Observations From A Paramedic

[SeekingSerenity]

Even the most compassionate doctor/nurse/EMT/FF/etc will have a point where they just say "You know what, forget it. You're sick, I did the best I could, I'm done." And that is okay, and normal, and healthy. You're not invested in these people permanently, so you shouldn't extend permanent parts of yourself to them.

This is, in my opinion, the bottom line.

How do we do the job, to the absolute best of our ability, but then walk away and leave all of the hurt and pain and emotion behind us. We cannot take it home, it destroys our relationship with our families. We cannot just throw it on the ground, it has a dignity. We cannot store it up inside ourselves, its festers and kills us slowly. We need to find a way to let it go, with compassion and caring, and empathy, and dignity.

But we HAVE to let them go...

 

[Meadowsweet]

I think to find compassion for others, we have to be able to accept and find compassion for our own mistakes or weaknesses. But there will always be some people who are beyond our ability to find compassion, and I think thats ok. But its more peaceful to simply accept that our compassion doesn't go that far and do the job coldly or act the part.

But there are not illnesses for good people and illnesses for bad people. So to measure out compassion or idealised judgements based upon the condition that is being presented is an irrational thought process.

In all honesty, I think it would be more beneficial to seek help for those thought processes and the emotions that go with them.

Avoidance is a part of ptsd. The idea that all your inside feelings will get better if you can avoid, in your case, 'undeserving' people, isn't necessarily going to happen.

 

[The Albatross]

I was just a base level aide...off and on for about 13 years - though I worked with many people in hospital, long term, skilled, post surgical, hospice, and home health settings. In my mind it was and is an "honor" thing. Honoring the life irrespective of the situation... with the caveat "the best that I can". I would search hard and find one thing I could appreciate and like about each client or patient. Just find one. And it made it easier. But my assistance was more long term and not emergency or trauma. The construct in my mind is to appreciate each person like we appreciate the subtle differences in snowflakes. To recognize and appreciate them for the finite time I provided care. The result, for me, wasn't compassion fatigue, but I did become very frustrated with coworkers and ADON's, DON's... some of whom didn't provide, I felt adequate level of care. I cultivated working relationships with people who, felt like I did... and got pretty upset at times with staff that were just there for the paycheck and didn't feel inclined to provide the level of care competently. I was always willing to take on the more difficult clients... along with a core group of nurses. I needed to be able to come home knowing that I did the best I could for each person every day. The script in my head, no matter the situation they were in before they came to me is, "This is someone's son or daughter, this is someone's husband or wife, this is someone's brother or sister, this is someone's mother or father... If this was MY son/daughter, husband, brother/sister, mother/father how would I want them to be treated?" and I focused on that.

Failure to thrives would break my heart. I always felt I had missed something important, some way to reach and engage them when they wouldn't participate in their recovery. Eventually I hit my "magic number"... and I went into health and wellness working for a Y... but up to last year I went back to caregiving... and I now do both. It provides a balance for me to be part time employed by a health and wellness place.

By sheer volume and the nature of trauma or emergency care... I think that there are so many things to attend to... life saving, that this would be of no use except that you shared you are becoming a nurse. Your client/patient relationships (and they are relationships however brief) will be of longer duration. So the above is just something for you to consider as you complete your training. I hope this helps you.

P.S. I have a friend who became an RN... and to get balance... she worked part time a couple weekends a month at McDonalds. Her job was to stand in a taped box on the floor at the counter and hand people their meals saying something like (I can't exactly remember) "Thank you for coming to McDonalds, enjoy your meal." She said after a grueling week of critical decision making... she found it balancing and comical. For her, her balancing was doing something practically mindless and at times funny.

 

[mamachick]

I also agree seeking help for the feelings surrounding your work, however, that can take a lot of time and will not happen over night. In the meantime, is it fair to those who are affected by your lack of compassion.

Many of those people who we are talking about already have encountered lack of compassion and empathy toward their situation reapeatedly, and feel that nobody cares, that their lives are unimportant, and lack value. Im sure that even so, they can be the most demanding, obnoxious, and pain in the butt to work with. There is nothing wrong with not wanting to work with this group.

I know a woman with ptsd that kept trying to do home nursing with Altzheimers patients who were combative-it was a trigger for her. She was much more calm and effective working with a different population. We need to understand our differences and accept the limitations. We do not have to change everything about ourself. Some of it can be a timing in our life as well. There was a time that I did not want to work with teens, I had 2 at home and was a single parent. I was bias toward the parents view. I didnt need to change this, I just needed to avoid it for the time. It can be self preservation more than avoidance.

I will not knowingly take work with the potential for violent clients. Im 53 yr old female with herniated discs. Im not in avoidance-I am self protective. Some collegues do not mind at all. I worked with men who abused women-most of my collegues thought I was nuts. I liked it. I was able to see the whole picture and found the positive in it. We are all different. We need to accept our limitations.

