“All of us have one call that always haunts us. 19 years later, I still have nightmares about this one.”
I had hit what I now know as rock bottom in February of 2014. I hadn’t gotten out of bed other than to use the bathroom for over a week. I hadn’t showered in days. Food was out of the question. To top it all off, I hadn’t been sleeping much, or if I did it was during the day. Nightmares haunted me whenever sleep dared to come.
I’ve spent the majority of my public service career as a Paramedic. Those who know me are aware that I’m not exactly the quiet type either. I try to organize my experiences and observations for the benefits of others these days in order to accomplish some greater good. We have a lot of room for improvement and it seems that we are on the way to a culture shift in how we deal with taking care of ourselves.
The word “wellness” is something that employers and organizations are starting to throw around more and more, but what exactly are they encouraging? What should that mean for our first responder communities?
Wellness can be defined as “the state of being in good health, especially as an actively pursued goal”. This leaves a fair amount of room for interpretation and presentation to others. Typically when we see a wellness program or resources pushed to us, it includes several variations of tacky stock photography including actors dressed in generic uniforms, water flowing over rocks, and phrases taken from various places on the internet. There isn’t normally a defined process or set of resources especially for us; it’s a general program rolled out and meant for the public and doesn’t always address our specific needs. They can be everything from temporary to things we just simply aren’t interested in. I know that from going through my own process that mind-body activities like mindfulness and specific forms of yoga are helpful in maintaining that healthy balance of needs and emotions, but I also know that some random person showing up at work who can’t handle our often dark humor or outlooks on society and may not be able to perform to our standards or expectations. We are different people, and there is no way around that. It should be managed how it is - not how others feel it should be.
I was having a discussion with someone recently about a wellness event that their employer sponsored about a year ago. No, I’m not talking about mine with this, so don’t bother emailing and calling them please. This event had various services there to explain all about what they do and how wonderful being well is. This person went off-duty and was surprised to see that all the workers were out doing work, but all the bosses were there engaging. Almost a year has gone by and nothing in how the organization deals with their employees has changed. Within the last few months they had someone in their organization commit suicide and they have now renewed the interest in promoting wellness. Sometimes it’s just for show, unfortunately. I hate to be blunt, but often the people orchestrating these events don’t have a good understanding of exactly what they are trying to accomplish in the first place. Sometimes it seems akin to throwing a hand grenade into grandma’s flower garden. You have a grenade and want to show it off, but at the same time, you care about nanny’s petunias. Let’s find a more constructive way to use the grenade without blowing up the petunias.
So where should we start? Every service, employer, and organization has different needs that should be discussed with the worker base - the people who do the work - rather than administrators following trends on social media or a Google search. This doesn’t have to be difficult or expensive; there are simple things that can be done that can have a positive impact. Here are some things to start:
1. Scheduling: Do you have a schedule that works for your needs? Can one be created that satisfies the needs of the service as well as to allow the people to live outside the world of public service? The answer is yes. Sometimes you have to push for it. There are many scheduling programs that allow for doing so and sometimes it’s just as simple as getting to know them. We work in industries that are 24/7 without an absolute way to know what the need for services is going to be so there are always unknowns. There are ways to plan around that using the analytics from past service utilization; it just has to be done. Having the ability to keep a professional schedule that allows for free time, taking care of loved ones or family, and maintaining a balance of the professional world and personal world is important and goes a long way keeping everyone happy, healthy, and productive for the organization. It may sound a bit silly and obvious to say, but it’s well established that when an organization invests into keeping the workers happy, the production and service benefits. Properly rested and maintained employee bases show increased benefit to the patient population. Things like positive attitude, positive work environment, and satisfaction go a long way to how we deal with the public. Proper schedules ensure balance with other activities including sleep and rest. With this, I think it’s safe to assume a reduction in things like medication errors, complaints, and better interaction with other professionals is all within the best interest of everyone. Speaking of which:
