All the er stories, never forgotten.

[FragileGlass]

I decided to try this method of unleashing my confusion to the masses. Like the title states, all my confusion centers around my diagnosis, however, the further I read into PTSD and ASD the more confused I get by the traumas that leave me awake at night versus the ones that should and don’t.

Working on the hospital emergency unit security team, I have seen far too many stories, eventually they start blending in to one another. Most are just typical days at work and I walk it off with no problems. When I say typical, would leave many with eyes wide open. My atypical shifts go far beyond eye opening.

Sadly, to date, I have moved countless bodies from barely five minutes old to the amazing celebrated age of 108 and everything in between.

I have suffered many moral injuries in the capacity of intervening during spousal domestic abuse, having to firmly control and manage families overcome and crushed by tragedy, I’ve had perpetrators and victims in the same unit at the same time, I’ve had information that could help cases be closed, bound by legal and patient confidentiality, my hands were tied. I’ve had to scare people into compliance and I’ve injured people, my most recent incident, injured me pretty badly, while I was not blamed. The patient also died 4 days after that violent interaction between him and I.

I’ve carefully waved batons to the air, giving clearance while marking the landing zone for an incoming LifeFlight team. I’m with the LifeFlight crew from the moment they touch down and take off again. I’ve watched far too many little ones take their first flight in helicopters barely only an hour old. Nothing implodes the soul more than watching an incubator make its way to a roaring helicopter. Instantly that sadness turns to vigilance again as you clear the chopper and control the helipad and surrounding zone for take off. That surreal adrenaline mood swing is something frightful.

Of the hundreds of stories I have been a part of, there are six that left permanent damaging marks but three of them technically don’t fall under the PTSD guidline, but have significant impact on me emotionally and physically in every capacity, the other three, do fall into the PTSD guideline, however I feel like they have the least impact on me.

I now have the seventh incident with long term potential but because it’s only recent it falls under Acute Stress Disorder and may not make it to the PTSD hall of fame depending on the emotional work I put in over the next year regarding it.

I am frustrated with my psychologist because we spend an awful lot of time discussing my emotions over the three actual PTSD qualifiers, little conversation on the three non-PTSD qualifying events that actually leave me panicking most days and actually trigger me at work frequently causing adverse effects to job performance. Touching only a little on the most recent event which I fear may become the most debilitating of all of them. If I don’t handle get a handle on it properly.

That’s my story so far...... sticking to it.

 

[ILoveLife]

Great start :) Will be following.

The most damaging things in my life are also not justifiable for ptsd, while the ones who are seem to be minimal in emotional comparison. I figure it's my brain trying to minimise the river by maximising tributaries.

 

[EveHarrington]

I think you may be a bit confused. Once you have PTSD, you have PTSD. There is no breaking it down to “this incident is only a few weeks old so it’s ASD and not PTSD”. PTSD isn’t broken down into “this trauma caused my PTSD because I have flashbacks about it” and “that trauma didn’t cause my PTSD because I don’t have flashbacks about it”. That’s not how it works. It all adds to it in one way or another once you get that PTSD diagnosis and have the disorder.

If your therapist only wants to talk about the three qualifiers, I don’t think your therapist is very good. You should probably get a new one. YOU are in the drivers seat in therapy, or rather should be. Why isn’t your therapist letting you process what is stressing you most? Bad, bad therapist.

 

[FragileGlass]

The issue for the qualifiers are due to briefing reports that are shared between my therapist and a case worker. In order for my case to be handled and paid for by my company. Every issue I have has to be justified for in time counselling. More issues, more time, more money.

The therapist is only focusing on the events that qualify for PTSD, because those events are covered. The issues that are deemed depression is not covered which I would have to pay for personally. If I could afford this on my own, I’m not sure I would face the same problem.

 

[FragileGlass]

Sorry if this gets hard for others to read. I’m just lashing out and tossing my head and heart into the wind.

