Invisible Wounds

"Female u/k age, tired, mental health problems"

"What's been going on?"

"About a year or so ago I witnessed something horrible. The death of a young man. I suppose, in the days / weeks that followed I expected to see his face in my thoughts. On the night itself I think the adrenaline kept me going until I got home. I just laid there on my bed and absorbed it all. I'd just watched someone die in the most horrific of circumstances and was helpless to stop it. Could I have done more? It was a helpless feeling that I just couldn't shift. His face. It was there all night. As the days past I thought about him less and less. I don't remember when his blood stained face stopped appearing in my dreams but within a month I'd say he was gone."

"So what's changed?"

"I found out his name. I was shown an online article about his death. I suddenly felt I knew who he was, what he was meant to be, what he had lost. His blood stained face came back. I'm plagued by flashbacks on an almost daily basis. I can't get his face to stop invading my dreams. It's weird though, now I almost take comfort in his presence. I can't imagine a day where he isn't present."

"And have you talked about this to anyone?"

"Sure, I've spoken to the people that were there and others. I feel like I'm the only one bothered by this. It's an overwhelming isolation which is eating away. Maybe it's just sleep I need. I can't remember the last good nights sleep I had. I've always had a problem sleeping but now it seems worse. After hours of trying I eventually get to sleep but once drifted off I'm awake again with an alarmingly predictability and the circle starts again. And again. Sometimes I just wake. Sometimes it's a nightmare. I picture his last moments again and again. Not from where I was though. It is as if I was watching it on TV. And I'm not looking at him really. I'm looking at me. It always ends the same though. His bloodied face, distorted, mutilated and swollen, lifeless. It's just......there."

I was clear just from looking at her eyes that this was taking it's toll. She looked drained.

"I have seen things that should upset me since but they don't. Maybe I'm hardened to it. I just feel numb. I try and keep busy to take my mind off it. The more tired I am the more I try and avoid thinking about how tired I am. I know if I think about sleep I'll think about him."

"What about your friends and family? Do they know?"

They do and they don't. They say they do yet I feel vilified for being irritable. Despite how I'm feeling they always have something trivial which is much much worse. Either that or I'm given happy clappy cliche advise about 'staying strong' etc. My mood swings back and forth and I try to only interact with them when I in a good place. It's just easier that way. I'll be fine, I'll get over it, I'm just tired."

"There is help available." 

A smile appeared on her face. Clearly I wasn't in on the joke.

"Yes I know, therapy, drugs, a sick note etc. No thanks. Can't be dealing with a disciplinary and P45 too! Work is a good distraction but they don't take kindly to mental frailties! Honestly, I'll be fine! Just venting!"

*          *          *          *          *

The 'patient' was me. The 'guy' was patient from '3am' (read). Post Traumatic Stress Disorder (PTSD) is very very real. It's often associated with the military due to the sights they see and the environment they are in. However, it is becoming more and more common, or more and more freely admitted in the Police and the Ambulance services. I have it, or had it, I'm not really sure. I'm also not really sure if it is ever something that goes. Maybe it is and it just hasn't gone yet. Maybe it is gone and what is left will stay. I don't really know. I wrote this post because of one I read on the One Police UK Facebook Page. It really hits hope what PTSD is all about. 

Despite what the PR department will say, there really is no provision within the emergency services for dealing with it. I tried accessing the 'free counselling' service that is offered and if anything just trying to make an appointment made me worse. Actually saying  'I have PTSD' was of huge importance, as cliche as it is. Not in the sense of standing in a circle and saying 'My name is....... and I have.....' but to admit that your mental health is affected is quite a big thing. Especially when until that point, you only ever had to deal with other people's mental health. In the ambulance service, the closest you come to your employers knowing something is wrong is going off sick with stress. And lets be honest, that only stands to give you a reputation for 'someone who goes off sick with stress'. i.e. chancer, faker, pulling a fast one, playing the game, abusing the system. It's true. That is how you will viewed by management. 

Admitting weaknesses isn't something that is done much in an environment full of black humour and bravado. Mess room banter probably wouldn't cope with someone saying 'actually no, I see his face in my sleep every night'. You just play the game. Put on the brave face and only confide in the ones you think won't judge your weakness. Let's be honest, it doesn't give much confidence in a new crew mate when a simple head injury causes you a panic attack. There a triggers everywhere, it's about learning to spot them and avoid them. Sadly, this job doesn't let you avoid seeing words like 'fall from height'. These are the invisible wounds that PTSD leaves behind.

