Tuesday 26 March 2013

Invisible Wounds

"Female u/k age, tired, mental health problems"

"What's been going on?"

"About a year or so ago I witnessed something horrible. The death of a young man. I suppose, in the days / weeks that followed I expected to see his face in my thoughts. On the night itself I think the adrenaline kept me going until I got home. I just laid there on my bed and absorbed it all. I'd just watched someone die in the most horrific of circumstances and was helpless to stop it. Could I have done more? It was a helpless feeling that I just couldn't shift. His face. It was there all night. As the days past I thought about him less and less. I don't remember when his blood stained face stopped appearing in my dreams but within a month I'd say he was gone."

"So what's changed?"

"I found out his name. I was shown an online article about his death. I suddenly felt I knew who he was, what he was meant to be, what he had lost. His blood stained face came back. I'm plagued by flashbacks on an almost daily basis. I can't get his face to stop invading my dreams. It's weird though, now I almost take comfort in his presence. I can't imagine a day where he isn't present."

"And have you talked about this to anyone?"

"Sure, I've spoken to the people that were there and others. I feel like I'm the only one bothered by this. It's an overwhelming isolation which is eating away. Maybe it's just sleep I need. I can't remember the last good nights sleep I had. I've always had a problem sleeping but now it seems worse. After hours of trying I eventually get to sleep but once drifted off I'm awake again with an alarmingly predictability and the circle starts again. And again. Sometimes I just wake. Sometimes it's a nightmare. I picture his last moments again and again. Not from where I was though. It is as if I was watching it on TV. And I'm not looking at him really. I'm looking at me. It always ends the same though. His bloodied face, distorted, mutilated and swollen, lifeless. It's just......there."

I was clear just from looking at her eyes that this was taking it's toll. She looked drained.

"I have seen things that should upset me since but they don't. Maybe I'm hardened to it. I just feel numb. I try and keep busy to take my mind off it. The more tired I am the more I try and avoid thinking about how tired I am. I know if I think about sleep I'll think about him."

"What about your friends and family? Do they know?"

They do and they don't. They say they do yet I feel vilified for being irritable. Despite how I'm feeling they always have something trivial which is much much worse. Either that or I'm given happy clappy cliche advise about 'staying strong' etc. My mood swings back and forth and I try to only interact with them when I in a good place. It's just easier that way. I'll be fine, I'll get over it, I'm just tired."

"There is help available." 

A smile appeared on her face. Clearly I wasn't in on the joke.

"Yes I know, therapy, drugs, a sick note etc. No thanks. Can't be dealing with a disciplinary and P45 too! Work is a good distraction but they don't take kindly to mental frailties! Honestly, I'll be fine! Just venting!"


*          *          *          *          *


The 'patient' was me. The 'guy' was patient from '3am' (read). Post Traumatic Stress Disorder (PTSD) is very very real. It's often associated with the military due to the sights they see and the environment they are in. However, it is becoming more and more common, or more and more freely admitted in the Police and the Ambulance services. I have it, or had it, I'm not really sure. I'm also not really sure if it is ever something that goes. Maybe it is and it just hasn't gone yet. Maybe it is gone and what is left will stay. I don't really know. I wrote this post because of one I read on the One Police UK Facebook Page. It really hits hope what PTSD is all about. 

Despite what the PR department will say, there really is no provision within the emergency services for dealing with it. I tried accessing the 'free counselling' service that is offered and if anything just trying to make an appointment made me worse. Actually saying  'I have PTSD' was of huge importance, as cliche as it is. Not in the sense of standing in a circle and saying 'My name is....... and I have.....' but to admit that your mental health is affected is quite a big thing. Especially when until that point, you only ever had to deal with other people's mental health. In the ambulance service, the closest you come to your employers knowing something is wrong is going off sick with stress. And lets be honest, that only stands to give you a reputation for 'someone who goes off sick with stress'. i.e. chancer, faker, pulling a fast one, playing the game, abusing the system. It's true. That is how you will viewed by management. 

Admitting weaknesses isn't something that is done much in an environment full of black humour and bravado. Mess room banter probably wouldn't cope with someone saying 'actually no, I see his face in my sleep every night'. You just play the game. Put on the brave face and only confide in the ones you think won't judge your weakness. Let's be honest, it doesn't give much confidence in a new crew mate when a simple head injury causes you a panic attack. There a triggers everywhere, it's about learning to spot them and avoid them. Sadly, this job doesn't let you avoid seeing words like 'fall from height'. These are the invisible wounds that PTSD leaves behind.

The problem we and police have is it doesn't stop. There is always a new memory around the corner. '3am' has effected me. It was the last job of the shift, the last shift in a run and I had seven days off to dwell on it. Maybe PTSD in the emergency services is more about timing rather that the event. I have seen things that a more tragic and more disturbing since but they don't effect me. Part of me wishes that they did. 
Another traumatic death or a dead child. Maybe the one memory that stays is protecting us. If every traumatic sight we saw effected us in the same way we simply wouldn't function. There is very little time to process information. Very often I have written about seeing something which most people would see as probably the most traumatic event in their lifetime, only to go to another call five minutes later. Maybe this is why

PTSD isn't going away, it is a fact of life and although some efforts are being made to treat it and make it more accepted, until it is fully embraced and tolerated by employers little will change. Let's be honest though, the reason why it isn't widely tolerated as a genuine reason for sickness is money. We can't have our police officers and ambulance staff on long term sick can we! There are targets to be met.....



