paramedicsuicide

[paramedicsuicide]

It's been a long week. After getting little sleep yesterday, I welcome the lull in call volume that let's me rest for a little while. Attempting to get comfortable in the front of a mercedes van is a futile effort. Tossing and turning in the seat like I'm having a bad dream. The silence of the radio wont last long. 

"AMR dispatch ADI for a call". 

"Please frank zone...please frank zone" I mutter under my breath awaiting the call to be dispatched. 

"In the Charlie zone medic hot, intersection of Street A and Street B, for the Male hyperventalating".

Fuck. I am not in the mood to teach someone how to breathe tonight. We mosey on over to the call. "Please shut the fucking siren off. Its 1 in the morning" I say to my partner as he presses the air horn in an apparent attempt to clear parked cars from the roadway. 

We arrive on scene alone. Aparently fire was not dispatched to this call. There is an obviously intoxicated male with a 40 in his hand, jumping around and screaming. 

"Looks like he is breathing fine to me" I say to myself as I grab a pair of gloves from the passenger door.

  "Help her! FUCKING HELP HERR!" He begins to yell. We approach and find a female patient sitting in the passenger seat of the vehicle he is standing near, unresponsive. I make a futile effort to ascertain what the hell is going on. 

"Sir...what happened" "Shes faking. Wake her up. Help her. What the fuck are you guys doing just help her" he screams as cheap beer flys through the air, scattered around the scene like rain falling from the heavens. 

I check a pulse and can not find one. The female is not breathing. I try and reposition her head as I ask again "what happened before we got here sir. Was she complaining....."

"DONT FUCKING TOUCH HER. SHE IS FAKING. WAKE UP MOM" he screams as he grabs my shoulder to move me out of the way. 

"ADI 228 needs police" I say quickly over the radio as I regain my ground, get the male put of the way, and begin to extricate our patient from the car. Due to her size, my partner and I each had to grab an arm and forcibly drag her out of the vehicle and lay her roadside in the cold, partially frozen dirt. You can see your breath on the cold, December evening. The air hurts your nose as you breathe deeply in. 

"GET THE FUCK OFF OF HER. DONT FUCKING HURT HER. I'LL FUCKING KILL YOU BRO. I'LL FUCKING KILL YOU". 

There is a random bystander that is trying to keep the patients son back as I begin CPR. The son gets through with little effort, grabs my arm and tries to pull me off his mom before the bystander and my partner can get ahold of him again. "ADI 228 expedite police. We are working a code and have a family member attacking us". 

I dont have time to give any more information as I have to continue CPR. From this point it is a bit blurry. The son is screaming and trying to get through to me. I'm doing CPR myself, trying to maintain my awareness of the scene, while my partner and the bystander try to keep the son back. Im trying my best to pay attention to the radio traffic in the background as well.

"ADI 942 is going"

"ADI 952 is going"

"228 police are on the way"

The son got loose again and I got up and backed away before he could get his hands on me again. CPR saves lives and his mom is getting none of that right now. Hes too drunk to understand how serious the situation is. His mom isnt faking it. 

"ADI 228 we have to leave" I say, walking backwards down the street to make sure he doesn't start coming after me. He has no plan at this point. He doesnt even go to his mother's side he just stands next to her screaming who knows what at us.

"228 did you say you are leaving the scene?"

I cant answer. I'm yelling at the son to get back away from the patient. At this point ADI doesnt need to know the details as long as police are on the way.

About 30 seconds go by that feel like 3 minutes. Sirens coming from all directions. Tires squealing in the background. Buffalo's Finest arrive on scene in a cloud of smoke from the hot brakes. You can hear the metal crackling from the heat of the engine meeting the cold winter air. They see us standing in front of our ambulance and slowly walk up to us. It isnt uncommon for inexperienced crews to call for an expedited police response when it's not actually needed so it's safe to assume they thought it was bullshit. 

"What's going on here" the first officer asks with her hands tucked in her vest, portraying an obvious feeling of frustration due to the lacking sense of urgency. 

"The female next to the car is dead and he started attacking us when we started CPR." I think the officer was taken aback by this news. 

"Get the fuck back!"