2. Sleep: A fairly large percentage of people in public service industries suffer from sleep problems, and I think it’s safe to say that what we mentioned before has a large effect on people. I’m familiar with the saying “I’ll sleep when I’m dead” implying that between overtime and other responsibilities in life, sleep is not always a priority. Your sleep is a far more complex situation that you may be aware of. Sleep disorders are one of the most frequently undiagnosed and mismanaged problems among the population, and we are no exception. We all know that person at work who does nothing but slam coffee and energy drinks all day. We know that is not healthy, but it’s far better than falling asleep at work. Even worse, literally every month there is another incident somewhere in the nation involving a responder falling asleep and crashing the vehicle causing injuries, death, and property damage among other things. It is common that during the course of the investigation, it becomes known that the person driving reported feeling tired or recalls falling asleep at some point. I find this to be a big problem, but I suppose that is just me judging from the amount of people who have no choice but to work dreadful hours like at 24 hour shift with no consideration of rest. Though it is illegal in some states, it still happens. Complicating the issue is when shifts are created during the hours that disrupt the normal human sleep cycle. Humans are designed to sleep when it’s dark. That’s just the way it is. This can be managed by proper re-cycling and acclimation to the scheduling, but an effort has to be made to do so and correctly. There are many things that can tip you off that you or someone else has a sleep disorder. Things like falling asleep during typical work hours, noticeable lack of attention or attention span, decreased activity, mood swings (that person who is always grumpy at the beginning of the shift), feeling tired all the time even after decent sleep (hypersomnia), problems falling asleep or staying asleep (insomnia), persistent headaches, waking up choking (may be obstructive sleep apnea), nightmares, problems with controlling hypertension (high blood pressure), frequently falling out of bed or sleep walking and a whole host of other things. Improper sleep can also aggravate existing issues like depression or cause an increase of events associated with PTS. You need your sleep to function, so why not have your organization take an active role in assisting you? Find a reputable Pulmonologist with a board certification in sleep medicine. In most cases, you will need to start with your primary care provider to “trial” some simple medication if deemed right for you. Most insurances require this anyways, so you may have to “follow the rules” or “play the game” to get started. The best way is to have a sleep study, and that can be coordinated. Those who know me are aware that I am the “king of sleep disorders”. I suffered for years before taking the steps to address it and I’m glad I did. I sleep better, I feel better, and I have an awesome sleep specialist that I now refer people to. Don’t be afraid of the CPAP machines either. The new systems are cheaper, more effective, and most can communicate via your home WiFi with your specialist to send data and make changes without an office visit. There are apps to see how you are doing (you may see me post them from time to time) and remind you about routine cleaning and maintenance. They can also alert you and your specialist to events that may require more attention and study that may not have been caught during your sleep study and would otherwise remain unknown. When I had my initial study, my oxygen levels dropped to 70% and I was having almost a dozen “events” per hour like incomplete breath cycles, waking up without being aware of it, and complete airway obstruction. Several months into having the machine at home, I got a call from my specialist. The conversation started off with “So, how’s your sleep?” and quickly evolved to “… so you stopped breathing about 18 times in the last week and I had to adjust your machine settings…”. I thought the headaches were from allergy season, but apparently not and I never would have known otherwise. Turns out the magic was in the change of my schedule and because of the tracking through the machine and monitoring from her we were able to determine that change and justify that on a medical basis. I worked with my HR department and scheduling coordinator to make the change. It was quite a difference. There is also the option of not having the mask that we all know about. It is far more comfortable and easy to work with than years ago. If you can’t tell, I love my machine! Don’t be afraid to reach out with a question about your sleep. I’m no sleep expert, but I’ve been through just about all of the problems with sleep disorders.
3. Access to primary care: Get a reputable primary care provider and stick to the visits. Get your organization involved to promote it. You may even be able to find a provider who will come to your organization and do the exams on-site and during odd hours. Most places require an annual physical evaluation for initial employment, but not all require it on a continuing basis. Since our jobs are completely stress-free (lol) we definitely don’t have to worry about things like: high blood pressure, high cholesterol from the wonderful diets we all have, weight gain, unhealthy habits, deterioration in health, and age related issues - right? Not so much. We are still humans (well, most of us) and prone to the things that plague others in addition to our own problems. Get off your butts and take care of yourself. Anyone who has taken an American Heart Association class should know that things like high cholesterol and high blood pressure knows that those two things can be mitigated through simple medication or diet management rather than killing you 30 years too soon. Most of these screening are available to you to free anyways (insurance depending) and may be required, but not always enforced. I’m looking forward to being 90 years old and ramming into other peoples carts with my scooter while shopping, and you should be too!
