Before I was diagnosed with PTSD, I thought I was infallible, hard as nails, tough as old boots. Looking back, I was quite naive. I thought that once I’d dealt with my first dead body, it would become gradually easier to deal with things.
People sometimes ask me if there had been signs that the job was affecting me and I’d ignored them. I honestly can’t recall any, even in hindsight. That said, hardly anyone in the service knew what signs to look for. I’d have the odd colleague who would say to me, ‘After a long day at work, I need a couple of beers or a few glasses of wine to help me switch off.’ But I didn’t put two and two together and it would be dishonest of me to say that I saw colleagues disintegrate before my eyes. Instead, they were there one day, gone the next.
One of the first ladies I worked with, who was a top trainer and the loveliest person you could meet, clocked off one day and I never saw her again. I heard on the grape-vine that she’d hit the bottle and I didn’t think to ask why. Just as in my case, the pressure had presumably built up gradually so that no one noticed, so that she was like the proverbial frog in boiling water.
It’s only now that I can guess that some colleagues didn’t leave the ambulance service simply because a better offer came up, but because the pressures of the job were making them ill. It wasn’t really until I was diagnosed with PTSD that I realised I was vulnerable – and that everyone was vulnerable. And having made that discovery, I wanted people to know that no one is immune to mental health problems and that it is okay to have one. So the day after that meeting with management, I wrote and posted the first of many blogs, detailing my crash and subsequent road to recovery:
In the ambulance service, we like to have this feeling that we’re bulletproof, and sometimes you can feel a bit ashamed to admit that there’s something wrong with you. But we’re humans, not robots, and I want people to know that they shouldn’t be afraid to talk and seek help if they need it . . .
The main theme of the blogs was the benefit of talking, whether to your partner, your mates, your GP or a counsellor. I explained that there was no shame in events getting on top of you, and that reaching out for help was the best – albeit one of the most difficult – things I’d ever done.
Publicly admitting I had a mental health problem scared me. I honestly thought I might lose my job. And what would my colleagues think of me? Would people not want to work with me because they thought I was weak, incompetent and therefore a liability on the frontline? Would they think I might break down on the job? I didn’t know how I’d cope either. I worried that I was more vulnerable than before.
As it was, though, I slipped straight back into the old routine and felt mentally stronger than I had before. They call that post-traumatic resilience or growth – or, proverbially speaking, whatever doesn’t kill you makes you stronger. Some people didn’t know what to say, because a colleague being off for so long with mental illness was new to them. But almost all of them treated me as if nothing had happened, so that I immediately felt like part of the gang again.
Back on the road, I worked mainly with my old buddy Paul. Those early shifts consisted mainly of bread-and-butter jobs – grannies falling over, heart attacks, fits and cardiac arrests. It was the same old hard slog with the same old stresses, but nothing overly taxing. However, I worried that if I had to deal with another child who had been seriously harmed – or worse – my world might implode again.
I’d been back on the job for a few weeks when my blogs went viral, which was a bit embarrassing. But they had the desired effect. Those blogs, and the responses to them, changed my life for ever. The proverb ‘A problem shared is a problem halved’ is slightly optimistic, but there is a lot to be said for it. Ambulance workers from all over the country sent me emails, thanking me for sharing my story. These were people who had been through similar things, some of whom had recovered, some of whom had been suffering in silence before reaching out to me. It’s such a simple thing, having a chat with someone. But people find it so difficult. So it was great to see people taking the leap.
One of the most hardened paramedics I knew collared me and said, ‘I read your blog. It was inspirational. I had a similar problem but never told anybody about it.’ With that, he shared his story for the first time. It turned out he wasn’t as hardened as I thought he was. Because I’d revealed my own vulnerability, others felt empowered to reveal theirs. They suddenly realised that they weren’t the only ones, so were no longer embarrassed.
Becoming the go-to man for people wanting to unburden themselves was nice, but also a big responsibility. And while I could listen, I wasn’t able to provide any practical help or solutions. It also confirmed that we had a long, long way to go. Why had these people been suffering in silence for so long? Was the ambulance service doing something wrong in terms of mental health support? Yes, because there wasn’t any. But nobody had ever suggested that they needed to do more. There was a deep-seated culture in the ambulance service, as impenetrable as granite. Sharing my story and encouraging others to share theirs was just the start; next it was a case of getting the powers that be to take mental health more seriously.
