The Tried to bury us. They didn't know that we were seeds. - Removing the "Disorder" from PTSD.

It came in like any other fender bender.  A one car collision on the off ramp of a local freeway; “Truck response”.  As we began the journey to the intersection in question, the dispatcher began to feed more information through the radio.  The Engine was already on scene and had called for us for extrication.  Driving the back of the Tiller Truck, I had the vantage point of the scene as we pulled up.  The passenger side had taken a huge hit, with massive intrusion into the passenger compartment.  The person in the front passenger side was clearly deceased, folded over in a way that defied classical anatomical teachings.  The Engine medic was assessing the driver of the vehicle, who appeared completely unhurt after the incident.  

I climbed out of the tiller doghouse and walked over to the Engine Captain.  There was a different air to his demeanour and I had a sense of foreboding that I didn’t usually feel, even on the more tragic calls.  As I neared the car, I noticed a cream woolen blanket covering something in the back seat, but thought nothing of it as people often had clutter in the back of their cars.  I finally reached the Captain, a gentle giant that usually had a huge smile on his face at all times of the day.  I could see the pain in his eyes as he began to tell the story of the incident we had arrived at. He told me that the car had lost control on the off-ramp and struck a huge steel post on the passenger side.  My son had just turned 14 months old at the time of this incident and had graduated from the baby seat to the upright version.  I had installed his seat on the passenger side of my car so I could see him when I drove.  

After listening to the tragic tale of the scene that had unfolded before me, I walked up to the crumpled passenger side of the sedan.  There was a three year old girl in the back of the vehicle, sitting in the same kind of seat my son had, installed in the same seat location. The blanket I had noticed earlier covered what was once her head.  The blanket wasn’t long enough to cover her whole body.  Red and white striped stockings and blue sneakers covered the little girl’s lower legs.  My mind would not stop asking the question “If she had been sitting on the other side, would she have been as unscathed as her mother?”  It made me completely rethink the position of my son’s car seat from that day on.  I often wonder why I get so angry when I see someone drive aggressively, then I’m reminded that I have seen the tragic results of the inconsiderate driver.

As this became a body recovery, we were sent back to the station for a while and then dispatched to return to remove the bodies.  My partner and I were getting on the truck when my Captain ordered us to stay at the station.  We both told him that we were fine and had no problem carrying out the extrication; which was true.  He replied with “You’re a new father.  You’re going to see enough images to fill your album in your career, there’s no sense in adding this one”.  He was right.  Both my Captain and Engineer were close to retiring and knew this would be one of the last times they would have to cut a dead child out of a car.  As young firefighters, we still had twenty plus years of images to collect, victims the same age as our children as they grew up.

“So did this crush you?” I hear you ask.  No is my short answer.  This became just one of hundreds of deaths in my twelve year career.  Some met a violent and tragic end whilst some passed away peacefully in their sleep.  Some died right in front of me whilst we fought tooth and nail to save them, whilst others had been dead for days before we found what was left of them.  Some codes went well, hitting every benchmark at exactly the right time whilst others were a futile attempt at gaining an airway whilst the body dispatched a non-stop flow of bodily fluids the wrong way down their trachea.  Regardless, none of them made it.  I have never saved a person from a full code.  The futility of doing everything you are trained to do but not being able to save a life is also one of the worst feelings a First Responder can encounter.

These calls have become a part of me.  This is not a “Disorder” the same way I did not have a back disorder when three ligaments tore lifting a patient.  This was the result of years of wear and tear.  Physical wear and tear resulted in a catastrophic back injury that was completely unforeseen.  This happens with the mind both physiologically and emotionally.  Each of these calls is an injury to the psyche.  As a compassionate human being that chose to serve others as a profession, each tragic incident, be it death, injury or loss of a person’s most cherished memories in a fire, these leave physical and emotional scars.  Seeing complete strangers’ lives torn apart by a lapse or concentration or murderous intent chips away at the childhood innocence we were all born with.

I am reminded of Michael Clarke Duncan’s character John Coffey in “The Green Mile”.  In this amazing story, although he is accused of a crime he did not commit, he takes the pain and suffering from people he meets and carries it himself.  One day, the burden becomes too big to carry on his own. In his speech to Tom Hanks’ character, the warden, he says: “I’m tired boss…..Mostly, I’m tired of people being ugly to each other.  I’m tired of all the pain I hear and feel in the world, every day.  There’s too much of it.  It’s like pieces of glass in my head, all the time...can you understand?”  I think this is the perfect analogy for a public servant.  We volunteer to be there on people’s worst days, day in day out.  Hoping to save a life or at least be the compassionate soul who holds them up after they lost their loved one.