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13 comments:

  1. I had an officer come to visit and check on me after a particularly difficult child call, but ended up being abused him. who to trust in the system now? he still works with us.

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  2. Thank you for your courage in sharing. I hope that in some small way sharing does give you an easing or relief.

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  3. What eats away at me is that I don't get effected by what I see. I feel that I am the least sympathetic and Empathetic person in the world because I can have a patient die in my arms and carry on the to the next job/shift/year without it effecting me. The only thoughts I have is "could I have done better" and "will someone blame me".

    I really wish I could feel more in these situations and question how bad things have to be before I finally crack.

    Maybe im bottling it up and one day it will all hit me.

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  4. Ella,

    Thank you for a very eloquent post on a subject that affects all of us in the emergency services. I am an 18 yr veteran of pre-hospital care here in Holland. The one specific thing that strikes me is your rightly cynical comment on targets at the end. I think it's appalling to see that numbers become before people. Also, the lack of professional peer support is saddening. We know the effects of the job and it's risks. Take lifting, for example: everything is done to reduce strain and subsequently sick-leave. Why is it any different for mental health?

    Carl

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  5. Well done for speaking out. It's not something easily discussed especially with the threat of a p45 hanging over your head. I suffer with depression but it generally doesn't bother me too much and occasionally I need a couple of weeks out. The ambulance service found out about my depression and had made up their mind that I wasn't coming back before the end of my sick note and was then just a case of playing the game. I was offered no support and they made it worse, I took my first overdose because of it. They said i might come across something that might affect me, I suppose I shouldn't turn on the telly then! Luckily I wasn't unemployed for too long before PTS hired me!
    Chin up lassie, your doing a great job!

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  6. PTSD is absolutely horrific to live with. I'm lucky in a way, because mine shows itself mostly through dissociation and amnesia, but the flashbacks and night terrors are truly soul-destroying. Plus mine is triggered mostly by hospitals, so it's taken ages to actually accept help as i was terrified they'd send me there. Luckily they've got a place nearby that doesn't look like a hospital, smell like a hospital and no one is dressed in a uniform. I sincerely hope for all of us with this, that this gets less difficult with time. I don't know you, but i send hugs *hugs*. You're doing a wonderful job, keep going :)

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  7. I'm almost speechless with helplessness with this one and wish I knew what to say that would make it better. As a nurse I feel I should be able to come up with something but hope 'sending hugs' doesn't sound too trite although I fear it does.

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  8. Thank you, I work for my ambulance service as well, and all too often these wounds, from the things we see and deal with, are covered over there is no actually support on place.
    So I thank you for sharing this. And I believe you are right too often it comes down to money

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  9. Thank you for writing this. Someone linked me to this post after I admitted that I was still struggling with a paed arrest from a months ago. It's good to see someone else writing about how this feels. x

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  10. I've been in the emergency services for 22+ years and for the majority of that time people exhibiting stress and certainly those "diagnosed" with PTSD were isolated pariahs - it's not contagious! I would like to think that attitudes are improving, albeit slowly, but reading some of these comments perhaps I'm being naive?
    I was supported well once I'd finally opened up to help but even so it was as if I was admitting a problem with drink or drugs (not to say the trauma I was reliving didn't lead to those "erroneous" therapies.) I received a lengthy period of counselling and intensive EMDR therapy. I was told that this wasn't a cure and what I want people to know is how true that is. I've remained in the emergency services, not all can, but after every call I assess myself.
    I'm always the last patient I deal with.

    Keep up the good work Ella, you often raise a lump in my throat or a smile. That's what the best EMS crews do for each other. Stay well.

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  11. I've been in the emergency services for 22+ years and for the majority of that time people exhibiting stress and certainly those "diagnosed" with PTSD were isolated pariahs - it's not contagious! I would like to think that attitudes are improving, albeit slowly, but reading some of these comments perhaps I'm being naive?
    I was supported well once I'd finally opened up to help but even so it was as if I was admitting a problem with drink or drugs (not to say the trauma I was reliving didn't lead to those "erroneous" therapies.) I received a lengthy period of counselling and intensive EMDR therapy. I was told that this wasn't a cure and what I want people to know is how true that is. I've remained in the emergency services, not all can, but after every call I assess myself.
    I'm always the last patient I deal with.

    Keep up the good work Ella, you often raise a lump in my throat or a smile. That's what the best EMS crews do for each other. Stay well.

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  12. this is really powerful post and I imagine it was hard to write too

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  13. Ella, this is horrible. What a thing to suffer. However, in a way I appreciate more than you can imagine you have helped me. My boyfriend is a police officer, he is currently suffering from PTSD, and although I try my best to be understanding (I worked for years in mental health), I often find my own selfish needs and emotions occupying my mind. He refuses to speak to me and is blocking me out almost entirely, which I interpret as "not loving me". So to read how it feels from a sufferers point of view has helped me enourmously. It has helped me refocus on his need and feelings.

    Incidentally, I'm disgusted to read the lack of resources your employers have to help you and fellow sufferers. The police have offered my boyfriend a week long stay at a residential "rehab" centre for injured (physically or psychologically) officers. If only these facilities existed for everyone who needs them.

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