I have been watching a friend of ours, “Lisha Fitz” work through some discussions on  paramedics and PTSD over the last couple of weeks and have been sitting on some of my own thoughts/experiences for a while. I wanted to stand with her in discussing the work based trauma that many of us in health care experience by virtue of dealing with people when they are not at their best. Now, I am not a first responder. Theirs is a “real world” work environment–uncontrolled and in real time. They are working on the street, in people’s homes, and in all manner of other public spheres. And they are regularly watched and critiqued, and often recorded, by the general public… people that don’t understand what they are seeing or why certain actions are required. And, like anyone who wakes up and goes to work, they sometimes make mistakes. And sometimes those mistakes mean that people die. In my opinion, that sets a pretty high watermark for work-place stress. The next time you see a paramedic, a firefighter, or a police officer, thank them not just for the work they do, but for the burdens they bear. They deal with some messed-up shit.

I do not have PTSD. I do not re-live traumatic events through flashbacks or nightmares. I do not avoid certain situations or stimuli that I know would trigger overwhelming emotional responses. And I do not live in a state of hypervigilance as a result of my job (at least not consistently). I think that the difference between my work and that of a first-responder is that theirs is a short, intense exposure to crisis. They are the first to intervene and get the situation in its rawest form. Nobody has cleaned up yet. My experiences come after the person has been secured, and they happen behind a barricade of privacy and confidentiality. But they happen for a long time. Days, weeks, months, with people that are in crisis. Day in and day out. And the crises ebb and flow, but I become a fixture in their life for a time, and they in mine. In the hospital, or detox, we deal with the aftermath, and hopefully, the reconstruction. So I feel less at risk for PTSD and more at risk for burn out, or, most likely, compassion fatigue.

Working with suffering people has changed me. There are days when what I see really affects me, when I really feel it. And days when I don’t. Sometimes, in a crowd, I keep my distance, because I have a really hard time making small talk. Or because I am watching. Because I am trained to watch, and to notice, and to analyze. Sometimes I make a joke, or tell a story, and realize from the awkward response that it was the wrong subject matter for the context. Working with people at their worst makes it a little weird to deal with people that are in a more normal/healthy phase (or seem to be). Sometimes when I go from work to a party, or to church, I can start to feel bipolar. I can feel like I have left one planet and flown to another. A lot of the things that seem to matter to the people on the one planet seem so insignificant, and the stuff that happens on the other planet seems so alien by contrast.

Anyways, this is going to get a little graphic, so don’t read it if you don’t want to. But here is some of the stuff I carry with me.  These experiences shape the way I see the world, the way I see God, the way I see myself, and the way I see US; humanity. This isn’t an accurate depiction of mental health. It is imbalanced, it is some of the worst I’ve seen. For each of these experiences, there are 10 positive ones. But those aren’t what I’m talking about now. Right now I’m talking about being a witness to suffering. Seeing and holding all that suffering, and not always being able to do much about it.

I am a witness. I spend my days steeped in broken humanity, trying to heal, trying to help, trying not to be part of the problem. Mostly, I witness. I have watched grown men shuffle nervously and silently down long hallways with freshly soiled pants. I have seen an amputee lap sanitizer from the hollow of his hands as though he had just found water in the middle of a desert. I’ve witnessed teenage boys weepingly try to convince themselves that they are normal; that they are not crazy, while strange visions dance all around their broken brains. I have seen the demands of severe autism destroy houses and homes. I have watched shattered families that can’t be in the same room without security guards to keep the conflict from getting out of hand. I’ve witnessed grandparents sacrifice everything for their grandson to be repaid with the business end of a kitchen knife.  I have seen the scars from an axe attack and know kind-hearted young men that have frozen to death, drunk in a snowbank.  I took care of a boy who beat his sibling in his sleep with a baseball bat. And a boy who slips in to bed with his mom when she’s good and sedated, or at least pretends to be. I’ve seen the X-rays of rectally-self-inserted coat hangers, while listening to the bump-bump-bumping of the poor girl’s head against the wall; trying to jar loose the voices and memories that made her do it in the first place.  I have heard the weeping confession of a man who hooked his girlfriend on meth so they could have crazier sex. What words did I have for him?

I am no stranger to the cuts, the railroad scars, covering every inch. Arms, thighs, neck. Cuts made with items you can only imagine. Found on hospital floors. And the insatiable thirst for more. I have seen the damage done by rage. The impulsivity of licked wounds; other people’s wounds. And oh, the infections… The despair of fecally painted “HELP.” I am a witness to the broken brain, the eternal, internal struggles, the voices and visions and delusions. Supernatural sex with One Direction and prophetic pronouncements. I saw a kid pee in another kid’s shoe. He didn’t know why. I have seen the irrational, illogical, uncontrollable suck of addiction. I have seen the tears of kind young men who burn with desire when they see boys. Young boys. Small boys. I have struggled against the power of people who take great pleasure in inflicting pain, in causing anger, and who become aroused when restrained. The uncanny calmness of the sadist, the sick expectation of the masochist, the cool detachment of the psychopath. I know people that have killed themselves. And people who will. I am a witness to sexual abuse. Not the act itself, but what comes after. The fragmented lives and deeply buried splinters. And the confusion. I have read dozens of suicide notes. Seen the broken souls of kids who found their parent dead from shotgun spray. Or hung. The soul-crushing guilt is palpable. The bewilderment, “was this my fault?”

I know the frequent fliers. The ones who likely won’t ever be well. The palliative ones. And the ones that will end up dead or in jail. The ones that will end up on the front page. I have seen people who have burned every bridge. And people who have jumped from them.  I’ve witnessed professionals talking to pillows like they were pals, and smelled the smells of homelessness and hopelessness. I’ve seen assaults, attempted suicides, and takedowns. I have put people in restraints. I’ve held freshly broken hands and watched self-mutilated arms be sewn back together. 127 sutures. Tract marks so thick they looked like a surgical scar. Antifreeze swallowed, Sharpies smoked, and drugs smuggled and sold in places intended for healing.

I have tried to talk down frantic people; tackled in the name of safety, and smacked a hand against the wall until the grip relaxed and the knife fell to the ground. I have seen tears. Tears. Tears. Tears. Tears. So many tears. And the screaming. I have been speechless. I have heard nightmares, and have seen them lived out in the middle of the day and the dark of night.

I am a witness to human misery and suffering. Often, quite helplessly, although sometimes I can give medications, or a kind word. I have felt the weight of brokenness as though it was the weight of the world and have asked, “Father, why have you forsaken us?” Because sometimes, that’s what it feels like. Like God has left us like this. To be like this. To do this to each other.

I don’t believe in a God who abandons. I don’t believe in one that fixes everything either. Not now. But I do believe in a God who enters. Who witnesses and weeps. And who suffers.