Observations From A Paramedic

[The Albatross]

P.S. I'm over tired and my brain scrambles some when I'm tired... but this is a pilot program like what I'm trying to talk about. They also implemented one in L.A.:
http://ehealthmd.com/content/want-reduce-ambulance-transport-and-health-care-costs

The article makes an interesting point: "In busy EMS systems EMTs hardly have time to drop one patient at the hospital before they're paged out on another call. Baltimore City EMS crews run about 150,000 calls a year, which works out to nearly 411 calls per day.

Once the EMT turns over her patient to the nurse or doc in the emergency room, she's done with that patient. She gives a report – to which the nurse or doc may or may not pay attention – but there's no system in place for the EMT to follow up on the empty fridge, the filthy house, the undertaken medications.

And in a typically overloaded emergency room, Mrs. Smith's need for a case manager to make sure she's got a primary care physician, Meals on Wheels, and heat in her home often takes second stage to the cardiac arrest happening behind the curtain to the left. Is this the fifth time Ms. Smith has been here in two weeks? That's usually worth a comment or two by hospital staff. But rarely does it lead to intensive case management, a social worker visiting Mrs. Smith at home, or any other changes to Mrs. Smith's life.

So at 2 am the next morning, Mrs. Smith calls again.

But – and here I'll differ from the Johns Hopkins Childcare’s Center researchers – Mrs. Smith's calls are not “unnecessary,” even if her physical condition does not warrant the ambulance crew taking her to the hospital. The calls these frequent users place are often very, very necessary – even if there's no immediate life threat present. These are cries for help, requests for social support, basic health care services, and someone to just plain care for a few minutes."

 

[Chook]

I guess the key would be being able to separate yourself from the nature of the call... whatever it is, and let your admin worry about the rest... but I would get frustrated probably too.

That is such wise advice.

I can appreciate the frustrations FF has described. But at the end of the day, who's problem is it?....Managements...:cool:

There should be a process for concerns with people we see as "time wasters" / "Doritos". Treat them as you would any other and let management sort things.

I have done this more than once, waited weeks for feedback, then after the investigation been humbled when management informed me of the person's bigger picture.

I understand their will always be people out there that treat us like shit, so unless it has become personal, then they are targeting the uniform and not the person.

Remaining professional and non judgemental is vital for open communication......Yes it can be a challenge for you with some.

 

[Chook]

The context of my post may be easily misinterpreted....Especially the time waster dorrito remarks.

Apology if offended.

 

[VeteranFF]

Barberian, I'm truly sorry for your experience in the ER but I'd like to clarify some issues. Many were offered in my introductory post.

Then I read your post about people being like Doritos. I don't know how many people on this site have attempted suicide. I don't know how many people on this site have self harmed. I do know there are more than one of each catagory. Several have self harmed.
I have attempted before; the first time required a 5 day psych admittance plus meds, the second failed simply because I fell and broke several ribs. The pause that the pain gave me enabled me to re-evaluate my decision. That episode required 6 weeks off work, counseling and meds.

I looked at your status on the forum "Undiagnosed" read most of your other posts and didn't see a confirmed PTSD diagnosis from what you wrote. I am very protective of people I care about, and I had my suspicions at the time you might be a troll. I almost reported your posts asking for a moderator to evaluate your post, but figured I may be over reacting, and left any decision along that line for others to make.

I do not wish you any more stress or pain. We all have our share and more of that. I only wish you peace and comfort.

My introductory post also states that I sought counseling 10 years ago and was told by my counselor that she could not help me. I had many symptoms of PTSD but not all of them. That was 10 years ago! I was troubled enough then to seek help only to be told that she couldn't. You can't know how many people have died in my care, how the stink of cooked flesh can NEVER leave my senses, what it's like to try to identify someone only by a scrap of skull & scalp in the past 10 years.

