My Father’s Daughter

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When I was a kid my dad had a Camaro.

Before you get too excited, it was a beater. I hated this car. I was 10 and had already discovered the necessity of “cool”- this car wasn’t it. 1967 body with primer grey and rust accented exterior, ripped up black leather seats (the front passenger seat missing) completed the visual affront. A rowdy muffler announced my arrival or departure at school for all to witness.

My dad was so proud of his car. He’s a car guy. When I was 5 or 6 he started to show me under the hood so I would understand how things worked- and before gender specificity set in I wanted to be a mechanic like my dad. This was his fantasy car and “when he won the lottery” he was going to fix it up like it used to be. There is something emotional about owning a car, a freedom, an identity.

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He normally kept it in the garage, but recent years were lean and we couldn’t afford a new car when the last one died. My 5th grade ego was tired of being teased and I was quite honest about my contempt and its perceived effect on my popularity regardless of our financial means.

One day I steeled myself to walk out to the pick-up line after school and meet my fate, but didn’t see the car. I looked around and saw my dad standing at the top of the hill up the block; his ripped jeans and black skull t-shirt stood out among the moms waiting for their kids.

I walked up to him, “Hey Dad, where’s the car?”

“It’s at home. It broke down so I had to walk here.”

Of course it did, I thought silently.

I was relieved for the reprieve.  A large group of us began to walk home, my dad bringing up the back talking with different kids. Slowly the group dwindled as kids began to peel off toward their homes. About half a mile into the walk he suggested we stop and get ice cream. No Camaro AND ice cream on the same day!

We got our treat and continued to walk for a few more blocks when I saw the Camaro. My dad pulled the keys out of his pocket.

“I thought you said the car broke down at home,” I asked.

“I know you don’t like the car, so I decided to walk today.”

I have NEVER  felt more like an asshole in my life.

I learned an enduring lesson about loving people and sacrifices we proudly bear because of love that day.

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My father appears to be a rough man, but would help or protect anyone in need. He doesn’t often tell stories, but when he does his face lights up and you imagine you are right there in the thick of it. He taught me how to fight and have situational awareness as a little girl so I would be safe when he wasn’t there. He watched as I learned hard lessons about people and never said “I told you so,” he was just there, silently supportive. At 17 when I had my own beater, I was the only girl (school uniform and all) who knew how to change tires and my friends and I never got stuck anywhere, because he made sure I knew how.

He taught me many silent ways how to care for others: teaching without judgement, providing, lending a hand. He has probably taught me things I haven’t even discovered yet. His example helped me become who I am and to be able to approach EMS, my brothers and sisters, and patients with open hands looking to help. I hope I end up being half the person he is.

 

 

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The Pit of Fear

The true terror began when I saw the room.

A friend sent me a photo of the room I was to be speaking in at my first national EMS conference just a few days before the event. As soon as I saw it the pit of mindless fear opened in my belly. Until that point, I almost felt as if I was preparing a program for someone else to present. That made it easier to quell the relentless voice in my head asking, “What if you mess up?” If you thought the world of EMS was small, I would call the circle of speakers at EMS conferences miniscule. Everyone truly knows everyone. If I blew it, this was the only chance I would ever get.

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Previously, I had been encouraged to submit to other conferences, but I was not ready. Trepidation and doubt nailed my feet to the floor. Submission dates passed and the encouraging voices waned. I had no intention of applying to this conference either, but someone reminded me about the deadline the afternoon it was due: New Years Eve. I heard somewhere that what you do on New Years Eve is what you will do all year. I submitted, not thinking I would ever get accepted. Imagine my surprise when I received an acceptance letter.