With the police now on location, my partner and I were able to resume CPR and connect the monitor. Pt was in PEA. I can hear her wheezing with every push of the chest. It was like one of those chicken toys that squeak when you squeeze them. I assume she had copd exacerbation prior to coding.

I hear behind me-  "Delta 540 radio send a second ambulance" 

"What the fuck is that all about?" I think to myself but I'm pre-occupied with my task at hand.

A minute goes by. 

"Where the fuck is the fire department?" I ask the officer next to me. I'm a fan of the Buffalo Police but I definitely dont expect them to be rolling in the dirt doing effective cpr.

Again, I hear behind me- "Delta 540 radio. ADI is here with a cardiac arrest. Can you find out where the fire department is" 

The supervisors arrive shortly after allowing us to begin ALS treatment. He hands me the new, fancy video laryngoscope. The lens fogs up immediately upon entering the patients mouth due to the frosty cold temperature meeting the warm breath of our freshly coded patient. I have never missed a tube so I just toss it in there the old fashioned way.  I attach the BVM and it feels like trying to pump concrete into her lungs. She is very tight, seemingly confirming my suspicions of a respiratory cause of arrest.

We obtained ROSC after about 30 minutes of working and transported to the hospital. I have yet to hear anything about her outcome. 

I learned after the call that the son was 22.09'ed to ecmc and had to be tied down and sedated. His mom and family were at BGH, while he was tied to a bed halfway across the city. In EMS we are often confronted with situations that leave us battling with our own morals and values. We are trained not to judge, and to treat everyone as equals. This is easier said than done, as the rollercoaster of emotions make it difficult to always see the whole picture. At first thought, I yearn for some sort of revenge or retribution. You want to put your hands on me? Learn to handle your alcohol. Have fun in jail buddy. As the rollercoaster slowly enters the station after the ride is completed, you reflect on the situation as a whole. This guy has had too much to drink. I believe he thought his mom was "being dramatic", possibly after an argument. I've seen that play out plenty of times in the past. We have all had the "use the big needle" moment when your patient suddenly wakes up. Between the alcohol and the stress of the situation, he was unable to handle the switch from "mom is being dramatic" to "the paramedics doing cpr on mom", roadside in the dirt.

"Did you press charges?" I was asked a handful of times. I think people were surprised by my answer. "For what?" He didn't injure me. He didnt ever really even hit me, although I think it was only seconds before that were to happen. Is it punishment enough that he has to live with his actions and how his family will react to his behavior? Will they care? Will he even remember? How do you balance the need for safety with the needs of your patient. Years of training about how every second without CPR is less chance of survival. With the stress of an escalating situation, it is very difficult to juggle all of the variables and make a sound decision for your patient, that also gets you home alive at the end of the night.

[paramedicsuicide]

What if......

