The straw that broke the camel’s back.

This metaphor has been coming up a lot for me recently. I am a paramedic and have recently suffered a breakdown. I am currently being treated for post traumatic stress disorder (PTSD) and depression.

This metaphor is so relevant. For me, depression crept up, one piece of straw at a time, until it became such a huge burden that I could barely get myself out of bed. When I broke it was not as the result of a big traumatic incident, it was something small. I was already carrying so much weight to begin with that one small incident was all it took to push me over the edge.

I want to dig a bit deeper into what this metaphor means and represents and how this can help us to understand things like depression a bit better.

The metaphor talks about a camel carrying straw. The camel can carry a limited amount of straw. If you keep adding tiny little pieces of straw one at a time the camel isn’t going to notice each tiny addition. However eventually you will exceed the camel’s strength and endurance and it will fail. One minute the camel will be able to support the weight of the straw. Then you will add a tiny bit more straw and you will exceed its maximum endurance and it will collapse. All you’ve done is add an insignificant amount of weight but that was all it needed. The last straw, so to speak.

People are like this. I have been told that ‘you can handle it until you can’t any more’ several times over my journey this year and this is what they mean. Each little increase in your burden is tiny; it’s insignificant on its own. But when you combine all the little insignificant additions they become too much to bear.

This is particularly relevant to health care professionals and mental health. You hear lots of different advice as a student. Experienced people tell you that for each sad/traumatic/painful thing you see you lose a piece of your soul. They advise you that if you can avoid seeing something particularly distressing, just don’t look because once you get images like that in your head you can’t erase them. I understand where they are coming from but I picture it slightly differently. Unconsciously, and without realising what was happening I took on a small portion of each of my patient’s suffering. I collected these pieces of grief one by one throughout my too short career in an effort to lessen their pain.

I picture myself as a glass. I started off mostly empty, but as I met and treated patients the glass started filling up. The glass empties somewhat when you go on holidays or take time out for yourself and fills up again in proportion to the trauma you are exposed to. Importantly this isn’t just physical trauma and gory scenes, this is mental trauma too, loneliness, hopelessness and grief. Horrific scenes may leave you feeling fine if there was room in your glass, but if you have had a run of bad cases or simply haven’t had enough time to unwind the glass may fill quicker until you end up in my situation.

We were taught how to better empathise with others at university. To listen, put ourselves in their shoes, repeat their problems back to them to make sure we are on the right track and then offer observations based on what emotions they seem to be expressing; ‘that sounds exhausting’, ‘that must be very difficult to deal with’, ‘I can’t imagine what you are going through’, ‘that sounds frustrating’.

This is a great skill to learn and I have seen first hand the relief on a persons face when someone finally listens to them and takes their concerns seriously. The problem arises when you are continually exposed to difficult, negative emotions. Over the course of a day as a paramedic I may have put myself into the shoes of an elderly lady living alone with no relatives. She is lonely and has no stimulation. She is scared of dying alone. Next I might attend a child with a serious illness. At this job I become the parents. I watch their beautiful child suffering as though it is my own. Next up is a middle aged man with chest pain. First I am him, scared I am having a heart attack and worried about what will happen to my family if something happens to me. I also become his wife and children and feel their love and fear. After that we go to a person that has been self harming. I feel their hopelessness, their anger, their feeling of no way out.

I imagine that the health care professionals who last the longest are able to display empathy without actually taking on what people are feeling. They can keep their work and their personal life largely separate. If I had known that this task was near on impossible for me perhaps I would have chosen a different career path, however it is almost impossible to tell until you try it.

If you are a health care professional, whether you are a student just starting out or a seasoned expert, do not underestimate the power of little burdens to bear. What you could handle last week may not be as easy this week and often by the time you realise it is too late. Use your family and friends to gauge how you are going as when it comes to depression the sufferer may not be able to see the forest for the trees. If your organisation offers regular mental health check ups take them. If nothing else they will provide a trend that may pick up something you miss.

Most importantly you need to take care of yourself before you can take care of anyone else. Make sure that you prioritise the things that empty your glass. Be it exercise, spending time in nature, reading, creating art or just sitting on the couch watching a movie. These are not and should not be luxuries, they are essential to your longevity and your patients will benefit in the end.

Grief Sponge

Depression crept up on me slowly. Incrementally. So gradual that I didn’t notice as the colour slowly faded out of my world.

It started with tummy aches that would begin halfway through 10 and 14 hour shifts. Bending over to pick up bags and treat patients caused discomfort and the cause was elusive. They were fairly mild at first but over the course of 6 months they got so bad that I’d end up driving home from work with my belt and pants undone.

At the same time as this was happening I started to get sick. Every bug that went around had me feeling lethargic, coughing and sneezing for weeks. My previously robust immune system was failing. Multiple trips to my GP provided no answers with serial blood tests revealing that I was perfectly healthy.

I would lie in bed on my days off and try and coax myself to get up and do something, but all the sparks were gone from the world. I let my veggie garden succumb to the ceaseless spread of weeds. Shriveled chillies and capsicums rotting on the ground amongst unruly and now inedible baby spinach and coriander, a constant reminder of my neglect.

I no longer had enough energy to leave the house or entertain guests in the few hours between shifts and sleep. For five days in a row I would cook-eat-clean up, cook-eat-clean up, breakfasts, lunches and dinners alone. Getting my washing done is an accomplishment and a necessity. Its completion becomes the main focus of my days off.

Prior to this I would have been the kind of person described as ‘bubbly’, ‘confident’ or ‘outgoing’. I was always doing something, always full of energy and giving my all to whatever challenge was in front of me.

When I finally broke it was like a dam wall burst. I had been collecting tiny pieces of grief, loneliness and pain from each of my patients over the course of two and a half years and it all poured out of me in a torrent of tears and hopelessness.

The most prominent feeling was an overwhelming sense of failure. When you are a paramedic you are told over and over again that ‘it takes a special person to do what you do’. What happens when you can’t do it any more?