Now was the time to put up or shut up. My chosen topic was The Silent Killer: EMS Suicide. I wondered why on earth I picked such a sensitive topic to talk about at my first event. I had previously had mixed reactions from different providers during discussions including quite a loud, angry discussion at what had originated as a fun outing.

painOf course, I had writer’s block for weeks while I was supposed to be updating my presentation. Intermittently, when I thought of me in front of the audience, all I could imagine was disaster. A good friend encouraged me to close my eyes and imagine every detail to the perfect performance: what I would wear, how my hair was styled, what the Power Point would look like behind me, how full the room was, and most importantly: the positive audience reaction. Thankfully, I also had an honest mentor that when I thought I was done (YES!), returned my slides back to me with more comments. His suggestions improved my presentation exponentially. If you intend on moving up in this business, clinical or otherwise, you need to find a mentor in the area you wish to excel in.

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The day to present finally came. I woke up with my stomach tight and my attempt at breakfast was poorly received. I didn’t go on for another 6 hours! It was going to be a very long day indeed. I watched some other classes and found my mind wandering back to my subject matter while I wondered aimlessly around the host hotel and eventually decided to review one more time. It comforted me to run through the slides and make notes like someone with OCD arranges their desk over and over.

998572_10151784552212290_476214675_nAbout 20 minutes before I was scheduled to start, I went to find my assigned room and attempt to mentally prepare and put on the business face. I felt like an imposter when I walked to the front of the room to load my presentation. Everyone’s eyes felt like an accusation, “You don’t belong up there!”

The room started to get a little fuller and it was time to begin. I opened my mouth to introduce myself and the fear that had plagued me for weeks dissipated with every returned smile from the audience. I spoke and spoke, people nodding in agreement, smiling at anecdotes, silent when convicted. I shared secrets I only realized I had days before, the vulnerability uniting us, members of a secret club, no longer alone. I concluded and people came up to hug me and shake my hand. One young woman came up to me, speechless only able to utter, “ I just wanted to say thank you.” My friends surrounded me as I surrendered the lectern to the next speaker, the terror of just an hour ago growing into an indescribable high. And as I walked out of the room the joy and excitement bubbling from my heart I wondered, “When can I do it again?!?”

The Author Speaking

Maybe this is how you feel about public speaking. Maybe you think, “ I could NEVER do that.” Is there a topic you are passionate about? If you don’t talk about it, who will? I’m just a provider with an interest that stood up and said something.

What do you have to say?

 

The Courage to Write.

Initially, I thought I arrived here by “accident.

I can be a bit rambunctious and not everyone can appreciate that, so I ran into a little trouble at work and avoiding a long story that will bore you, I found myself looking for a new gig. A few weeks later, I went on an interview at a place I did not really like or want to work at and afterward found myself trolling Marshalls trying to feel better. New shoes, clothes, purses, or household crap for you to dust can do that for a girl.

thWhile strolling through the aisle of various pots and pans, a friend messaged me and asked if I could read something. We had talked about our individual school work and research demands previously and I thought highly of him (hes kind of a big deal), so I was SO excited to be included into this exclusive club to check out his writing! I read it right there next to the All-clad frying pans, the Stepford Wives shooting me dirty looks for blocking up the aisle and all. It was a management article, but he was speaking about my life! Specifically, the trouble at work situation and the type of manager I just encountered. I silently wished he had written it a few years earlier and saved me some agitation.

I began to wonder, “How can I write like that?” So I asked.

Hey, how did you get started writing for magazines?”

This gentleman was gracious enough to tell me a little bit about his journey and even offered to review anything that I wrote. WHAT!?! ME?!? I was honored, but didnt think anyone wanted to hear what I had to say, much less felt that I could influence someone positively. Didnt I just get into trouble for opening my big mouth?

Honestly, I was scared.

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As time went on, this militant thought consistently reared its head, “Why not me?” I began to write a piece and shared it with a few people. To my surprise and pleasure, they liked it and were honest with me and told me how to improve it. Still I waited, unsure if I could really “do” this, I mean who was I to tell anyone anything? I had A LOT of “reasons.”

I don’t have a degree.

Im only an EMT.

I don’t have a fancy job as a platform.

I just ride on a truck.

Who would listen to anything I had to say anyway?

