Fixing the Unfixable: The Absurd Hero

Not too long ago I came across a quote by an unknown author that struck me as a rather important life lesson, and especially pertinent to the work we do as pre-hospital medical providers: “Sometimes the most broken people try to fix others because they cannot fix [themselves]”.  It took a little bit of time for me to truly appreciate this quote because, naturally, like many others, I’m often in denial of that within myself in need of fixing.  But after absorbing the words I saw on the screen in front of me, I realized that everyone is in need of fixing, to some degree. 

No one is perfect.  No one is unbroken.  Everyone has a past that has left them with a scar or two, physical or emotional.  Everyone has a present that is, in some fashion, etching scars into their skin.  Nevertheless, it is those scars that led us to where we are now.  It is our past that has brought us to our present where trying to fix others is our passion.  It is those scars that attracted us to a profession in which we can help prevent, treat or heal others’ scars.  It is those scars that brought us into the business of helping people, of healing people, of fixing people.  It is those scars that drive us to continue to do what we do.  And, as with many in the medical field, I too have an undeniable, unrelenting, nagging desire to fix people and things. 

Aside from our superficial, yet deeply personal motivation for pursuing a career in EMS, why do we have this urge to fix others?  At what cost?  And who are we really trying to fix?

According to Messina (2008) this need to fix is a “compulsively driven behavior to rescue or help another person, place or thing to be the way you believe it ‘should be’”; or our “inability to accept people, places or things the way they are and the chronic attempt at changing them even if they are unchangeable”.

By this, I don’t mean that we live our everyday lives working toward the goal of making people become what we want them to be, or how we feel they need to be; rather, I mean we have taken on the responsibility, the job, of doing what we can, of doing the right thing, in order to save people from their ailments, self-inflicted or otherwise.  In doing so, we interact with others in such a way to gain insight into their behaviors.  We utilize the attribution theory, to some extent, to assign certain behaviors to either dispositional or situational causes.  In other words, we make a judgment: is this person the way he or she is because of an internal desire, thought or personal motive, or are their actions a result of their situation and surrounding environment, such as socioeconomic status, upbringing, or home life?

We’ve all had those patients who, no matter how much effort we put forth to fix their COPD exacerbations, we see them again the next week for the same thing.  This time, however, they know the protocol almost better than we do, and definitely better than any of our trainees.  They tell us what to do, how to treat them, and what course of action they know will work best for them.  No matter how hard we try to fix them, though, we can’t.  We can educate them, but they still won’t take their medications as prescribed.  We can administer albuterol, steroids, magnesium and continuous positive airway pressure in the acute setting to help them breathe again, but the hypoxia and feeling of impending doom doesn’t persuade them to be compliant with their medications in healthy times.  We can fight for their life, and they still won’t fight for their own life.

Likewise, we’ve all had that friend or family member whose life means more to us than anything else.  We will fight for them, for their success, for their happiness, and for their friendship.  But no matter how much effort we use to help them fix their own issues, they still fumble just a week, a month, or a year later and need our help again.  Or we have that friend we wish we could help, but he or she won’t allow it. 

Similarly, we have all been that friend or family member in need of fixing and have either allowed it, fallen again and needed the support once more, or we have been that friend who refused to allow someone to make an impact on our life due to stubbornness or simply denial, trapping us into a lifetime of enduring turmoil.

This brings to mind the Greek Mythology story of Sisyphus.  Sisyphus was a king who conducted himself in a less than favorable manner.  As a result, he was punished by having to roll a boulder up a mountain forever.  As soon as he’d near the top of the mountain, the boulder would slip down the hill, and his task would begin again from the base of the mountain.  Thus, he was fated to eternal struggle; to what has become known as a Sisyphean task: one that appears never-ending and represents perpetual torment.

In his essay, The Myth of Sisyphus, Albert Camus recognizes that Sisyphus is considered the absurd hero of the story because he persistently started his punishment from the beginning each time the boulder rolled to the bottom.  But Camus (1955) suggests that instead of viewing Sisyphus as a miserable mortal who would forever participate in his routine in sadness, he should be viewed as happily undertaking the mundane, everyday life allotted to him.  And that is what makes him a hero.  That is, instead of giving up, Sisyphus remains steadfast and inclined to complete his interminable task that has become his life’s challenge, or his challenging life.