"If its a good idea today, it will be a good idea next week". Those words will stick with me forever. Spoken by a Cheektowaga Police officer-- one of the best, most humble men I have ever met. He spoke those words to an Iraq war veteran who had just been tasered in an attempt to prevent him from jumping stomach first on a large wooden spike. I think of this man every time I have thoughts of suicide, and remember the phrase "If its a good idea today, it will be a good idea next week". This veteran was on a humvee patrol during the first few years of the occupation. It was his turn to drive, but he was not feeling good that day and swapped spots with another soldier. Their humvee hit a roadside IED, killing everyone in their patrol except him. The driver was killed instantly, and he left a wife and 2 kids behind. To this day, he blames himself for those deaths. All of his friends dead because he "didnt feel good". Why wasnt he killed? "Why not me?". I think about him, I think about MY issues, and say to myself, "If its a good idea today, it will be a good idea next week". It never is a good idea next week. Unfortunately I have had to use those words often with my patients, as mental health issues are all too common. I like to think that I can help these people, even though they don’t always want it or sometimes even believe they need it. Unfortunately I am not always lucky enough to whisper those words. On December 24th, 2016, a mother and father made plans and left their 16 year old daughter home alone. It was a cold Christmas eve with ice covering the sidewalks. Your eyes hurt from the cold breeze. The loud crunch of every step you make echoing off the walls. For Phyllis, the lonely 16 year old abandoned by her family on Christmas eve, it would be a night where many lives were changed. It would be a night I will never forget. "Car 18, head to *address*, we have a caller on the line who states the 16 year old is live on facebook actively attempting to hang herself". Its midnight and the plows have not been out. Without being dispatched, we head to the address fearing the worst. Its difficult to believe that we made it there in one piece-- in hindsight the speeds we reached for those road conditions would have been considered criminal had something bad happened. We arrived on scene at the same time as the first patrol car to find the address in question was a multi-unit apartment building. Car 18 starts kicking down doors to find startled residents with no idea who we could be talking about. Minutes go by.  Was this a fake 911 call? Are we at the wrong address? Just as we run out of options, my partner noticed a somewhat hidden stairwell in one of the foyers that lead to an upstairs apartment. The door goes flying across the kitchen in an awe-inspiring explosion of wood shards. There's no one home. No one is answering our calls. Why are all of the lights on? Just then we see the glow of a laptop screen sitting on a chair in the back bedroom. It was then we found Phyllis, live streaming her suicide on facebook. We found out later on that Phyllis had attempted to call her best friend who was unavailable due to being with family. She then facebook live chatted the boyfriend of her best friend, and hung herself in the closet with a belt as he pleaded with her not to do it. As if a sign from god himself, the belt that she used broke. "That's a sign Phyllis. You aren't meant to die tonight. Please don't do it." he begged. Phyllis walked to the other room, found a better belt and did it again. The belt did not break this time. Upon our arrival, Phyllis was not breathing and did not have a pulse. After a very short amount of time, I was able to secure an airway and get Phyllis' heart beating again. Great news. She was not down for long so she should have a good outcome. She can get the help she needs. Today's story has a good ending. Or so I believed. A few hours later I arrived at my fathers house for Christmas festivities. I was not greeted with a "Merry Christmas". I was greeted with "are you ok?". I instantly broke down crying. I have been able to handle everything thrown at me in the past 8 years as a paramedic. Not this. Not a teenager left home alone on Christmas. What if I was able to tell her "If its a good idea today, it will be a good idea next week?". What if. On January 15th, 2017, I met with her parents at Childrens Hospital to check and see how Phyllis was doing. Embraced in the arms of a crying mother, I learned that Phyllis had severe brain swelling after the incident and was now brain dead. 9 months later, tears run down my face as I type this story. Nothing in your life can prepare you for the tears of grieving mother who has to make the decision to pull the plug.  Hearing stories from mom and dad about what a wonderful daughter they had. Hearing that her parents had no idea about her pain until being told by her friends in the hospital. Hearing the story about their decision to donate Phyllis' organs to save other lives. Seeing her obituary in the newspaper. It was very difficult not to be angry at mom and dad for leaving her alone. I asked the question and they had no idea that Phyllis felt this way. Phyllis never told anyone how she felt. No one could help. When things feel like they cant get any worse and you want to die. When you can no longer take the pain. When its time to give up. Ask for help. It may be scary. It may be embarrassing. You might not even want it. What if the help WORKS? What if the help is what you need? It cant make things worse, right? "If its a good idea today, it will be a good idea next week." I wish I could have told her this. Over 39,518 people died by suicide in 2011 in the United States.  In general, it is the 10th leading cause of death for Americans.  Even more alarming, it is the 3rd leading cause of death for those between the ages of 15 and 24.  It is estimated that for every completed suicide, there are approximately 25 attempts made.  The most important thing to know about suicide is that it is preventable.  Warning signs include talking about suicide, helplessness and hopelessness, dramatic mood changes, and withdrawal from normal activities.  If you, or someone you know, are suicidal please call Erie County Crisis Services at 716-834-3131 or the Kids Helpline at 716-834-1144. Rest in Peace Phyllis. You are loved more than you will ever know.

[paramedicsuicide]

First responder suicide -- PTSD, or something else?

