WRITINGS FROM A WHITEBOARD WIZARD

Sometimes….pizza

Depression.

Suicide.

Websites and news outlets almost on a daily basis announce another death of one of our brothers or sisters in public service.  Some are accidental or in the line of duty, but what about the others we hear about taking their own life outside of work?  What was going through their mind before he or she completed the task?  How long had they been feeling that suicide was the permanent solution to a temporary problem?  Did anyone notice, and if so, did they say anything?

It’s been estimated that 15-25% of first responders suffer from PTSD and that the rate of suicide among first responders is 2–3 times that of the general population [more than 1 in 20 EMT deaths are due to suicide (2)].  Why?  Some would say it’s inherent to the people that choose the profession of public service.  Others would say it’s the stress, the long hours with little pay, the conditions we work under, or dealing with the public, in general.

It might be any of those issues, but I’d offer up this.  According to the Center for Disease Control, it is estimated that 1 in 10 Americans suffer from some type of depression.  Additionally, 80% of the people who have symptoms of clinical depression are not receiving any specific treatment.  Realistically, the possibility you know or work with someone who suffers from depression is very high.

How many times have you noticed that a colleague, coworker, friend or family member appeared to be what you would label “depressed”?  How did you come to that conclusion?  Maybe he or she just weren’t themselves, were more withdrawn than normal, or simply just seemed to have more bad days than good?  Many times, someone we know is depressed, but we miss it, or worse, don’t bring it up in conversation. But why? There are lots of reasons, not limited to: it’s an awkward topic, the fear of upsetting that person further, simply keeping to oneself because “it’s not my business”, or you’re unsure if it really is depression and God forbid you bring up this sensitive subject and be wrong, right?

How can you tell? I’d refer you to a simple mnemonic (InSADCAGES) developed by my colleague and friend, Dwight Polk:

Interest – lack of interest in things s/he usually takes comfort
Sleep – either too much or too little
Appetite – some eat to forget, others forget to eat
Depressed mood
Concentration – can’t seem to focus, sometimes even on simple tasks
Activity – the person who abruptly seems to transform into a gym rat, or the couch potato
Guilt
Energy – lack thereof
Suicide – thoughts, words and/or attempts

People suffer from depression for a number of reasons.  Some, it’s simply a matter of screwed up physiology, and abnormal levels of serotonin and dopamine in the brain. Heredity plays a big part – researchers have identified several genes common in people with bipolar disorder and depression. Long-term use of medications for high blood pressure, birth control and even some types of sleeping pills have been linked to the development of depression, as have diets with deficiencies in folic acid and vitamin B12.  People who suffer from heart disease (depression occurs in up to half the people who have had a heart attack), stroke, diabetes, cancer, dementia, and/or an under-active thyroid gland are at a higher risk, statistically.  Even something as simple as personality can predispose someone to depression, especially those who are overly-dependent, self-critical, pessimistic or have low self-esteem.

I am one of the many who suffer with depression.  Maybe you are too.  I’ve been to therapy, took medications to no avail, read books to try and change my outlook.  I have learned to deal with it and I usually have more good days than bad.  But, the bad days still come, sometimes worse than normal and sometimes over multiple days.  I get through because I’ve learned how to cope.  It might be a sit down in the park, a drive in the car, a chat with a friend or family member, or a good rerun of a favorite movie.  Sometimes, the best thing that fixes it is just enjoying a beer and pizza. 

It is estimated that every 40 seconds, someone in the world successfully commits suicide.  Every 41 seconds, someone is left behind to try and make sense of it.  Suicide is the 10th leading cause of death in the U.S. and most recent data shows that from 2016 to 2017, the death rate increased 3.7%. (1). 

Truthfully, not everyone who is depressed is suicidal and not everyone that is suicidal is depressed.  When we hear about another suicide of a brother/sister, or anyone for that matter, we have no idea how terrible he or she must feel to get to that point.  Yet, we always say: “How could they do such a thing?”  “It was such a selfish act.”  “I would never do something like that.”  and on and on.  All the days I have felt depressed, I never had a conscious plan to take my life.  August 30, 2013 changed all that.  I was driving back from New Orleans across Lake Pontchartrain.  I hadn’t been feeling well, mentally, the entire day, but I never had thoughts of killing myself.  As I got halfway across the causeway, suddenly I felt my mind falling into the deepest, darkest, saddest, most horrible hole.  At that moment I remember thinking, to get out of that hole the solution was to drive my car off the bridge and into the water.  So, I started to do just that.  When my front tire hit the guardrail, the jolt immediately snapped me out of it and I jerked the wheel back the opposite direction.  I drove onto one of the crossovers and just sat there.  The thought was completely gone, but now my consciousness turned to “what did I just almost do?” There was no plan, no preparation.  Just a few minutes of major distress that could have had a disastrous outcome. 

