Waiting for Patience


My office door is always closed and locked, remnants of a day when an angry man stood over me and yelled words filled with hurt, anger, and frustration, flinging his arms out as if to grab me and shake the understanding into me.

“Why are my dreams so vivid?” they ask me.

“Why does it still feel like I’m there, fighting all over again, when it happened so many years ago?”

“Why am I still here?”

The brain never forgets, unless the insult is so severe that the parenchyma itself is damaged then dies off, or if we don’t feed it the oxygen it needs. Hypoxia we call it, but those memories don’t just need oxygen.  They need light in all its forms.  The soft rays of sunlight that come in the early dawn of a dreamless night.  The probing surgical intensity that exposes every forgotten detail of curved hair on bloodied arms. The incandescent glow of the faces of loved ones holding back the shadows.

Some injuries to life and limb are obvious. Every day when I walk into this hospital, I see veterans in wheelchairs, leaning on canes or walkers, arms and legs in braces or scarred, but the hurt that comes from post-traumatic stress disorder is not so apparent.  We are confronted with stories on the internet of people leaving nasty notes on the windshields of people using handicapped parking spots whom they judge to be unworthy of the designation and of what they consider a privilege.  Though I’m sure there are those who abuse these “privileges”, for every one of them, there are countless others who would gladly give back the parking placard for pain-free days and nights.  And for those for whom the wounds are invisible, there is no parking placard.

PTSD is real. The patients who seem to have the best grip on this have good support networks–spouses willing to tough it out, family open to seeing it, or friends willing to listen.  When my husband calls me in the middle of the day, it’s frequently to talk about a tough case or to hash out the best way to have handled a patient or incident. Because I don’t know anything about being a paramedic or firefighter, most of the time, I’m just listening or offering a “That’s terrible.” I know it is a way of debriefing for him, just like what he does when he first gets home, and what I do when I’ve had a bad case. He has people he can talk to at his firehouse, but I’m glad he chooses to talk to me, too.  This week was his first shift on call as a SWAT medic.  Luckily, he did not get called in, but every time his phone rang or he received a text, I could see him tense up.  I understand his reasons for wanting to do this work.  How could I not? But I also know that my job as his wife is to look for the signs that he needs help.  We have an increased awareness now about PTSD with social media and trending tweets, and the focus on our military has helped to bring the issue to the forefront, but still too many first responders and veterans are dying off the battlefield, and after the trauma, from suicide and the effects of substance abuse.  It can be difficult for these men and women who are held up as heroes to admit they are struggling.

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All of us need to recognize the concept of sonder, which in my mind should rhyme with wonder.  It means the realization that each random passerby is living a life as vivid and complex as your own. If you have been lucky enough to escape sorrow, tragedy, hurt, and pain in the years that make up your time on this earth, count yourself among the lucky few.  We all have been through the fire at some point.  The trick is looking past our own wounds to see the scars that everyone carries after the flames have passed, and recognizing those who are struggling to carry on.

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June is National PTSD Awareness month, and June 27 has been designated National PTSD Awareness Day.  In the days before we knew better, they called it by a variety of names: shellshock, nervousness, hysteria. Those who have served in our military, first-responders, and survivors of any catastrophe from rape to hurricanes are at risk for developing this. It affects men, women and children.  Know the risks, learn the signs and triggers, and most of all, please try to develop the patience with humanity that comes from sonder. Today as we honor those veterans who gave everything on the beaches of Normandy, let us not forget those who came home with invisible burdens that had not yet been given names, or forget those who risk their lives every day.

http://www.frsn.org/Resources/web-links

http://www.nctsn.org/resources/public-awareness/national-ptsd-awareness-day

The Call


As a firefighter’s wife, you learn to accept certain things as part of the job.  When he was a volunteer for two different fire departments, sliding out from under warm covers in brutal Michigan winters to get to the scene of another person with difficulty breathing or another structure fire, I learned how to go right back to sleep before he had even finished putting on his boots.  When he came home with bandaged hands and told me he could not wear his wedding ring anymore because 100 pullups made his hands bleed while in the Fire Academy, I learned how to apply antibacterial ointment without adding the salt of my tears.  When he got held over because he was force-hired when another paramedic was ill, I learned how to rearrange schedules for pick-up for dance class, Cub Scouts, Girl Scouts, and soccer without even a change in heart rate.

As a physician assistant, I thought perhaps I had an advantage over other firefighter’s wives.  I’ve been trained on how to react in emergencies, explained to wide-eyed patients that the chest pain they felt was not indigestion, sutured gunshot wounds, bloodied numerous pairs of gloves in procedures and surgery, and so thought I was prepared for the life as the wife of a firefighter.  And then, in one moment, this illusion which I clung to was swept away.

It was a simple photo. Taken by his partner in a candid moment after a house fire, then posted to Facebook.  When he first became a firefighter, he would call me on his way home, just to let me know he was still alive, and this habit continued at his new department, after he got off from his shift.  Frequently, his calls come while I am with a patient, so the conversation consists of only a few reassuring words, but it is enough to let me know the world is as it should be.  He is safe for another day.

Like most couples, at the end of the day, we share work stories. Since he is a paramedic/firefighter, we discuss Patient X, treatments, and transports, and our children are used to dinner table stories of crashes and fires, though most stories have to be edited for little ears.  He will say only “It was a bad one,” and I know it will be a conversation for later after bedtime stories, nighttime prayers, and goodnight kisses.  I have heard so many variations of cases, and somehow this has lulled me into thinking of them as routine, part of the job, just another fire.

On this day, I am between patients, checking Facebook, this picture of him, so unlike most I’ve seen pops up on my screen.  My son has inherited his daddy’s smile, all cheeks and teeth, full of life and laughter, infectious and enthusiastic for all the blessings we are surrounded by, and pictures of my men are lit by these smiles.  But not this picture.

In this picture, he is tired.  The house smolders behind him.  The air is thick with the haze of smoke. The ground in this desert city in which we now live is wet with the efforts of hours, and criss-crossed by hoses.  The uniform which I’ve seen hanging in his locker, is smudged with soot.  The helmet with his name emblazoned across the front is held in one hand, and I can see that he is trying to muster up the energy for that brilliant smile, but he can’t quite manage it.

I have visited each of his fire stations, trying to nod knowledgeably as he points out gleaming rows of knobs and levers on the fire trucks, listened to explanations of all the safety equipment and training, shook hands with his station mates, but, of course, I’ve never been on scene.

Never seen the fires raging, smoke billowing, men and women moving in concert to save lives and homes.  Never seen this man, who gave up a lucrative position to go back to school for his 3rd career finally doing what he loves, look like this.  This man whom I met as a boy, who asked to hold my hand 3 babies ago, who loves being a firefighter because he can help people, looks out at the camera, and I finally see him, in his element, and my heart contracts in fear.

I am a firefighter’s wife.  I thought I knew what that meant until this photo.  And later, when I get that call, that tells me he is home, and safe. . .I know it is only for today.  And I pray, with renewed urgency for strength to a merciful God and His blessed mother, that I and all the other partners of firefighters, continue to receive that call.Image