Its 1:30am. I sit on my computer in complete darkness, having just slept for the past 10 hours. As a Paramedic in a suburb of a relatively small US city, I work 12 hours shifts for 4 straight days. I get 4 days off to recuperate after that, and at this point in my career those days are essential for my survival. Many of my co-workers are not lucky enough to be able to stop at just 4 days, and must work additional overtime shifts in order to make ends meet. The private EMS industry has relatively low wages nationwide. We are the "red headed step child" of emergency services, often hiding in the shadows of police officers, firefighters, and nurses. There is no such thing as a "typical" shift when working in EMS. There are the occasional shifts where I will sit in the parking lot of the local convenience store chain for 12 straight hours without picking up a single patient. The glow of my cell phone screen illuminating my face for each passing person to see the life draining out of my body. The boredom sets in after hour 2.  My legs and butt hurt. I am hungry, but I can't tell if its true hunger or just my body telling me to get up and move. I decide to walk inside to browse the aisles of colorful treats, getting nauseous at the thought of eating "lunch" out of a gas station at midnight for the 3rd day in a row. Despite my disgust, I walk outside with 2,000 or more calories of junk food at a time in an attempt to eat myself to death. "Ill be diabetic by the end of the week" I say to my partner as I open my fudge dipped granola bar. As the career of a first responder goes on, most quickly start to pack on the pounds like a bear preparing for winter. Company policy prevents you from sleeping during your shift, so your food (if you can call it that) is washed down with 16oz of your favorite energy drink to keep you awake and ready to pick grandma up off the floor when she attempts her 2am bathroom run. I have palpitations from all the caffeine. Hopefully one day those PVC's turn into an arrhythmia and the lord takes me. "Anything to get out of this job" I say, as I polish off my second monster of the night.  Morning rolls around. 50mg of benadryl will help me fall asleep after drinking energy drinks all night long. I have severe shift sleep disorder. I am depressed. I just want to sleep. I wake up ready to go after just 4 hours of sleep. Great. Another night of pounding monsters. I punch in 15 minutes early for my next shift and am assigned a call before I am even scheduled to start. I am the only ambulance available in the surrounding 15 square miles of suburbia, and that trend will continue for the next 12 hours. Call after call, I don't have time to finish my paperwork before being sent on the next run. Its 11pm and dispatch calls my unit number for the 5th time today-- "With the fire department for a 1 year old post choking". I have taken 50 calls of the same nature before and say out loud-- "Great, another bullshit call". Every day, nervous parents call 911 over the slightest cough or sniffle which eventually numbs you to the potential of a true pediatric emergency. Its never a real emergency. Until it is. Rolling up on scene after the fire department, I grab my house bag and begin to waddle towards the low income apartment building for the third time this week. I think -- "I should have brought the tablet for a signature so I don't have to walk back outside". Suddenly, a firefighter rounds the corner carrying a limp child like he is holding an offering platter. "That's not good" I blurt out , going from zero to 100 in the snap of a finger. The firefighter tells me the child was eating chicken and rice when he began to choke.  As my partner digs out the pediatric bag valve mask that has been sitting unused in the house bag for an unknown number of years, I set up the suction, only to find an unresponsive, apneic child with a clenched jaw. "That doesn't make sense" I think to myself as I try to peel apart his tiny jaw without any luck. Thank god-- he has a gap in his front tooth that fits a small, 12fr suction catheter. I start to go through the motions. Is he seizing? Nope. Any trauma visible or reported? No. Mom was asked again-- and again says the child was sitting up, eating, and suddenly started choking. What is going on here? With little to be done on scene, I rush to the small local hospital, nervous that the next squeeze of the bag could lodge a piece of food in this kids airway. I am getting good air exchange but his spo2 isn’t amazing. He must have aspirated. Great news. He is now moving his arms, and his eyes just opened. Wait, why is his jaw still clenched? That's not great news. This kid hasn't made a noise. What the fuck is going on. As I roll the stretcher into the small emergency room closest to the scene, I am greeted with that dreaded sentence from the ER Physician-- "why did you bring him here and not children's hospital".  I bite my tongue-- its not the time to have that fight. The kid is now posturing. A few minutes go by and the doctor asks me to get my laryngoscope because the emergency room is not currently stocked with the proper pediatric equipment. Maybe he was right. The thoughts start rushing through my head-- "they are going to kill this kid. I should have just risked it and bypassed. It was only an extra 7 minutes or so further". As I sit there and wait for the next order, new thoughts take over. "Someone shook this kid. There is no other explanation".  