November 18, 2013
By Lori K. Grey, M.D.
Dispatchers commonly ask me how to cope when healthy eating, restful sleep, exercise, and work-life balance aren’t enough to help. In other words, how can we persevere and thrive when our capacity for caring becomes overwhelmed or depleted? What do we do when the other stuff doesn’t work? Let’s break this down based on reasons why this happens.
Human suffering and cruelty
We have the privilege of experiencing humanity at its truest level, at its finest and cruelest moments. We learn that there is no limit on what one human being can do to another, which is reflected in phrases like: “Only the good die young” and my favorite from policing—“No one is truly innocent.” The challenge of weighing the best- and worst-case scenario to arrive at a more “realistic” perspective doesn’t work for us.
It is important to consider not just the traumas but also the moments—the moments that are the reason why you do what you do and that carry you through what you do, regardless of whether it’s your best or worst call. A violent crime in which a little girl and her parents survive but all other kids died and the girl says in a humble voice, “Thanks for helping me keep my mommy and daddy.” Or the elderly gentleman who found his wife deceased due to natural causes and asks, “What do I do? She was my everything!”
It’s not about a pat on the back. It’s about aspiring to have the strength that those people had. We need to think not just about the stressors but also the moments, and the moments are much too easy to miss.
When the toolkit runs out
Through my experiences working in inner-city Detroit with victims of torture and horrendous sexual assaults, I learned that we have to develop a comfort in being there with people. This is how we help when our toolkit runs out. Never underestimate the comfort and security that you provide by being with someone at their worst moment.
We also need to ensure that our expectations of ourselves are reasonable. Getting a “save” (e.g., resuscitating a cardiac arrest patient who then survives) is not reasonable. The odds are too low and these calls are too infrequent to keep you going. A more reasonable goal is to “increase the odds of survival to the best extent possible.” This is something that we can achieve regardless of whether there are positive/negative outcomes and high-/low-acuity calls.
High frequency of low-acuity calls
Frequent low-acuity calls can be frustrating. We get conditioned to call frequency and acuity and may get bored when those thresholds aren’t met. Perspective works for some—the view that you get paid the same regardless of the call that you’re answering. This doesn’t work for many or when you’ve just taken the pediatric arrest and the next one is for a stubbed toe. Although that isn’t an emergency by my standards, that person is quite lucky not knowing the world as we know it: Where bad things happen to good people and life can end in the drop of a hat.
We go through loops: stimulus overload (the initial catch-up as you sit down and get into the groove), stimulus max (on the ball and rolling with the information flow), and stimulus saturation (hitting the wall mentally). Regular breaks are important. Schedule a minimum of two consecutive weeks of vacation time to spend your time catching up rather than recuperating.
The burden of caregiving
It’s part of dispatchers’ character to help; they want to contribute to the greater good. As a result, dispatchers tend to care for others before caring for themselves. When a group of people with these attributes works closely together, we end up with people preferring to deal with others’ problems rather than their own and caring for others to the point of depletion and sensitized to feeling devalued. We need to realize and embrace that you can only care for others in so far as you care for yourself. We need to support each other in doing so.
It’s not “just a job” and we need to be mindful of that in how we care for ourselves and how we look out for each other.
A father whose child died—an innocent victim of a random crime—said something that I will always remember. He dropped to his knees and then froze in utter disbelief for what felt like forever until he looked up and said: “I made a mistake. I made a mistake. I assumed that my child would live a long life. I realize now that the only thing in life that is guaranteed is death, not when. My mistake was assuming when.”
That father was absolutely correct. Life is too short to devalue your incredibly important role, to lose sight of what truly matters to you personally and professionally, and to lose sight of the reasons why you show up each day to help others.