The PTSD Qualifier: A 19 year old kid committed suicide by hanging. I had to prep the ER bay for ambulance arrival, open all doors, on stand by with secondary respiratory kits, crowd control the family from entering the trauma room. Listening to the mom screaming in my ear as I held her back. Arms wrapped around her as she repeatedly beat on my shoulders hating on me for stopping her. To finally having to remove the body, his best friend didn’t want to leave his side and walked his buddy to the morgue with me. This is the first time I have ever seen this kid and this is how I meet him. In the coming weeks after his death, the family crusaded about Depression advocacy, everyone of them putting a life size photo of this kids face on the side of their cars, houses, billboards. Not a day goes by that I don’t see one of their cars or his photo somewhere. Kind of surreal to meet someone at their death through asphyxiation, and then see how their eyes should have looked as opposed to the aftermath.

The PTSD Non-Qualifier: I had a frequent flyer patient three years ago, suicidal ideation, threats, attempts, ongoing violent behaviour, had to stand guard on this patient frequently as he kept stating his desire to die over and over. He did this over a period of a year, his last frequent flyer run lasted 33 days in a row of presenting to the ER. His 33rd day, he arrived with police escort, became violent, myself and a paramedic had to assist the police officer, the patient was escorted to cruiser and he destroyed the cruiser. Myself and paramedic were called to witness in court proceeding which took a year before it got before a judge. The day of the court appearance, myself and paramedic were told not to come. Later that day, news reports appeared that this patient was missing. 6 days later, he was found dead in the woods just on the hospital perimeter (not at my hospital or my shift) from suicide. He left a note at home, his life was ruined, he was going to be sentenced that was the end of the line for him. But what makes the story even sadder, he regretted his suicide attempt, tried calling his girlfriend in a panic, tried to walk to the hospital, he bled out on the way. This incident haunts me daily.

Sadly, a couple of weeks ago, the paramedic I was supposed to testify with, committed suicide. Completely unrelated to this event. I’m sure there were many stories under his belt that lead to this decision. This adds a new layer of damage to this event as the paramedic and I had a good working relationship on many other events.

 

[ILoveLife]

Both stories are horrific. Qualifiers or not, its natural for you to suffer consequences from being so close to them.
Hope you can treat the non qualifiers in the future.

 

[Freida]

Oh I so feel your pain.
I used to tell my trainees -- the call that will take you down may not be the big screamy holy crap shooting. It may be something very quiet or routine that just happens to hit you on a personal level. And when that does, do not worry about if it is a big call or a little call. It's the call that breaks your heart that matters.

That whole "is it ptsd or depression" thing sucks and happens in dispatch too. We got one trip to the dispatch shrink after a bad call and it was supposed to make it all better. If you needed more than that one visit you had to go through your own insurance and pay for it. Because it was "stress related" not work related. So very frustrating!

Could you ask your therapist if they could be tied together? Did the non ptsd call cause the ptsd related call later? Did is set the groundwork? If so maybe you can use that as a way to get help to deal with the ones that are really bothering you?

 

[FragileGlass]

@Sietz
Thank you for hangin in and reading :) I appreciate the support!


@Freida

The therapist is trying to tie them in together somehow because he does recognize the issue. Up here in Canada we have the WCB which takes care of workers off work due to injuries. They only cover PTSD under certain criteria. The PTSD vs. Guilt / Depression battle is so frustrating in this line of work. PTSD is recognized and covered and depression is not. It’s agonizing and I think this is where they are failing us completely in this industry. Honestly I think the repetitive guilt / depression can be far more damaging than the PTSD component. It’s what leads to the exhaustive fatigue that burns us out so badly. God help us when we’re that burnt out and the ‘big event’ happens.

 

[gealach]

The PTSD Qualifier:

I've unfortunately been in a similar situation. They just don't teach you how to manage this stuff in the moment, or process it afterwards.

The PTSD Non-Qualifier

I'm really not sure how this doesn't qualify, it's so obviously traumatic. Could your T argue that 2 people you were frequently exposed to, as part of your regular duties, died violently? 2 of 3 people involved in a single violent work related incident (you being the 3rd) have subsequently died by suicide, that's not inconsequential.

Condolences for the loss of your friend.

