Fire/Rescue StreetSense ❘ By Kate Dernocoeur
You can’t be in this business and not be witness to unusual numbers (and sorts) of deaths, especially these days. For people who entered the helping professions to make things better, our encounters with death can sometimes be unnerving even for the most well-balanced and seasoned veterans.
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It’s easy and quite human to adopt a “win-lose” attitude about our work. Someone was better when we delivered them to the next caregivers? A win. They died? A loss. But is it really about winning and losing? The dying and the death will never stop being a part of what we do. Maybe it’s helpful to regard this aspect of our work differently. Maybe it’s more about adopting a viewpoint that isn’t such a gut punch.
Gain from the Losses
This idea is especially pertinent with the hovering specter of coronavirus. This new battle has blindsided humanity. For those in the blue center of the flame providing health care, it can feel so damned defeating. Losses are mounting, too, from within our own ranks. In the fourth week of April, reports from New York City included two suicide deaths: one a fresh-from-training EMT, age 23, who had been on the job less than three months; the other, the head of a Manhattan emergency department, age 49.
Whether your encounters with loss are a new or an old thing, infrequent or overwhelming, each arrives on your psyche and leaves some sort of mark. How does one cope? Since there is no stopping our involvement with death and dying, it seems relevant to seek ways to regard it differently—ways that don’t wear you down, chew you up, and spit you out.
Strategies for the Individual
How can you gain from the losses? There’s no one single, simple remedy. All the familiar refrains of self-care and stress management and the specific measures they represent are a part—a very important part—of the answer. It does matter to press on with getting some exercise, sleep, decent nutrition, and time with people and activities you love.
For the individual, it’s worth taking time to ponder your beliefs and philosophies about the end of life and what it can represent. Being honest with yourself about past experiences and their impact is worthwhile—much better than thrusting them into a dark corner of your mind somewhere. Do the inner work of cleaning out old emotional debris. Otherwise, allowing painful memories to accumulate can topple you emotionally when you least expect it.
The next step is to actively adopt helpful strategies for coping in a healthy manner with the scenes your world serves up. Do the work of self-awareness and clear-eyed self-assessment to recognize how loss impacts you. Learn and practice skills that will carry you forward without the push and pull of a win/loss viewpoint. It’s a choice, but using these skills is a very powerful habit.
Specifically, try the following:
- Take an inventory: What is your general comfort level in death situations? What death experiences have impacted you? Do you have a spiritual belief system that is helpful for managing your responses to death (or, possibly, is it actually unhelpful)? Are there death scenarios that hit you harder than others (such as children or those reminiscent of a personal loss)? Those that remain vivid are especially worthy of attention. Next, plan ways to build your resilience for handling losses, using healthy and helpful habits that will sustain you over time.
- Make a pact with yourself not to shy away from the gifts of your experiences. Choose to notice ways to gain, not lose, from the lessons offered in death situations. There is always something there, no matter how harsh the experience. If the goal is not to let these lessons wear you down, assign yourself the task of finding ways to view them productively. For example, after seeing the deep regret of a wife who said, “We had an argument and he went upstairs to rest,” my lesson was to vow never to part angry from people I care for. Another: From seeing many lives snuffed like candles, I learned to live as fully as possible and take no day for granted.
Group Dynamics
The other half of learning from death situations involves the group dynamics of your emergency team. Recently, a friend who is facing the loss of her mother was fretting the denial of others that the end was near. Denial (an interesting topic by itself) is an all-too-familiar coping mechanism in death situations, but it’s not all bad. Others often see their way forward differently. Just because you share the same uniform as others on your team doesn’t mean you have the same ways of viewing death and dying. Sometimes, viewpoints are wildly different, even negative, bitter, or deeply hurt. Everyone comes to this difficult topic with different personal background experiences and beliefs. No one has the only answer.
Specifically, try these tactics:
- Create a work environment that makes space to talk about different ways of viewing death and dying without judgment, shame, or pressure to conform. Avoid being derogatory or judgmental of others. And hopefully, someone on the team (you?) will have the courage to dig in when someone who professes to be “just fine” probably actually isn’t.
- Critical incident stress debriefing is (should be) available when situations are abnormal even for us, but not every death situation needs a debriefing. Still, each one hits different people differently. The days of “suck it up, buttercup” (should) have ended. Is your organizational culture supportive and sensitive? Check in with colleagues appropriately to keep the lines of communication open, even on “everyday” losses.
Emergency care demands that we delay our emotions while we work to save lives and help others grapple with the shock of their bad days. It’s also necessary to attend to our own responses. If you have had a soul-sucking shift, use your skills for resilience, be kind to yourself and others, take a walk, and do whatever (healthy) measures work for you. You have the power to manage the inevitable accumulation of losses and even gain from the lessons they offer for living more fully.
KATE DERNOCOEUR, NREMT and retired firefighter, still serves as a medical examiner investigator as well as a SARTECH-II with the Kent County SAR K9 unit in western Michigan. She retired from the Ada (MI) Fire Department in 2019 and was a paramedic for the Denver (CO) Paramedic Division (1979-1986). Her emergency services career began in 1974 with the Vail (CO) Mountain Rescue Group. Educated as a journalist who also earned an MFA in creative writing, she has written extensively for EMS publications, including JEMS, since 1979, and was a frequent speaker at EMS conferences from 1984-2004. Her book, Streetsense: Communication, Safety and Control, was released in its 4th edition in 2020. She also coauthored Principles of Emergency Medical Dispatch with Dr. Jeff Clawson, MD (first edition, 1988), among other books. Her blog, “Generally Write,” is at www.katedernocoeur.com.
