Sunday, April 8, 2018

What to do if you are struggling in EMS

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You are not the first person to struggle in the Emergency Medical Services. You will not be the last. To exit the facade of your previous world and enter into the violent reality of reoccurring suffering and death is a traumatic transition. Your successful adjustment into your new role as transitory guide through the misery of the human experience depends on your ability to adapt, and acclimate to the new stressors placed upon you.

What is normal?

You may be wondering if the way you feel is normal. Yes, it is absolutely normal to struggle at the beginning of your EMS career. This will occur to varying degrees, and manifest itself in different ways including sadness, distraction, fear, and anger. It is also normal for this to go away with time. I estimate that it should take you no more than a year to figure out yourself and your job after you begin working in EMS, with steady progress observed along the way, and no more than 5 years to become truly, naturally confident in who you are and what you do. 

I believe it's less common to struggle emotionally after becoming acclimated to the routine demands of the job, but if you are having issues after about five years, it's likely you went through an exceptionally traumatic experience (or multiple experiences), such as a line of duty death of a coworker, an assault, or an especially tragic call that you haven't encountered before. More than likely, outstanding issues in your personal life are a major contributor to the problems you're facing, compounding any issues at work. In any case, the burden of multiple stressors accumulates exponentially. Is what you're feeling normal? If you are human, then yes. 

This might sound cold, but you are not special or unique. If your experience is 1 in a million, there are 7000 other people in the world right now who have experienced or will experience the same situation you're in. The odds are that the way you are feeling is exceptionally normal and predictable. 

The way you choose to deal with your problems, however, should not be normal. Far too many people choose weakness and failure in response to adversity. They refuse to harden themselves appropriately, and to develop solutions to the specific problems they face. In this case, I do not want you to choose normal. I want you to choose strength, and success in the face of what may seem like overwhelming opposition. 

Why do I feel this way? 

The complexity of your world now outweighs your current capacity for processing complexity. This is why people in high-intensity professions like EMS commit suicide at a higher rate - it is a final attempt at reducing complexity. The Canadian intellectual Jordan Peterson explains this in the following short video: 

You may even begin to feel that you are mentally ill. Perhaps you are. Most likely the complexity of your life simply outweighs your current capacity for complexity, which you have the power to change. 

What can I do? 

Your options for success are: 
  1. Reduce complexity 
  2. Enhance your capacity for complexity 
  3. Both 1 & 2 
 As far as I can tell, the only other option available is to fail. 

How do I reduce complexity? 

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The most obvious way to reduce your complexity is to quit EMS. Throw all of your hard work, money, education, and professional contacts into the dumpster and quit. You can find something else to do for work that is less complicated, like filling customers' soda cups and letting them know to be careful because their fries are still really hot. You can tell people stories about your glory days of riding around in ambulances, and most likely no one will care. 

If I sound mocking of this option, it is because I am. I detest the weakness of people who choose to fail, and quit EMS altogether rather than find real solutions for their problems. 

Complexity reduction is the more difficult option. It requires active involvement, a willingness to change, and the ability to admit that what you're currently doing may be wrong. It can not be passively accrued with time. 

The best place to start is in your personal life, even before focusing on job complexity. Your personal life is a foundation which must be poured and cured before you can even consider building a successful career. If you have outstanding issues in your personal life (debt, child custody, addiction, etc.) which are contributing to your overwhelming complexity, begin by remedying those. 

Find a reason to live which doesnt involve your career. If your identity doesn't lie solely in your work, the problems associated with your job won't of such devastating proportions. Join a church, a club. Learn an instrument. Pick up a hobby, new or old.

Complexity reduction at work is then your next target. Your job complexity can be reduced by developing routines and check lists for your daily tasks so they don't feel so overwhelming. Directly confront people who are causing you problems, and resolve those issues if possible. If your job expectations are murky or unrealistic, ask your employer to clarify his or her expectations of you, and get them to acknowledge unrealistic expectations by asking them to walk you through how to accomplish those tasks. If you are working too much overtime, figure out why you feel compelled to work so much and then develop targeted solutions for those specific issues which don't involve working yourself to death. If you were thrust into a leadership position before you were really ready, meet with your boss and discuss the possibility a controlled step-down into a position with less responsibility. 

If your job environment is overly complex due to a pathologically hostile management team, you have two options for reducing complexity: you can either outlive them, or find a different EMS job. I will tell you right now that outliving a hostile management team is nearly impossible. It requires an extended time commitment and superhuman patience on your part, and the off chance that new members of management coming in won't be infected or ran out before positive change can occur. Start looking every week for job openings elsewhere (I recommend, and get your household in order so that you have the flexibility to seize the better opportunity when it comes along. 

