I have been put “on the spot” more than once with this question and I don’t think its possible to respond appropriately without offending a few people on either side of opinion polls. So lets break this down and try to respond in logical way.
1. The Event.
Talk to any professional who works in immediate response and they will tell you that “we are trained to do a job and we do it”. Doctors, nurses, fire fighters, police persons and even we therapists have a plan. We may not be able to articulate that plan so well while we are at work, but we have a plan. The hours of training and practicing and updating and re training help us to update and modify the plan until it becomes second nature. We observe and we respond. From my perspective,it has always been a little like working on auto pilot. I can feel myself acting and responding but I can’t always stop and explain what my thought process might be.
I suspect it is part of the personality make up of those of us who choose to enter professions that require a level head but who are attracted to danger as well. We like to know we can control outcomes even in chaotic situations. I have a dire fear of rodents to the extent that when a mouse got caught in my house I had to call in “the reserves” to trap it and set it free. Yet I can also recall walking down Vestry Street at 4 AM in NYC after the Towers fell. The sidewalk was teeming with rats big enough to be cats, but I got through. I was “on the job” and going to work. I would never survive that walk in my personal life. My turn on switch was kicked up to maximum and I made it. I never allowed myself a second thought. It never bothered me again. I still think about the mouse in my kitchen. It bothers me a lot even though I have not lived in that house for over a year.
2. What you see and what we see.
After the Towers were hit, I called my family members and loved ones and told them I was safe and then I went back to work.Good thing I made my calls early because our communications were out soon after and were not restored for hours. Once I was sure that the people I care about were not worrying about me I went back to work again. I did not have time to watch television and revisit that awful event over and over as my family and friends did. I was busy and distracted. I didn’t get to see on television, what everyone else had seen until the following Wednesday at three o’clock. I was sitting at my dining room table in my underwear, after peeling off filthy clothes,after 36 hours work and I was very tired. I remember sitting there and thinking that I was right in the midst of the tragedy but didnt have the same information everyone else did. I truly had no sense that this was a global event. I was in the backyard of the tragedy and so for me it was local and hence just part of our job. I had no idea of the scope or the view. I sat and stared at the televsion in disbelief. I had been there. I had watched the towers fall from a window in the hospital where I then worked, but it was only that Wednesday before I learned what others knew who were no where near the event.
I did have a long time close friend who was also “on the job” as a Port Authority policeman. I couldn’t raise him on the phone and of course the Port Authority was not going to give me any information because I am not a member of his family. He did not perish in the tragedy but was consumed with the dig for survivors for several days.
I heard from him the Sunday following that Tuesday’s terror. My non” first responding friends” got me out of the house for brunch and I returned home to hear his voice on my voicemail. I guess I had held in my emotions a little too long. The floodgates let loose and I had myself a nice little two hour cry the likes of which I have not seen since. I had prepared myself for the worst and in my relief, I found it necessary to purge the pain I had kept inside the first few days.
3. Natural Disasters versus Man Made Disasters
I have many friends who disagree with me on this point, but to my mind they are the same. In both scenarios, you have goals and objectives that must be met and in a very rapid fashion. My goal has always been ridiculously simple. I think about the best ways to keep people safe. Once the fire and medical personnel have done their heroic work, it is my job to help people to process the trauma of their experiences. I work with loss, fear and the “shell shock” that accompanies unpredicatability and upheaval. My job is hard because I have to listen and not talk so much and that I do. I am a quick thinker and a quick talker but in a role of first responder, I am forced to step back and listen. I listen hard. I cannot let my mind wander and I cannot lose my focus or attention. The process is known as “active listening” and it, at least on my part,requires a great deal of discipline and practice. I work as a brief treatment,solution focused clinician in my day to day life, but as a first responder in a crisis situation the focus of the work is more of a “witnessing” than anything else.
I have first responder friends and colleagues who view man made disasters as different from natural disasters but in my experience its best to keep your politics to yourself and be as neutral as you can to do the best work. I have never been timid about expressing my political views and disappointments but in the first responder setting I do not believe I have the luxury of projecting my perspective on anyone I treat. Its a personal choice but I strongly believe this and I teach my students and supervisees this process.
4. Vicarious traumatization.
Yes it happens and it is dangerous and even can be lethal. You can only tolerate so much fear and pain before you yourself become overwhelmed. First responders need a safety system in place,before,during and after events. Generally all of us have “supervisors” whose jobs are to make sure that we are safe and sane. Many of us also have “peer supervisors” comprised of other first responders with whom we can share our feelings. While many of my friends are clinicians I do not want to talk to them about what I feel when I am working in a disaster effort. I often refuse to answer questions about my work. I talk to disaster supervisors and my peer supervisors only because the nature of the work demands such a high level of trust and empathy. I have friends I see only every five years or so (which is as often as I will work a relief effort) and they know more about me and what I feel and think than some of my colleagues who I see every day. Its in the nature of the work.
One of my best defense mechanisms is an ability to compartmentalize. I have a relatively easy time after a hard day of putting the work aside and at least temporarily letting it go. I learned this hard way. In my early days as a therapist, I found myself worrying all the time. I was never able to relax and I developed an eating disorder for six months that forced me into a long term pyschoanalysis. The eating disorder came back again ten years agoafter a mission in Asia and forced me back into therapy. I had to work hard to train myself not to think and not to worry so much. It has taken thirty years but I am finally getting the hang of it.