Another good friend with a flair for the literary and a silver tongue encouraged me to build a blog. I thought, “Uh, arent blogs for people with nothing going for them?” I received a quick education on EMS blogging and got lost in the internet for many hours finding amazing writing ranging from clinical topics to florid tales regaling the family that is EMS. More talking myself out of writing ensued after I read some of these authors who left me in stitches unable to breathe and others who made me shut the computer off heart broken and crying, knowing I could NEVER write like that.

c3d4fe411b27e8acd660c1509e0babc2I didn’t get here by accident. Life, destiny, the Universe, whatever you want to call it has been setting me up for years. As a little girl, I got busted sneaking books to bed and still I stub my toes on the stacks that don’t fit on the shelf. As a young hellion, I met a new friend whose mother was a writer and preacher and despite my alternative and undesirable appearance (which she still talks about in front of the congregation when I am in town at church) let me wait in the wings and watch. I learned how to speak to people in power. I learned how to write and speak and back up my position, so I did not just have an opinion. She let me learn how to serve others by imparting parts of myself via her example. She laid the foundation that others would build on during my creation as a writer. This was no accident. Neither is your journey.

speakingLike most FNGs in EMS I decided to fake it ’til I made it. With a lot of help from an accepting and encouraging EMS writing community, I built the blog and posted that first article. Then another and another and another and THEN I got my first piece of hate mail! That sealed it for me, people were listening!

I will tell you a secret. I am still terrified.

We do this every day. We speak to people and influence their healthcare decisions as a provider. We uplift our friends and family when we offer messages of encouragement or commiseration. We make strangers smile when we offer a pleasant word and smile of our own. Writing is just life via our fingers.

It is easy to listen to your inner critic knock you down and silence your voice. Its easier to turn a blind eye and keep your head down and get by, but what the hell will you have at the end of your life then? A bunch of “I should haves” and no time left.

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There are many things that will try to slow you or distract you or stifle your voice. Dont let them. Your voice is important, what you have to say can only be said by you. You never know who your words will affect and improve or inspire or save.

Yes, the power of life is in your words. Use them.

The Silent Killer

 There is a great hypocrisy in the world of Emergency Services.  Our job is to help people in any circumstance, at any time, at any place usually where unimaginable scenarios present themselves.  These are the worst days of peoples’ lives, but they shouldn’t affect responders…at least that is the popular conception within our circles.

