Like most, I remember where I was on the morning of
September 11th, 2001. The
historical moment occurred during a quiet and transitional period in my life,
what Joan Borysenko calls liminal time, the moments between no longer and not yet.
I’d just left an obscure French movie at the Toronto Film
Festival, which featured, among other things I forget, the presence of a witch
doctor.
I stepped out of the Cumberland
Cinema in downtown Toronto and could sense something foreboding in the
atmosphere. The mood of the early day seemed
pensive, introspective, slightly foreboding.
I don’t remember how long it was until I heard someone speak aloud about
the events in New York City. It wasn’t
very long - news like that travels quickly on the currents of our instinct-driven,
subcortical brains.
The events of 9/11 brought a sudden awareness of, and
interest in, the role of first responders.
For some time, a new generation of heroes ascended the center stage of
human interest. They had their brief
walk of fame, which would wax and wane for months, and last perhaps years after the last ashes of the burning, then burned, twin towers had cooled.
I remember hearing about Canadian paramedics heading down to
New York, in a spontaneous upwelling of pride and willingness to serve. Many Canadian emergency physician colleagues
also stood ready to travel south and devote their energies and skills.
Some days later, one of our newspapers (the National Post, I
believe) published a full page advertisement honouring first responders and
emergency department staff. At the time,
I had my personal computer inside a narrow work cabinet. I placed the ad on the inside door, where it
lived for over a month.
I was surprised then how touched I was by seeing such
profound public acknowledgement of the dedication and sacrifice that
characterized emergency medical responders and emergency department staff. It wasn’t that I’d felt deprived of respect
before that moment. It didn’t really
bother me much when people asked when I would become serious about my medical
career, or when I confronted the general lack of respect for emergency physicians
within the medical establishment. Whatever deficiency
of praise existed then had always been balanced by the amazing community that
existed in every emergency department.
Within our small world of heightened urgency and intimacy, each day
brought its fresh blessing of connection and the opportunity for shared acts of
care, kindness, skill and courage.
Somehow, though, the ad touched something deeper in myself,
something that – at the time – it was okay to feel without absolutely
understanding.
EMS personnel I have known, both as an emergency physician,
and later through my interest in PTSD, remind me of the uncertain and
uncontrolled environments they frequently face.
And it’s so true. If I was to set
the archetypal stage of an emergency physician, it would be displayed in the
moments before the arrival of critically ill or injured patients, standing
gowned and gloved in an empty trauma room, with all the supplies there and
ready to go: intubation equipment and rapid induction drugs, central line and
chest tube sets, highly skilled nurses stationed at their own respective
places. Excitement, calm, the senses
gathered together in a familiar state of high preparation.
I can only imagine the scenes that face paramedics on
scene. Dead bodies in their final
positions post-suicide, homicide, or other cause of death. Asthmatic children gulping air through pursed
lips in filthy apartments. Overweight
cardiac patients awaiting carriage down narrow flights of stairs. Dangerous scenes; hostile onlookers. Abused infants and children in the native
scenery of their misery.
Before starting to write this afternoon, I looked for
something like that ad I’d so long ago posted next to my desktop computer. I could find many images honouring first
responders, and some honouring emergency department nurses, or even emergency
department staff. But nothing any longer
connecting E.R. staff and first responders in a single web of camaraderie and service.
As I return to my old memories, I wonder what went through
the minds of the medics as they brought in the most critical of their
patients. Did they believe in the
capabilities of the E.R. at the end of their run? Did they believe in us? Did they ever arrive and wonder which E.R.
physician was working? What did they
think when they knew it was me?
I know that things are different now. There’s a lot more distance between E.R.
staff and first responders. Emergency
departments are overcrowded, and often chaotic.
A resuscitation in the field and ensuing hospital run is often
followed by an unacceptable wait. It
must be terribly frustrating for the medics, to sometimes discover a lack of
urgency in the hospitals that await their patients. As I write now, I wonder if I can even start
to imagine. To be out in the field,
amidst the unknown and unpredictable.
There must be such a powerful need to know that body bleeding out from a
stab wound, or that flat, shocky child in septic shock is going to a place
where expert help is available. To stop
believing in the E.R.s must feel like a bad nightmare to those EMS providers
who put their very soul and being on the line.
And I imagine it cannot be that much better for the E.R.
staff themselves, when they feel less a part of something magical and
intact. When my mother was early on in
her year of suffering from metastatic cancer, she spent some time at North York
General Hospital. She had a kind and
conscientious emergency physician, and she mentioned to her that I had also
worked for a long time in emergency medicine.
And, of course, there’s the kind of questions that follow that kind of
admission, the need to determine if indeed I really was legit, and where I
worked, and so on. My mom’s attentive
doctor seemed surprised at the length of time I’d spent doing full-time
E.R. She mentioned that the current
lifespan of an E.R. physician in my province is now six years.
And this leads me to say this: To come to this broken system with a heart of gold
and the desire to make the world a better place, breaks the hearts of those who
most desire to serve. We call this moral
distress and burnout these days. But it’s
worse. It’s seeing beneath what the
blind eyes of popular culture and the distracted sensibilities of our
contemporary age miss, gazing into the emerging betrayal of truth and human goodness.
Last year, about this time, I published a post on feeling “felt.” Today I write about feeling recognized. Is there a difference? I think of the thirty-eight Canadian first
responders and twelve military personnel who died by suicide this year. I wonder if, on a certain level, our collective
ability to feel others and to recognize on an individual level is eroding. When I think about the full-post ad, I think
of a collective recognition of bravery and valour. And yet, like any war veteran who’s been at a
few medal ceremonies will tell you, that kind of recognition very quickly shows
its dark underside, its shallow rhetoric.
I remind myself that every individual who put on a uniform,
whether firefighter, or cop, or paramedic, or E.R. physician or nurse – started
with innocence and a dream, and a hope.
Somewhere they discovered an aptitude and a calling. And each and every one of us have a story of
our own. We need both the collective
story and the individual one. We need to
be recognized and felt for the moments we worked seamlessly as a team, and for
the sleepless nights that found us bleakly and profoundly alone.
