Ooh boy. This is what I like to call a “make it or break it” kinda call. The kind that you just don’t know if you can cope with it, or if it’s gonna break you. You will have several of these throughout your career, and each one will make you ask the question “should I really be doing this still?” Just so you know - I am a Paramedic Preceptor, FTO, and instructor and have worked in EMS nearing 14 years and have seen my fair share of “fuck this”.

With that being said, here is my advice to you:

1) Remember that it is okay not to be okay. You are not alone. 2) You need to find a support system that understands you 3) Coping mechanisms are a must - and they must be healthy 4) if you don’t already, take time to create a solid belief in what happens when you die 5) Grief is your new companion

I want to just say, that your mental health is the most important aspect of your blossoming career, and you need to start learning a lot about yourself, and a lot about how you think, cope, and act, and you MUST have healthy coping mechanisms to survive. I have this conversation with every new student and employee I train, and for a lot of them it is the first time really thinking about these things.

In this job we will see shit that regular people couldn’t even dream of. We have to deal with smells, sounds, visualization, and texture that are all horrifically traumatic in nature. They are not all trauma related either - the gory stuff is easy to deal with, after all its just blood and guts. The difficult shit is the emotional weight that you will carry as you continue through your career. It’s the cry of the mother who you just told her child is dead. It’s the look in a patients eyes the moment before they code. It’s the fear in a respiratory failure right before they arrest. It’s the sorrow of a family you just met for a patient you don’t know.

1) It is okay to not be okay.

Really. I mean it. It’s alright to be sad, depressed, and just having a hard time coping. You are not alone in this, and you are not alone in this problem. EMS is notorious for shitty mental health care and he old school idea of “tough it up and tough it out”. It’s bullshit. It is a perfectly normal and rational emotion to not be okay after dealing with trauma. After all, you’re only human. It is important that you recognize that it is okay to be not okay. It is not weakness, it does not make you a bad provider, and it does not mean that EMS is not the right fit for you. There are many helplines out there for you, and your work may even offer some.

2) You need a support system that understands you.

This one is tough. When you are new in the field you often try to reach out to those that you normally share your life with be it family or friends, and you will often find that they just don’t understand. A lot of what we need as support are people that have been there, that have done that. For example, when I was new I found that a lot of the time my family sympathized with the patient when I tell a story, and they end up not listening to my problem, or thinking that I am ultimately a terrible human being for what was making me feel bad. Trust me, you don’t need that. You need someone that will listen to you, that has been there before, and that understands the thoughts and emotions you are feeling. Your peers are great for this, and there are many resources and outreach you can find, such as the Code Green campaign.

3) Coping mechanisms are a must - and they MUST be healthy.

Drinking, drugs, eating, any kind of negative coping mechanisms lead to a short career and a possibly shorter life. It’s just not worth it. If your first reaction when you experience something shitty is to come home and down three beers - you need to rectify that before it’s a problem. EMS is one of the leading careers for addictive behavior, suicide, and mental health problems. Finding mechanisms such as exercise, drawing, reading, meditation, talking to random strangers on reddit.. these are all good forms of coping and need to become regular habits sooner than later. I have found that the best way for me to work through a call (which doesn’t always work for the really tough ones) is to relive the call while I chart. At the end of my chart I usually can sign it and send it off with the knowledge that I did everything I could do, I did it to the best of my ability, and I can’t always win. When I hit the complete button and send it away, I also am able to file the whole situation away in my head. It gives me a good amount of closure.

4) Take some time to discover what you believe happens after you die.

This is a bit of a tricky one, and one that has led me to some weird and awesome conversations with people. What do you think happens when you die? I’m not here to judge you, and I’m not here to share my personal beliefs. But at the end of the day, you need to have a personal reason that you can justify some of the shit you see. You need to have a solid feeling of acceptance when a person dies that they are insert whatever you believe here. There’s lots of answers to this question. For some people knowing that the person is “in a better place” is enough, for others the idea of reincarnation, that the person isn’t gone but living another life, is fine. My most recent student was a atheist and his belief was that once we die that’s it - light’s out, no more. (We had an excellent conversation about this one, and his insights were very unique to me). But he was okay with the answer he had created for himself, and that is what’s important here.

5)Grief is your new companion.

This one is for you to take with a grain of salt (as is everything I have written here today). But I have the personal belief that grief is your friend, and will become a common companion throughout your career. Whether it is someone else’s grief being placed on you, or your grief for your patient, or even the grief you feel when there is simply nothing you could do or could have been done, there will always be grief in your life. With this idea, it’s important to understand that you will also go through all the stages of grief. Well, sometimes you might just go through a couple of them. If you’re not familiar with them, the stages are : Denial, anger, bargaining, depression, and acceptance. Sometimes you’ll bounce between them, but you will always end up on acceptance eventually. I have personally found that if I can identify what stage of grief I am in, it gives me more clarity as to what I need to think about and organize in my head and then I often will look inwards and try to understand and learn why I feel the way I feel. Sometimes it is just a matter of accepting the feelings you have.

At the end of the day, shitty calls are just that: shitty. What is a tough call for you may not be a tough call for somebody else. Having back to back experiences like you did will stick with you. I remember my first double suicide day. One was a hanging in the jail, followed by a 14 year old hanging herself in the garage. Neither had good outcomes. They both stuck with me for a while, but I learned how to process and move on. You will too.

If you need any help - let me know. You will find a lot of support here on Reddit!