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58 MAY 2016 | EMSWORLD.com THE MIDLIFE MEDIC By Tracey Loscar, NRP, FP-C Knowing where you end and the patient begins is impor tant. I t 's O K t o b e O K Difcult calls impact us in diferent ways "I am not what happened to me, I am what I choose to become." —C.G. Jung A couple of years ago I did a talk about EMS war stories. To build it I asked my friends what their "worst calls" were. The stories were horrific, even by EMS standards. They are difficult to read on a page and heartbreaking to narrate aloud for an audience. After the session a woman about my age approached me. She was a 20-year veteran of a local urban depart- ment and seemed genuinely worried as she asked me, "What if I don't have a 'worst' call?" She had seen the things we've all seen, but at the end of her shift she would take off her uniform and go home to her family and did not give those calls any more consideration. She did not have nightmares or see evil behind every door, and she viewed bad calls as part of her work. She appeared to be every bit the well-adjusted adult professional. Now she was worried that something was wrong with her. She felt out of place among her peers because she did not believe herself to be permanently damaged by serious calls. I reassured her that just because a call is memorable to someone does not mean it also inflicts irreparable damage. I know how she feels. Today I am almost afraid to say aloud when something doesn't bother me. I went on my first ambulance call at the age of 17. Terms like "critical incident stress" were not in the EMS lexicon yet. There was no structured debriefing model or other attempts made to mitigate the harsh reality of being exposed to tragedy on a daily basis. It would be a few years before the idea came about that responders might be at risk for psychological damage from exposure to traumatic scenes. Eventually people began to notice that many respond- ers were addicted to one thing or another, developed depression or were really bad at things like marriage. This awareness was galvanized when some of those responders began dying by their own hand. Terms like "PTSD" and "resiliency" moved from the research jour- nals to the topic of conversation for operational leaders and rightly so. Today we have things like the Code Green Campaign and other advocates who have admitted they struggle with stress and depression. Consideration for our mental health is moving to the forefront. With all this outcry about traumatic stress and its negative effects, what happens to those providers who have demonstrated resiliency and remain functioning and even well-adjusted? Not everyone struggles or suffers long-term issues. In a media wash filled with despondency and devastating images, it can be easy to lose sight of the positive aspects of the work. Yes, we all take hits, every one of us. However many of us, most of us, can and do get up again. In a couple of my presentations I open up with my "dead baby resume." I never script it, I just rattle off the first dozen or so dead infants that come to my head. Some are from abuse, others from SIDS or other mala- dies, all of them represent a class of patient that gets universally touted as deeply traumatizing. I do it without flinching, as if I were reading the offerings on a menu. What's worse, the fact that I have seen all those things or that I can say them aloud without crying? What does that say about me? Am I a sociopath or the bearer of some other antisocial personality disor- der? Perhaps enough time has passed that the emotions have faded to a functional level, or maybe I simply did not identify enough with the mother or situation for it to bother me. I could have worked through my stages of grief and simply internalized it. Maybe it is as simple as my experience and training helped buffer the stress and allowed me to work through it. Resilience is unique to the individual, and we are just now learning how to offer the tools to build it with. I worry that by not balancing the advocacy of resil- ience with the need for increased awareness we are infusing new providers with fear and expectation that will become a self-fulfilling prophecy. Empathy is a powerful thing and it comes with risk. Knowing where you end and the patient begins is important, as is a strong support system. Choosing a career in emer- gency services does not doom you to a life filled with failed relationships, addiction and depression. There is joy here too, relief, success, satisfaction and familial bonds that form outside of blood. Not everyone in EMS is broken and there is nothing to say that by doing this job you will be too. It is OK to still be OK. Really. A B O U T T H E A U T H O R Tracey Loscar, NRP, FP-C, is a battalion chief for Matanuska- Susitna (Mat-Su) Borough EMS in Wasilla, Alaska. Her adventures started on the East Coast, where she spent the last 27 years serving as a paramedic, educator and supervisor in Newark, NJ. She is also a member of the EMS World editorial advisory board. Contact her at taloscar@gmail.com or www.taloscar.com.