I have been changed...

As I've mentioned in previous posts, often I have been asked why I chose to become a paramedic; why I remain a paramedic.  The answer I frequently provide, jokingly, of course, is because I am selfishly selfless.  The looks I get after giving that answer are generally perplexed.  So, let me explain.  I enjoy helping people.  I feel it is my calling to render aid to those in need.  Thus, when helping someone else, I get the warm and fuzzies; I am selfishly helping others.  However, how selfish is it really?

According to a Psychological Reports article from 1996 by Francine Grevin, paramedics show the highest rate of burnout among all other healthcare professionals due to "dealing with life and death emergencies in hazardous environments and chronic exposure to human tragedy" to name a few.  That is, we see graphic things in austere environments.  Grevin (1996) comments that such astonishingly high rates of stress lead to burnout, drug and alcohol abuse, and work-related and family problems.  Furthermore, Drewitz-Chesney (2012) explains that paramedics experience higher rates of PTSD than police officers and firefighters for the same factors listed above, which can be severely detrimental to personal and family lives.

So, I ask again, how selfish is it really of those of us who chose to become paramedics because we get a good feeling from helping others?

My co-workers and mentors in EMS always told me that EMS changes people, but, naively, I chose to ignore what they had to say and pretend that I was invincible and couldn't be changed.  My mind, and thus behavior, could not be altered by the effects of EMS. 

But I find myself wondering how invincible I truly am, or was.  I have seen, over the years, friends get married and get divorced and get married again and get divorced again.  I have seen relationships blossom and relationships die.  I've seen the spark of happiness in a new employee's eyes and the look of horror and defeat in their eyes just years, or even months later.  But I have also seen marriages and relationships flourish in EMS for whatever reasons; maybe strong coping skills, resilience or a sense of coherence (a view of the world that recognizes the meaning and predictability of it), as Streb, Haller and Michael (2014) suggest.

My parents recently asked me if I actually have feelings, if I have the capacity to love another human being, trust another human being.  And honestly, that got me thinking.  Do I think I have that capacity, of course.  I have grown to truly love many of the people I work with, if for no other reason because of the common bonds we share, because of the tragic images that will forever remain stained in our brains.  For the sounds of gunfire that will forever ring in our ears.  And for the stench of a dead body that will forever remain in our nares.  We share that.  We get that.  Not many other people can understand what we understand.

I've recently found myself at events with friends of mine from my pre-EMS life.  They do and forever will have a special place in my heart.  But every time I see them, I find myself thinking about how much THEY have changed.  How little we have in common because they're all different.  Although, I can't help but think that maybe they're all the same, and I have changed.

For example, the things we used to discuss no longer interest me.  It's no longer intriguing to hear about so-and-so and whatever mishap has happened in their life.  It no longer piques my interest to hear about so-and-so and their 60-, 80-, or 100-thousand-dollar-a-year job.  Or about their children who are constantly misbehaving, or their children who are perfect angels.  It no longer makes me smile when they talk about how inexpensive their ridiculously priced haircut or shirt or suit or shoes cost.  All I hear in my head is how petty the discussions have become. 

Why should I care that you are cooking a 10-course meal for people who just moved into the neighborhood when I have to walk into homes in the middle of the night and see malnourished children who have never, and likely will never experience a 10-course meal?  Why should I care that your pool man or housekeeper didn't show up today, even though they were supposed to, when I see people who are the pool man and the housekeeper both for their family and yours?  Why should I care that your kid can read at 1 year old when I see 50 year olds who never had the luxury of attending school, and still have no idea how to read?  Why should I care about your debate between this name brand pair of shoes and that name brand pair of shoes when I have patients who couldn't dream of such shoes or having a debate about such shoes?  Or where you're going to eat for dinner tonight when I see people who don't even have enough money to put food on their own table, in their stomachs and their childrens' stomachs, not to mention eat off the dollar menu at McDonalds??