On a personal level, like many others, I am in need of fixing.  I do what I can to fix myself, but sometimes I fail.  I can try, but often, I don’t succeed.  I'm human; by definition, I’m not perfect.  And so, over the last year I’ve taken on an incredible challenge: transition into a person I’d want to associate with and revert back to the person I truly am.  I have not only bettered myself physically, becoming a healthier and more active person, but also have made strides toward bettering myself emotionally and mentally.  Now, don’t get me wrong, it hasn’t been an easy road and I’ve hit multiple speed bumps on the way: socially, emotionally and physically; nonetheless, the journey I set out to trek seems worthwhile, despite the trials and despite the grief it has caused.

Elizabeth Kubler-Ross (1969) describes the grieving process in five stages: denial, anger, bargaining, depression and acceptance.  Kubler-Ross (1969) notes that these stages do not have to occur in the above order, nor do they have to occur at all.  The author also explains that each stage is not bound to a specific timeframe.  While these stages are generally relevant to loss by way of death, I’d like to attempt to use them in analyzing the following situation, starting with what I wrote above: that like many others, I was initially in denial of that within myself in need of fixing.

As a generally calculated individual, I have been surprised by the things with which I’ve been confronted that I didn’t, and probably couldn’t have planned for during my personal evolution.  For starters, emotionally, I have allowed barriers once erect to fall to the ground.  As I’ve shed weight in the form of fat, I too have shed weight in the form of emotions.  In fact, as difficult as it is to admit, for the first time in a very long time I can honestly say I feel again, both positive and negative emotions; I can truly empathize and sympathize with and for others.  I can genuinely smile, laugh and cry again, all of which I’ve done in the past year.

I learned this through various experiences, including thoughtful introspection and interpersonal interactions. When I first started exercising and working toward bettering myself, I received a lot of flak from the people I once considered close to me.  I was told by many that I became a bad friend as I ditched them for the gym and my trainer, one of my closest friends.  Many things from my past resurfaced, both internally and externally, which taught me that no matter how difficult a physical feat getting healthier can be, the social and emotional aspects of getting in shape, too, are difficult.  Alas, the depression kicked in.

I’m not really sure why my physical transition became a threat to anyone else, or how any person, whether a friend or an acquaintance could possibly see a downside to my becoming healthier.  Despite opposition, I continue to grow.  In spite of what people think and say about me in my pursuit of happiness, I continue to try to better myself; to fix myself.  Despite some of the immaturity, bullying and down-right viciousness, I’ve continued to try to put a smile on my face, keep it moving, and persevere.  In the face of struggle, I’ve chosen to proceed in happiness rather than in sadness, even though there was, and still is, a lot of sadness and hurt.

What this has uncovered, at least from my somewhat belittled perspective and perhaps for many of you, is something that I believe has afflicted our profession for some time; a pandemic issue that we are all aware of, but somehow haven’t taken a stand against.  Something that, conceivably, if unfixed, can ruin our profession, or at least prevent it from progressing to the greatness it deserves: dirty politics. 

In a profession that theoretically attracts individuals who are innately good, who try their best to help people they’ve likely never met or whom they might never meet again, it is, instead, one littered with individuals who, while potentially excellent practitioners of pre-hospital medicine, lack the interpersonal skills and emotional intelligence quotient to recognize that we are not here only to help fix our patients, but also to help fix ourselves and our colleagues.  We are here to fix each other, our team. 

In an age where mental health issues and emotional well-being are common conversation topics, less stigmatized than even five years ago, where multiple organizations and movements exist to promote personal health, mental and physical, for pre-hospital providers and other public safety workers, it is unfortunate that in many cases, we ignore the needs of our co-workers.  And for what?  Personal gain? Status?  Ego?  Reputation?  I'm still not quite sure.  The way I see it, the stronger our workforce, the better care we, as a cohesive group, can provide for the people we serve.  The more mentally and physically healthy our workforce, the more meaningful our service becomes, to us, our peers in the medical field, and most importantly, our patients and their families.

Linking this to a relatively current incident, there have been a set of viral images floating around the internet that depict a pre-hospital provider giving the middle finger in front of dying patients.  Much of the commentary surrounding this circumstance relates to how awful an individual she is.  Many people have nothing but harmful things to say about her.  However, one of my respectable and noble bosses very astutely pointed out that instead of berating this provider for her actions, why hasn’t anyone stepped up to ask her what’s wrong?  Why have many assumed she is an evil person, and that’s why she did what she did?  Why are we perpetuating the evil by portraying her as evil?  Don’t get me wrong, I do not, in any way, condone her actions; however, we as a group of pre-hospital providers, all too familiar with the effects of burnout, should, instead of pointing the finger at her for doing something terrible, ask her why she did it?  Why don’t we ask her what bothered her so much that she felt she had to do that?  Or simply ask her if everything is okay?

