Paramedic and Family Caregiver "First Responder" Stories

Many of our first responders will be diagnosed with PTSD during their careers, and will battle mood disorders, substance abuse, and suicidal thoughts as a result.

These are kids who live on borrowed time and would test anybody's resilience.

                                                     

Hi Everyone!

While making my monthly stop at CBC Radio's, White Coat, Black Art, I've just come across two programs that are well worth your listening time. The quotes above are from the series host, Dr Brian Goldman, MD.

1.  The first program, Sock Drawer Stories: Portraits of Hope and Healing, describes the posttraumatic stress of emergency paramedics, one in particular who learned to deal with her PTS symptoms through painting. Teresa Coulter paints powerful portraits of colleagues with PTS, "opening their hearts and her's to healing". 

Teresa uses the analogy of a sock drawer (similar to the "file folder in your chest" you've heard me speak about in workshops) to describe what happens when we take the memory and emotion of each "bad call" or medical emergency or other trauma and stuff it in the back of our sock drawer. This works pretty well in the short term, allowing us to "forget" the trauma and present an "I'm fine!" face to the world. However, as time passes and the drawer fills up, opening it to add one more memory can cause all the old memories and feelings to fly out onto the floor.  This is what happens when we find ourselves "over-reacting" to a situation. It makes our PTS warning signs come out on full display.

In this piece, Teresa and her colleagues are interviewed by Brian Goldman about their PTS experiences and their individual paths to healing. 

2.  The second program, One More Thing Moms' Club, describes the experiences of another group of "first responders", a passionately articulate group of family caregivers in the Ottawa area faced every day with the frontline primary care and advocacy for a child with complex illness. While these Moms discuss the realities of life as they care for their children, much of what they say also applies to those caring for adults with similar conditions.

When I first saw the name of this support group, it occurred to me that it could have more than one meaning. Not only are these parents people who always have "one more thing to do" but they also have " one more thing to ask" of helping professionals exiting the room  because there's always another question, arrangement or issue to stress. I can't think of a more apt name for this group!

The unabridged interview with this amazing group of caregivers is well worth hearing in its longer-than-usual format.  

I hope you can take the time to settle into a big chair with a cuppa and really listen to both of these excellent programs. You'll come away inspired.

   

Compassion Fatigue: Who's At Risk?...

A case manager is supposed to do just referrals and that's it, but many times ... you're the first one that they're telling ... everything to. ... You end up hearing everything as if you were their psychologist and (it is hard to know) how to deal with those emotions when sometimes we don't have training aside from whatever we review.

Case Manager, Los Angeles Children's Hospital

Hello, everyone,

It's the beginning of a new year, so I thought we could go back to the basics today and take a fresh look at who is at risk for Compassion Fatigue (CF).

The primary criterion for determining CF risk is exposure to the trauma stories of the people we serve.  (Other vulnerability and protective factors also come into play but this is the primary contributor.) The greater and more graphic the accumulated trauma exposure, the more likely we are to develop CF.

These days, we are quite used to thinking of moderate CF as a natural consequence of working as first responders (paramedics, physicians, nurse practitioners, fire and police professionals, and humanitarian and victim assistance volunteers) or other helping professionals like nurses, teachers, social workers, lawyers, prison workers, mental health professionals and clergy. On the other hand, there are helpers at risk of CF who don't come to mind so readily.

In one of the best written articles on CF I've read in a while, Sophie de Figueiredo and her colleagues at Children's Hospital, Los Angeles and USC describe the cross-diciplinary experience of CF among service providers for highly traumatized children and adolescents, focusing much of their attention on case managers. 

We rarely think of medical receptionists, medical office assistants or case managers as being at risk and yet, of course, they are. Not only are they often the first to hear peoples' trauma stories and crises, they can be obliged to write or re-tell these stories again and again as they communicate information to other helpers, thus increasing their exposure exponentially. Hear some of the case manager risk factors de Figueiredo reports in her 2014 article in Traumatology:

Descriptive findings provide evidence to suggest that case managers may be more susceptible to CF than other providers. Their caseloads were significantly larger than those of other provider groups. They were less likely to report having access to reflective and individualized supervision and reported higher dissatisfaction with the amount of supervision they received. Generally, they were younger and reported fewer years of education. Case managers were also less likely to receive trauma-specific training in traumatic stress or on the effects on providers of working with traumatized populations... Unfortunately, these providers received the least amount of support to address and combat the development of (CF and burnout).   (p 293)

Also at risk are middle managers and administrators who may hear the most difficult of the trauma stories and situations, ones that can't be dealt with lower in the hierarchy, and yet have no primary "hands-on" contact with the trauma survivors and thus are left holding painful stories without an outlet of direct action to alleviate suffering (the survivors' or their own).

