The Smile After the Storm

Emotionless. Cold. Robotic. “How can you feel nothing with all the tragedy you see?”

I was asked this continually in my early years as a paramedic. My nickname in the ’80s was “Castillo” after the captain on Miami Vice who never showed emotion. I felt nothing…until I did. You never know what will open the floodgates.

My Great-Aunt Bella was an amazing woman. She was active her entire life. One time when she was in her early 80s, as we were coming off the badminton court after she’d beaten me again, the pro from the club said, “Bella, why don’t you let your nephew win sometime?” She puffed up to her full height of 4-foot-11 and responded, “If I want him to win, I’ll have him play you.”

All that changed after she wore the wrong shoes home from a New Year’s Eve party not too long after that game. She developed a blister that never healed properly. How could a blister take out this amazing, vital woman? That simple blister festered, and by not healing it limited her mobility, which impacted her overall health. That changed her outlook on life, and within nine months she was gone.

As her closest relative, notifying the rest of the family around the country fell to me. My mother thought I would need medical care when I called to tell them she’d passed. I was inconsolable. I had never felt grief like that before. That is not unexpected. What was unexpected were the feelings now near the surface at all times. Emotions I’d never felt were now bubbling up, catching me off guard when I didn’t expect them. I went from an emotionless robot to a man who teared up watching a telephone long-distance ad or sappy video on Facebook.

The Calls That Haunt Me

I’m not sure if my aunt’s death changed my outlook on patient care or not. I’ve always had a spot in my heart for my elderly patients. For many years, while running orientation sessions for new staff, I would tell new recruits I had a great-aunt in the city, and if they ever picked her up and didn’t treat her like gold, their career would be short. I also wouldn’t tell them where she lived or what she looked like. All our seniors deserve to be treated with the same level of professionalism.

Losing my great-aunt did change some things about my career, though. Mental health is a focus in EMS right now, and deservedly so. This breakdown—or breakthrough, however you look at it—made me recognize that I have been affected by my career. It forced me look at my support systems and take stock. It allowed me to realize that the same career that put my mental health in jeopardy had put me together with amazing people who could help me through those times. In 34 years of service, I have had three calls that have haunted me. All three were in the days before things like CISM and debriefings. What I had available was the support of good partners, friends, and family.

It was a phone call to a friend I hadn’t spoken to in a while that made me realize I was having issues with one of these calls I’d run. He heard it in my voice when I didn’t even know myself that I was having a problem.

That conversation was in 1998, and I am still impacted today when I talk about that event. I want to be clear, though, that I’m not talking about PTSD. I don’t want to diminish that term for the people who truly suffer. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is very clear on the criteria that must be met for a diagnosis of PTSD, and the term can be thrown around too loosely in EMS. People with PTSD are impacted every day of their lives. Without treatment some never escape. I have down days occasionally, just like anyone else, but because I have bad days and happen to be a paramedic does not diagnose me with PTSD.

Coworkers, Friends, and Family

So how can you protect yourself and your coworkers? First and foremost take care of yourself. Ensure you have a life outside EMS. Take care of your physical health and have an outlet—exercise, hobbies, or whatever. Make sure it’s a healthy outlet, though; drugs and alcohol are used too often in EMS but not helpful in this situation.

Next, take care of each other. To have good friends you need to be a good friend. Look out for one another. Often you know your partner better than some of your own family. You may recognize a change in their behavior before they see it themselves. Don’t be afraid to ask how they’re doing. If you see something, say something, as the phrase goes. Truly listen if a coworker or friend comes to you.

Coworkers, friends, and family are a great line of defense, but if that defense is not strong enough, recognize the need to take the next step and get whatever help you need to keep you healthy. Seeking help is not a sign of weakness. Being afraid to seek help is. Ensure you know how your company’s employee and family assistance program works. Take the time to learn how to access information and services, both for yourself and to be a resource for your partner and coworkers should the need arise.

There’s a collage of Aunt Bella behind my desk at work that my coworkers put together for me after her death. Within the frame there is a woven piece she picked up in one of her overseas travels with the word smile hidden within the design. I see that every day when I come in to my office, and it reminds me of my family and the great people I work with who have helped me through my dark times.

It also is a reminder that sometimes you have to look very hard to find the smile, but it is there.

Tim Hillier is deputy chief for professional standards at Medavie Health Services West in Saskatoon, Saskatchewan, Canada.