No, I have not been formally diagnosed. Logging onto this forum is my first step to gain insight, am I the only one who feels like this?? Is my balancing act between rage, apathy or crying normal??? I imagine it took a lot of courage on your part to become a part of this forum and share yourself, am I not afforded the same acceptance? It takes courage to put yourself out there to strangers but even more to sit in front of a living person and decide if you can really bear your soul to them. By being here I'm hoping to gain support, insight & enough courage to seek professional help.

If the Moderator determines that my posts aren't germane to this forum I'll seek assistance elsewhere. Mu intent is to help myself, my significant other and those around me that I care about who are concerned about my "demeanor".

 

[Barberian]

I don't know how to respond without a large post. --- We all have our "baggage" of PTSD.--- I saw red when I read the Doritos part of the thread and may have not been as compassionate as I should have been. [meaning I may have jumped the gun]


Then I read your post about people being like Doritos. [and jumped with both feet]

I do not wish you any more stress or pain. We all have our share and more of that. I only wish you peace and comfort.

I guess I didn't explain myself very well. Communication is not a strong point for me. I was indirectly trying to apologize for my jumping the gun, and explaining why i jumped the gun. At the time of my original writing, I was afraid you were a troll. Repeat... At the time fo my ORIGINAL post... My opinion has since changed. I'm long winded when I write so I can easily see how my message might have been lost.

I do not wish you any more stress or pain. We all have our share and more of that. I only wish you peace and comfort.

 

[Eleanor]

FF - I appreciate your honesty and efforts to come to terms with what's gone on/going on in your life. It's our burden as human beings to always be limited to the partial view of any situation we are in.

I'm wondering (just guessing, and hoping I might have hit on something helpful) if you aren't muddling up three rather separate (although deeply interrelated and similar) issues:
1) compassion fatigue
2) moral outrage (three kinds!)
3) the effects of cumulative trauma from your work

I think the posts here in reply to yours tend to address one, but not usually two or all three of them.

With respect to compassion fatigue (about which there are a number of posts you can search for here, as it has been/is an active topic of discussion among both sufferers and supporters) the solution seems to be - rest. Care for yourself, fully and deeply for as long as it takes. That's my guess for the "dorito's" defense mechanism - too much pain, too much suffering it is too hard to extend yourself to the hard cases. No blame here, human beings get tired, and compassion and caring is exhausting business.

With respect to the moral outrage (yours and others) - a disorder from which I suffer/ed for many years - I think there are three separate areas: Moral outrage at individuals, at systems and in threads here.

What I have learned is that I am most grateful that I am not a judge, civil, criminal or cosmic. I have, over the years, so often discovered myself to be wrong, uninformed, misinformed, straight up ignorant or (worst of all) un-or anti-compassionate that I am greatly relieved that my judgments held no power. With respect to the last it is most often in those areas where I lack compassion for myself - when I ignore/deny my own needs and pain that I am most apt to ignore the legitimate needs of others. It is hard not to be deceived by appearances and resemblances to prior experience - but it is all to easy to be so. Is it possible that the fellow with the itchy crotch had some far more serious issue that he couldn't/wouldn't express (obvious he had some rather serious issue, sane and balanced people do not make such calls!) In my experience many men are appalling bad at asking for help with medical issues, and when they finally get around to doing so what comes out of their mouths may or may not have anything to do with the actual issue. So it is possible something else might have been going on there. Or not, he might just be a selfish jerk (which, alas, our medical system cannot cure.:))

The problems with treatment and admission and resource allocation (nod to Barberian's experience) are legion, and one wishes that the people with the power and resources to deal with such things would loose more sleep over it, so that the people who have to live with the irrationalities of the system might loose less sleep. In any case, one can look at where one might have an impact, do that thing, and then get on with other stuff.

Finally, it is hard to "perspective switch". Particularly if you have unresolved/unassimilate trauma. I, for example, cannot think about labor and delivery without getting pissed off at my OBGYN for any number of things. And when the topic comes up I have to STOP myself from ranting. And I don't have PTSD. So when you talk about your experience as a care giver - others on the forum are likely to relate only as patients and project their experiences onto yours. And there are a number of people here who have had very bad experiences indeed. I think you are Barberian are well on the way to reconciling your viewpoints - which is (IMHO) an extremely valuable process. I kind of think that the threads that get a bit "heated" (or even more than a bit) are often the more valuable (at least for me, can't speak for others).