I think it is time to redefine the mental burden of the tragic events that First Responders witness on a daily basis.  PTSD has acquired a negative stigma, an image of some mental abnormality, viewed as some sort of weakness.  This couldn’t be further from the truth, but I think this image is so embedded, and needs to be redefined.  This is not a disorder, disease, tumor or stenosis.  This is the load that the Firefighter, Cop, Paramedic, Dispatcher, Medical Examiner, ER Nurse and all associated professions carries from the pain they see.  To ignore or negate this is the recipe for tragedy, the catastrophic failure of the mind where the only escape is death.

PTS, Post Traumatic Stress, occurs from all of these incidents and accumulates the way a retiree carries visible scars from a lifetime of physical trauma.  From childhood scrapes to adolescent streetfights, the body tells a story and the mind is no different.  The trauma we see creates trauma in the depths of our minds.  The dark side, the shadow self is an ever present part of each and every one of us.  How this manifests is the result of three factors.  The first one is basic mathematics.  As time goes on, the images stack up like some precarious game of Jenga.  The longer the career, the more baggage is accumulated.  The most recent slew of suicides have been veterans of their respective professions, with decades on the job.  

The second element is what is going on outside of work.  As the burden grows, life events can have a magnified effect on an already heavy burden.  Relationship problems, financial strains, family health issues and deaths can be the final straw.  Family can be your greatest support structure or your greatest source of stress, depending on its dynamic.  I saw this first hand during my divorce as a single father, juggling two jobs and paramedic school whilst running 56 hour weeks on one of the busiest rescues in the County.  This is where removing the stigma from PTS comes in.  Having that support from family and peers is imperative to lessening this burden.  We must create an environment where we are comfortable talking to each other about calls and how we are coping.  Talking about the incidents and their effects on us is one way of offloading some of the accumulated stress.

This leaves the third and most important element in this perfect storm.  The coping mechanisms that we choose are really the only part of this trifecta that we can control.  A healthy outlet for this Post Traumatic Stress can help unload some of this burden.  The most common positive outlets are exercise, family, faith and altruism.  Healthy body, healthy mind is not just some catchy phrase.  It is true both physiologically and psychologically.  Exercise releases endorphins and flushes out cortisol, resulting in reduced stress and an increased sense of happiness.  Having a functioning body eliminates additional stressors such as pain and ill health.  Sleep is another area were wellness and hormonal balance can be achieved.  This takes a concerted effort from the first responder who works shifts.  

PTS becomes a “Disorder” when you stop controlling your shadow and it starts to control you.  Choosing poor coping mechanisms further breaks down the pillars that were holding you up.  Drugs and alcohol, infidelity, gambling and other self-destructive practices weaken our defenses in an already compromised structure.  So let’s remove the “Disorder” from this acronym and all start acknowledging that we suffer from PTS.  Make a video and join your brothers and sisters on The Dark Side Project Facebook page.  Listen to the amazing men and women on the Behind The Shield Podcast and use their lessons.  Create a positive environment that enables healthy conversation around the table, a chance for all of us to say how we feel.  Help lift those who are hurting and learn from those who have pulled themselves out of the darkness.

We ALL suffer from PTS.  It’s a simple as that.  I have listed the most common symptoms below.  I hope we can remove the stigma once and for all and stop any more of our brothers and sisters from feeling they have nowhere to turn. Remember, if you bury the seeds, they will only grow until they cannot be contained anymore.

Stay safe out there and Happy Holidays to you all!

James

SIgns of PTS in the First Responder:

Flashbacks of traumatic calls
Unexplained anxiety
Difficulty sleeping or inability to sleep
Dreams or nightmares
Unexplained anger or frustration
Lack of energy
Susceptible to “Triggers”.  These can be sights, smells or sounds.
Unexplained sadness or depression
A feeling of hopelessness
Feeling emotionally numb
Feelings of guilt or shame
Loss of sex drive
Memory Problems
Self destructive behavior
Thoughts of self harm or suicide

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