When Your Job Becomes a Waking Nightmare
Paramedics are on the frontlines of a never-ending crisis that exacts a toll on their mental health.
By Hal Newman
My nightmares can be spectacularly realistic.
So realistic I need to wake myself up to convince myself that I’m not out on an ambulance. And even then, sometimes I need to get out of bed and wander around a bit so that my brain disconnects from a train of thought that went off the rails.
My family will tell you about the hypervigilance which intrudes when we go for a hike as I conjure up all of the possible outcomes other than, of course, a nice wander in the woods.
My nightmares are the stuff of nightmares. And that’s a problem because I don’t want to share them with anyone lest my nightmares become their nightmares. The other night I was back on the scene of a high-impact road crash involving a single vehicle striking several trees. The driver was bloodied. The front seat area was destroyed. The intrusion of a tree trunk into the driver’s immediate area was catastrophic. It was a prolonged complicated extrication. The driver survived.
Somehow the backseat of the car was untouched. The shards of razor sharp metal and a million pieces of exploding safety glass flew forwards and backwards and missed the kids who were still belted into their car seats. The children were miraculously unscathed. They looked like they had slept through the entire horrendous crash. I was back on that scene talking to those children as the firefighters cut the wreckage away from them so we could gain access. “Why don’t they wake up with all this noise?” I shouted in my dream much as I did in real life all those years ago.
Both of those children were dead.
The impossible forces of impact had conspired against their bodies and provided invisible unsurvivable internal trauma. I wake up and unless I can somehow shake the synapse that is misfiring, I’m doomed to relive the same scene over and over again in the course of a night.
In interviewing my friend and former colleague Jim Robson, I realized we had a lot of common ground in our post-trauma mental health — or lack thereof — with a major difference. He sought help and accumulated a toolkit full of resources he uses on a daily basis to live with his PTS. I was still going it alone.
So, I reached out to Robson, who works in patient advocacy now, and he referred me to a psychologist who specializes in trauma. My first appointment was last week. Once and always a paramedic, Robson continues to make a difference in peoples’ lives, including my own.
“The last couple of months before I was taken off the road, I had a couple of calls that really put the final touches on my PTSD,” Robson told me.
James ‘Jimmy’ Robson graduated from the prehospital emergency care program at John Abbott College in June of 2011. He was hired on as a part-time paramedic with Groupe Radisson a few months later. His base station was in his hometown – Huntingdon (one town over from Hinchinbrooke where he grew up on a farm).
“I loved helping people. I loved working with my partner, the bond. I was so proud to wear the patch. I loved that my kids got to see me as a hero,” he said. “I have realized now that they see me as a hero regardless of my career. I loved the adrenaline. I loved it all. I even loved the pain sometimes, I felt as though I was sacrificing a little of myself for the greater good. I know that may sound a little sick, but I am trying to be as honest as I can.”
For the next six years Robson developed a well-earned reputation as a paramedic on top of his clinical game while keeping his genuine nice guy approach to colleagues and patients. In autumn 2017 Robson was hired as the Adjoint Chief of Operations for Groupe Radisson in the town of Pointe à la Croix in the Gaspesie region.
“I started at the end of January 2018 and then moved my family across the province in April. I was eager to make a difference not only in the lives of my patients but as well for the paramedics who I would be serving in my new position.
“I had seen fellow medics go through some tough times and some who didn’t make it through those tough times. As much as I tried to help and be sympathetic to their pain, I never imagined that I would be in their shoes. I was too strong mentally – or so I believed.”
Stress accumulates. Paramedics are especially good at packing stress into emotional duffle bags and then trying to hide them in dark recesses of their minds hoping to revisit them on their own terms. Rarely does it work out that way.
Imagine having to decide which of your ambulance crews is going to respond to a motor vehicle crash with multiple victims and knowing that one of those victims is the daughter of a paramedic en route to the scene. At the end of March 2019, Robson was confronted with just that scenario.
He remembers every second of the drive. The medic he had sent alone was close with both her partner and his daughter and had already experienced several traumatic calls related to motor vehicle crashes
“As soon as I heard her report 10-17 (on the scene) I radioed constantly to re-assure her that more help was on the way. I was strong and sharp and man, did I do my job well. I made sure everyone was okay on-scene – constantly checking in with them all. I was actually an active paramedic as well as a supervisor on scene.
“Arriving on scene. Ouf. My fellow medic staggering towards me, bright green paramedic jacket soaked with the blood of his daughter. His face was broken and still haunts me to this day. I decided to assign the other medics to take care of the other patients. After all, I was newer here and didn’t know the daughter like they all did.”
Robson went to see if there was anything to be done for the daughter of one of his paramedic colleagues. There wasn’t. “I don’t remember the next 10 minutes or so. All I know is I got her covered up and into the back of my ambulance. Her face will always be engraved in my memories.”
“I took her to the hospital alone (to be declared dead at the ER). I returned for a debriefing at the station and then went home to cry and try to sleep. I spent the next couple of weeks covering shifts for medics who couldn’t come in and needed a break. I made sure to follow-up with my team to see how everyone was. And I thought I was doing all right for a while.”