This fall, I've also been surprised to speak with a number of 5th Step volunteers in 12 Step Programs who have developed CF over years of hearing others' 5th Step stories. (The 5th Step = "We admitted to God, ourselves and to another human being the exact nature of our wrongs.") Hearing "the exact nature" of others' behaviours while in the throes of addictive behaviour can be more than a little traumatizing, though I have to admit I hadn't thought to include these folk within the fold of CF risk.

Others who might be at risk but not necessarily cross our minds as needing education and support are the translators/interpreters and community volunteers who are making significant time, energy and emotional commitments to the Syrian refugees coming to Canada over the next few months. These helpers may have little or no understanding of the potential impact of refugees' trauma stories on their lives. It will be crucial to provide these caring folk with CF information before they become overwhelmed by trauma stories of the people they seek to help.

Not-for-profit workers in food banks, meal programs, community outreach programs and disease-specific support organizations may also be at risk and unprepared.

Even librarians can suffer CF in some circumstances. Librarians and library techs in home library programs form strong, long-lasting bonds with homebound patrons who can experience the abuses and/or traumas and losses of chronic ill health and disability. During harsh weather and harsher economic times, the homeless and displaced may also seek shelter in community libraries and spend time sharing their stories with kind but untrained and unprepared helpers.

These are just a few of the under acknowledged at-risk populations that come to mind this morning. I'd be interested to hear of any others you believe to be poorly recognized.

A Word for 2016 ...

What is your word for the year ahead? 

A word which contains within it a seed of invitation to cross a new threshold in your life?

Christine Valters Paintner

Hello everyone!

Here we stand on the edge of 2016, a new year full of promise and possibility. Thresholds such as these are times when we can consciously choose to relinquish the old, the tired and the overly familiar to step into a new space with arms and eyes wide open, ready to receive whatever gifts await us in the months ahead.

Thresholds are in-between places where the old is gone and the new has not yet arrived. In many spiritual traditions, these thresholds are seen as sacred places where the veil between earth and heaven is particularly thin. They are places where we can pause to reflect upon the past, deciding what wisdom and experiences we want to take forward with us into the new year. They are also places where we can look ahead with intentional openness to all that is to come. The ancient Celts, who honoured such thresholds, believed that there were unseen presences in these liminal spaces waiting to support us as we step onto new paths.

A more concrete support for the journey, one about which I've written in the past, is the process of allowing a word to "choose you" and act as a guide through the new year.  (You can click on the link to see the steps in this process and "receive" your own intuitive word for 2016.) 

As I look back over the past few years, I can see the positive effect wrought in my life by receiving and reflecting upon each guiding word. There is a clear (to me) connection among the four words I've "received" since learning about this enlivening tradition and I can see, in retrospect, how each has built on the one before. The words I've received thus far are act, veriditas, suppleness and alive.  I will be excited to see what my unconscious will produce for 2016.

As we each wait for our word to come clear, let me leave you with one of Jan Richardson's lovely blessings (you know how I love the notion of blessing!) along with every good wish for this new and beckoning year.

Blessing the Threshold

This blessing 

has been waiting for you

for a long time.

While you have been 

making your way here

this blessing has been 

gathering itself

making ready

biding its time

praying.

This blessing has been

polishing the door

oiling the hinges

sweeping the steps

lighting candles

in the windows.

This blessing has been

setting the table

as it hums a tune

from an old song

it knows,

something about

a spiralling road

and bread

and grace.

All this time

it has kept an eye

on the horizon,

watching,

keeping vigil,

hardly aware of how 

it was leaning itself

in your direction.

