Splashed Sadness – A look at negative emotions in EMS

WARNING TO NON-EMS PEOPLE: This post is pretty emotional. If you’re not emotionally equipped to handle really sad descriptions of EMS calls, don’t read it.

Here’s a revelation: EMS People are better suited to handling sadness than are laypeople. Of course we are. Not because we are necessarily any emotionally stronger than anyone else but because we have experience in dealing with it. As anyone could see, a good number of the situations we respond to and either assist with or observe are really sad. In my two decades or so of riding the ambulances I have come across more situations than I could possibly remember that I wouldn’t want to casually discuss outside of the industry for fear of really making laypeople very uncomfortable. A story that might turn into a running joke among your colleagues might just depress a layperson for weeks.

Like all medics, I have my coping mechanisms and some of them are healthier than the others, they include sarcasm, dark humor, clean humor, running, blogging, fishing, picking on my wife, playing with my kids, cats, and sarcasm. There are a few other things in there too, I’m a rich tapestry.

This blog gets read by mostly EMS people, but there are public people out there that read me too. For both of your benefit, I’m going to relate some stories here of calls that I’ve personally attended to over the years:

  • A 16yo male takes his 24yo soon-to-be brother in law out into the city for the 24yo’s bachelor party. On the way home, they’re both just obliterated after drinking all night. The 16yo boy is driving home and is going way too fast to notice the semi hauling gravel that pulls into the right hand lane of the 4-lane road they’re driving on. The kid notices it at the last second, swerving just in time to impact the passenger side of the car against the back of the semi trailer. The impact shears off the left side of the 24yo’s skull, popping out the left side of his brain and leaving it, mostly intact, in between the front seats of the car (I almost put my knee into it). The 24yo dies a not-so-immediate death (I don’t want to get into it. Hopefully it was mostly painless). I pronounced the 24yo dead and took care of this very intoxicated 16yo. He was barely able to comprehend the terror of the situation and was covered in blood and brains that formerly belonged to the man his sister was going to marry. He was unhurt but I ran him into the hospital anyway. How could I leave him there immersed in the terror of that scene, in the terror of what he was more or less responsible for?
  • A 19yo male comes home from the military and his friends throw him a house party. During the party the 19yo takes his 18yo male friend down to the basement of the house to show the friend a new pistol that the 19yo brought home with him. The friend takes the gun to look at it and playfully twirls it around his finger ‘Old West’ style in an attempt to be cool. When he does, the gun fires, shooting the friend from the chin through the top of the skull. When I got to him, he was still breathing and had a strong pulse however it was mostly his brain stem that was controlling the reflex. Most of his brain was splattered on the basement floor. We worked him, transported him to the trauma center, and I believe that they were able to harvest his organs.
  • A man and his wife of upwards of twenty years are just bumming around the house on a nondescript weekday. It’s about lunch time and they’re going to eat at home before they go to the wife’s doctor appointment. The wife gets up to make sandwiches, gets to the counter, and slumps to the floor. She never woke up. We worked her very hard, but her heart had just decided that it had reached its allotted number of lifetime beats.

The above short summaries of calls that I’ve been to are sad. There’s no joke that can make them not sad. If you read this, there are two reactions I expect from you here:

  • For non-medical people: You’ve related these stories to yourself. You may be crying. You’ll think about them and your heart will go out to the unfortunate people involved. You’re sad.
  • For EMS People: Don’t these sound like good calls? They were. Yep, they were sad and I felt very bad for the people that were involved. Good calls though. What’s for lunch?

I think I remember what I did after the above three calls. I think that it was profound although my memory is pretty foggy after all these years. After the first one, I cleaned up the truck and actually got to sleep the rest of the night. After the second I cleared and went to a few more calls and then had lunch. After the third I um, had lunch because it was lunch time.

EMS people can probably know what I’m talking about here. I call it “The Howl”. It’s the sound that a family member makes after you’ve transported their close loved one to the hospital where the patient is pronounced dead by the ER Doc before the family gets there. So there you are, cleaning your equipment while the ER staff makes the sad announcement to the family. Here comes The Howl of anguish that the family member makes when they hear the news. I’ve heard it time after time in hospital after hospital. It’s loud. It’s haunting. It haunts my dreams some nights. I say that The Howl is an example of direct sadness. Direct Sadness is the pain/sorrow/anguish/horror that a person feels when they are a primary person in the situation. In my position of hearing The Howl after working the patient and unsuccessfully trying to save their life I experience Indirect Sadness. For the coworkers that I tell the story to and the readers of this blog, “Splashed Sadness” is the term I use. I think that “Splashes Sadness” is what a person experiences when hearing a terribly sad story like that.