 

[Zipperhead]

Seems strange that a thread started to discuss valid issues around someones PTSD has turned into a forum to criticise. Not so helpful there folks. Sometimes we have to recognise if we are triggered and avoid posting when we are.

 

[VeteranFF]

I regret that my post ignited such a firestorm of opinion. I don't know where to start but I'll take the opportunity to respond. I want to take the comments as thought-provoking. I stated in my first post that I can't stop caring and I think Sea made the point about whom we choose to extend ourselves to. Making that choice does not mean that I give less or substandard care.
I regret that my post ignited such a firestorm of opinion. I don't know where to start but I'll take the opportunity to respond. I want to take the comments as thought-provoking. I stated in my first post that I can't stop caring and I think Sea made the point about whom we choose to extend ourselves to. Making that choice does not mean that I give less or substandard care.

Let me present to you a few scenarios and privately let you decide how you would react. The 32 year old man who calls 911 because he had been jogging and now he's got crotch rash, the individual who calls for pain and meets you at the curb who wants to go to a hospital on the other side of the state line because he's been banned from 4 hospitals in your area for known & documented drug seeking, the family who calls because grandma has had diarrhea for 1 day and wants her taken to the ER by ambulance because they know EMS will take her directly to the ER bypassing the waiting room and triage who would have held her if there were any patients with more emergent conditions. Do you want her going ahead of you wife or husband if they're having chestpain or signs of a stroke? How about the guy that calls 911 for a vague nondescript complaint wanting to go to a hospital 30 miles away. He refuses any treatment. While getting his demographics you find out that he lives 10 blocks away from that particular hospital. During transport he sits on the cot texting his girlfriend. When you get to the ER your patient checks out AMA before you even finish your report an walks out the door. I've just become a taxi for someone who didn't want to pay for a ride home, robbing YOU or your loved ones of an EMS crew for over an hour.

Every time I roll out the door on a REPORTED emergency call, besides my Med Unit I have an 80,000 lb. Ladder Truck running emergency as well as 1 or more Police Officers. I'm risking my life, the lives of my entire crew and the lives of the general public..... REALLY!!!! because you have crotch rash?????

The difference between these kind of people (systems abusers) and patients in oncology, hospice or where ever in the clinical setting is how much of myself I will extend. I CAN make a difference in their lives.

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

Brat17 - I'm still processing your question about fear of losing my own cookies. I've ignored this condition far too long and have to look at it as objectively as possible.

Zipperhead - all I can say is Thanks.

 

[The Albatross]

Hate to tell you folks, but there are people here who are emergency personnel, medical, and care givers - who also have PTSD. PTSD is no respecter of professions... and I appreciate honesty a whole lot more than superficial stuff. A genuine issue was shared honestly. This is a big board... there's room for everybody.

Veteran FF... I'll come back to your scenario this evening... got to get to my afternoon shift. But I see no problem with this thread or the content. It's honest, and it's something people in some professions experience and need to come to terms with.

 

[VeteranFF]

Thanks Albatross, I'll be looking forward to your post. What I posted is a byproduct and a possible symptom of what ever this condition is (maybe just bad attitude) not the source. I can gauge my months or years in body counts. Those are the source not the abusers. These systems abusers add to my frustration that undoubtedly exacerbates my underlying condition. I could post pages of graphic detail of memories and that I hold but this may not be the place.

 

[suzie q]

Thank God that our feelings and thoughts don't make up the "whole" of a person. I think experience and healing are part of who we really are in life. If you can't express yourself verbally, how can you heal internally or spiritually?

In my journey to healing, I have learned a valuable gift. When I come across thoughts that put my mind to defending my feelings, I have to stop and ask myself "Does this trigger me and remind me of something that I don't like about me?" Is my reaction "but for the grace of God, go I?" Do I remember a time in my life where I was the "victim" and therefore I can relate to the victim part of the topic?

My reactions to topics that feel attacking or lacking of kindness are a trigger to be defensive. When I'm defensive, I lack the ability to be rational and I close my mind to things that might help me understand myself so I can heal. I have to allow others to share their true feelings and nature no matter how that may seem to come from a lack of compassion.

If after investigation I find that I disagree, I can express that by agreeing to disagree. This process helps me stay out of denial and judgement which never helps me towards my own healing. Words are a terrible weapon. In my opinion, we don't spend enough time paying attention to how that will affect someone's feelings or perspectives. Having said that, I certainly don't wish that someone would stop being honest in their attempt to heal. I was allowed that gift by others and I don't wish to stop others from the same.

In my experience, honesty is the only way to truly heal on all levels.

 

[Barberian]

I don't know how to respond without a large post. Sorry for writing such a large post, I am not trying to hijack the thread, just trying to show my motivation for getting angry at this post. I've read the thread up to this point and I am not as critical as when I posted above. 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.