Sending lots of support your way. :hug:

 

[FragileGlass]

@brokenEMT

My stressor and potential trigger are suicidal, suicide ideation, self harm, self destructive behaviour. I have seen so many suicides in person, that it wasn’t overly difficult for me to fill in the blanks with this patient who bled out in the woods. I think that therapists don’t realize that we have enough experience to fill in blanks of events we are not a part of specifically. While I wasn’t present for the body extraction, watching it unfold in ER, receiving that persons body at morgue. However the therapist will focus on events I was present for, which in some cases is helpful but not in regards to how damaging that particular event was due to all the moving parts involved in the case. This is what try to keep driving my therapist to focus on. Collectively I have dealt with 30 or so suicides in my time.

I remember the day I was told not to arrive in court, I had a massive mood swing shift of being vigilant and ready to assist in getting this guy jail time, to watching the news every day knowing that he was dead long before they found him. My then relationship couldn’t understand how I went from getting ready to help put this guy away in jail. Knowing my anger towards him. To being very emotional, isolated and fearful that he would be found dead. She asked ‘why does this guy now matter to you so much? Doesn’t make sense.’ I broke down in tears when I found out he was dead.

I guess this is where I keep trying to lead my therapist, while not all parts fit perfectly. There were enough elements to make this incredibly damaging and should be my primary focus.

 

[Freida]

wow --they recognize ptsd but not work-caused depression. That is just idiotic.
What about cumulative injury ptsd? Or is that what she is already trying to tie together?
We have had therapists come into dispatch to do sit alongs to get a better idea of what the work environment was - maybe that would be something your T would be willing to do?

I'm so sorry you have to deal with all this. I went through something similar when my insurance company and the VA couldn't decide who was going to cover what. I was a mess -- having to deal with all the money issues as well as dealing with the ptsd treatment itself. It sucks.

 

[FragileGlass]

Right now I’m pushing for long term disability with hopes for career retraining to get out of this industry. I truly don’t want to go back into that environment. Especially now that I’ve seen how they meticulously pick events apart into what is justifiable or not. Because the short term program is developed for employees for return to work. Everything is focused at a narrow scope. I want them to view the collective damage as a whole and realize that now that I’m here. There is no sense in splitting hairs over qualifiers because I hit bottom enough that even the smallest incidents bother me.

Sorry I keep ranting - I’ve been bottling these issues, keeping them inside for so long.

My last session I was trying to relate one of my other emotionally hard hitting incidents. 73 year old former prison guard with PTSD from a hostage event in the early 80’s. His partner was killed in that incident. This patient now has dementia. The hospital and mental health system absolutely failed this man. He was dropped off as an Adult Abandonment case. We had to put him in secure lock room. Which peaked his PTSD and made him explosive. The dementia version of him was far more violent. He was holed up in that cage for 24 days (we don’t keep people in this room for more 48hours). It was inhumane to put a former prison guard in a prison. There were so many aggressive interactions with him that I eventually felt like a horse slaver, beating that man down into total submission. The look of fear in his eyes and recoil from me made me realize he was scared of me.

He was all voice and no strength, but you always have to approach threats with force. He had a habit of flaring up and when you came in to deal with him, he gave up. No fight. One night as per usual he did the same thing, held his aggression long enough that I had to tackle him to the floor. You always hope for the best. It doesn’t always work that way. He gave up as soon as I made contact with him. My strength was far too much, I knocked him unconscious and unresponsive when his head hit the floor. I tried to catch him on the way down. The ER team had to run in and check his vitals and prepare for potential life recovery. I was panicked.

It was a few hours later when the patient woke up. He was calm, tapping on the door. I opened it. He stood there crying, ‘I’m sorry I’m like this, im sorry I hurt you’. He gave me a hug. I absolutely hated myself in that moment. It was me that should have been apologizing to him. Not the other way around.

While driving home after my shift, I was so overcome with grief. I had to pull over on the highway. Yelling, screaming, crying. Beating the hell out of my steering wheel. Damn near ripped my mirror off because I saw a monster in the reflection.

This event doesn’t get nearly as much air time as it needs in therapy. It’s maddening!