Once you’ve been in EMS for a while you notice that you’re a bit different than your family and friends. We see a lot of things that people out in the “normal” world generally have to deal with. It makes us react differently to many things and sometimes causes us to distance ourselves from our family and friends. Things that through them into a tizzy don’t faze us in the least. Emergencies aren’t emergencies to us, we’re used to dealing with real emergencies. Sure, a lot of what we do can’t even remotely be characterized as an emergency, but several times a year we DO have to deal with problems that are a matter of life and death.

To survive this over the course of the years we build emotional walls. Some of this is good and necessary. It’s just not possible to spend years responding to calls and watch people suffer and die despite our best efforts without building barriers to keep us sane.  In the process of building those walls we necessarily have to exclude those who don’t share our professional lives with us. For the most part I don’t discuss my work with family or friends because for the most part they wouldn’t understand. If  they did understand, they’d be horrified that someone they thought they knew so well could live such an alien life. Sure, people want to hear the funny stories and there are plenty of them. They don’t want to hear the tragic stories, although they’ll watch a fictional movie that contains the same type of content. I think that’s because they can enjoy watching play actors die horrific deaths because it’s all pretend. When it’s not pretend, it’s not nearly as much fun to be exposed to the same gore. So, to protect them and ourselves we build that wall. The wall is even thicker for strangers and casual acquaintances. They generally don’t even get a glimpse at our professional lives.

From discussions with close friends of mine who served in the military, it’s pretty much the same for them, especially if they served in combat. The guys I’ve known who saw serious combat (as if there is any other kind) are very reluctant to share any of that with anyone who didn’t serve or even some who did serve, but served in non combat positions.  Even within units there are walls between those who served early on and saw the most combat and the ones who came  “after”. There is a wall between them that is never fully breached because the experiences while common to an extent don’t extend to the first shock of action. There are those who were there and those who weren’t. Those who weren’t are never going to be fully included as are those who were there.

It’s the same in EMS. Every once in a while we’ll be involved in a major incident, one that makes the local and national media and is talked about for weeks, months, or even years. The people who were there and saw the sights, smelled the smells, heard the sounds, will share a bond even if they weren’t particularly close before or after the  “bad one”. Other people, even close friends who weren’t there, will be excluded from that circle just as the people who were at that bad one but not others will be excluded from those particular circles. Thus we build walls within walls and further barricade ourselves. The people who were there will talk with each other about the call, but for the most part people outside that group will get only the most superficial responses if they ask for details. The people who responded own that call and most of the people who didn’t respond will be excluded from participating.

I suppose if you build up enough walls you can eventually exclude everyone in your life from your life. Which is where the trouble usually starts.  Humans are by inclinations social animals. Hence “hermits” are an oddity that we pay attention to.  Insulating ourselves as a protective measure can backfire if taken to extremes. That’s when anti social and destructive behavior starts to replace normal human interaction.

Sometimes that condition lasts for a few days or weeks and the people are labeled as “moody” for a while. Eventually they return to their baseline and their friends and family stop noticing their “moodiness”. Other times the change, because of it’s cumulative nature becomes permanent. Relationships are ruined, marriages end in divorce, the effected responder starts to engage in heavy drinking or other self destructive behavior. Work becomes torture and eventually becomes a distant memory as a career is thrown away. Sometimes professional help can reverse that, but often it can’t.  Mental health professionals will try to tear down the walls and clear away the barriers, but the human mind is so complex that sometimes it’s just guesswork.  Some people will respond positively, others will just build higher and thicker walls. Some people just cant’ be reached.

And of course the walls are cumulative so that some people reach a tipping point where all they’ve seen and done over the years just overwhelms them.

The trick is to build the walls high enough and thick enough to provide us with protection, but not make them so high and thick that we’re cut off from the outside world. It’s just that there doesn’t seem to be any rational or consistent way to do that, because it’s all so unpredictable. So, most of us just stumble through the process and hope that we never get to that end point where we can’t deal with the tragedy any longer. Which would be much easier if we could only predict where that tipping point lies.