It struck me that there was far more discussion in the media about mental illness in the military. I’m sure the military’s mental health support isn’t perfect, but the myriad documentaries and stories in papers and on the news about soldiers returning from Iraq or Afghanistan with PTSD had made the Ministry of Defence take notice. But the media’s focus on the military gave me hope, because it demonstrated that raising awareness about an issue could lead to a change in culture. Soldiers publicly discussing mental illness sends out a powerful message, because it shows that however tough you are, you are susceptible. Our soldiers should receive as much support as possible. They’re incredibly brave and selfless people who do a vital job for our country, and they must see some terrible things in war. But ambulance workers see terrible things, too. Certainly, ambulance workers deserve the same level of support.
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A couple of months after returning to work, I’m in the ambulance with Paul and a job appears on our screen: FEMALE BLEEDING PV. PV is the abbreviation for ‘per vaginam’, or from the vagina. It’s not uncommon and there is nothing in this job description to suggest it will be anything out of the ordinary. The usual process is to assess whether the patient is hypovolaemic, which is a state of decreased blood volume, specifically a decrease in plasma. Meanwhile, we do what we can to stem the bleeding and get her into hospital to see a gynaecologist as quickly as possible. But when we turn up at the address, the situation is a bit more complicated than normal.
A guy meets us at the front door and says, calm as you like, ‘In here, lads.’ We stop off for a quick chat with a toddler in a highchair in the living room before making our way through the kitchen and into a bathroom at the rear of the house. Sprawled in the bath is a woman. There is blood everywhere. All over the bath, all over the tiles, all over the woman. She looks like she has been drained of blood, so that her papery skin is almost transparent. She’s just about able to open her eyes and talk to us, but not able to make much sense.
Despite the grisly scene, there is nothing to suggest foul play. My initial thought is that it could be a ruptured ectopic pregnancy, which is when a fertilised egg implants itself outside of the womb. Or maybe it’s a miscarriage. But when I ask the guy if there was a risk of pregnancy, he replies that there wasn’t. It doesn’t enter my head that he could be lying to me. And whatever it is, it’s not our job to find out. Instead, we slip seamlessly into battle mode.
We aren’t able to get a canular into her to give her some fluids, because her body has almost completely shut down. She’s unable to stand on her own, so simply removing her from the bath is a major operation. I have to move all sorts of stuff out of the way to get to her – baskets and cabinets full of toiletries, towels and toilet rolls – and sling it all in the hallway. Paul arrives with the wheelchair and I try to get a grip on her top end, which is easier said than done, because of the blood and the clamminess of her skin. Paul grabs her legs, we lift her out and how we manage to get her in the wheelchair without either of us slipping over and breaking something is a minor miracle.
We wheel her out to the ambulance, lay her on the stretcher, get the oxygen on and eventually manage to get a canular into her. But I still think there’s a very good chance she’ll die on the way to the hospital, because the address is probably as far from the hospital as it’s possible to be. We don’t even have time to wash ourselves down, so while Paul remains in the back of the ambulance with the patient, I drive to the hospital covered in blood.
Typically, it’s one of those days when my fellow road-users decide to be a royal pain in the arse. Cars keep pulling out in front of me and choosing not to stop. And all the time I can feel the pressure rising. On arrival at the hospital, I slam the handbrake on, snap on some fresh gloves and open the back door. The woman looks even worse than when we first turned up at the house. But she’s still alive and still saveable, which is the most important thing. We race her into the resuscitation room and hand over to the nurses and consultant. And with that, me and Paul think our part of the job is done. But while we’re washing ourselves in the sink, making idle chat and thinking about doing the paperwork, cleaning up the ambulance and getting ourselves home, the consultant walks over and says, ‘Paul, Dan – where’s the baby?’
During his examination, the consultant has discovered a severed umbilical cord and delivered a nearly full-term placenta. But we tell him we don’t know about any baby. We asked the man in the house, and he said there wasn’t one. But I get this feeling in my gut that we should have probed a bit more.
I radio the police and my control room and tell them they need to get over to the address as soon as possible, because there’s potentially a baby in there somewhere. Later, I learn that the police did indeed find a baby, in a plastic bag in the hallway. Sadly, it was already dead.
If we had known there was a baby in the house, we’d have got another ambulance round there straightaway. But all we could do in the circumstances was ask the question. As it was, I wrote a statement for the police, went back to work and did a pretty good job of forgetting about it. The case didn’t go to criminal court and I didn’t ask why. Given what had happened before, I think colleagues were concerned what effect the job might have on me. But I didn’t feel anything beyond the concern which was to be expected. Maybe it would have been different had I seen the dead baby, but it was probably more likely that I was that much more resilient.