The problem we and police have is it doesn't stop. There is always a new memory around the corner. '3am' has effected me. It was the last job of the shift, the last shift in a run and I had seven days off to dwell on it. Maybe PTSD in the emergency services is more about timing rather that the event. I have seen things that a more tragic and more disturbing since but they don't effect me. Part of me wishes that they did. 

Another traumatic death or a dead child. Maybe the one memory that stays is protecting us. If every traumatic sight we saw effected us in the same way we simply wouldn't function. There is very little time to process information. Very often I have written about seeing something which most people would see as probably the most traumatic event in their lifetime, only to go to another call five minutes later. Maybe this is why

PTSD isn't going away, it is a fact of life and although some efforts are being made to treat it and make it more accepted, until it is fully embraced and tolerated by employers little will change. Let's be honest though, the reason why it isn't widely tolerated as a genuine reason for sickness is money. We can't have our police officers and ambulance staff on long term sick can we! There are targets to be met.....

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Just say No!

“51 year old female, can’t sleep”

You may have noticed a large proportion of my writing is done about night shifts. This is mainly because at night there are the drunks, the drunk drivers, the gangs, the violence, the stabbings, the business, the tiredness and the crazies! These are generally more interesting than picking up an elderly lady from the GP who has shortness of breath and needs taking to the Clinical Decision Unit (Can't Decide Unit) at the local hospital. Let's be honest... that would be dull! 

The other thing that happens at night, obviously, is people sleep. Some need 10 hours, some need a square 8 every night, others 6, and people like me cope with 4 or less. Everyone, now and again, has trouble sleeping. You’re either too hot, too cold, just wide awake, don’t feel well, are restless, neighbours keeping you awake or a car alarm repeatedly going off. What do we do? Deal with it! We try and try and try to fall asleep; we put our head under the pillow, we flip the duvet around, we take sleeping pills; anything to get to sleep! None of us want to get to that moment where you are awake because you are worrying about how soon you have to get up. Eventually, the alarm goes off and we all realise that we did, eventually fall to sleep! One thing we don’t do is call 999...

If there was anywhere for me to storm off to I would have done so in a instant.

“CAN’T SLEEP?! Are you having a laugh?”

My finger could not have moved quick enough to call up control and ask as politely as possible:

"What...

The...

F**K!!" (I never really swear!)

The response I got was basically, and I’m paraphrasing here:

“I know, I know, it’s ridiculous, but she keeps ringing back so we don’t have a choice but to send her an ambulance.”

My crewmate sat there quietly while I launched in to a tirade of foul mouthed obscenities (to myself) about how much I hate this stupid job! I’m fickle; one minute I hate it, the next I love it, then I’ll blog about it and move on! 

After a stubbornly slow drive, hoping desperately we would be cancelled for a) a nearer vehicle, b) a higher priority call or c) no longer required, we pulled into the road and stopped. There wasn’t the usual grinding to a halt and enthusiastically hopping out of the cab. Instead there was a 10-15 second silence where we both just looked forward, exhaled slowly, then begrudgingly trudged towards the house. We were met at the door by the patient wearing her My Little Pony dressing gown and a fag hanging out of her mouth. We followed her into the living room where she sat down.

“So, what’s the problem tonight” I said whilst picking up some old ambulance paperwork off the coffee table. 

“I can’t sleep.”

“What would you like us to do?”

“Give me something to help me sleep.”

“We don’t carry anything and you were told by my colleagues 4 hours ago the same thing.”

Yes, you got it; this was her second ambulance of the night for the same ‘problem’. 

“Yeah but last time I really needed a poo so the ambulance men told me to have a poo and then go to bed.”

“So why didn’t you?”

“What? Have a poo? I did.”

“No, why didn’t you go back to bed?”

“Because I’m not tired.”

“So why have you called 999, which is for emergencies.”

“Because I should be asleep and I’m not tired.”

“Without being rude or dismissive, this is not an appropriate use of an ambulance. There is nothing specific wrong with you, nor are you complaining of anything that we could treat. You need to speak to your GP if you are having problems sleeping and stop calling us unless it's an emergency.”

She looked at me blankly as if I had just spoken to her in Mandarin about quantum mechanics. 

“But I can’t sleep.”

*walk over to brick and hit head repeatedly until the relaxing state of unconsciousness is reached*

This conversation went on for about 10 minutes. We left, having given her strict instructions not to call back for not being able to sleep; I had every suspicion that she would regardless.

