicides, wanting the help they never got, etc.

Your therapist can probably help you order things out in a way that's both true AND makes clinical sense.