It’s been a year now, buddy. For me, there are still those days where I think, “maybe, if we’d just had that visit; if you’d gotten to visit with him like you’d wanted too…” Guilt is so common after suicide. Everyone will find an ounce of guilt to torment themselves with, it is engraved along this path of grief that we walk.

This weekend was likely an emotionally difficult one for a certain family. I send them all hugs and strength, hoping they remember the joyful times – and that facetious look he’d get in his eye when he was scheming up another practical joke.

A friend recently gifted me a wonderful little book called The Wilderness Of Suicide Grief by Alan D. Wolfelt. I am going to outline his “Suicide Survivors Bill of Rights” for you:

1. I have the right to experience my own unique grief.”

Each of us has our own grief, there is no right way to grieve.

2. I have the right to talk about my grief.

Please don’t ever let people silence or shun you when you tell your grief story. Talk it out as much as you need to.

3. I have the right to feel a multitude of emotions.

A multitude is right, it is such a rollercoaster but it is your rollercoaster and you must feel your way along.

4. I have the right to work through any feelings of guilt and relinquish responsibility.”

Way easier said than done but your grief is a process that you must traverse.

5. I have the right to know what can be known about what happened.”

There will be endless and repeated questioning, but you have a right to the known facts.

6. I have a right to embrace the mystery.

Life and death are mysterious, death far more so and it’s okay to accept that which we cannot know.

7. I have the right to embrace my spirituality.

Death and spiritual beliefs go hand in hand, if you need to explore that in your own way, no one can say you’re wrong. It’s your journey.

8. I have the right to treasure my memories.”

It’s not uncommon for it to be hard to connect to happier memories at first but they do come back. Don’t let the death overshadow those joyful memories.

9. I have the right to hope.

Having hope for your own future and life without your loved one doesn’t mean you love them or miss them less. You are still alive and you can still live.

10. I have the right to move toward my grief and heal.

As we walk our grief path, we don’t suddenly one day come across a flashing sign that says, “Congratulations, you’ve reached the end.” That’s not how grief works. Eventually we hope to integrate the loss into our story and accept how it has changed us and continues to shape us. Don’t let people try to push you to “get over it”, find people who will allow and accept your ongoing grief and how it has changed you.

Because it does. Suicide changes us, fundamentally so.

I’ve been thinking a lot about you and your family lately, going through a lot of my own grief and pain once again. But you know what?

Sometimes I picture the two of you, sitting in that big truck in the sky, telling jokes and waiting for calls that never come. Forever Young.

PRPS 40839 & 36378

(Thanks to my friend Sam and I’m hoping Dr. Wolfelt won’t mind me sharing his insights.)

– Wolfelt, Alan D., 2010. “The Wilderness of Suicide Grief; Finding Your Way.” Companion Press. Fort Collins, Colorado.

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Paramedics & PTSD: The Monster Inside

It’s a thankless job.  A common sentiment among the paramedic community and it brings to mind a question posed to my pre-paramedic psychology class by our professor, “Before you get out on those streets, it’s important to ask yourself, why do you really want to do this job?” I believe his intent was to hopefully weed out the praise seekers because his lecture that day mainly centered on motivations for behavior and personality styles. He pointed out repeatedly that there is no praise for a job well done in the paramedic sphere, just another call, another hand reaching for help and criticism about how the job was done, whether that be from peers or superiors.

At the time, I thought his use of criticism was misplaced, because it takes a certain amount of critique to foster perfection and in the world of the paramedic there is little room for error, after all, people’s lives depend upon your performance, so each and every call must be reviewed for “educational purposes”. Looking back, I see that when well intended critique is coupled with repeated calls for help where you’ve done the absolute best you can, it can eventually feel like criticism.  It can feel like criticism because you are emotionally taxed already.

