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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Snap out of it

“27 year old female, feeling unwell, tired"

Just another day, another dollar. The usual routine; wake up, shower, get dressed, make lunch, drive to work, get crap out of locker, chuck it on a truck, check the bags, check the cupboards, drive off for 12 hours of the usual. Job to job to job; the same old patients, the same frustrations and no thanks for it. It really does get you down sometimes! As for the patient, man up springs to mind!

She lived in a nice area, her flat was a nice size, clean and tidy, nothing out of place and she was well dressed and well presented. She was well spoken and very polite. What could possibly be wrong? She didn’t seem in any pain, she had a smile on her face and cracked jokes. She couldn’t really explain what the problem was and knew it was nothing she needed an ambulance for, but she didn’t want to go back to the GP. The last time she did she was fobbed off with a prescription and told to diet and exercise.  She was just... feeling unwell. So here we are. What is the problem?!

She took a deep breath... “OK, from the beginning...

...I suppose it started during my teenage years to a point; broken family etc blah blah blah, always a brave face but I suppose it took its toll. Self esteem was low, confidence was low but I suppose you just cope don’t you? A marriage painted over the cracks, 6 years of happiness and distractions and a lovely child to add to the mix made everything seem OK. After the marriage ended there was a rebound relationship that painted over more cracks. I suppose that wasted year gradually chipped away at any remaining confidence there was and after being left a shell, rock bottom was reached. All the while though, a well painted exterior left no one the wiser. Even my closest allies were unaware. Panic attacks began, intrusive thoughts plagued me and sleep became an issue. 3 months of 2-3 hours sleep a night took its toll. Bags under eyes is not a good look on me!


Despite the self-inflicted isolation and a full box of prescribed anti-depressants that I refused to touch, I found a way out. I suppose being as low as can be makes improvement all the more possible. I climbed out of the swamp of self pity and changed my lifestyle. The fake smile was more sincere and I felt good again. This lasted for 6 months. I found ways to deal with my insecurities and achieved a lot of personal goals. I had a good relationship with my ex which my son benefited from, I was fit, active, had a close group of loyal friends, I got this lovely flat in a lovely area, my family is caring and supportive, I live comfortably, I eat well, I could do what I want when I want. What is there to be miserable about? Nothing!


Not so. Despite my new found ‘happiness’ there was also an inherent loneliness. A void that was not being filled. A cloud I was unable to see through. A cloud that engulfed me. The unspoken D was looming again, threatening to rear its ugly head. No one could spot the signs as no one knew it had been there in the first place. For 4 months now I have not been sleeping. I don’t mean the odd night of broken sleep, I mean not sleeping. My job is demanding and exhausting; after an 84 hour week I should be tired enough to sleep but I can’t. I can’t switch off. I lie awake for hours on end. 1am, 2am, 3am, 4am, 5am, now it’s time for an hours kip, 6am, hours kip, 7am, wide awake. The next day I am back to work. The annoying thing is it was work that triggered my current demise. There was an incident in which I was hospitalised which caused a long spell on my sofa. A long time to think, take stock and over think. I couldn't exercise, I couldn't really socialise and it felt like all the positive changes I had made were being undone. It was like I was watching it happen but unable to stop it snowballing. It knocked my confidence and left me resentment about the job I loved. Once back to work the damage was done,and I was left feeling like I was existing, not living, yet all the while the smile is still there. 


I hear people talking of depression and saying ‘why don’t they just snap out of it’. I want to. I can’t. It isn’t a choice. If I had a choice between a physical illness or a mental one I’d choose the former. Instead I get both. Maybe that is the problem. If it's not one it's the other. I don’t know. Looking in from the outside I have nothing to stress about. I have more than most people. I have a lovely, happy, healthy son who lights up my world. Surely that is enough? I have a job that pays well compared to a lot of people. I am not isolated from friends or family even though I feel it and isolate myself. I have a roof over my head. Seriously, surely I can just snap out of it?


It’s a cycle. You lie awake not able to sleep. Because you are awake your mind is at work. 5 hours awake in the dark gives you time to over think everything. You confuse yourself. You upset yourself. You feel alone. You wake up exhausted. You feel like you have been hit by a bus. Every day it becomes more and more of a struggle to leave the house. Your motivation is completely gone. The simplest of tasks become a chore. You feel lazy but there is no willingness to be pro-active. You feel horrible about yourself because you are so tired you are snappish. You start to snap at the people who are close to you but they just think ‘someone woke up on the wrong side of the bed’. You feel guilty and obsess over everything you are doing or saying. Tired and weary you get back into bed. Now you are stressed about your behaviour and your relationships in your life and can’t sleep or switch of. 1am, 2am, 3am, 4am, 5am, now it’s time for an hours kip, 6am, hours kip, 7am wide awake. It eats away your confidence and your self esteem. You feel like a shell.

Work doesn't help. I see things every day that add to my problems. I do have forums to vent and talk it out but I would be lying if I said things don't get to me. They do. I'm haunted by a lot. I struggle to deal with what life throws at people. A lot of the time I am fed up with hearing everyone else's problems. What about mine?! I can't avoid my work, I have to drag myself in every single day knowing that there is a high chance I'll be lying in bed later thinking about it. 

When does it stop? I don’t want to be that medicated patient. I don’t want to list antidepressants to the ambulance crew. I don’t want the big D on my medical record. I don’t want to talk to my GP about it; I won’t talk to best friend about it so the GP doesn’t stand a chance! Maybe I’ll just carry on smiling. No one will know. I don’t know. I think I’ll just stay here.” 

She didn't need hospital and didn't go, she just needed to talk it out, but it does raise questions. It’s a very common job, a very common problem. It’s probably more common that the stats suggest. How many people are suffering in silence? It isn’t an emergency and doesn’t warrant an ambulance but it does need addressing. Like all mental health, there is a stigma around it, a perception of weakness and misery that is not true. The fact that it can go so well hidden is testament to that. You can't just snap out of it. There is help out there, it just takes the courage to admit and find it. Unfortunately, until it is accepted as a genuine illness people will hide from it, deny it and do nothing about it. Luckily, she isn't hiding from it, denying it and is doing something about it.

The she is me.

If you are struggling with any of the issues raised in this post I highly recommend The Blurt Foundation. They are great to talk to, in total confidence, anonymously and online.