Tuesday, 21 April 2015

They're Killing Us

A year ago today, I watched my mother die.

An otherwise healthy woman, she unexpectedly started to suffer a decline in health early last year and by March, she was immobile, confused and emotionally volatile. I, along with my two younger sisters, cared for her at home. We did what we could, watching helplessly as she continued to deteriorate. The last 10 days were especially traumatic as her body refused to give up despite her inability to eat or drink due to her brain being decimated by the incredibly rare (1.4 in a million) sporadic Creutzfeldt Jakob Disease (sCJD).

It was last year today when I held her emaciated hand, watched her breathing slow and felt the last palpable beats of her heart. The woman who had given birth to me, had loved and cared for me for my entire life and who had become my close friend and confidant, finally ended.

I didn't - and still don't - know how to feel.

I feel compelled to share this here, not because I seek sympathy, but because how it affected me in subsequent months is relevant to the discussion currently raging on this blog and elsewhere. My Mum encouraged me to start this blog when she became concerned about ambulance cover in North Norfolk. I think that she would have been happy to help me make a point now.

Coping with Trauma

Due to the healthcare background shared by me and my sisters (a paramedic and a former care worker), we felt we could take responsibility for Mum at home in her last weeks. With superb support from the district nursing team, the GP and others, we did exactly that and I believe we provided Mum with a level of care that no hospice in the world could compete with.

But it left me tortured by the experience and constantly questioning the decisions I had made. For the last year, no amount of support or condolence was able to penetrate the darkest corners of my thoughts - I even found irrational cause to despise many of those closest to me. Compounding this, I found myself unwillingly mentally reviewing countless events from my ambulance career. Watching my baby daughters sleep triggered vivid, unwelcome images of ambulance attendances I'd previously been able to suppress.

I became inert, useless and negative. People made excuses for me, 'he's grieving, give him time'. I have been lucky to have a fantastically caring and patient wife and small children who are an uncompromisingly positive influence. I also benefited from a close relationship with my sisters - who also continue to struggle with the experience - and a network of tolerant friends. The birth of my second daughter last November was perhaps a real catalyst for my recovery (although it continues to sadden me that she and my Mum never met).

But not everyone is so lucky.

PTSD: Cautionary Tales Ignored

My point is this: although undiagnosed, I am fairly certain I was (and perhaps still am) suffering from PTSD. It impacted my ability to think objectively or contribute constructively to many aspects of my life for a long while.

The kind of emotionally traumatic experiences dealt with by front line ambulance staff undoubtedly has a long-term psychological impact, even if they successfully compartmentalise the memories in order to carry on. Only after my medical retirement due to injury did parts of my mind start to 'unwind' and release previously buried trauma. I know from personal experience that the damage caused can lay in wait and be triggered long after the actual events. This 'drip-drip' effect and any debilitating impact it has is largely ignored by current ambulance culture and even actively exacerbates it by forcing staff to work in such a relentless environment which allows no time to decompress or reflect.

Furthermore, a number of cases I have been made aware of recently which have resulted in staff suspension and an edict of 'no contact' enforced on colleagues can leave the individuals bereft of the support network they so desperately need. In many cases suicide becomes a very real concern.

It is heartbreaking to hear about the breakdowns and suicides of ambulance personnel who, having chosen to dedicate their working lives to helping others, are unable to help themselves.

Del Rutter-Wilton 'took his life in 2013 whilst suffering from work-related depression and PTSD.'
If compassion is truly at the core of healthcare, then those who govern and manage it need to be reminded of the fact. If they cannot find the means to provide a compassionate, supportive working environment to protect their own staff then they are failing in their role and should get out.

Because they're killing us.

5 comments:

  1. Amen.
    Unfortunately, the stigma regarding mental health in the UK is such that it isolates people. It concerns everybody regardless race, gender, age, profession yet we carry it around with us like a dark secret. Fear is a strong component: we are afraid what admitting our struggles might do for our job, promotion, esteem. We are afraid to deal with it because we don't generally understand MH. We are afraid 'because I don't know what to say, it might make it worse'..

    Although I have a MH professional background I don't profess to know everything about MH. I do know one thing though: if we approach somebody with MH issues with respect and as a fellow human being we have won half the battle. I struggled with my own trauma and depressions (my mother died in a car crash when I was 15) and had to learn what caused my reaction, how to recognize when I am on the slippery slope and what to do about it. That is not right; we wouldn't expect any patient with physical problems to do that!
    Now I use it in my patient contact because, as the subtitle of the blog says: 'There is no medicine like hope' and seeing it is possible to get out of that dark hell hole has motivated many a patient I had the privilege to have a chat with!

    So the next battle is to get this elusive 'parity of esteem', the same attention, care, funding as physical health problems get. That goes for the Government but also for Ambulance Trusts who conveniently tend to gloss over the problem and ignore it in both patients and staff.