Finally Finally the trauma - at the very least I hope you find and talk to someone who has a lot of experience with specific and cumulative trauma. I can't tell you whether you have PTSD but clearly you are suffering as a result of your experiences and you deserve help in building some peace in your life. The huge emotional swings, nightmares, etc - they are not inevitable or irreversible, and there are people who are successful in bringing about healing of such things.

 

[BloomInWinter]

WARNING - Trigger ALERT. Blood. Gore. Violence. Death.

This forum is about support. If a thread is triggering for me, it's usually because I have issues. I 'take what I leave and leave the rest' - generally.

There is a 'gallows humor' which I too have used as a mental defense by a psyche in retreat from humanity out of repeated exposure to the worst it has to offer.

VeteranFF, I stand with you. I have made different versions of the same psyche-defending comments. We need that ability to 'stand aside' from the violence, gore, misery, and death sometimes, or we're at risk of our core selves disintegrating from the onslaught.

It's ok to be sickened at the loss of humanity, both in ourselves and listening to others. But let's all try to be kind to each other.

I'm very glad most people don't have to experience what it's like.

My paramedic years did cause part of my PTSD. (ER tech/paramedic, so I'd take the call go out, bring them back, and be on the treatment team until admission, discharge, or death.) I remember working my a$$ off for hours trying to save someone who wanted to live; only to lose them as their life bled out all under my aching feet. Then, was expected to wash hands, change gloves, and try to find empathy 2 minutes later as we dealt with a suicide attempt....it was an emotionally demanding job that was unreasonable for human beings to be put through. Many of the nurses and partners I worked with broke down in one way or another.

I doubt the healthiest person could do this over and over without losing their compassion sometimes. Yet, emergency rescuers are expected to do this all the time.

It's hell on earth to document the death of a murdered child right before shift change - then be expected to 'be happy' at a child's birthday party just 30 minutes later.

Or have to search the ditches for the matching baby to the failed empty carseat found far away from the crash impact.

Or have the person you 'saved' before finally succeed (in a messy bloody way) just a few shifts later. Or be bitten, spit on, kicked, hated, and threatened just because you're the one taking that person in for their own safety.

But that is the reality.

Having human brains on your shoe. Maggots living in the chair of the neglected disabled person someone finally noticed hasn't gotten up in a month. Really.

Having to hold down screaming traumatized hurt children for their safety.

Having to debride burn victim's wounds while they are screaming and the stench of their destroyed skin, fat, bone is urging your stomach to try to rapid eject from your throat.

Watch a domestic violence victim repeated go back to the person who is destined to murder her.

Had to walk through the crackhouse past wailing children....hoping nobody had a gun, because they lied to dispatch to save their asses and now you find yourself without an escort.

Been on 'baggie patrol' picking up the remains of a successful traintrack suicide, or trying to find the amputed body parts, or matching up pieces to get into the 'approximate' bodybag.

...ugh. Well, you get the idea. We're all entitiled to feel whatever we feel about what people post. But I choose to try to have empathy first, silence if that fails, or stay off a thread entirely if I'm in one of 'those' moments. I don't always succeed.

But I hope I'm never the reason someone walks away from hope. Because I try to remember that could be any of us under similar circumstances.

 

[4L150N]

I think maybe I'm just too removed from emotion to get outraged by the doritos
comment. I have holed myself up in my apartment for the last few months because I can't handle the stupid people out there. I guess with everything that I've been dealing with, ridiculous nit picking and people taking advantage to their right of free speech is just WAY too much to listen to/be compassionate to when I'm teetering on the edge of merely surviving the day.