I suspect there are many who have committed suicide had a similar experience.  However, there are many others that have thoughts for so much longer.  These are the people we hear or know that develop the plan, write the letters, the emails the tweets or post something on Facebook.  They say things that alert us, give away prize possessions, make funeral arrangements out of the blue, spend all their money, etc.  

I know the darkness, the pain, and the anguish that depression causes.  Maybe indirectly it lead to my near-incident.  Maybe it was something else.  Similarly, when this happens to others, maybe there just isn’t the chance to think and the result is heartbreaking.  Those are the one’s we probably can’t help, but I know there are so many more we can.  If you feel suicide is the only way out of your problem(s), consider this:  call me.  I don’t have all the answers, but I’ve been there and luckily I’m still here.  419-704-9701.  Leave me a voice mail, if need be.  I’ll call you back. 

If you don’t want to talk to me, talk to someone.  You are not worthless, a piece of shit, or anything else your mind tricks you into thinking.  Don’t have anyone or don’t want to let anyone close to you know how you’re feeling?  It’s OK.  It really is.  

I would suggest these resources:

National Suicide Prevention Lifeline 1-800-273-8255

Disaster Distress Helpline  1-800-985-5990

Fire/EMS Helpline 1-888-731-3473  or 1-206-459-3020

Veterans Crisis Line  1-800-273-8255; press 1

Police Helpline  1-800-267-5463

Traumatic Brain Injured Vets 1-866-966-1020

https://www.safecallnow.org

http://www.frsn.org

https://www.nvgc.org/programs/share-the-load-program/

http://www.copline.org

https://www.ptds.va.gov/public/treatment/therapy-med/disaster_mental_health_treatment.asp

*Help & Resources*

We always say in public service that we are the helpers and not supposed to be the help-ee’s; that we should just shrug it off, suck it up, let it go…whatever.  We’re human.  Sometimes life, the job or who we are get the best of us.  When you feel that way, don’t be afraid to say something.  Trust me, someone is always willing to listen.  Talk.  You’re too important.

WW

 

References

1. Murphy SL, Xu JQ, Kochanek KD, Arias E. Mortality in the United States, 2017. NCHS Data Brief, no 328. Hyattsville, MD: National Center for Health Statistics. 2018.

2.  Counts, C. (2018, 11/13). Making EMS Count.  Retrieved from www.ems1.com.

Musings

Over my 20 + years of teaching, I’ve come to adopt certain concepts and mantras that hold true through the test of time.  Here are some of my favorites.

  1. Retractions of any kind are just one thing – BAD
  2. Just remember, your patient didn’t read the textbook.
  3. There is Registry and then there is Reality.
  4. You bag groceries and ventilate patients.
  5. Examine thoroughly, so you can anticipate and treat properly.
  6. Just because you can, doesn’t mean you should.
  7. Always be prepared because Murphy is always watching.
  8. You can’t count respirations, but you can count ventilations.
  9. When faced with an obstacle, focus and work the problem.
  10. Physiology is how the body works, pathophysiology is how it’s busted. You must have a working knowledge of both.
  11. Every willing student can learn, s/he just won’t learn the same way as their peers.
  12. The best educators are flexible and can diversify their delivery of information.
  13. There is no substitute for a positive, encouraging, and understanding mentor.
  14. Teachers make the slides; Instructors read the slides; Educators don’t need the slides.
  15. When a student mentions the “Q” word during a clinical rotation, preceptors cringe.

 

What are some of your guiding principles that have stuck with you throughout your career?

DAY ONE

This blog is the beginning of something new for me. Its been on my agenda for some time and now it’s here. I hope you’ll check back often and also tell all your friends to look me up. EMS, education, travel, conferences, sports; anything is fair game!  I hope you’ll enjoy it as much as I will.