And now that

you are here

this blessing

can hardly believe

its good fortune

that you have finally arrived

that it can drop everything

at last

to fling its arms wide

to you, crying

welcome

welcome

welcome.

Welcome to 2016, dear friends!

The Presence of Absence at Christmas ...

I notice your absence.

I notice your non-presence and reflect

on the time when you were present ...

Jarod Kintz

Hello everyone,

I've just finished all the happy "work" of the holidays and now there is time to sit back by the fire with a cup of tea to reflect on the holiday experience thus far. 

The winter holidays are usually the most joyful time of year for me. I love everything about them - the lights, the colours, the gifts, the music, the connection with family and friends. This year, however, changes in the pattern of life have subdued some of that joy. One sister, who lost her partner last spring, is grieving. The other sister is far away in Dawson City, without her family, working through the holidays. My dear friends, whose daughter is spending Christmas in a hotel room in a small city in Borneo rather than joining them for Christmas dinner, are missing her presence. And my own traditional plans for Christmas Day have taken a different path this year, asking me to spend most of Christmas Day alone.

At one point during the week, I sat down with my journal to better understand the strength of my emotional response to these "absences". I was sad and angry and lonely to a degree that seemed a bit of an overreaction to the actual circumstances. (After all, I am hardly a Syrian refugee being torn from everything I know or a family caregiver saying goodbye to a loved one who will die over the holidays.) As usual, after digging a little deeper, I realized that the intensity of my response came from layers of similar experiences in times past, times when the presence of absence figured strongly in my life. 

Whether at the very beginning of life when I lived as a boarder baby in a hospital nursery or during the many times in my childhood when my beloved father disappeared without warning on an alcoholic binge or throughout the early years of my bereavement following the deaths of my husband and mother, this "presence of absence" has had a strong, if sometimes unconscious, effect on my life. Now, when current holiday experiences trigger the emotional memories of these absences, my old and new reactions can mix together and become a little over-the-top.  

It is in the nature of life that we live in the presence of absence. Something or someone is almost always missing or about to go missing. Most of us build up an internal file folder of "absence experiences" over time, a folder that has the potential to raise our emotional intensity whenever it is reopened by a current loss or disappointment. 

So, what do we to do when this file folder is opened unexpectedly and all those old pages of absence fall out on the floor with their attendant emotions?

The first step is to recognize that this, indeed, is what's happening. This recognition lets us separate present experience from past emotion, allowing us to respond to the current absence with more appropriate intensity.

Secondly, we can reach out for a "presence" to calm and balance the experience of absence. Tell a trusted friend how you're feeling, write in your journal, pray, meditate, lean into the web connecting all human beings for support and comfort.

Thirdly, make a concrete action plan for doing the best you can with the absence situation that faces you. I have a large turkey thigh in the fridge waiting to be stuffed tomorrow morning, a fire all ready to be laid in the fireplace and a new book on hand to open tomorrow afternoon. I've also booked telephone visits with particularly supportive loved ones, spread throughout the day. It won't be the Christmas I want but it can be a better one than the lonely one I'd imagined.

And, finally, after the holidays have passed, you can consider seeing a good therapist to work at emptying your absence file folder of some of its older pages so that your holiday emotions can gradually become less overwhelming.

Whatever the absences present in your life this holiday season, may each of you find sufficient gifts of peace and joy to balance them. 

  

Merry Christmas, everyone!

Jan

oops ...

Hi everyone!

I understand some of you are having trouble accessing the song, Joy, from the last post. I've changed the link to the YouTube version so you should now be able to access it through the last paragraph in the December 13th post.

Sorry for the difficulty.

Cheers, Jan

When Christmas Hurts...

I think there must be something wrong with me,

Linus. Christmas is coming, but I'm not happy. I

don't feel the way I'm supposed to feel.

Charlie Brown

Hello, everyone,

Today has been a wonderful day of trimming the Christmas tree, decorating the house and baking the world's best ginger snaps (if I do say so myself!). These winter holidays are my favourite. I love the cold air and sparkling lights outside and the fire and coziness inside, the sounds of carols in the air and the visits of beloved family and friends.

However, for many, the holidays are not such a happy time. This week, for example, three of my friends and family are having serious surgery, one on Monday, one on Tuesday and the third on Wednesday. They and their families are stressed and worried.