That being said I did want to make a suggestion to the OP (FF) regarding a possible switch to hospice care.... One thing I learned in treatment is that I care more about other people than I do about my own wellbeing. That's what I've been programmed to do. I've always had WAY more responsibilities than someone my age should have by this point, and as a result I feel as though I am always responsible for everyone. That I'm the only one who could possibly understand someone having a rough go of it. I gravitate towards people who need someone to take care of them because I don't feel worthy to give that time and care to myself. I'm always putting everyone else on a higher pedestal than me because I have learned that I'm not worth caring for and that everyone else is more important than I am.

My suggestion to you FF is that you perhaps get into something career wise that helps you take care of YOU. You've done your share of selfless acts and rescuing.
Life is all about balance and the balance between selfishness and selflessness is especially hard when you're a caregiver by nature or necessity. I'm a caregiver out of survival, so a career that puts me in that position day after day is really only harming me as it gives me an excuse to ignore my own needs.

<Inserted Paragraph Breaks>

 

[BloomInWinter]

The labeling of human beings with dehumanizing terms is a psychic defense employed by severely traumatized human beings.

VeteranFF's dorito's comment is, to me, hard-evidence of crimes against his psyche by a job environment that is unhealthy at best. VeteranFF, I don't believe you owed an apology for a symptom of this psychic injury. That you have is evidence to me both of the real empathetic person you are, and that you deserve witness and compassion.

Barberien, your feelings about that comment is a symptom of your PTSD. I found after awhile that the feelings I feel are a beacon to discovering my own healing path. You reacted in a way that further traumatized someone else, but we have all done that. You apologized...no need to continue any further. It's ok. Truly., as far as this thread. The rest is between you and VeteranFF.

If the two of you need to smooth things out, sometimes private messaging or on each other's walls can be an excellent practice for conflict resolution.

Repetitive apology posts aren't healing in the long run, as the 'flogging of self' becomes avoidance of the feeling originally triggered. Believe me. I have far too many ranting posts to pretend this isn't a major issue for me.

Thank you all for making this forum emotionally safe for all of us.

 

[timetorecover]

ScaredOfLonely, timetorecover & Barberian - I'm sorry that I offended you.
.

I am sorry:oops: and I fully understand your analogy now! - I should not have posted when I felt triggered.

I wish you well on your healing path and this is a great place to do so. Please do not be discouraged from sharing your memories. Welcome and sorry again!!

 

[Meadowsweet]

By being here I'm hoping to gain support, insight & enough courage to seek professional help.

For me, asking for help for the first time was the most difficult thing. At my assessment, I mentioned that there was an attack, but wasn't ready to share details. I'm waiting for therapy, and I worry that I'll just freeze and not be able to talk. But, I've started a trauma diary here, and I talk about bits and pieces that come up in my mind. And I really feel that doing this is like a practise, preparing me to speak face to face with someone.

Also, you mention that you had counselling that pretty much failed to meet your needs. If you go to the therapy section, there is a thread explaining the difference between therapies "what is a trauma therapist". It may explain why the counsellor didn't help much.

 

[VeteranFF]

I had to take some time to stand back and evaluate what's been said. My first acknowledgement will go to Barberian. He & I had a heated discussion and I was, at first, taken aback by the intensity of his response but I now realize that he & I are opposite ends of a spectrum with such a great distance between our points of view that without communication of the type we had it would be impossible to see the others view. That is not to say that we can't find or haven't found some common ground. I hold no ill will for Barberian and would like to thank him for helping me see what it is like from his experience.

I'm grateful to everyone who has responded both in support & criticism. Without differing views information cannot be exchanged. There have been some very good points raised, 4L150N mentioned always putting others needs ahead of his/her own because of self worth issues. That struck a chord in me that I need to explore. I didn't have a nurturing childhood. There was physical and emotional abuse so that I enlisted in the military at 17 just to get out and never returned home. That may be a later post.

I expect this thread to now die a graceful death. We've exchanged views and perhaps changed a few, I believe that mine have to some extent. Thank you.....