I really could have screamed! Why did that conversation have to be had in person?! Why did she NEED an ambulance? Why did control HAVE to send one? Why has NO ONE got the power or willingness to say no to these people? Maybe when I can’t sleep EVERY night I should just phone 999. Clearly it’s my right. Clearly as a taxpayer it is what I am entitled to. Who cares what the consequences are or how much it all costs? No one apparently! What this country needs is a government with balls; balls to say ‘NO’! I don’t mean the wishy-washy policies and PR friendly trials. I don’t mean working-groups and consultations on the best way to say ‘NO’ without hurting someone's feelings. I simply mean:

*ring ring*

“Which emergency service do you required?”

“Ambulance”

“Hello, what’s your emergency?”

“I can’t sleep.”

*hangs up phone*

Simple! Don’t even waste the manpower talking to these people. By sending an ambulance we are making it OK to ask for one. It isn’t! There has to be retrospective fines for abuse of the service. The fire brigade now charge for various things they deem they shouldn’t have to do like lifts breaking down etc. The police can charge and fine someone for wasting police time. Why oh why oh why can the ambulance service not issue fixed penalties for people who repeatedly abuse the service?! It’s beyond me. 

Anyway, the night shift had a few hours left to run. We did a couple more jobs and at about 5:30am became available for our last one. I didn’t take long to get it...

“51 year old female, can’t sleep”

Don’t...

So near yet so far

“42 year old female, difficulty in breathing”

It was the last of 5 night shifts; the end of a 60 hour week; the countdown to a whole day and a half off! Typically, at my most tired, I am treated to the most horrendous of shifts. It was constant from start to finish. Every single job took something out of me, be it having to carry someone down the stairs or having to work outside in the rain; it was just exhausting. We did jobs with the police, were verbally abused by the very people we were there to help, had to wear our stab vests and never got a second to ourselves. We were given no break and had no hot food. The 3am lull was torturous and all that kept me going was the promise of my bed. It had been a long time coming. I had averaged 3 hours sleep a night all week and was running on fumes. Every job we did was one closer to home time. Every time I heard that annoying, inane, stupid, ear offending, piercing, relentless tone of our radio going off with a new job it was one assault on my ear drum closer to freedom! 

It was 5:30am and THAT noise went off for the last time. A 25 year old unconscious in the street. It was miles out of area and would mean going to a hospital miles away from our ambulance station, but I didn’t care, it was the last job. Once we pressed ‘on scene’ that was it! All we had to do was deal with this guy and get the fuck out of dodge! In all his glory he was lying topless on the pavement. The circle of shame on his jeans for the world to see was glorious! We checked him over, loaded him up and off we went to hospital. Another victim had succumbed to excess alcohol and another valuable hospital bed was going to be wasted for a few hours! We dropped him and two of his cronies to A & E and left. We made it back to station and signed off only 40 minutes late. Now the 25 minute drive home was all that stood between me and SLEEEEEEEP! 

My eyes were heavy, I felt myself drifting off at traffic lights. Had I finished on time I would have missed the rush hour traffic; as we were late off, I hit the best of it! It was OK though, because every set of traffic lights I made it through was one closer to home. 4 miles... 3 miles... 2 miles... 1 mile... 1/2 mile... 400 yards... 300 yards... 200 yards... 100 yards... 50 yards... turn into my road... 30 yards... 20 yards... 10 yards... HOME! You beauty! I opened my front door, kicked off my boots halfway up the stairs, went into my room and closed the blackout blind. Shirt off, trousers off, PJs on, light off and fall back on to the bed. Perfection! That lovely feeling of a cold pillow on my head was sublime. I closed my eyes...

What’s that?!... it’s the annoying... inane... stupid... ear offending... piercing... relentless tone of a radio going off!

NOOOOOOOOOOOOOOOOOOOOOOOOOO!

I sat up, rummaged through my trousers and there was my radio. On the screen:

“42 year old female, difficulty in breathing”

Light on, PJ’s off, jeans on, top on, out of my bedroom, boots on, out the house back in the car and off to work. 

55 minutes later I arrived at work. Handed the radio in. Got back in my car. 45 minutes later I pulled up outside my house. I opened my front door, kicked off my boots halfway up the stairs, went into my room, top off, jeans off, PJs on, light off and fall back on to the bed.

It was 10:14am. You couldn’t make it up.

Insomnia: At What Cost?.........