This is why our coworkers, employees, partners, mentors, friends, brothers and sisters fall prey to treatable conditions unseen and unheard.  We look away at the worst time of their lives when they need the most help, but cannot ask for it.
“If ‘the job’ bothers you, then maybe it’s not for you.”
“I don’t know why you are so upset, you can’t save em’ all.”
“Man up!”
Maybe, there was no warning at all.  No complaint, no altered personality, no telltale sign of something amiss.  These people who we would protect and defend in the street are consigned to silence by the fear of our judgment in headquarters.  If you have been in this business for more than 5 years you have witnessed the phenomenon yourself.  Someone mentions that a particular call affected them or they seek treatment before the feelings progress and suddenly they are riding a desk or are forced out of the agency.  The typical line that is produced by the powers that be at the time is, “We have to know our people can make sound decisions under pressure.”  I admit this is a necessary component of our profession, but have you seen some of the people that get hired?  These providers are usually veterans who know to get help before the issues progress and were attempting to obtain help.  That is not good decision making?  What makes this whole situation worse is that we at the bottom then complete the abandonment by ignoring the person affected.  The person we used to be a brother or sister to is now treated like a leper because we “don’t want to deal with THAT.”
Some responders even commit suicide.  These are our friends!  We swim in each others pools and eat each others food.  We celebrate holidays together when we cannot be at home.  Our children play together and we tell each other secrets our loved ones wouldn’t begin to understand.  Yet we might as well show up to the funeral en masse in our dress blues and turn our backs for how some of their families are ostracized.  
Got cancer? We have a fundraiser.   
Got injured?  We come help around your house.  
 Have PTSD and kill yourself?  Oh, I’m sorry, do I know you?
There are no hard and fast statistics related to EMS or Fire related suicide.   Quite honestly, there are no statistics related to suicide by EMS providers. There are several reasons why: 70 percent of fire departments in the United States are volunteer departments and death certificates are completed with a profession noted, not volunteer activities.   Until recently the hero culture and machismo within Emergency Services had absolutely no room for discussion on first responder suicide, but like many things, the military attention on PTSD and responders with PTSD after 9/11 have shifted our attention to the topic.  The demographics within the EMS community are more varied than the Fire Service, but we are all exposed to some high risk factors for suicide.  We are all exposed to violence on a higher level than most citizens, whether via patient care or being assaulted during the incident ourselves.   Death is encountered by first responders in the normal course of duty and the loss of one’s life is accepted as an occupational risk.  A study, Occupational Fatalities in Emergency Medical Services: A Hidden Crisis, published in the December 2002 Annals of Emergency Medicine found that EMS providers are almost as likely to be killed at work as police officers and firefighters.  Between 1992 and 1997, 12.7 per 100,000 EMS Providers died at work compared to 14.2 per 100,000 police officers and 16.5 per 100,000 firefighters.  The national average for the working public is 5 death per 100,000 workers. We are also exposed to suicide or attempted suicide at higher levels than most citizens. This elevated exposure desensitizes providers to violence, death, and suicide and can lead to disinhibition and likely a more evolved capability for suicide than the general public.
Many non-demographic risk factors of suicide related to Emergency Services include alcohol abuse, mental illness, divorce or separation and the presence of a firearm in the home.  As you are well aware, we work long hours at multiple jobs, we don’t get paid very much, we deal with copious amounts of stress on a daily basis and this can lead to a myriad of difficulties in our personal lives without an outlet to release it all.  We all know someone, or maybe have had personal experience, with financial difficulties.  Having a strong work ethic is commendable, but 100 hour weeks dealing with everyone else’s problems is bound to lead to problems of your own. After working all those hours that’s just enough money to live in a tiny apartment eating butter noodles because that is all you could afford after paying your bills so you could get to work to do it all again next week.  We have all been cheated on or know someone who has or is currently involved in a love triangle (or square).  Everyone knows everyone else’s business in our world and in twenty years people will still remember.  And whisper.  If you are married or have a relationship with children involved this can lead to custody issues and likely a lawyer bill that your butter noodle budget cannot afford.  You know what happens when you don’t have a lawyer.  I’m sure we also know someone that lost their home because things got out of control and lived in their car and showered at the gym or work.  As if ALL that wasn’t bad enough add being ignored and told to “man up”  to the list.  The solution to the issues listed above is not simple or easily unraveled, some of it is the nature of the beast and some are personal choices.  These issues need a national forum for solution and voices from members of our community demanding change and improvement.  Some of these issues need better decision making skills in our personal lives as well.  It won’t solve the problem of suicide outright, but improved lives and life choices will contribute to stemming the tide.
FDNY EMT Daniel Stewart
While there aren’t many numbers to quantify first responder suicide what we do know about suicide in general is alarming. Of those who completed suicide, 70 to 80 percent suffered from alcohol abuse and a mood disorder, 40 to 60 percent were intoxicated at time of death and 56 percent used a firearm to carry out the suicide.  These are statistics for the general population, but closely resemble the majority of first responders.  In a study conducted by the International Association of Firefighters (IAFF) alcohol abuse was qualified as more than 2 alcoholic beverages a day for men and more than 1 alcoholic beverage a day for women.  The “two” beers and shots at the bar or party on your day off is qualified as binge drinking which is related to alcoholism as well.  Some other alarming numbers: various studies have cited PTSD rates, specifically related to firefighters, range from 16 to 24 percent while the average for American adults diagnosed with PTSD in their lifetime is 6.8 percent.
 Philadelphia Firefighter Jack Slivinski (left)
While suicide can be preceeded by a number of mental health issues, recent studies are linking PTSD and Suicide.  Per the Mayo Clinic, PTSD symptoms can include: flashbacks, upsetting dreams about the event, reliving the event, avoiding thinking or talking about the event, feeling emotionally numb, avoiding activities once enjoyed, hopelessness about the future, memory problems, trouble concentrating, difficulty maintaining close relationships, irritability, anger, overwhelming guilt or shame, self-destructive behavior, trouble sleeping, being easily startled or frightened, and seeing or hearing things that aren’t there.
Unfortunately, many of us, including our leadership are not educated on these warning signs.  Alternatively, the psychiatric and counseling communities are not usually well versed in our culture to understand the unique parameters that define our workplace.  Fire, Police and EMS units (unless aligned with a hospital) do not typically have Employee Assistance Programs (EAP) to call and speak with.  Those that do have programs in place still have providers with fear that their job will be affected.  These responders either pay out of pocket to go to a counselor of their own so the treatment does not show on their insurance or don’t do anything at all, letting the feelings grow in strength.
Chief Kyle Ienn of Ralson, NE Fire Department
There are many wonderful people advocating and researching PTSD and First Responder Suicide.  Peggy Sweeney of the Sweeney Alliance promotes educational programs for dealing with stress, trauma and grief and writes several newsletters including Grieving Behind the Badge.  Her colleague, Shannon Pennington is the founder of The North American Firefighter Veteran Network and together they have produced a training program for first responders called FIRST STEP HOPE: Not All Wounds are Visible.  Both have been first responders and understand the difficulties faced in our line of work.  Jeff Dill holds a Master’s degree and is a Licensed Counselor. He is also a Captain at Palatine Rural Fire Protection District in Inverness, Illinois and the founder of Counseling Services for FireFighters.  He educates leaders on the importance of counseling and awareness of PTSD and Suicide.  He is also compiling statistical data based on confidential reports of Firefighter and EMS provider suicides.
 Awareness, like many other topics in our profession is key to prevention.  Having an Employee Assistance Plan (EAP) and CISD Teams and leader education is a great first step, but until the change in our culture flows through the ranks, our brothers and sisters will continue to be cut down by this seemingly silent killer.  Ask about your workplace EAP Plan or why you don’t have one.  Educate yourself on issues that affect providers socially and emotionally and ask to have them addressed. Help each other when you notice a change.  Let your legislators know EMS needs funding for studies on these issues and ask what they plan to do about it. 

