EMS – You Can Never Leave

Last thing I remember I was running for the door

I had to find the passage back to the place I was before

“Relax,” said the night man, “We are programmed to receive

You can check out any time you like but you can never leave”

EAGLES – Hotel California

EMS is like the Hotel California: “You can check out anytime you like… but you can never leave” the memories, faces, successes and failures will always be with us. They dim at times over the years, but they are always there. I read a thought provoking and honest analysis on being a paramedic a few months back and have been mulling over her post, digging through ramblings from my field journals and the skeleton of a story I have been working on for about 2 years… these all prompted me to ramble further…

The blog post that triggered this article is: Unless you’ve been there, you wouldn’t understand: A Paramedics farewell to the job. Posted on February 10, 2015 by Di McMath

https://dimcmath.wordpress.com/2015/02/10/unless-youve-been-there-you-wouldnt-understand-a-paramedics-farewell-to-the-job/

One of the key issues for me is the ability/or lack thereof to detach from what we are doing and seeing; this drags one into the massively dehumanising temptation of EMS. I do feel that this dehumanisation is both inexorable and dangerous – as practitioners we need to know how to halt or slow it down. After 30 years of emergency medicine practise; I am still not entirely sure if we can entirely halt the process, which is why we can never fully check-out.

Being a fan of the poetry of Wilfred Owen, and as I reread his poems on a regular basis, I was drawn back to his poems during this thought process and found some further insight on reading “Insensibility”:

And some cease feeling

Even themselves or for themselves

Dullness best solves

The tease and doubt

The poem plays along the interesting juxtaposed lines of detached versus involved, and the varied degrees of these mindsets. Those of us in the profession have over the years dabbled with both approaches, the trick is for each individual to find his/her own balance. That is all part of the process of slowing down the dehumanising process. Finding this balance is key, if we do not, then we are doomed to keep repeating the mistakes of our past (mistakes as regards emotions and those of a clinical nature).

Emergency Medicine has the ability to dehumanise and diminish or renew and expand our powers of feeling. It is our choice to decide which path to follow. We realise soon on in our profession that this is one of the many choices that we have to make. How we deal with this choice determines how we deal with another key critical decision we as practitioners in the field are confronted with at numerous times in our career. Who lives or dies, or why do some people die despite our best efforts; and the pain of admitting defeat and saying okay, we need to stop now, the patient is deceased.

It is on these crucial scenarios, that I have to agree with the title of Di’s blogpost:

Unless you have been there you wouldn’t understand – Its sounds trite, but it is so true.

Trying to explain this process of immediate Triage, that at times needs to be done in very short time frames, less than a minute, is very difficult. Those are some of the choices we can never walk away from, and even when we do make them we cannot stop thinking about “What If?” the curse and bane of every paramedic. The cursed ability to second guess yourself long after the fact on an ongoing basis. It is here where we as emergency medicine practitioners are faced with the dehumanising and diminishing or the renewing and expanding of mental and medical health.

The goal of our profession should be a living force in the quest for and prevention of human suffering, but that sometimes comes at the cost of our own mental health. As we enter, continue in and exit this amazing profession, lets consider the cost to those we have served and continue to serve. All we can do as practitioners is warn, and that is why the practitioner needs to be truthful.

6 thoughts on “EMS – You Can Never Leave

  1. Thanks Mike. Glad it is helping to remove some of the stigma of talking about how a lot of us feel. Until I wrote it….I had no idea that anyone else was thinking and feeling the same – but it’s certainly started conversations, which is great.

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    • Thanks for the comment… yes their is still a stigma, in fact on some job applications (in South Africa and for work in Africa) that ask if you have ever had mental health issues, its better to just lie, as some companies will not hire you for the contract. Their is very little actual support, its just lip service…

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      • That’s disappointing from employers! Actually, if you take out ‘income protection insurance’ there is an exclusion from making any claims for 2yrs – if you have sought help for any mental health issue. Very sad that it can even have that sort of ‘discrimination’ so much that it could possibly prevent anyone from seeking help if they need it.

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  2. Sadly we do not have those options in SA or Africa, and yes we would be very much discriminated against if you have any mental health issues, be it depression, bi-polar or even if you have at one time or another been on medication for work related PTSD. The is a small change in the approach from some managers, which it was a bigger shift, as PTSD is a huge concern in our industry (we never speak about the invisible scars). Especially with the high levels of violent injuries we encounter and violence from patients, bystanders and criminal elements. It has been on my mind a lot of late and am now wanting to try and activate for more support in South Africa re this pressing issue.

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