"25 year old female, tired, grouchy, can't sleep & fed up"

Seeing the word insomnia will give all EMS who read it a wry smile. A smile of knowing. A smile of understanding. A smile of tiredness. In fact it isn't just EMS. All emergency services. All shift workers alike. Insomnia is something large numbers of us live with and cope with.

'Insomnia is repeated difficulty in getting to sleep, staying asleep or getting enough good quality sleep, despite adequate opportunity, which leads to some form of impairment of performance of well being during the daytime. If it occurs regularly or over a long period of time, it's called chronic insomnia.'

I for one suffer with chronic insomnia. Self diagnosed yes, but with no more than 4 hours total sleep a night at least 6 out of 7 days that is what i'm going with. I've known for a number of years that I've had trouble sleeping but having had a few weeks off work and not feeling refreshed and not getting good rest made me realise the semi-permanent impact shift work has had on me. Shift work isn't the sole cause of insomnia but it is a common denominator amongst the emergency service workers. You'd think that having been awake for 24 hours and done a gruelling 12 hour night shift sleep would come easy. Well it doesn't, and I'm not alone. Getting to sleep is hard enough, but staying asleep is the bigger problem. Stress and worry are big contributors and combined with a pre-disposition to not sleeping well, you're left awake unable to sleep because you're worried about not getting enough sleep and stressed as to how this will effect you. Then, your shift pattern changes. After 4 shifts of nights, your body clock just about adjusted, you now need to fall into a normal sleeping pattern in preparation for an early shift in a day and half's time. This routine continues throughout any shift workers career. Grim!

For me, the major worry with insomnia is how I am at work and how my colleagues are at work. After a prolonged period of poor sleep you just feel drained. Physically and mentally. You exist rather than actively do. You float through you shift not really knowing how you got to the end. Driving on blue lights when physically exhausted is scary but at least you have the lights and sirens to keep your eyes open. When not on lights it's dangerous. I'm sure fatigue plays a huge part in EMS RTC's and I don't like to admit it but I have fallen asleep behind the wheel at traffic lights in the past. Thank god it was at traffic lights. Driving home after a 12 hour night shift is a hairy experience too. Fighting the body every step of the way to stay awake. Driving aside, you're expected to treat every patient you come into contact with, with the same professionalism and courtesy. You're expected to make on the spot decisions that in reality can mean life or death. If your husband, wife, child, parents or friends were gravely ill, how happy would you be knowing the crew attending had been awake for 22 hours, were exhausted, hadn't eaten and hadn't had a break for 10 hours? Would it fill you with confidence? It wouldn't me. Personally I don't think enough support is available, 'being tired' isn't a reason to call in sick and with the strictness and disciplinary procedures around absence being a very contentious issue it is of no surprise we just put up and shut up! We make do. We drink coffee (by the bucket load), take pro-plus, play loud music, keep the window open or in extreme cases take matters into our own hands.

Staff in London will be aware of the name Lorna Lambden. Lorna was a paramedic who worked Camden. I knew her and had worked with her on both ambulances and when she worked as an FRU. She was a lovely girl. Always smiling. Always happy to see you. Always tired. Like many, she suffered with sleep problems due to the effects of a 12 hour rota with a constant change in shift. In an effort to get some sleep on her rest days she bought some sleeping pills off the internet. Tragically, she suffered a heart attack brought on by the medication and she died. Her body was discovered two days later by her boyfriend.  For the full article click the link. This tragic loss of life is symptomatic of the problems insomnia can cause. The desperation to get some sleep can drive people to extreme and desperate measures. In Lorna's case it was non-prescription medication. Obviously the dangers of buying medication not prescribed by a GP are painfully evident but that is what she thought she had to do to get some sleep. Possibly because GP's commonly prescribe an anti-depressant which in small doses works as a sleeping tablet and like me, she wouldn't want a prescription for anti-depressants on her medical records. I don't know what the solutions are. I've tried all sorts to get a good nights sleep but little works.  What I do know is that whilst working a varying 12 hour shift rota with no breaks is deemed acceptable, little will change and until insomnia is regarded as being as debilitating and genuine as stress and depression we will continue to plod on regardless.  Insomnia at work is talked about with an air of humour about it, being tired is almost vaunted as right of passage in the emergency services and is something that is seen as 'just the way it is'. I think that speaks volumes about the length of time it's been ignored.

And just so you know: People who regularly get less than six hours sleep increase their chance of dying over a 25 year period by 12%. Bummer!