There’s No Bad Time to Start Getting Better

The Association of Air Medical Services launched a campaign for Mental Health Awareness Month. Awareness of mental health issues is critical, especially in EMS, but there has been limited discussion around recovery. AAMS reached out to members of the EMS community with recovery in mind. Among the responses were this piece from Angela Caruso-Yahne. She is a former reservist in the U.S. Air Force, where she worked as an aeromedical evacuation technician and flight instructor. This is her story.

As a reservist in the Air Force, I had the best of both the civilian and military worlds. Operating as an aeromedical evacuation technician and flight instructor/evaluator around the globe while cultivating and maintaining a career as a paramedic was an opportunity well worth the blood, sweat, and tears it took. After nearly two decades of zipping up the flight suit in a part-time military role while working full-time in civilian pediatric critical care air transport and fire-service EMS, I had accumulated a wealth of education and experience.

The problem is that along with these experiences that honed my skills came a heavy load of trauma exposures. Several combat-zone deployments, abused children, friends and colleagues lost to aircraft accidents and suicide, and the subtle, persistent insider view of humanity at its most vulnerable eroded something in my core. Where I once had a solid sense of capability, satisfaction, and inner calm, I developed a growing state of self-doubt, indifference, and anxiety.

While I tried not to reveal it, I knew I was losing my edge and becoming less in balance with my emotional state. Inside I was suffering, but I didn’t let it show. I had a good game face. I could see the changes in my thoughts and behaviors but discounted them as temporary and stress-related, something that would subside on its own when I was less busy or under less pressure. But it didn’t ease up over months or even years.

Eventually my irritability and anxiety began to impact my personal and professional relationships. It wouldn’t be ignored. Like many others drawn to these kinds of high-intensity medical professions, I felt I was a natural problem-solver. We also are independent types who usually focus more on how we can improve someone else’s situation than our own. We want to get it done by ourselves, with the resources at hand, and not look beyond that for help. The mind-set is that we don’t need help, we are help—and we tend to be a little stubborn.

With these characteristics, it is not difficult to see why I got deep inside my own head and decided I had to figure this out for myself. I read all the books and studies, knew all the modalities. Even though there were tons of people and programs at my disposal, had I been willing to engage with the assistance, I hesitated for a very long time. I knew people who had followed a similar career path to mine and seemed unaffected. I also knew others who, by my own measure, had been through far “worse” and were more worthy of support. As long as I could focus my energy on comparisons like these and arbitrarily determine what cases were deserving of appropriate care, I could continue to avoid addressing my own needs. In the meantime, my military career was no longer fulfilling, and my general sense of contentment in other areas of my professional life was gone. Finally it was apparent I had to take some steps to improve my coping strategies and abilities.

I engaged with a private therapist who helped me unload and unpack some of the most significant events and communicate about these experiences with my spouse. Meanwhile, I reached out to my chain of command in the Overland Park Fire Department and found it to be extremely supportive. Our administration has become very aware that the old and entrenched culture of “suck it up and press on” isn’t helpful to the well-being of our providers or the longevity or their careers. I wasn’t ready to disclose much, but they understood I needed some time off to tend to my mental health and they wanted me back up and running at 100% as soon as possible. Also, they genuinely cared that I was struggling and wanted me to find some relief.

I found a veterans’ program and registered despite assuming it would not have much to offer. I am so glad I did. As it turned out, completing an anchor program with Veteran’s PATH (https://www.veteranspath.org/) was the doorway to significant recovery from the prolonged stress and serial secondary trauma exposures so prevalent in prehospital and critical care work. Even though as part of our CISM team I was regarded as an in-house expert when it came to peer support and self-care (maybe I thought there was nothing else to be learned), there were a so many things I gained by truly immersing myself in the work of self-care and improved coping strategies. Not only did I learn a lot, I left Veteran’s PATH with a new set of coping skills, a network of support (both peer and professional), and an unexpected group of friends.

My only regret is that I didn’t start the process sooner. I gave away some time in my life that I didn’t have to. That said, I am extremely glad I started when I did. Had I gone on longer, I would have continued down a path leading to less happiness each day. There is no bad time to start getting better. There’s no time like the present. The truth is that we are all complicated people. No matter what our specific set of experiences has been and how we feel it ranks compared to someone else’s, everyone at some point in their lives could benefit from mental healthcare, even if it’s just a minor tune-up.

If any part of this story resonates with you, consider this: What would you want for your best friend? Think about it. If a coworker with whom you’d been flying for years told you one day they were feeling whatever it is you feel—maybe burnout, anxiety, depression, anger, thoughts of suicide, etc.—what would you do? I believe you’d support them however you could. You’d encourage them to get the help they need and let them know they deserve it. You’d let them know they were not alone, and you wouldn’t judge them.

So what if you simply treated yourself as you would a friend or coworker? Give yourself permission to take care of yourself. Let your friends, family, coworkers, and administration surprise you with just how supportive they can be. Find a good therapist (it may not be the first one you contact) and be honest about what you’re experiencing. Find a peer group of first responders or medical professionals and be part of a community that really “gets it” on a different level than the general public does. You will be offering just as much as you gain, and I suspect you will gain a lot. You deserve it.

And finally, remember that just because you didn’t reach out yesterday doesn’t mean you lost your chance. Every day is an opportunity to take a step.

Angela L. Caruso-Yahne is training coordinator for the Overland Park (Kan.) Fire Department.