I worked on an engine company in the south end of Vallejo, California, during the crack cocaine wars of the 1980s. EMS responses to gunshots were almost a routine occurrence, often two or three a day.
In the “what happened” line of standard questions to those victims fortunate enough to be able to speak, the response often began with, “I was just mindin’ my own damn business….”
It certainly can be quite interesting when life creeps up on you while you’re minding your own business. I begin in this manner because I was minding my own damn business recently when it came to my attention that the cumulative mental trauma of several of my former fire and police colleagues had caught up with them almost simultaneously. Seems they were only guilty of minding their own damn business as well.
Most of us, at some point, have rolled our eyes at the senior members of the fire service going on and on about “back in the day.” Believe me, if it wasn’t absolutely necessary to illustrate a point, I wouldn’t be using the expression. However, “back in the day” no one mentioned post-traumatic stress disorder (PTSD). For that matter, no one mentioned any of the mental health risks of our line of work. The only focus of health and safety discussions dealt with the obvious physical risks of the job.
How We Got Here
Some of the first-acknowledged examples of what we now call PTSD were seen in soldiers from World War I and World War II, but most likely mankind has wrestled with it since the beginning of time.
In the military, “combat fatigue” was a term to describe soldiers who had become unable to continue, and those afflicted were often scorned, ridiculed, and branded as cowards. There is a famous scene in the 1970 film Patton that further reinforced this stigma.
Yet with what we know today, it’s not difficult to imagine that shoving naïve, 19-year-old farm boys into the horrors of war with little preparation would likely result in mental meltdowns.
PTSD and the Fire Service
Some years into my career, we started to see some attention being paid to mental health issues but typically only sporadically and only after “major” incidents. Firefighters involved were given debriefings that were viewed with both skepticism and suspicion. The debriefings were usually awkwardly conducted by well-meaning, but unqualified, do-gooders from other disciplines who didn’t have a clue what our jobs were all about.
In the final years of my career, there was a push to bring credibility to the debriefings by organizing the approach and only staffing them with folks from the trenches who “get it.” These improvements were largely pushed forward by our EMS director and flight nurse Danny Richards, who can add that to the incredible contributions he made to the delivery of emergency medicine.
Memories
One call I’ll never forget was a response to a reported apartment fire less than a dozen blocks from the firehouse. We arrived to find fire out three windows on the first floor.
We pulled a handline, forced entry, and advanced through the living room, crawling onto the bodies of the two boys, ages 2 and 4, who always waved to us from their front step as we returned to quarters past their home, multiple times a day.
With big smiles, they would give a pull-down gesture with their arms, hoping for a quick air horn blast from the engine in return. The boys were survived by their uncle, who had left food on the stove before passing out in a back bedroom. He awoke to the fire and escaped out a rear window.
Also surviving was their mother. At the time of the fire, she had gone to the bus station a few blocks away to conduct her drug transactions from the pay phone. Just another day in the ’hood.
I don’t remember any classes in the academy that would prepare you for that. Knowing for certain those kids were in that apartment and being unable to reach them in time has haunted me for almost 40 years.
Retirement and Remembering
It’s tempting to think that once you enter retirement without a significant mental health episode, you have successfully cheated the devil and the rest is, to quote a brother, “all cake and balloons.”
Unfortunately, that doesn’t seem to be how it works, and with increasing frequency it is the retiree who experiences a crisis. The sobering reality is that when it’s time to enjoy all the things you have worked for, and the family you have spent so much time away from, everything on earth again becomes significantly at risk.
We all start out the job with the firm belief that we are certainly on the most noble of missions, sent directly by God. And so, we assume, we must also be bulletproof as well.
At mid-career, we have likely taken at least a couple of bullets, have the scars to prove it, and are beginning to feel a little less invincible.
Toward the end, whatever physical wreckage remains of our carcass begins to ask what the hell we have done to ourselves. Subconsciously, we start to become fearful of the ticking time bomb of various toxicities that are now forever lurking in our operating systems.
What is amazing is rarely, if ever, do we take our mental health through the same awakening journey we afford our physical health. Since mental trauma doesn’t leave the same visible scars as the physical, it doesn’t tend to get the same attention.
I have come in contact with several very close colleagues recently who have been retired for several years, and they are only now experiencing the mental symptoms we have all quietly feared.
Protections on the Job
As much as remaining on the job continues to compound the mental harm from the situations we face, there are also a couple of defensive countermeasures we can take while we are still working.
Active duty provides the distraction of constant chaos. Crappy-schedule-induced sleep deprivation allows us to continually kick the can down the road and postpone issues to be dealt with another day.
The interaction with others at the day room table also provides some “off-gassing” in a candid and often crass environment that few outsiders would ever understand. With separation from service, however, comes the inevitable eventuality of being alone with your thoughts, which is when the processing phase tends to begin, whether you like it or not. Whether you’re ready or not.
Sleep itself can become both a blessing and a curse as you settle into this new “retired” phase of your life. The increased opportunity to sleep can also provide a new forum for the battered psyche to act out without boundaries like an ADHD child on cotton candy. In my own case, the first few weeks were like Christmas as I discovered what the gift of a night’s sleep actually felt like. A short time later came the nightmares that became my nightly companions and have diminished only slightly over the past 10 years.
It’s extremely humbling to admit to yourself that you may be only one particularly bad incident away from a meltdown. It’s even more humbling to think that incident may have already occurred and is rattling around inside you like an opportunistic carnivore waiting for the right moment of weakness. However, with admission comes awareness, and the resulting honesty with yourself can have the benefit of providing its own layer of protection.
Much like the Predator movies of the 1990s, it’s extremely difficult to do battle against an unseen enemy. Everybody understands when “Suzy fell through the floor searching the floor above and separated her shoulder,” because physical injuries are, for the most part, objective.
However, when it’s “Louie came back from a pedi code last night and was so jacked up he couldn’t finish the shift and went home to hug his kids,” the injury isn’t acknowledged in the same manner.
The four members of an engine company who all experience the exact same critical incident will often be affected in four completely different ways that are unique to them. If faulty safety equipment was instead causing our personnel injury that could result in permanent disability, we would have taken decisive action long ago. It’s way past time to realize the hardware of our people can be rendered almost worthless if not directed by a healthy operating system.
We must also reconsider the concept of the “tough” guy or girl to have a meaningful discussion about PTSD. The emotional side of all of us plays by a different and unwritten set of rules than our physical self. The mind could give a damn how tough the body is; it’s irrelevant.
“Shingles” can become a painful reminder of an otherwise forgotten, dormant case of chickenpox, experienced long ago, typically early in childhood. The virus may reside quietly in the body’s nervous tissue unnoticed, often for decades.
Long forgotten, the virus that caused chickenpox may seize an opportunity of heightened stress or other systemic weakness in its host and manifest itself in an excruciating and scar-producing body rash. Similarly, it would serve us all to remain mindfully aware of the cumulative trauma associated with all we have seen and experienced as a constant, and now permanent, dark passenger.
With the passage of time, it’s increasingly likely that at some point the dark passenger of one of your colleagues will forcibly take over the wheel of the bus. The look of pain in their eyes will be unmistakable, and the only thing you cannot do in response is mind your own damn business.
Bio
Greg Falkenthal is a retired assistant chief of the Vallejo (CA) Fire Department with more than 32 years of service. He was on the Fire Engineering Editorial Board and the FDIC Advisory Board and was an FDIC H.O.T. instructor.