We strike for better pay and health benefits, we complain to get better couches or recliners to watch TV in, we gripe about not enough milk in the fridge for afternoon coffee.  Why don’t we speak up and stand in the gap for our friends and ourselves?  Who will pay attention if we don’t?  How will the culture change if we don’t change it?
If you are thinking about suicide or need help you can call the National Suicide Hotline.  It is open 24 hours a day, 7 days a week.  1-800-273-8255  1-800-273-TALK

 

Just Keepin’ It Real


A few nights ago I was relaxing and reflecting on how I got to this point in my life and reminiscing about the people and circumstances that helped mold me into the person I am today.  One person in particular came to mind, although we haven’t spoken in many years. I wondered what happened to them, how their life turned out and if they are still alive.  This person had a short tenure in my life, but left such an indelible mark on me that many others have not been able to affect in years. How can one person motivate such change in such a short time?  How can we leave that legacy when interacting with others?

 

 
I am sure there are several articles from big name magazines and Ivy League review magazines trending on LinkedIn and professional websites that address this topic.  They will have 5, 7 or 10 points or suggestions for you to implement in your professional or personal life to “make your mark” or “leave a legacy”.  I submit there is ONE thing you must do to change people’s lives and make your legacy in any area of your life.  It is the most difficult thing you will ever have to do.
 
Be authentic.
 
Yes, the one thing you have to do to change lives, both yours and others, is be yourself.  It might be the most terrifying thing, exposing the true you to the world.  There are a myriad of fearful questions that take flight in the mind when thinking of what taking off the layers of protection personality and ego afford.  When authenticity was first suggested to me I thought, “What if they don’t like me?  What if I fail?”  My initial solution was to stop writing.  If authentic was a quality then maybe this wasn’t for me because that kind of failure was just too much.  It took a while to realize that my fear was defeating me and I was failing by giving in to fear. 