So in this era of understanding, why is it that we allow the bullies and the childish gossip-mongers to continue to do what they do?  Why do we allow such behaviors and verbal or emotional assaults to continue to bring down our own?  To bring down OUR workforce?  In a profession that is supposed to attract innately good individuals, why have we allowed our profession to be consumed by some who are incapable of expressing that innate gift of kindness and caring?  Why have we allowed our profession to be consumed by some who are not just incapable of fixing and of being fixed, but who alternatively cause damage and create the very scars that brought us into this line of work?  And then there was anger…

And what have we become?  Who have we become?  How have we been changed?

Messina (2008) explains that when we become overwhelmed by our compulsive desire to fix others, we subsequently become incapable of emotional detachment; thus, we will be unable to walk away from someone we know needs help, our help, or anyone else’s help.  Furthermore, we will lose sight of our own needs, our own wants, our own desires; our self-identified physical and emotional characteristics in need of fixing.

But how do we walk away?  Or how can we walk away?  As part of my challenge over the last several months, I’ve decided to rid my life of toxicity and toxic people.  I’ve cut off ties that I previously couldn’t fathom severing.  I’ve removed certain people from my phone, stopped saying hello to them and even do what I can to avoid them altogether.  Now, I’m not preaching that avoidance is the key to being successful in such a mission; on the other hand, when communication is unproductive or impossible, and all avenues to decrease hostility or toxicity have proven fallible, distance is what I’ve found to be effective.  And yes, I’m happier as a result, even though it took some time before I could accept that fate. 

Messina (2008) adds that in our fight for someone else, in our pursuit for their happiness, we allow them to become dependent on us, incapable of fixing or even making the attempt to fix their own wounds.  And then we continue to fight for something or someone that we cannot control, who we cannot change.  We begin to fight a losing battle against our self, and only our self because no one else is fighting.  We begin to bargain.

And so, I offer a different set of questions related to Sisyphus’s heroism:

Why did he not walk away from the challenge?  How could he not recognize that his task was endless and that his efforts would be fruitless?  Perhaps Sisyphus is stubborn, or in denial.  Perhaps he was fueled by his anger with the gods and the underworld or by the fact that his task could never be completed.  Perhaps Sisyphus didn’t want to be a quitter; he bargained for a better outcome.  Or perhaps Sisyphus just accepted his depressing fate and continued to push forward, despite opposition, or in spite of opposition. 

Still I have a hard time believing that anyone, including Sisyphus, can truly be happy without attempting to alter the mundane, to affect change, to create their own happiness.  And not through acceptance of the routine, but by crafting a routine, a life that is fulfilling; a clever method of pushing the rock over the mountain top.  I have a hard time with accepting a task as inflexible, unchangeable, or futile.  I have a hard time accepting that some are capable of accepting as final that which they know they can change and that which they know if changed would create a world of happiness.  I have a hard time giving up, unless I’ve tried everything in my power to make a seemingly losing battle meaningful, until I’ve exhausted all options, or until I can prove to myself, without a shadow of doubt, that my continued effort would be wasteful.

A lot has happened over the last year and it affected me in ways I never could have imagined.  I lost friends who I thought were close friends but turned out to be less than acquaintances.  I lost a lot in investments I made and continuously bought into over the last several years.  And despite my overwhelming desire to fix messed up relationships and situations, I’ve decided that in this specific situation, with these specific relationships, I needed to give up.  Instead of persevering as Sisyphus and accepting a losing fight, I chose to continue my walk up the mountain, leaving the boulder at the bottom where gravity dictates it should stay.  I’ve accepted that which I cannot fix.

And I’m not accepting it in a way that makes me a quitter; I’m doing it in a way that proves I’m a winner because I tried.  I did everything I possibly could and realized there was nothing more I could do to fix this except move onward toward affecting change on a global level by taking a stand against bullying, trash-talking, pitting people against others, back-stabbing and ultimately damaging individuals who we are supposed to help, fix and heal.

Messina (2008) concludes that we must learn to “accept the belief that others must accept personal responsibility for their own lives and actions.”  Not everyone has to be Sisyphus, forced to fight for an unattainable goal.  In fact, we shouldn’t want to be the absurd hero.  We should want to be the hero who refuses to accept the status quo and takes a stand against that which can be changed.  And we should want to be the hero who can happily accept that some people or situations are unchangeable.  That at some point, our efforts become futile, rigor mortis sets in, we can no longer try to fix the unfixable, and we must subsequently let the boulder roll to the bottom of the hill so we can keep moving forward a few pounds lighter.

"God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference." -Reinhold Niebuhr

References:

Camus, A. (1955). The myth of Sisyphus, and other essays. Vintage.

Kubler-Ross, E. (1969). On death and dying. New York, NY: Macmillan.

