Rescuer Guilt

[u/Anonymous_Chipmunk]

I've been a paramedic for almost 15 years. I'm fortunate not to be burnt out, love my job, have good work:life balance, and have good mental health. But in June, on my birthday, I ran a call that would change me.

We were paged to a road where it crossed a creek (a common place for people to recreate) for a drowning. When we arrived a first responder was doing CPR on a 10 year old girl. She had been walking along the road when she slipped, fell into the upstream side and was sucked into a metal culvert under the road where she became entrapped for 5-10 minutes.

We resuscitated her on scene, did excellent patient care, and everyone executed flawlessly. I was truly proud of how our team performed that day. We obtained ROSC and transported her to a nearby LZ for a 25 minute flight to the nearest hospital.

She has since been transferred to a children's hospital where she stayed for over a month before moving to a rehab. She is currently vented with a trach, has minimal conscious activity, but does apparently have sleep and wake cycles, and some movement.

I struggled with this call for a while. This isn't my first pediatric call, they all suck, but this one was different. I live in a very small community and, unbeknownst to me, this family was very prominent. Everyone knows them. Everyone. The story was all over the Internet. Not just locally, but regionally. I couldn't escape coverage of it. Even now a few months later it's still everywhere. Signs, tshirts, gatherings, fundraisers, etc. I'm okay with all of that, but it does mean there's no "ignoring it."

For several weeks, maybe a month, things were hard. I struggled a lot. One day I was overcome with guilt. It was so hard to explain. It felt like survivors guilt, but I called it "rescuers guilt." I felt guilty to her parents. Not only did we not save your daughter, but she didn't get to die. She, and you, are left hanging in the middle. I understand rationally the chance of survival and the practicality of the situation. But I felt so guilty. I cried a lot that day. That was also the day I decided to use our EAP and get help.

I'm doing much better now. My therapist has helped my process my emotions and the trauma, but it's still a work in progress. I just wanted to post this because it would help me process, but also don't want anyone else burying themself in guilt for doing a great job against immovable odds. No matter what you're feeling, it's justified. Don't be afraid to seek help and talk it out. You're out there doing amazing things every day, don't hang your hat just on the big ones.

PS: I had a set back yesterday. I got dispatched to a drowning at the exact same crossing. It was an adult this time. Importantly for me, I handled it well. I was shook for a few minutes while we were responding, but I had managed it before we got there and again, our team did great. He will survive.

[u/CaptAsshat_Savvy]

I understand on a personal level. We fly some messed up people and I think to much. I also, have guilt, more so, I feel guilty that we are prolonging this persons suffering, what's the quality of life? is a positive outcome even realist, what else could I have known to impact a better outcome etc.

I also have worked hard to get that out of my head. I found it helpful to try and look at it from a different perspective and perhaps this could help.

I did not cause this event to occur. I have no control over any part of what happened. I only have control of what happens when I have this patient in the time that I have. While my actions have impact down the road, what's important is now. I'm hopefully making time. Time for loved ones to say goodbye. Time for life. That little bit is beautiful and I hold onto that small piece of beautiful to rationalize the madness.

[u/Wise_Screen_9462 → u/CaptAsshat_Savvy]

The best kept secret of air medical. Most of them die anyway.

[u/Goddess_of_Carnage → u/Wise_Screen_9462]

That is a fact. The sad part of that fact is in the futility of what even success looks like.

My shaping experiences in high acuity CV/trauma showed me that not all wins are victories.

[u/Bootsy_boot7 → u/Goddess_of_Carnage]

“Not all wins are victories” reminds me of what my husband always says whenever we “win”… “the battle is won, but at what cost.” (He’s a flight RN, I’m a medic) we both believe that at a certain point, doing nothing is the best thing.. but we keep those thoughts to ourselves and do our job.. many people don’t agree with us.. :/

[u/Wise_Screen_9462 → u/Bootsy_boot7]

In my mind, there are two classes of prehospital providers. First Responders and Clinicians.

First Responders go home happy when they get ROSC, Clinicians don't want to hear about anything less than survival to discharge neurologically intact.

This is probably an extremely petty way to look at things, but I recognized early on that I was different from my peers.

[u/valgerth → u/Wise_Screen_9462]

Eh, I also think there is a pragmatism viewpoint as well. I know I am one link in a chain that effects the final outcome, but ultimately there are situations where everyone in the chain can do their job completely correctly to the utmost of their ability and a patient can still end up either dead, or disabled in some way. That's just the reality of the line of work. So you take the wins you can get, and try to improve on your skills/knowledge if you think there is something you could have done better for the future. I'm not trying to bag on you wanting a perfect outcome for patients but "I was different from my peers" comes across exactly as petty as you think it does in my ears. It seems like you are ignoring what is potentially someone looking at the job being done correctly, and taking the win they can from it.

[u/Goddess_of_Carnage → u/Wise_Screen_9462]

You’re spot on.

[u/Goddess_of_Carnage → u/Bootsy_boot7]

Not many people haven’t been in the deep trenches.