FF, When I read the thead, it was one day after I was ambulanced to a local ER. I had an anxiety/ptsd/rage going on and was almost totaly out of control. This was 8-9 pm. The only control I had was not to physicaly strike out at those around me, but that was about it, and it took all of my self control to do that. I was able to tell the ambulance crew that I wanted to be taken to the local VA hospital, about a 40 mile drive. My wife told them to take me to the local VA hospital. I had been taken there before by that same ambulance company, and it was not against thier policy. I knew if I was taken the the VA hospital they would probably admit me to thier psyc ward. The crew that picked me up took me to a local hospital instead, against my wishes. I was not in a condition where I could object. The ER I ended up at treated me like a "Doritos" chip as well. I was put in a room, asked a few basic questions, left alone for almost an hour as I tried to not leave the room and kill everyone in the ER. I was in a lot of physical pain, and the bed was in an upright position, which only added to my pain as it was extremely uncomfortable. I'm 6'3" and around 250 lbs. Not much room on the flat part of a hospital bed for a guy my size. I couldn't get anybody to change the position without going into a homicidal rage so I just lay there, alone, in tremendous physical and emotional pain, scrunched up on the flat part of the bed until they finally came in with medicine to help relieve my problems. I was then left there until the next morning when food service came in with my room temp eggs and cream of wheat. I was then left alone until around 9am when local mental health councelor came in to assess my condition. She had about as much compassion as a rock. She kept trying to say I did not have PTSD based on 10 min of conversation with me. She then went on to tell me SHE had PTSD and I didn't know what it was like... After another 15min or so of the interview she determined I did not require inpatient at her facility, but I could check myself in if I REALLY felt I needed to. The way she said it was like "Please don't waste our time". Sitting here today as I write this out I still want to go to the local VA and check myself in because I'm really not stable. I can be in an almost good mood for a while untill just about anything sets me off. I am still a danger to my wife and my pets who I've been doing my best to stay away from when I'm not sure of myself and my ability to remain calm. The only reason I haven't checked myself into the VA psyc ward is I can't get there.

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. Reading your post, knowing there are people on this site who may have, probably have needed emergency care from self inflicted harm, and relating your post to these people who may read your post, combined with the treatment I recieved at the ER set me off. Was I out of line? I really can't answer that as I'm very biased right now. 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.

 

[Zipperhead]

I guess it's a two sided situation. Yes, the vast majority of people do not understand mental health issues, and the end result is the appearance of apathy on the part of the healthcare system. Now the other side, the part that the thread is about. The end effect of the constant demands on our healthcare profesionals. The constant exposer to traumatic situations. The ever present danger that dealing with emergency situations entails. The constant reality that any mistake on their part could mean a life, and a demand from society that they perform flawlessly. The good samaritan principle does not apply to professionals. And now it would seem that we are going to add that they be immune to the effects of this to the list of job skill requirements. Does constant exposure to these situations cause calouseness? I hope so. If it doesn't, how would they ever bear it?

 

[The Albatross]

...Let me present to you a few scenarios and privately let you decide how you would react. The 32 year old man who calls 911 because he had been jogging and now he's got crotch rash, the individual who calls for pain and meets you at the curb who wants to go to a hospital on the other side of the state line because he's been banned from 4 hospitals in your area for known & documented drug seeking, the family who calls because grandma has had diarrhea for 1 day and wants her taken to the ER by ambulance because they know EMS will take her directly to the ER bypassing the waiting room and triage who would have held her if there were any patients with more emergent conditions. Do you want her going ahead of you wife or husband if they're having chestpain or signs of a stroke? How about the guy that calls 911 for a vague nondescript complaint wanting to go to a hospital 30 miles away. He refuses any treatment. While getting his demographics you find out that he lives 10 blocks away from that particular hospital. During transport he sits on the cot texting his girlfriend. When you get to the ER your patient checks out AMA before you even finish your report an walks out the door. I've just become a taxi for someone who didn't want to pay for a ride home, robbing YOU or your loved ones of an EMS crew for over an hour.

I got no doubt that all these are real scenarios the EMT's have to deal with... I saw an expos"e (sorry no accent mark) on south Los Angeles and they followed units to their calls. I know that a certain segment of people are using/abusing emergency services in this manner... because of many reasons. I almost went through EMT training here, but didn't after going on a "ride-along" because I didn't think I would be suited.

I almost wish that there was a dispatch unit for traveling "nurse practitioners" who could respond first before emergency personnel... but of course someone would have to pay for that as well and if it was cardiac or a life threatening call it would be a huge liability for the service or municipaliity. 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. I imagine it took you a very long time to feel this way... and think that Compassion Fatigue is a risk of all emergency/rescue/law enforcement and some medical professions.

When I was in the nursing home... we had a client with chest pains, a history of heart attack and all the area responders were involved in transport. I and an nurse wheeled them two blocks in a wheel chair to get them to the hospital. And after we got him there it still took a few hours before we could be seen because the ambulances were rolling in. None trauma, none cardiac... but they had priority.

I think though, that it will be easier to regain some empathy when you are an RN. It's a mixed bag still, but it is easier than being rescue/emergency because you aren't involved in the admittance process and as an RN you primarily will be charge nurse or managing a unit. LPN's and aids do most of the direct care now.