The skeptic and the shrink

Yachats, Oregon: a few dozen of a rare breed: Human “mules” sat in class; I among them. USFS, BLM; a smattering of state agencies. For us, “mule” meant Medical Unit Leader; the job was to deliver emergency medical services wherever wildfire took thousands of firefighters every season.

Its been a good session, but next up–boo!–some fool invited a psychologist to our training; some soft-headed academic who was going to lecture us, the street weary, hardened heroes of EMS, about something called “Critical Incident Stress.” Heck, I know about stress, been doing this thing a long time and I know the routine and the subtleties, the nausea of adrenaline on an empty stomach, the flashbacks that cycle up and snap at me. But this is what we do, and those things go with the territory. So why muck up a great conference with touchy-feely talk? How’d we get roped into this one?  A shrink? Seriously?

He takes the podium; we slouch; he speaks, his words sink and slither through the miasma of visceral, palpable cynicism that is rampant in the room.  Why can’t we be in the exhibit hall, playing with all that orange stuff with lots of straps and snaps? Who invited this guy?

Until.  Word by word he deconstructs that which is within, and never shared. He knows what I’ve seen, and he knows what I thought when I saw it; he tells us our secret tricks for getting through the moment, and why the moment doesn’t stay in the past. Quietly, patiently, persistently he says in public everything I’ve carefully crammed into into a mental corner. He is taking me apart.  This is wrong.  I’m not prepared for this–the guy’s a psychologist, and he’s not really one of us, but he knows what I thought and when I thought it.  There’s a weird wetness near my eye…no, in it.  Crap.  I am not going to let this happen…but I sneak a glance around the class and it’s evident that what I’ve lived with is a common experience, glistening tears reveal what words would never admit.  He knows, and he isn’t one of us….  Fifty, sixty or so of us, and what begins as a snuffle here and a tear there turns into puddles, then pools, then the whole damn room is awash in soft, sobbing, tears.

How?

A year passes; the experience was profound and even though your second EMT gig with the local dirt poor, low-buck, beg-borrow-and-steal volunteer fire department can’t manage a ‘real’ CISD team, you follow the routine that started after the CISD training; the habit of hashing things out for a minute over the still-warm hood of the rescue rig–tonight, rain-spattered.  The night is late, the run was rough, the gentle rain cloaks the night in unmerited tranquility.  Tonight’s the night, though, where you save four broken bodies and one blasted psyche—the mind of one of your own.

You didn’t think that much about it. Yes, the scene was worse than average nightmare of twisted metal and trauma: Flail chest (“that’s unusual,” you think) on the driver, incoherent; passenger on the right a head injury and combative; fourteen year old multi-trauma wandered and screamed down the highway center line, having escaped the cab.  In the middle of the ratty old heavy metal mid-60s Ford pickup was what stopped you cold: the one who begged to be let out; the only one of the four who was coherently speaking yet was horribly and thoroughly impaled on the that long, straight stick shift.  She’s half on the floorboard; long iron rod rammed through here abdomen, come to rest, unseen, deep inside and against her right shoulder.

So it was rough, but we volunteers handled it, even when the first-in ambulance paramedic freaked and walked away, helpfully telling us, “I can’t handle this….” Meanwhile Sue kept calling for more dressings; you not knowing that as she fought to stabilize the patient, contorted into the cramped space between floorboard, seat, and patient, she was being spattered by lung tissue and blood with each straining breath.  You were in the pickup bed, reaching through from behind to help stabilize her neck, then handing off and moving to the cab to saw off the stick shift.  It was bad, but you did not yet realize how bad your partner working alongside you in the crumpled cab was having it.

So an hour later, back at the station, Sue came unglued; the rest of you just chitchatting about what was an unusual run, yet well handled.  Her words came spattering out, spattering like the lung tissue that speckled her face breath by breath; inches from the gaping tear; her horror, fear, the utter frustration of needing a major trauma pad and being handed a gauze 4X4 in the dark. The next day, the surgeon at the hospital would show us his souvenir: a 2″ divot of denim and cotton: the gearshift knob had punched a near-perfect circle through her jacket, blouse, and camisole that he found lodged against her shoulder blade.

But that was tomorrow: in this moment Sue wept; convulsive tears, and somehow the same group that danced the crazy, clumsy ballet of extrication turned inward to their hurting own.  Suddenly we knew, we shared, we stood beside her as our own worst fears became incarnate, as those words we always knew we would utter were said for us.

Highly trained CISD team, we weren’t–but we knew what was happening and why–and we shared those minutes of anguish, knowing now in all fullness what a normal reaction to a grossly abnormal situation is.  I hated that shrink; the day he made me cry.  I loved that shrink, the day we saved one of our own.

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