You can reduce your life complexity by not making choices which would cause your life to become more complex. New EMS providers often feel compelled to get involved in the personal life of a patient in need, such as offering to drive them to doctor appointments, cook them dinner, etc. I'm telling you, unless you are on duty and in uniform while performing these services, you are headed down a very dangerous path, especially if you give that person your contact info. You must have solid boundaries separating your work life from your personal life, and the patient's life from yours. Any small permeation in that boundary is an invitation for a much larger failure. 

You cannot save the world by bearing the burdens of every unfortunate soul you encounter. To attempt such an icarian task will inevitably burn you up, and burn you out. It is unlikely that you will accomplish any lasting good, and very likely that you will cause harm. Bearing burdens rightfully owned by your patients is effectively theft, in that you are stealing growth opportunities from that person, allowing their coping mechanisms to atrophy and ensuring they will be unable to independently handle the next major obstacle to come their way. You are also stealing from the part of yourself which belongs to you and your family. No one has a right to that part of you which belongs to your personal life. 

Your patient's suffering is not yours to feel. You do not have a right to their suffering, and they have no right to cause you to suffer. Women should expect to have much greater difficulty attaining this necessary compartmentalization than men due to the way their brains are wired, but it is absolutely vital that you establish strong boundaries. 

Will suicide reduce my complexity? 

No. Suicide does not reduce complexity. Instead, suicide takes all of your complexity, compounds it, and then deposits it into everyone who knows and loves you. Your soul then goes to God for judgment and you must explain why you garbage canned the amazing gift of life given to you, and why you decided it was appropriate to harm so many innocent people on your way out. That sure doesn't sound complex it all. If you are an atheist and think you have no soul, I advise you to be really, really sure about that first. 

If you attempt suicide unsuccessfully and instead cripple or disfigure yourself, you will only then begin to learn the meaning of complexity. Suicide is one of the most selfish things you can possibly do. If you have children, you have DEFINITELY forfeited your right to suicide yourself. Don't commit suicide. 

Safe Call Now: 1-206-459-3020   
A 24/7 help line staffed by first responders for first responders and their family members. They can assist with treatment options for responders who are suffering from mental health, substance abuse and other personal issues. 

How do I enhance my capacity for complexity?

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You must harden yourself. You must choose to no longer be weak, and you must choose to be hard. You must choose to be confident and capable of handling whatever comes your way. This ability will accrue passively with time, but you may choose to speed up the process. Confidence is indistinguishable from fake confidence. Act confidently, walk with your head up and your shoulders back like a human, and fake it until you make it. This is especially important if you are the provider in charge of your truck - other responders are looking to you for stability, so if you aren't exactly confident, you have a duty to your coworkers to fake it until you make it. 

As with complexity reduction, start at home when seeking ways to enhance your capacity for complexity. You must build coping mechanisms into your personal life, otherwise you risk bringing all that shit home with you and making it your family's problem, which they most certainly do not deserve. You must have a creative outlet to channel and cool your frustrations. You must have a support network of friends or family to rely on for help when life throws an unexpected curve ball at you. You must have solid communication with your spouse so that he or she can feel comfortable telling you when you need to toughen up, or when you need to stop being a dick. 

I hung this motivational poster in my office for a while but I don't think anyone else really appreciated it
You must find a real meaning in what you are doing. Otherwise your job is no different than a truck driver hauling cargo. The depressing reality is that you are effectively accomplishing little more than that truck driver, since the few lives you do save aren't really saved - those people will just go off and die again in a matter of years or decades. In order to handle the complexity of such a dispiriting situation you must find an alternative motivation. My two motivations are to help give people and their families more enjoyable years of life, and to give people more time to get right with God before they die and meet Him directly. Your motivations may somewhat differ. 

The typical EMT class or medic school does a poor job at preparing the new provider for what they will encounter in the field, and therefore it is extremely normal to feel anxiety and fear during the initial learning curve as you find yourself ill equipped to do right, while simultaneously responsible for everything that can go wrong. You may find this affecting your sleep patterns, temperament, and overall health. Alcohol is a common medication used in the self-treatment of this condition. On the job, you may find yourself dodging patient care by calling for flights or other intercepts more often than necessary, or by making excuses for not performing complex procedures in the field that you know you should be handling yourself. 

The very best remedy for enhancing your complexity processing capabilities at work is to build your confidence through education. Even the alphabet classes (ACLS, PALS) are great for this. Ask your employer if they'll send you to a difficult airway class, or a Bob Page class. Find some educational podcasts that you enjoy (e.g. EMCRIT) and devour them. All of them. If you're going to obsess about something, you're better off OCDing over your own education than worrying about whether or not you'll screw up your next RSI. 

Will I make it? 

You will make it if you choose to make it. It is a binary choice: if you do not choose strength and success, you are choosing weakness and failure. Your success will require active involvement on your part. I urge you to harden yourself appropriately, taking the necessary steps to reduce the complexity in your life while enhancing your ability to process life's inevitable complexity. For further assistance, visit the Code Green Campaign resources page.

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