Messina, J. (2008, December 22). Overcoming the need to fix. Retrieved January 26, 2015, from http://www.livestrong.com/article/14696-overcoming-the-need-to-fix/ 

The Worst Thing I've Ever Seen

"What's the worst thing you've ever seen?"

This undoubtedly tops the list of FAQ's to all paramedics, EMTs, and probably everyone in public safety.  Needless to say, all of us have our go-to story that isn't quite the worst thing we've ever seen, but will nevertheless satiate the inquirer's insatiable appetite for drama.  Although everyone enjoys the graphic, traumatic tale that many of us could relay to our listeners, I think the most profound response that I've ever heard to that question was from a paramedic who used to work at my service, Ramon Henderson.

When I asked him this question, I was a rookie; still very, very green.  I had no clue what was in store for me.  All I wanted was to hear the war stories.  I wanted the sultry details of every bad call.  But his response left me speechless and dumbfounded, and admittedly, at that time I didn't quite understand how to digest what he had just said.

His go-to story was simple.  In fact, it wasn't a story at all.  It painted a picture for any person seeking a word thrill, without the gory, blood-and-guts-type details that most want.  Instead, it painted a different style of a grim story.  It conveyed a message to all those searching for excitement through others' tragedy and despair that the exciting moments, the desirable moments of our job, aren't those represented by the collateral damage of a human life.  Those certainly aren't the moments we want to remember in a positive light, not to mention share.

His answer with some of my own extrapolation: The sheer poverty that exists in our city.  The poverty that prevents those who need to care for themselves and their family from truly being able to care for themselves and their family.  The child abuse and child neglect.  Children unable to reach their innate potential due to extenuating environmental circumstance.  Children unable to meet their potential due to lack of parental guidance, concern or attention.  Children unable to achieve their potential because their parents lack the resources - financial, social, and otherwise - to provide for them.  Or children incapable seeing their potential and of surmounting the preconceived set of rules that govern their life and abilities to develop and then conquer their goals.  Hungry children.  Fearful children.  Children who don't know where their next meal will come from, when it will come, or if it will come.  The blatant maltreatment of and disregard for human life.  The human trafficking.  The drug abuse and dependence.  The elder abuse.  The sexual abuse.  Abuse of disabled.  Abuse of Veterans.  Lack of education, both in school and at home.  The substandard, overcrowded, often lacking water and power housing arrangements.  Or no housing arrangements; homelessness.

Worse, however, is our interpretation of those issues.  Our frequent or occasional denial in the face of reality.  Our society's refusal to acknowledge the existence of these conditions and those that cause these conditions.  Our desire to maintain a photo shopped world sans the violence and death that occur in their reality, but only in our local news, the TV shows we watch, and while we're on the clock.  The us versus them mentality.  The approach from an often (more) privileged and myopic perspective.  And the stance we take from afar with a certain blindness to the inequalities that exist in this world, natural or environmental.

We all have our stories that will forever scar our hearts and leave long-lasting images in our eyes and brains; the stories that create audible tension in our minds and palpable tension in every room we enter (or maybe that's also in our minds as a result of our experiences). But sometimes, despite overwhelming negativity in our daily work lives, some positive light can shine through.  And, in fact, as a general optimist, I try to see or create the positive in the face of all the negativity.

For example, recently I experienced two fairly juxtaposed situations that have definitely left a mark on me.  The first is probably, to date, one of the saddest, yet touching moments of my career.

I was posted at a gas station across from a skating rink.  My partner and I walked into the gas station to buy a few snacks and some drinks.  As we exited, we were met by an 11 year old child who appeared to be upset, but we didn't really think anything of it.  We continued walking toward our ambulance and the child called out "Excuse me, do you have a phone I can borrow?"  My gut instinct is always to say no.  In fact, I even considered using my standard line "we're not allowed to give money or let people use our phones because we're on camera".  I guess after working in EMS for some time I am always suspicious when someone asks to use my phone (especially after someone tried making an international call at one of our northern posts).  But something about this situation felt different, so I turned around and asked the child who he needed to call.  He said his mother.

So naturally, I asked the kid for his mother's phone number, put my phone on speaker and made the call for him.  He told his mother that he needed her to pick him up because the "guys" wouldn't pay for him and he has no way home.  His mother, screaming at him through the phone, asked him where he was, who's phone he was using, why he wasn't skating, etc.  She told him she was out and couldn't pick him up and he'd have to find another way home.  I interjected and explained that I was a paramedic and would see to it that her child would get home safely.  The kid looked devastated and embarrassed.