In this business, Splashed Sadness is everywhere. It is one of the hallmarks of professional EMS. Think about it like this, I will always remember a conversation that happened between a group of coworkers and me one nondescript morning some time ago. They told the story of a college age male that overdosed on illegal drugs, stopped breathing, and was resuscitated from asystole (flat-line) by the paramedic that was telling the story. He mentioned that the fiancé of the patient was in the ER with the most-probably brain-dead patient and was holding the patient’s hand and telling anyone that happened by that they were supposed to get married that weekend. He said that she just kept repeating “We’re getting married this weekend” over and over again.

The sadness contained in that story splashed on to me and I’ve remembered it to this day. It will probably be there tomorrow too…

I responded by asking if they recommended that she cancel the caterer. Then there were fart jokes and wrestling (It was an all male crew that day). That’s how I dealt with the splashed sadness. I try not to get any of it on me and I try to psychologically squeegee any of it that I do get on me off as quickly as possible by interjecting humor and sarcasm into the situation. Extreme humor to deal with extreme sadness.

EMS people gain experience in dealing with negative emotions and sadness through all of these routes, direct, indirect, and splashed. While I have dealt with Direct sadness in cases of the deaths of close loved ones including my father, I don’t want to deal with any more. I get indirect sadness a lot of the days that I show up for work, and splashed sadness happens every dang time I talk to a coworker or discuss a bad call with a peer. I’m splashing sadness on you all right now as you read the above stories. If you’re an EMS person, you can deal with the splashing. If you’re a layperson, I’m very sorry for doing that to you but I did warn you before you started reading. My theory is that the more experience you get with sadness, the better equipped you are to deal with it.

Or you go nuts.

Or you go nuts and start blogging and drinking martinis like I did.

Maybe I’ll get credit in a psychology journal for coining “Splashed Sadness” in EMS.


  • medicblog999

    Great theory CK, do you mind if I use that one,"splashed sadness"?

    There are many times I say to a crew mate or police officer on scene how weird it is that we can literally turn our backs on a situation which would have the vast majority of the public struggling to sleep that night.
    It doesn't mean we don't care, it just means that we want to go on caring and choose not to 'burn out'

  • Ckemtp

    I would be honored to have you steal from me!

    Use it as you see fit.

    Of course, I'm going to lift the heart attack vid you posted.

    The episode of "Scrubs" where Dr. Cox points out a doctor telling a family that a patient has died and states "See all of the people in that room? Do you think that any of them are going back to work today?"

  • The Grumpy Dispatcher

    Those were sad stories.

    But when I read the "What's for lunch?" comment and laughed out loud, I knew once again for sure which team I was on.

    I am debating letting my wife read this, to help her understand me. She is still trying to figure it out after 17 years. But… she is a visual person, and I tend to not bring that work home with me much lest it weigh on her. After all this time I haven't figured out how to help her understand me without burdening her with the baggage we carry, because I don't think she would ever recover from the splash.

    I guess we'll just keep going the way we are. But this is the best candidate I've seen so far if I ever open that door for her.

    Thanks for the laugh, Ck, and for sharing your pain. We relate.

  • Anonymous

    There is a story/myth about an RAF Tornado (plane) crashing into a hillside (inverted – so no ejection possible). The last call over the radio was "Fuuuuuuuuuuck – Cancel two late dinners!"

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  • My theory is that the more experience you get with sadness, the better equipped you are to deal with it.

    Or you go nuts.

    Certifiable right here.

  • epijunky

    Excellent post.

    It took me almost five years to get to the point where I could go on an emotional run like one of these and still come home and not lose it completely.

    Do they affect me still? Oh absolutely. I've just had to learn to deal with it, as you've said. Sometimes by splashing sadness on my coworkers (i like that term, by the way), sometimes by writing, sometimes by sitting back with a beer and watching Grey's Anatomy.

  • nikifire

    kudos to you for putting in print what we all feel on a daily basis at our jobs. It gets really hard to tell the layperson how you deal with situations like thos mentioned and not sound like an alcoholic! or at least I cant anyway lol.

  • Awesome Post. I hope you do not mind, but I put a link to this post in my blog (http://www.josephfclark.com/blog).

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  • So very true. But the stress does build. My last drug OD was also my last call as an EMT. I reached a point where I had to say “I don't want to do this any more.”

  • I see dead people…seriously. I can remember most, if not all the codes I have worked. I hope over time I'll start to forget a few because they're really starting to pile up and crowd my sense of reality.

  • chc57802

    You have truly captured, in a very concise “day in the life” way of what we do, kudos. The only thing I could add is that you probably need to add the one in a hundred that keeps us in the business – the really great call, like delivering the breach/cord around the neck, 25 week, 1 pound baby that was breathing on its own by the time you get to the hospital (and is subsequently given your name by the parents).
    When people ask “that question” though, I still revert to some ungodly call that involved picking up pieces of a pt – just to see the expression on their face. Unfortunately, to the lay-person, what I am describing has no basis in reality, I may as well be describing a movie to them.
    To Gate Keeper, they do not go away (sorry if that's not what you wanted to hear), you just have to learn to accept them for what they are. In most cases, you were their last link to life and the last person that gave a damn about them. I always treated codes as a very personal thing and gave it my best effort – I guess what I would want someone to do for me. when we started running codes on a LP5 with the recorder and our med director used to get pissed at me cause I would not only talk to him, but to the pt., on one hand reviewing the call and protocol, but on the other, explaining that I did what I could for the pt and it was just time, i.e., the allotted number of beats was up. You were the last-best chance for them.