Robson was haunted by that call. He held onto a part of his notes for more than a year afterwards.
“My wife helped me throw it away. I just couldn’t let go. I feel like it was a part of her that was still here and I couldn't accept that she was gone. I kept it in my nightstand and would look at it frequently.”
At this point in the interview, I ask Robson if he’s okay with me asking him more questions. I mean, I’ve been through more than my share of awful, but Robson’s story is the stuff of paramedic nightmares.
“Absolutely. It’s very therapeutic. The more I talk about it, the better it gets. It took two years for me to be able to speak very openly about it. And Hal, remember, everyone has been through stuff. My experience doesn’t diminish yours. We all have our battles, and they are all relative,” Robson says.
Robson describes his symptoms. “I was very irritable, depressed, easily distracted with no concentration. I became angry a lot and even yelled at my children more than they ever deserved. They didn't deserve it at all. I was nervous to leave the house. I feared being judged or making mistakes. Flashbacks during the day. Slept very poorly because I was afraid something would happen if I fell asleep. I had anxiety attacks when I had to be away from my family for more than one day. I even had an attack while on a work trip to Quebec City.
“I was transported by ambulance because I thought I was having a heart attack.”
By June 2019, Robson was taken off the road by his employer and was referred to a psychologist.
“I took help everywhere I could get it. I wanted to go back to what I loved to do. What I thought would be a couple months turned into over two years of therapies and treatments. I tried to even invent a position for my former employer to at least return to work in the same domain. To no avail. My insurance ran out and we had to use all our savings. This last summer was very difficult.”
“The insurance had a psychiatrist interview me for an hour and decided I could work a different job, so they stopped my payments. My employer held my position for me, but I realized that I couldn't do the job anymore, so they replaced me and that's it for them. They put my badge in a plaque and gave it to me as a gift. They said that they had no other position for me. Hey, it's a business, I get it, no hard feelings.”
Eventually, Robson’s psychologist explained that his PTSD would be a forever thing.
He received a service dog – Stitch – at the end of June 2021. “He helps me with my anxiety and helps me get around while keeping me distracted.”
I ask Robson what he means about being distracted. “Distracted from what, Jimmy?”
“When I am in public or outside, I keep track of everyone and everything and it stresses me out. I imagine all the bad things that could possibly happen. Stitch holds my attention, so I don't have time to overthink things or get too anxious. And if he feels me getting too anxious, he will jump up on me to really grab my attention. At home he is there as soon as I feel anxious for cuddles and contact which really helps. He also helps with my sleep. I trust that if someone were to break into the house he would bark and let me know of any danger, so I can sleep fairly well,” Robson said.
Robson initially struggled with the news that his colleague, the paramedic who lost his daughter, has recently returned to work on the ambulance. However, he says he realized he has “other demons that keep me away from that work now.”
“There are movies and TV shows I can't watch. I sometimes stop and turn off movies 10 minutes in. I can't watch any type of reality emergency shows like "Night Watch" or anything similar. Driving by certain areas or houses will trigger flashbacks and anxiety. I have become pretty good at managing that though.
“I have worked very hard in therapy and it's really paying off. Anytime I hear about suffering, I can usually get triggered because there is probably a call I've done that can relate to every bad thing that happens to people. I have no tolerance for negativity anymore. Makes me angry. Hearing the sirens or seeing an ambulance makes me miss it and cringe all at the same time. It's actually quite confusing.”
Robson credits his family and friends with providing the scaffolding that has supported him as he deals with PTSD and works on re-inventing his life.
“I have been very lucky to have family and friends who have always been there for me. My mother would message me every day to see how I was. My wife put up with a lot of terrible behaviour on my part and didn't budge. My children have been so understanding and have always made me feel like a king. I have a couple very good friends who have also been a rock for me.”
Robson’s reinvention continues in his adopted hometown. The man who once was a paramedic has rediscovered his purpose as a guide for people trying to find their way through the healthcare system. “I was finally hired as Patient Navigator for CASA (Committee for Anglophone Social Action), who are a community organization in Gaspesie to support the English-speaking community. I am happy to say that so far, Stitch and I love it.”
He says he’s learning to live with his truth now.
“As of now, my biggest goal is authenticity. I try to be as honest as possible with myself and others. Sometimes I worry that people will think I am being dramatic or looking for attention or pity. I have to get past that. If it happened, it happened. It's my story and my truth. I really am working on letting people think what they wish of me and loving myself in all my damaged glory. I look to my children for guidance in this as their love for me has never wavered throughout this whole experience, and they have always seen me as their hero. As I have seen them as my little heroes.”
About the author…
Hal Newman is a former paramedic/firefighter who has more than four decades of experience in emergency health services. Newman has always believed an essential part of his job was listening attentively to people's stories and then leveraging those narratives to advocate on their behalf. Newman has a BA in Communications from Bethany College in West Virginia.