When illness, trauma, loss, worry or chronic sorrow fill your heart, the light celebrations of Christmas and the other seasonal holidays can ring hollowly at best or sound a note of pure pain at worst. One of the hardest things about this kind of holiday suffering is that no one wants you to feel it - so family and friends do their best to "cheer you up". It's such a relief when the rare person comes along who will allow you feel exactly as you do without having to "fix"you. Such people are worth their weight in gold.

While checking in with a few of my favourite websites this week, I came across a young woman who, through her music, encourages others to feel their grief and sadness. Her name is Latifah Phillips of Page CXVI and she takes traditional hymns and spiritual songs and changes their words and arrangements to make them more relevant for today. Recently, she took a popular Christian children's song, "Down in My Heart", a typically "go-ey" tune as my husband used to say, and reinterpreted it as a melancholy reflection of pain and grief, written in a minor key.

The dissonance of the song's usual cheer and her own sad arrangement seems to bother her a little for she adds a new refrain:

I can't understand
And I can't pretend
That this will be alright in the end. 

But then she goes on to end the song with a verse from the old hymn, "It Is Well With My Soul", a song of acceptance and trust in the face of suffering. She seems to be saying that even in the midst of great pain we can still find joy. And even when we can't seem to find anything to hope for, we can anticipate that peace will come eventually.

So, I invite you to take a listen and allow this new song, Joy, to companion you through whatever sadness is present this winter season, whether it is the pain of secondary traumatic stress, the grief of losing a family member or friend, or the chronic sorrow of living with a loved one's unending illness or injury. (It's not particularly my style of music - I'm more a Mozart, Schubert or Abba type - but I like Latifah's idea of juxtaposing the happiness of the season with many people's true emotions.) May having your sadness acknowledged in a musical way bring you some peace.

Share A Secret - Support World AIDS Day ...

Started in 1988, World AIDS Day is not just about raising 
money but also about increasing awareness, fighting 
prejudice and improving education. World AIDS Day is 
important in reminding people that HIV has not gone away. ... 

Its time people treat the AIDS patient equally with dignity and pride and stop treating them like down-trodden people. This year, try and do your bit. If you cannot lessen their problems, do not increase them.

India.com

Hi Everyone!

Today is World AIDS Day and as you'll know if you read this site regularly, it's a day that holds a special place in my heart, having lost  Barry, a dear mentor, teacher and friend through AIDS a number of years ago.

One of the greatest barriers to HIV-AIDS treatment and support worldwide is the shame, secrecy and stigma associated with the conditions, even now in 2015. While things have improved mightily in some places since the strange, new and frightening virus first appeared in the 1980's, we still have a long way to go in countering the stigma that surrounds it. People in many parts of the world still keep their conditions secret from family, friends and employers, and even from their health care professionals, for  fear of being ostracized or worse. As a result, they can wait too long to get the treatment they need and the support they deserve.

While reading various World AIDS Day articles on the internet this morning, I was struck by a video by Prince Harry introducing his hashtag #FeelNoShame Campaign. Prince Harry, who founded, Sentebale, a charity in Lesotho, Africa for the support of vulnerable children fighting extreme poverty and the ongoing HIV/AIDS epidemic, challenges us to take a step toward breaking the stigma of HIV/AIDS by sharing a personal secret on social media in exchange for his.

The power of shame lies in secrecy. When we take our courage in both hands and honestly admit to something that causes us shame, we break its hold on us and we open the door for others to do the same. So, why not join the movement of brave people sharing their secrets today and do your bit to counter the shame, secrecy and stigma of HIV/AIDS?

(And, for those of you who would like to go even further with your support, please remember that "(RED) Partners" (Apple, Starbucks, Coca-Cola, Le Creuset, dre, beats by dr. and others) will donate 50% of the profits from (RED) products to the Global Fund HIV/AIDS to provide life-saving antiretroviral medication to pregnant women around the world. Ticketmaster and Live Nation have also partnered with (RED). November 9th to December 20th, the ticket sales companies will display a (RED) button on their websites, allowing patrons to donate $10.00 during purchases.)

Thank you to each of you from each of us who has loved someone with HIV/AIDS.