4. Your spine: Take care of things before you are disabled. I advocate for Chiropractic care a lot. We do a lot of lifting, bending, and carrying that is far from ergonomic and considered normal. This causes many issues with joints and specifically with the spine. People are often turned off when it comes to the field of Chiropractors, and it’s no wonder when you do a simple internet search. Chiropractic typically falls under the category of “alternative medicine” and tends to be ridiculed by other, established branches of medicine for various reasons. Perhaps some of that has to do with the founder of the speciality promising to cure everything with a few snaps of the spine. One thing that should be kept in mind is that this was not uncommon for the day in the medical establishment, so feel free to do your own research. As things have evolved, the care has become more streamlined and evidence-based like other branches. As with all things under the umbrella of alternative care, the secret is in the provider. If they are trying to sell you snake oil, then you should think twice. I love the smell of lavender oil, but I also know that isn’t going to cure me of my insomnia - just like a Chiropractor who tells you that doing spine adjustments is going to fix your heart disease is full of crap. Look for a provider who does proper assessments before working on you. Things like a screening and proper imaging which are typically X-rays. If you walk in and they offer to start manipulating your spine (or any joint) without knowing what is actually going on, you should promptly walk out. Part of the theory around the spinal adjustments is being able to flex those joints so they move properly and align in the proper anatomical position. If your disc is destroyed or there is a problem with arthritis that is so bad it could cause injury to do the manipulation, a good Chiropractor will not touch you and likely refer you to a spinal surgeon instead. This is what you want. It may not have been what you had in mind, but I presume being in a wheelchair or confined to a bed isn’t either. I caught quite a bit of flak for engaging in his years ago, most of whom are people I see every day. One person I work with suffered from back pain to the point where bending over or down became a task involving groaning and selective profanity. I mentioned seeing the Chiropractor that I did and was initially met by additional profanities and accusations. It wasn’t until they bent over to pick up their keys one day and couldn’t get up that helped the decision to reluctantly call and schedule an appointment. Their back was pretty close to destroyed to the point of surgical intervention, but was appropriate to a slow start to the therapy. Three weeks later, I noticed a marked improvement of their overall appearance, attitude, and reduction in the use of said profanities. It’s been about four years since then and they haven’t had a regret besides not doing it sooner. Keep those joints moving when possible; it’s not worth being sore all the time and being miserable from the pain. Most insurance plans offer a set number of visits with a low copay. I would encourage you to get others involved after finding the right provider.
5. Routine mental health evaluations: The sooner your baseline is established while working in the public service sector, the sooner others may detect an issue and avert crisis situations. I know this is going to strike a nerve with most of you, but the fact of how working in these fields changes you as a person cannot be denied. We often aren’t aware of these changes as we progress through our careers, but that doesn’t mean someone shouldn’t be looking out for it. We do not offer crisis services here, but occasionally people who are in danger to themselves or others come to us and we handle that accordingly. Putting some barrier in the cycle of the disaster that may strike us or another coworker is something that needs to be established, taken seriously, and maintained. You should encourage your organization to get interested in doing this on at least a semi-annual basis. Find a provider, likely someone who is a LCSW or Ph.D, with the proper credentials and clinical experience looking to get involved. You will benefit from having the oversight of a provider with the right mindset and experience of conducting these evaluations and rendering opinions on how to improve the way people are cared for. You may have the idea in your head that these evaluations will involve someone sitting in a chair etching notes on a pad while bobbing their head saying “I see..” as you spill your guts while you lay on a couch. We get these ideas from what we see from various films and stereotypes; not from reality. It is not a test, there should be no pressure, and it shouldn’t be painful either. It may involve some uncomfortable questions, but keep in mind that the process is designed for a reason - and that is to keep you and others alive and well. Depending on the data you look at, we are around three to six times more likely to resort to substance abuse and/or suicide than the general population. No one wants to hear it, but that doesn’t make the problem dissolve. Take the steps to save yourself or someone else.
6. Make it accessible: most administrators work such challenging shifts like Monday through Friday, 9-5 with no weekends or callbacks and get to enjoy holidays. The rest of us don’t have that luxury. So why does it make sense to have these things available on a schedule that benefits only a few? it doesn’t, and you should speak up. It’s not usual to have specific services available all the time, but there should be some discretion and choice as to what is. If you are holding an event or educational outreach on these things, make them so the majority can benefit from it. What’s the point if everyone can’t get involved? Use the tools out there that people use - you have the internet, social media, email, and word of mouth. Get out there and get it done.
As it has been said, “Rome wasn’t built in a day, but they sure burned it down quick”. Take your time and get the right things in place. Start simple and work from there. Find what is effective and necessary without falling for trends or aiming to make a show. In the end this involves us all, so it’s worth the investment.
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