    Mat, I never knew your mum and I am only starting to get to know you. But the love in your family speaks in every thing you do, in every way you react. That is something your mother had her hands in, her true legacy. That is where she lives on.
    She would have been proud. x

    ReplyDelete
  2. Hmm certainly sounds like PTSD. I feel as though I have it too. I'm a Paramedic Practitioner and like all ambo staff have had my fair share of horrendous sights/sad depressing situations. I'm too undiagnosed but knowing the signs and symptoms I'm pretty convinced. Poor sleep patterns and multiple nightmares nearly every night and now my own mother is declining in health rapidly before our very eyes. Although I feel fine in myself I should probably seek professional help at some stage. I just don't feel I could justify an appointment with my GP. I've never been off with stress and work well under pressure.

    ReplyDelete
  3. Anonymous, why would your mental health not justify an appointment with your GP? The admirable fact you have never been off with stress and work well under pressure is not a guarantee you will be able to continue doing that. PTSD is sometimes caused by one for that person significant event but far more often it is a build-up of several events which erode the person's ability to cope. Don't carry on until you find that straw to break the camel's back, just do something about the burden before it gets to that point!

    ReplyDelete
  4. Mat, you use the word decompress. That is a term used throughout the military community. I worked for a number of years in Cyprus which has British Army, Navy and Airforce bases in the South. There were three sorts of servicemen on the island. Those based there, those who were part of the United Nation's contingent patrolling the demarcation zone between North and South, and those who were on decompression leave having returned from Afghanistan and Iraq. They included Canadian servicemen as well as British and a handful of other NATO troops as well. The Military has learned from its mistakes. In WW1, soldiers were being shot for cowardice when in fact their mental health had collapsed. In today's ambulance service staff are being put on sickness monitoring, disciplined and sacked because their mental health has collapsed. The WW1 soldiers executed have all been posthumously pardoned. Sadly for most ambulance staff, there has been a limitation date exceeded whereby they could take further legal action to win their jobs back and seek compensation. There is no further retrospective mechanism available to them. Soldier's mental health has become a big issue these days, hence their active service deployments are staggered, and limited. They have time to decompress which is why their return to the UK was interloped with a beach holiday in the Mediterranean with their surviving, uninjured comrades. It was designed to boost their morale. It is accepted that high stress environments with death and destruction being the reality of every day life in theatre will affect troops if they are exposed to it for long enough hence they are monitored, returned home from active service if their mental health is affected and supported with counselling. Obviously the criticism is that it does not go far enough, but balanced against what the ambulance service provide - for instance an occupational health meeting at a private company such as PAM where they say "it is my intention to get you back to work within two weeks" (I have been told to get you back and I am being paid on results) anything is better than the nothing offered to road crews. The Directors of HR, HR Business Partners (whatever they are but EMAS has at least two of them) the HR Managers, the HR Assistants, the HR Assistant Assistants and the managers from top to bottom are nothing more than the firing party from the victims own regiment who are shooting their staff at dawn for daring to collapse under the unbearable pressure that they have brought down on them. The difference between executed soldiers in WW1 and the ambulance service of today is that it was recognised that it was wrong and inhuman to do what they did 100 years ago on the orders of people who had never served on the front line. There are some exemplary parallels to be drawn here.

    ReplyDelete
  5. Mat, I am so sorry for your loss and the trauma of your recent experience.

    Anyone reading your articles can see your mother was absolutely right to encourage you to start this blog, I'm sure she was very proud of the result.

    Your writing is second to none, you have the skill of being concise and hitting the nail on the head of the issue. The possibility of making an anonymous post (although a double edged sword with its pitfalls) is absolutely what is required when you consider what has happened to whistleblowers.

    You have certainly given me and I'm sure many others 'hope' that bringing these issues out into the open may change things.

    Most EMS workers can get over the constant trauma and distress they see daily with the support of their colleagues and employers, but that is where it all falls flat. When I consider the appalling way I was treated by managers and the perjury of my Trusts inHuman Resources department after an incident.

    We necessarily try to emotionally detach when dealing with incidents and mostly are detached by the fact we have a job to do (after all who wants to see a paramedic in tears or distressed at an incident). The problem is you end up constantly emotionally detaching inappropriately the rest of your life if you are not careful. You deal with bodies and the old hands will tell the new ones "its the live ones you have to worry about", you deal with body parts all over the place on the railway line and necessarily have to treat it like pieces of meat. Then what happens when you have the friend of a close family member jump in front of a train? You can't now use the black or sick sense of humour that would help you distress behind the closed door of the crew room. You end up walking around like an emotionally detached zombie because the alternative is you will explode with emotion. Your wife or family may even try to goad you to elicit some form of emotion from you.

    There was an interview on the radio the other day with one of the surviving child soldiers from the Rwanda genocides. He was describing how he had to emotionally detach when he was ordered to hack to death his best friend (another child) for not following orders, his friend was pleading with him to stop but he couldn't because otherwise he would receive the same fate. (what would we have done?) After a while this callous behaviour became nothing unusual for him. Yes I know horrific and different from ambulance work, but the principle of the emotional trauma is the same.

    The workload is constant and horrendous now compared to even 5 years ago. There is no downtime to destress, no support and very little ongoing training when you can meet colleagues because they just want 'bums on seats' to hit the red call targets.

    Thank you for the hope your blog brings.

    ReplyDelete