I asked the kid where he lived and he told me.  I can't really go into the part of the story about how I was able to get permission to "figure out a way" for the child to get home, but what I can write is that at some point during that process, my partner pointed out to me that he thought the kid didn't have money to skate, not to get home as I had thought.  We went back to the gas station and withdrew money from the ATM.  It required no further thought.  It's what needed to be done.  After all, skating only cost five dollars, so what the hell.  We gave him $5 for skating and $5 for food/snacks/drinks and watched him overcome with relief, joyfully walk back to the skating rink where he'd presumably join his friends and have the fun night he planned on having.

Whether anyone else in my situation would have done that or not is irrelevant.  What is relevant, however, is the fact that this child was upset.  The child was nearly in tears when he asked us for a phone to call his mother.  The child felt abandoned by his friends, and now by his mother.  This child still had the innocence in his eyes we often don't see in our line of work.  He still had a kindness and respect that we generally aren't afforded.  He had something different.  He hadn't yet been affected by the gangs that patrol his neighborhood, the violence that he regularly hears in his back yard, the limitations society has placed on him.  He hadn't been scarred by his version of normal.  He was a child.  A child that no one (until now) would know.  A child that, unless something unusual, or spectacular occurs, may succumb to his surroundings and lose his sense of self and his dreams.  Or the potential to form an alternate future for himself, rather than the one he has been taught to believe exists.  A child incapable seeing his potential and of surmounting the preconceived set of rules that govern his life and ability to develop and then conquer his goals.  Maybe that's who this child was, or maybe not.  But at that moment, that was the child I saw and that was the child I felt was different; a child I felt needed someone, anyone, to stand up for him and show him that the world is not always a terrible place.

The second situation is almost the opposite.  My partner and I were called to the home of a young child who recently had a catheterization to repair a hole in the septum between his atria and was now complaining of dizziness and left arm pain.  Of course, on the way to the call, I went over the list of cardiac medications we carry and their pediatric dosages in my head and out loud with my partner, as I think anyone would (or at least should).  When we arrived on the scene, we were greeted by a very worried mother holding her young child.  En route to the hospital, I could see the worry on the mother's face and we started talking.  The child, by the way, was stable and considerably stoic.

The mother explained to me that she noticed her son wasn't as playful as her other kids were when they were his age, but thought nothing of it.  She said the doctors discovered the hole in his heart because she wanted to take her son to get his teeth cleaned, but because of his age, the dentist required a physical.  The pediatrician who performed the physical noticed some abnormal heart tones and referred the child to a cardiologist.  At the cardiologist, multiple tests were conducted and it was determined that the child's lack of energy was likely a result of a congenital atrial septal defect that would need to be repaired.

I spent the majority of the transport monitoring the child while quelling the mother's fears to the best of my ability.  One thing we don't spend enough time on in paramedic school is the interpretation of pediatric 12-leads.  I pulled out my smart phone and started researching after explaining this fact to the mother.  I assured her, that regardless of my ability to interpret the 12-lead, I would be able to care for her child as he needed.  I also transmitted the 12-lead to one of our local adult emergency departments and spoke with the doctor over the phone who confirmed my interpretation as unremarkable.  After discussing the situation further with the mother, I called the pediatric receiving facility to which we were transporting and consulted with the pediatrician over the phone to again confirm that nothing acute was apparent on the 12-lead.

The mother explained to me that she had never had paramedics seem so invested in her child's health or her own well-being as a mother.  She told me that given her limited education and financial resources, there are some times that she is incapable of providing for her children, but that she does everything in her power to do so and to raise them right.  Regardless of her best efforts, her child will forever have a cardiac history.  He will forever have this history.

Both children in the above examples will forever have the situations in which they were brought up, but what they do with those experiences, those limitations, with the blessings and the curses, is what will define them and what will make their lives seem limitless.  They will not be defined by their past social or medical histories.  They will not be forgotten.

When people ask me what the worst thing I've ever seen is, their faces, among the many other children I see on a regular basis will populate in my mind.  What I will think about are the conditions that produce the sick children we see and society's sightless view of them, both their present state and their presumed future.  I will internalize their plight.  I will sympathize with their suffering.  I will convey to whomever will listen that the worst things we see are not the colossal car accidents or the mangled limbs they produce; they are not the people shot or stabbed; they are not the strange anatomy through which we were able to pass an endotracheal tube; they are not the cool and unusual cardiac rhythms; they are not the tragedies of others' stories.  Rather, they are our own tragedies and lack of awareness.

The worst thing I've ever seen is the unfairness in this world that cascades to produce further disparity affecting the lives of children, their social and psychological development into adolescence and adulthood, their futures and ours.