Look at me, no tears
With the ambulance bed remade with clean linen, I pushed the trolley back into the truck and locked it in place. Frowning, I took in the mess of discarded waste, used equipment and empty drug vials that lay ahead to be cleaned or restocked. We had shortly before handed over a critically unwell child to the emergency department staff. The aftermath was that someone now had to clean it all up again. Lucky me.
Placing one foot onto the rear step of the ambulance ready to make a start, I caught out of my eye someone sitting on a similar step at the other end of the ambulance bay. Some sense told me something didn’t appear right.
I stepped back and subtly tried to get a better look at who was there. The boots and trousers made it clear it was a colleague. No surprise there. Stepping back a little further, I could see a young woman leaning forward holding her head in her hands. Though I was still some distance from her, I could see she was upset.
Unsure about intruding on a private moment, I decided I should perhaps casually say hello. She was focussed on her thoughts and didn’t notice my approach. Without doubt I could see she was troubled. I suspected I probably knew why. This colleague had been at the last callout with us.
I called out hi. Her immediate response was to look away wiping her face. She had been crying. She hesitated to answer at first then appeared to just give in to my presence. I felt awkward, almost intruding. When she looked back her words confirmed that indeed I did know what was wrong.
“I don’t think I can do this job.”
The call out had been straight forward. By straight forward I mean horrible. A young father had been cuddling his weeks old baby whilst lying on the couch. The child had fallen asleep and soon after so did dad. At some stage, he rolled over. By the time he awoke, well, his first desperate act was to make a frantic triple zero call for help. This wasn’t his only desperate act though as he then faced the horror of listening to the calm words of a call taker’s voice tell him how to perform cardiopulmonary resuscitation on his own baby’s lifeless form.
We arrived quickly enough. The usual efforts unfolded. Needles, tubes, drugs, plastic and paper waste strewn around. Given the lack of response for our efforts, and since nobody wanted to be the one to say stop, we scooped the infant up and continued pumping her tiny heart all the way to hospital. For much of the trip, my now distressed colleague was the one who pressed her two fingers onto the tiny chest whilst we pushed puffs of air into the lungs and drops of drugs into miniscule veins.
The efforts though remained in vain. That little heart stopped well before we arrived and it stayed that way. The father’s grief was overwhelming to watch. His initial distress when we first met him, his pleading at our efforts, the anguish of his breakdown in the hallway of the hospital when the final glimmer of hope was taken away. Then his wife arrived and it all started again. Her beseeching contrasted terribly with the impotent solemnity of the nurses and doctors. She lurched between frantically begging us all to keep working on her child to agitatedly asking her husband what had happened.
My colleague had walked out of there greatly disturbed by all of this. That shouldn’t seem surprising. It was a disturbing job. So we talked about it. Start with the obvious I suppose. Did she feel upset about the call out? Yes. What in particular? The grief, the agony, the helplessness, the anguish and guilt the father will have to live with, the inevitable blame the mother must feel and, worst of all perhaps, those glassy lifeless eyes and the limp form. She had a long list.
I hate these situations. I’m no psychologist and this conversation made me feel a bit like I was trying to cheer up a grieving husband or wife. You can say the right words but they still won’t help. How do you know if they aren’t just words to make yourself feel better? Nonetheless, I was here now.
My colleague continued. How could she do this job if she cried at times like this? What if she kept on crying each time? This was her first child death.
Then it dawned on me. The problem wasn’t with her. I told her so. Let’s think about this for a moment. You are upset because you have seen and heard something horrific. Something everybody else thinks is awful too. Amazingly, you played your part in the resuscitation and did a damn fine job. That makes you a good ambo. Only now, quietly, alone, afterward do you let out some of the same anguish as most others would be letting out publicly. This makes you human, not a failure.
Every part of her response was normal and understandable. It might become a problem if she was still crying in a few weeks.
I asked her not to give up her humanity and compassion and instead to hang on to it. Did she enjoy this work? She loves it. Then keep doing it because you do it very well. I’m sure she wasn’t fixed with these few words, it isn’t that easy. She did smile and help clean up the ambulance.
Another thought began to nag at me now. If my colleague was the normal one, what had happened to me? How had something so disturbing become my normal? Whare had all of my tears gone?
Jeff Kenneally www.prehemt.com
prehospital ambulance paramedic medical trauma first responder