  • I loved this post the first time I read it a ways back, and love it just as much with the re-read today. Thanks for the re-post and the reminder, this one is worth seeing again.

  • Splashed Sadness. What a genius phrase to describe what is a difficult subject. I think what we all learn to do is compartmentalise, store the memories where they will bother us the least, so that we can continue doing this job, and gain more memories…

  • I can remember sitting at the kitchen table having a conversation when a call came in. I guy put a hunting rifle too his head and pulled the trigger. We noticed that he had stuffed animals all around. We immediately made the joke that he always hit what he aimed at. When we got back to the station, we literally started up the conversation with, “Now where were we?” just as if we had been interrupted by a phone call.

    I can remember an ER staff placing bets on which patient would die next when they had had a rough shift.

    We are a sick bunch. I love it.

  • Tavi B

    I loved this blog so much that I shared it on my facebook and re-posted it in a note. It is one of the truest and point-blank-est things I've read in a while…… but I also agree with chc5782- that we must also remember the few 'great” ones that make all the other ones worth it….. a few thousand terrible dreams throughout our lifetime in exchange for truly, actually saving someone's life (and having them come back around to thank you for it!!) are worth it to me….. otherwise, I couldn't continue on with this job!

  • 725gus

    I absolutely agree with you. But I still find myself asking if I'm even human any more when things like this don't affect me like they used to. We do get calloused, and maybe this is our way (or our maker's way) of helping us cope so we can continue to do this job. They don't call it a “calling” for nothing.

    Some one mentioned we are a sick bunch and I have to agree. I can look a family member dead in the eye at their most hopeless and devistating time of their life, but cry like a girl when I see a commercial on tv for abused animals. What the hell?

  • As a Community First Responder in the UK, I don't get trauma or kids under 12. I do, though, get older people who I can't defibrillate and have done lots of CPR on older people, until the paramedic calls it.

    It's always sad, but then you go on to the next job. It's worse when you either get no more jobs that shift, or the next job you get is a total nonsense.

    However, after a couple of years, I've managed to compartmentalise. I can accept that old people die. I can even accept that people younger than me die too.

    Any death makes me sad, but I can now pick myself up and get on with helping the living. Does that make me sick? Possibly, but it's necessary.

    Just don't ask me to do kids.

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  • hilinda

    I think Splashed Sadness is important. For one thing, the splasher can relieve stress some by sharing, but also the splashee hears a wide variety of stories of things they may never have experienced directly, and then, when they do, it isn't something completely unheard of, which makes it a little less stressful.

    But it is also important to limit the splashing to those in EMS. Other people really don't seem to appreciate it. This can be particularly difficult if you have family members who are not in EMS, but are who you talk to about everything else.

    As I've gained experience, I've managed to compartmentalize a lot. During the call, I stay focused on what I need to do. Immediately after, I feel the emotions, especially concern for the family who must be even more emotional. And then I manage to separate some from the grief, if need be.

    There is also a difference between “that's really sad, but I'm not personally emotionally involved” and “that's really sad, and I'm emotionally in the middle of it.” The first is in the “so I can keep it more distant” category, and the second in the “I don't know how to deal” category. So far, those categories seem to sort themselves out.

  • I know I'm a bit late responding to this one, but I felt it was all so true. I get worried sometimes at my lack of emotion in emotional situations, but it's just the fault of the job. I try very hard not to take the sadness home, and I love when lay people ask what my worst call was- they don't know that they don't want to know.
    Blogging is the greatest therapy in the world. And ice cream.

  • I know I'm a bit late responding to this one, but I felt it was all so true. I get worried sometimes at my lack of emotion in emotional situations, but it's just the fault of the job. I try very hard not to take the sadness home, and I love when lay people ask what my worst call was- they don't know that they don't want to know.
    Blogging is the greatest therapy in the world. And ice cream.

  • Great post, and I know exactly what you mean. Very eloquently expressed. Thank you.

  • Great post, and I know exactly what you mean. Very eloquently expressed. Thank you.

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  • Great post. I’m not a professional EMS provider, but I am a certified paramedic with a few years of experience in doing events and for sports teams and worked along side of a lot of EMS personnel. I may not have the same kind of response calls you do, but I do have the same way of coping with Splash Sadness or even a horrible situation like I was trained to. Again great post. Thank you

  • Your bullet: “For EMS People” cracked me up! Nice. Exceptional article, superbly told. I never thought of it as splashing onto me, but you’re absolutely spot on. “Splashed Sadness.” I like it. Great blog post, I enjoyed it immensely. Thank you.

  • Nice content thank you for sharing very informative thnaks