Do I feel this way because I have changed or do I feel this way because they have changed?  If it's me, is this a good change or a bad change?  Is it bad that the conversations and people who used to interest me rarely do so now?  Is it a problem that with whoever one of us has changed, a distance has grown between us?  I can't answer that question for myself or anyone else.  What I can say is that things that once were run-of-the-mill, important, life-altering questions and decisions no longer seem to be; in fact, many seem unimportant and petty.

This previous line of questioning brings to mind a song from the epic Broadway play Wicked: "For Good".  A line from the song "Because I knew you...I have been changed for good".  I think of my career in EMS in a similar way; however, to define the word good appropriately in context, I have to figure out if EMS has changed me for the better, or forever; both of which sufficient definitions for the word good.

I know that over the years in which I have been in EMS, the way I view the world has changed.  The things that used to have meaning, don't necessarily carry the same weight as they used to.  The people and interpersonal relationships I've known no longer have the same significance.  The context of the world has changed in my mind.  Certain things, materials, individuals and experiences don't have the same relevance as they once did.  However, the world is still a meaningful place for me.  So, have I changed for the better, have I changed forever, or both? 

I'd venture to say that to those who once knew me, my world, my attitude and my ability to express and receive emotion, I have changed...not for the better.  But does that make me a worse person?  No, it makes me a person more familiar with what may or may not be as important in MY world as it may or may not be in someone else's world.  It makes me an individual who recognizes that the world and the environments in which we live are ever-evolving, dynamic and, to some degree, predictable.  It makes me a person who is more aware, both of my self and my surroundings.

But, again, to those who once knew me, it makes me appear more distant, withdrawn and, perhaps, less compassionate.  The truth is, externally, I may not convey compassion, I may not be the model of kindness and caring, but I am compassionate and I do care and I am kind.  I just express my sense of caring in a less exaggerated fashion to things, material and individuals who aren't experiencing true tragedy or dilemma.  I don't appear compassionate to those suffering from a bump in the road versus a life-changing, sentinel event.  That, however, does not mean I don't care; it just means my view of what is important has changed.

So, relating back to relationships outside of my EMS family, I can understand why people say I have changed, because I have.  But, because they don't know what I do, how I do it, or even the circumstances under which I do it, they don't get it.  And they never will. 

To reference my last post regarding burnout, which is very much related to this post, paramedics and EMTs might find it easier to confide in and express emotion to others who have experienced the same or similar incidents as they have, that's just human nature.  Is it something to become offended by?  No.  It is just a reality that those who aren't in the EMS family must learn to understand and accept.  It is also why having people with whom you can relate is so important for those of us in EMS, because most of the time, we won't find it at home.  And at home, our behavior, emotions (or lack thereof), and point-of-view may not be favorable, even if we can no longer control it or provide reasonable explanations for it. 

But there is a reason.  In fact, there are as many reasons as there have been patients under our care.  Every patient has a story, and every story affects the story of my life, of our lives, of any EMS provider's life.  Those stories have changed us for good.  Those stories make all of us question whether or not we pursued a career in EMS for selfishly selfless reasons, or for selflessly selfless reasons.  While we may gain a stronger sense of self throughout our careers, to others who knew us before, we appear to lose some of ourselves.  Maybe we do lose some of ourselves, but that which we lose, we gain in other areas of our lives and we do become better people forever, potentially just more difficult to understand.


Citations:

Drewitz-Chesney, C. (2012). Posttraumatic stress disorder among paramedics: exploring a new solution with occupational health nurses using the Ottawa Charter as a framework. Workplace health & safety, 60(6), 257-263.

Grevin, F. (1996). Posttraumatic stress disorder, ego defense mechanisms, and empathy among urban paramedics. Psychological reports, 79(2), 483-495.

Streb, M., Häller, P., & Michael, T. (2014). PTSD in paramedics: Resilience and sense of coherence. Behavioural and cognitive psychotherapy, 42(4), 452-463.