Hypertensive, bradycardic, posturing. But mom said he was choking on rice? Where would she get that from? Hmm. She doesn't seem as concerned as a mother should be. She answers a text message while being questioned by the police.  She has yet to ask anyone how her son is doing. The texts start to come in to my phone. "Are you ok?". "I hear you had a bad call. You guys ok?" "WTF was that all about?". I am fine. Any provider who plans to have a lengthy career has to distance themselves from their patients. I can think back to every "bad" call I've taken, and never once have I been able to recall processing a patients face. Its not important. What they look like is irrelevant to my job. Its the circle of life. Some people live, some people die. Its my job to try and make that circle a little bit bigger if I can. Sometimes you are successful, sometimes you aren't. You have to come to terms with that early on. Minutes after calling in service from restocking, the radio chimes my unit number again. "Cold response to the fitness center for a hand laceration". I arrive on scene to find a psych standing out front in his blue paper clothes, clearly having been to an emergency room at least once today. “Hop on in buddy-- take a seat” I say as I shake my head. We drive him 3 blocks down the street to the same emergency room we left just a couple hours prior. I am not greeted like one would expect. Not with "Hello", not with "whats the chief complaint". I am greeted with a sentence that is never good news. "Did you hear?". Our child from earlier had been emergently transferred 6 miles away to the childrens hospital by a specialty transport team. The news from them was not good. "That kid -- he has a brain bleed". My suspicions were confirmed. He was never choking. Someone hurt this kid and tried to cover it up. I know how to handle this, because its not even the first time this situation has happened to me. People hurt kids often enough that I am not even shocked. Stories like this don't make the news *for a reason*. People cant handle stuff like this. No one needs to know that savages live in apartment 3. Some people have to know though. WE have to know. Its not OK. I talk about suicide often. My previous partner was a veteran and has PTSD from being deployed overseas. He has had many friends commit suicide after returning from war, and was concerned about my mental health. That should concern me. He would ask me once a week-- "Are you sure you are ok?".  My little comments here and there come off as jokes to most people. "Id rather die than come into work tonight". "Pull out in front of this semi truck-- we wont feel a thing I promise". "Stage for police? Fuck that. I hope I get shot". In reality, its not a joke. I am not suicidal at this point in my life-- I am apathetic about living. I'm not going to take my own life, but I am definitely not excited when I wake up each morning. This feeling has slowly crept up on me over my almost 10 year career as a paramedic. I tell myself daily that I need to get out before its too late. What will be the breaking point where I become truly suicidal?  I have to answer one question before I leave. "Where will I go?"   I am burnt out. Everyone says "go to nursing school", but the passion-- the fire inside that makes you want to help people has been extinguished for years. Where can you go at 30+ years old with a paramedic certification and no useful degree. I have made financial commitments at my age that makes starting from scratch somewhere at entry level wages an impossibility. What can I do? Where can I go? I am stuck. This job is like quick sand, and I'm up to my shoulders. If I struggle much more it will be above my head. We get to see what goes on behind the curtains of society. How much would you enjoy a magic show if you knew how the magic was performed? That is what life is like for many first responders. Members of the general public get to wear blinders during their day to day lives. There are people who post rants to facebook if the garbage man didn't put their garbage can back in the correct spot. A terrible day for a typical person is a flat tire on the way home from work. They have no idea what happens in their town or city on a day to day basis. They have NO IDEA that 3 doors down, a husband beat the shit out of his wife for the 4rd time this year and she wont tell the police what happened. They have NO IDEA that people call an ambulance from the parking lot of an emergency room because they don't want to wait in the waiting room.  They have NO IDEA that someone in apartment 3 just hurt their baby and tried to cover it up. But we know. We see it all. I have talked with a lot of people who have similar feelings. Its due to me being so open about my apathy towards life. People who I see every day, smiling at their coworkers and telling war stories and laughing. You would never guess these people were at the end of their ropes-- fighting off their own demons. "Make sure they have bagpipes at my funeral". I don't try and talk these people down because they don't want help. How could I help anyways? You cant just "un-know" the things we know. These people just feel comfort in the fact that they aren't alone. I have been lucky that none of these people have taken their lives yet. I know the day is coming. Its been a long time since a co-worker has committed suicide, and the statistics say we are over-due. How will I handle it?