 
People are waiting for something real!  We all look for it: the real deal, a real love, “I’m just keepin’ it real”.   Post Secret is immensely popular and addictive because it allows the poster and the reader to connect and share on a level that society does not subscribe to. The problem is when folks are face to face no one wants to take off their mask first.  No one wants to take the risk.

The Velveteen Rabbit
There is no simple fix to expedite the process of “being real”.  Protecting ourselves has been ingrained in us since we were first able to process thought.  You will have to apply yourself and look for opportunities to reveal the true you, choosing between putting up a front and being authentic.  Like a deep friendship or relationship, time will slowly strip away the layers and bonds will be formed based on these revelations.  These bonds can be within the workplace, friendships or with family.  The results are far reaching and beneficial.  Your personal and professional relationships will be improved because your colleagues, family and friends will feel valued.  You will get more accomplished because the roadblocks of ego and grandstanding will be washed away.  Your interactions will be more intense and people will be authentic with you because they know they can trust you. Take off your mask and see the difference it can make.

Post Secret Submission

I Used to Love Her

Gwyneth Paltrow and Joseph Fiennes
Shakespeare In Love
Do you remember what it was like when you first fell in love?
 
Something about that person piqued your interest.  Your brain perked up, bright and alert.  You couldn’t wait to hear from them or see them again!  Even the briefest encounter or conversation was played over and over in your head until the next time you could interact with them.  Time went on and the relationship developed.   You learned about each other’s idiosyncrasies, patterns, ideas and started to plan a life together.  Then one day, without warning, your love ripped open your pericardium and tore out your heart!  “Why!?!” you wailed while envisioning every moment in a torturous movie reel playing only for you. Some time passed and you saw your lover, beautiful, invigorating, beckoning you to love them again.  (This is where the movie audience screams, “NO!”)
 
Yeah, EMS is like that.
EMS has broken my heart several times, and yet I keep coming back for more.  I’m caught in the Siren’s song like a fisherman in the Aegean.  I have left EMS before, two or three times, declaring never to set foot in an ambulance again.  Damn the Man, Fight the power and all that.  I planned to have a lovely, wealthy life in marketing until I found out most marketers make less than EMTs.  Shortly after this discovery, my old partner came around for coffee one day throwing out the line, “Come on, you can work with me!”  I’m not here to sell you some ad space so you know what happened next.

 

 
Australian Ambulance Headquarters turned coffee shop.
 
I suppose the question is, “Why keep coming back if you know you might get hurt again?”  The risk of not doing something meaningful with my life was greater than the risk of having my feelings hurt.  Deborah Mills-Scofield wrote an article called “Are Entrepreneurs Really More Comfortable with Risk” in the Harvard Business Review that addresses this theory.  While she is comparing large companies and entrepreneurs, I believe this theory is very applicable to the practitioners within EMS as well.  Long term EMS providers, five years or more, define risk and satisfaction with work differently.  We all knew after the first few paychecks that this was not the job to get wealthy with, but our riches lie in other currencies.  Our wealth is measured by stories told by veterans or old, seasoned souls, secrets people entrust to you about their deepest sorrows or fears that they cannot tell anyone else, a thank you from a young patient’s family weeks later at a chance meeting in town.  When I was a new EMT I relished being able to “fix” people with my hands, now I relish holding someone’s hand and listening to the gift the patient is imparting to me.
 
There are several kinds of people in EMS.  There are those that are here for a stepping stone into Police, Fire, or another medical profession; they get their experience and move on.  There are those that find EMS is not for them or isn’t exactly what they bargained for and leave shortly after they start.  Then there are those of us that weren’t looking for it, but we fell in love with this job and all that it entails.  We just can’t leave it alone and even once we get that nice office job with a thick carpet we still have one foot in the truck working a shift a week just to keep our chops and to keep the withdraw at bay.  I never thought I would become a dinosaur, but the experience, compassion and knowledge amassed in this group is staggering and I am humbled to be on the fringe.  I don’t think I will ever leave EMS, I don’t think I can.  This is what I know how to do, no matter how many degrees I might obtain or how high on the ladder of life I climb.  She may break my heart every now and again, but I will always come back around.