Look, the reality is that nothing can ever go perfect on calls. You’re going to forget some tiny measure, like taking a blood sugar on an unconscious patient when you’re juggling through an MCI. In the grand scheme of things the probability of that patient having been unconscious due to a diabetic emergency in the middle of a bus crash with 14 patients is pretty slim, but I will guarantee you that despite all of your efforts to feel good about how you performed on that scene, it will all come crashing down when you get the call review pointing out that you forgot to take that blood sugar. It can seem like a thankless job when viewed through the eyes of the monster inside of each of us that can eventually rear it’s ugly head and begin to poison your thoughts.

Being a paramedic can be tiring, it can be relentless, it follows you everywhere you go because you cannot shut that off, it becomes you and you become it. We are “tightly wound” because of how we have to look at people and situations every day, several times a day, not only because we need to be safe, but because we need to keep other people safe; it’s our responsibility. But being “on” all the time feeds the monster inside, it can lead to psychological issues like anxiety, depression, PTSD, burnout and even suicide. Being “on” all the time can break you, destroy your normal coping abilities leading to negative or addictive behaviors, such as substance abuse, gambling, smoking, high risk taking activities and oddly, what some may not view as an addictive behavior, gaming. The motivator for addiction is escape, you are escaping your reality for a period and as the pressures of your reality build, your need for escape increases.

My husband was a “gamer”. He had his consoles and monitors and cases of games. He often said it was “stress relief” for him and he often lost himself in his games when going through a burnout phase. My husband died by suicide and once, several months prior to his death, when I expressed concern over the amount he was gaming, (at that point it wasn’t actually bad) he sighed and said, “It gives my brain a rest. Work stuff isn’t in here. It’s how I get rid of stress.” So I allowed it, after all we were still doing the other things we loved doing. But in retrospect, it actually wasn’t doing anything to get rid of his stress, it was merely allowing him to escape and temporarily put off dealing with his stress. Stress is cumulative. It adds up. He needed to seek professional help. You see, eventually he degraded to the point where he was constantly staring at a device, he was angry and irritable when he was away from his games. His stress cup was overflowing. His attempt to escape from work issues wasn’t helping anymore and my attempts to steer him toward more positive coping activities didn’t work because he’d lost all interest. He had isolated himself.

I guess what I’m trying to say is, it’s important to take stock of where you are in your coping from time to time. Be honest with yourself, there is no one judging you here but you. For example, when you get that call review and you feel like you’ve just been crushed by a ton of lead, realize that your perspective is suffering, you are not a bad medic, or a screw up or any other negative idea that your mind may feed you, that is depression talking and left unchecked, it can poison your entire outlook.

Let’s say you pick up that call review and see you forgot to write down a time at some point through the call and there it is highlighted, glaring back at you. Angrily, you crumple the paper up and say to anyone near, “I forgot to write down a time! They’re after me for that!? I was busy trying to save a life!” Anger is anxiety’s tool for expression. You see, anxiety isn’t actually just being fearful, it can be sub-threshold worries that spill out as anger. Irritability is often a sign of anxiety. Those of us with PTSD are very familiar with irritability, it becomes a daily occurrence in our lives and it surfaces with a vengeance when we encounter the slightest pressure.  If you’re reacting this way to your reviews (or any thing else for that matter), it’s time to get things in check.

Eventually, as paramedics, the job we do takes it’s toll on us, in this climate of mental health awareness, it is important to become more aware of when you are starting to cope negatively with the pressures of your job. Acting early can stave off more serious mental illnesses that can rob you of your quality of life.

It’s very important to be aware of when that monster inside of us is getting restless. Check what you are feeding it, try starving it out for a while, that is, deny it the ability to negatively influence your outlook. Engage in positive, healthy activities that make you feel good. Keep track of your thinking errors and work to correct them as you go. Remember that it is okay to let your hair down once in a while and have fun, you don’t have to be on watch ALL the time. Practicing positive mental health can carry you a long way in your career.

So, do me a favor, every once in a while, do a mental health check, ask yourself, “Why am I really reacting this way?” Find the issue, ask for help and put it to rest before it can grow out of control.

Wishing you all better mental health.

In solidarity.

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