I am very well known for my sense of humor which has been a life saver in both personal and professional arenas. Behind the scenes of every relief effort I have worked there is a certain amount of “dark humor” that would offend many people. Police personnel and fire fighters,doctors, paramedics and just about all of us have inside jokes, mostly self deprecating humor that my friends and family would not find funny.I make observations about myself “on the job” or “in the field” that border on the ridiculous but of course are quite genuine and authentic. All of us have observations about the irony of disturbing situations. When you work with intelligent people (as I do) it is inevitable that sometimes in the most awkward and disturbing situations there is something so ironic and so funny that you must just laugh.
I have a close friend who is a therapist with whom I worked the World Trade Center tragedy. I cannot sit across the table from him in any meeting because he will make me laugh with a single lookat just the wrong time.
When you are tired and stressed you are vulnerable. Some are criers and some are laughers and then there are those (like me) are laughers and criers. After one very solemn event a few years back I had deep cuts in the palms of my hands from where I had dug my fingernails. My then “partner” kept making these perfectly appropriate but hilarious comments to me. No one else could hear him and no one else could appreciate the ridiculous irony of what he had said to me, but there I was vulnerable, working in a very tough situation and very sad. To this day he reminds me of my humanity and yes my frailty. I cannot even repeat, to this day, some of his statements to me over the years. I also know that when I first see him after a few years absence in my life, his hug will reduce me to sobs in an instant. We have shared some very rough times together.
There are a few tools that are not so effective. After the towers fell we saw a rise in alcoholism and drug addiction across all disciplines of first responders. Its a fast and easy way to cope with pain but ultimately renders you ineffective and worse. That little martini still in Hawkeye and BJ’s MASH tent may have worked in Korea before we had better and more effective processing and supervision, but it no longer works especially if you wish to work in disaster relief again. I do an entire day of training on the pitfalls of addiction with my trainees. You have to be alert, aware and on your game in our business. There are too many depending on you to take a risk of even a small hangover.
After Katrina the suicide rate of police officers soared in New Orleans. Returning soldiers from Iraq and Afghanistan have also shown us the need for quick and effective interventions so we can save lives that were lost in prior events. Post-Traumatic Stress Disorder is easy enough to treat and yet it has taken a long time for us to put the steps in place to offer treatment to front line workers. We pay much closer attention to our front line responders who need to know that we are here and we care.
I am very fortunate in the way that I no longer have close immediate family to worry for or who will worry about me in a relief effort. I can volunteer for some precarious missions without worrying that I am being selfish or at very least insensitive to my loved ones. I have a luxury in my life that our armed forces heroes and heroines and firefighters and police personnel do not enjoy. I can pack up in a few hours and be on my way and focus fully on my work. I am aware that I work in potentially fatal situations but I do not have responsibilities to others that might dissuade me from taking a job. Several of my “field” colleagues are in the same position. Many are “career relief workers” who chose a different lifestyle while others have children grown and not dependent upon them. Still others are young singles whose parents do worry mightily and who I hear from on a regular basis with inquiries as to their children’s safety.Of course there are some who take relief assignments who do have young families and loved ones they leave behind. I can’t speak for them but in truth, it is not something I could easily do.
My best answer to these queries is that disaster workers are a breed that thrive on a commitment to humanity that might over ride their other commitments and endeavors. I believe it is a difficult and individual choice that we all make for entirely individual and highly personal reasons. I never took a mission when my parents were alive or while I was married. I never even considered relief work until I was in my forties. When I completed my first tour abroad I realized that I had a talent for the work, but also that while I will probably never be remembered by the people I have served,it does in fact,make the most meaningful memories of my life.
7. Field Romances.
I am sure they happen, but I have never seen this in my career. There is nothing romantic about working in disaster relief. In fact, the work is gritty, fast and all consuming. Disaster delegates live in close and austere quarters and we are generally too tired to work up a friendly wave much less pull off an affair. You have no privacy and no time to work on your personal life in the field. Yes we develop very close and enduring friendships but a field romance is dangerous on another level as well. Objectivity is at the core of the work and you just can’t be objective enough to do the work effectively when your “honey” is in the next care station to yours. I have some friends and trainees who have identified my field partner as my “work husband”. They choose to think this way because we share the same very quirky sense of humor and there is a sort of chemistry in our banter that gives others an impression that there is more to us than field partners. Aside from our work experiences we have never socialized and we rarely communicate when not in the field. On the rare occasion we have run into each other we are delighted to see one another and warm and affectionate toward each other, but that’s about all there is to it.
For me, coming of age in a MASH era and in fact working in very difficult jobs in the early years of my career as a therapist primed me for disaster relief. No one would ever describe me as an adrenaline junkie and in fact I live a very simple and unemcumbered life when I am not working the field. I do get a certain thrill when the phone rings and I am told to pack up and pick up my orders.
I have a grave fear of rodents, reptiles and insects but every job I have worked is rife with all manner of “critters”.I hate helicopters a great deal but I spend a lot of time in “choppers” when I have to work. I see things I pray others will never see and cope with a great deal of support and help from my staff both in the field and not. Its certainly not for everyone, but for those of us who do it, there is no other life.
A shout out to my friends and colleagues working in Chile right now. I admire you and your brave work.