Thursday, May 21, 2009

coping strategies

‘Let me begin by telling you a little bit about myself.’

The HR manager’s words drift out across the room of paramedics with the enervating creep of carbon monoxide. Everyone sprawls, a green slew of bodies scooped up from the big Trust pond in a bucket marked: Continuous Professional Development and tipped into this conference room. The programme today will cover Equality, Diversity, Coping with Stress and Listening Skills.

She smiles with political levels of resilience, and continues.

‘I’ve been a manager all my working life, after completing a degree course in Business and Economics. I worked five years as a senior HR manager with a large department store, enjoying the challenges of that position enormously. The retail world is fascinating, fast-moving, pretty demanding, and I loved it.’

She scans her audience. She reminds me of the robot Gort from The Day the Earth Stood Still. She has the same smooth metal styling, the same bulletproof purity of purpose.

‘But when the business was subject to a takeover, I was forced to evaluate my position with the in-coming regime, and actually found I didn’t much want to work for them. So I took voluntary redundancy and started a new business. In fact I ran away to Guernsey and opened a Bed & Breakfast. I enjoyed that challenge enormously, but anyone will tell you that running your own business is probably one of the most stressful things you can do. So after three years I’d decided that I’d explored everything that particular arena had to offer, and was ready to come back into a more formal place of work. So I joined the ambulance service, and have been here now as senior HR manager for about twelve months or so.’

She lifts her visor to gauge the level of interest.

‘But enough about me. Let’s go round the room and learn a little more about each other. I want you to tell us your name, where you’re from – and one thing you did this weekend that you really enjoyed.’


Jeannie is sitting on the bed with both hands resting palm upwards in her lap, the backs of her fingers and her red-painted fingernails lined up and resting against their opposite number, thumbs on top and relaxed, a neat arrangement of studied calm. The soft underside of her arms are turned upwards, and where Jeanie has striped across them with the kitchen knife, the skin stretches apart like a torn stocking.
‘Jeannie – it’s the ambulance. My name’s Spence and this is Rae. I can see you’ve hurt yourself, but what we need to do before we come any closer is to make sure you’re not going to do anything to hurt us.’
She looks across at us with a curiously tender expression.
‘I wouldn’t hurt you,’ she says, and smiles.
‘I just need to get that knife out of the way, though.’
I pick it up by the bloodied black handle and toss it across the room.
‘Any other weapons?’
She gives a shake of the head.
‘Where are the police?’ she says.
‘They couldn’t send anyone at the minute, so we thought we’d come in anyway and see how you were.’
‘That’s nice.’
Her bedsit is a compact world of light and dark, order and disorder. The rucked-up bed that Jeannie sits on is an island in a sea of magazines, food cartons and tangled clothes, but above the squalid brown horizon of all this, neatly tacked-up across the institutional magnolia walls, Jeannie has an array of baby photos, laid out in a grid.
‘My brother’s child,’ she says.
On a pile of books in one corner, there is a red plastic hamster cage.
‘And that’s Aiko. It’s a Japanese word. It means Little Love.’


We’ve been put into small groups and asked to think about all the things we do to cope with stress. We are to write them in a list, and then share what we have when we all come back together. The manager drifts between the groups. She comes and sits with us.
‘Show me what’s top of your list,’ she says.
We tell her that meeting back on base, sitting with our colleagues in the mess room, talking about the jobs we’ve done – this is one of the most helpful things. They’ll have come up against the same jobs, we say. They’ll have a view on it.
‘Unfortunately as you know the move is away from ambulance stations as such, so let’s just put that idea to one side and think about what other mechanisms you have to cope with stress. I see here you’ve written sport down. Good. Sport’s a good one. Doesn’t it create endorphins, or something? Is that right? You’re the experts.’


I clean Jeannie’s arms with a gauze pad soaked in sterile water. The new wounds overlay older wounds, where the skin has knitted back together in a tangle of puce coloured scar tissue.
‘I’ve had a few grafts,’ she says.
I bandage her arms up right and left.
‘One or two of these need attention at the hospital, Jeannie. Plus I’m not happy leaving you here alone. Will you come with us to the hospital? You’ll be able to talk to someone there.’
‘I think I’ve done enough talking,’ she says. ‘I’m all talked out.’
‘But you will come with us?’
‘If you want.’
She puts on a heavy brown woollen jacket, and roots about for her keys.
‘I’ll have a tidy up tomorrow,’ she says. ‘See you later, Aiko.’


The HR manager stands alongside a flip chart and explains how stress works.
‘I spent some time with the Samaritans,’ she says. ‘They deal with this stuff all the time, and they have a really interesting way of explaining the equation of stress, if you like – and it’s a diagram that I found really useful. I’ll draw it for you.’
With a fat black marker pen she squeaks out a more than wedge, then two parallel lines cutting down across the middle of it.
‘This end of the wedge you might call extreme happiness, or euphoria. The kind of feeling you have when you first fall in love, or look at a newborn baby. This end – the thin end – you might call despair, depression, suicidal thoughts, when you feel you can’t carry on. Of course, no-one could live either absurdly happy all the time, here at the euphoric end of the spectrum, but by the same token, nor could they live constantly in the pits of despair. So what happens is, people live mostly in the comfort zone, which is here, in the middle. Neither too happy or too sad. And what happens is that their emotional life is a series of little adjustments, sometimes this way, towards happiness, or sometimes this way, towards despair. It’s a constant battle to maintain the status quo here in the middle, the comfort zone.’

She taps the marker pen in her hand and gives us a sly look.

‘Now – here’s a story for you. A man rings up saying he wants to kill himself. Okay. Fine. The Samaritan is trained to deal with this. He says something like: ‘What’s happened?’ And then the man turns round and says he wants to kill himself because his toaster has broken. What do you make of that?’

Frank puts his hand up.

‘Has he got a grill?’


These pavements are the town’s arteries and these people its blood cells, pulsing through town, bustling and jostling beneath the high midday sun.
Jeannie sits with me in the back of the ambulance, staring out through the window as we rattle on towards the hospital.
A woman and her partner cross the street with a buggy.
‘You should see my brother’s baby,’ she says. ‘She’s such a cutie.’


Day Three of the course runs to a close. The HR manager thanks us for our participation and wishes us luck in our careers. She packs away her folder and pens as we make for the door. Outside in the hotel car park the spring air flaps around us, its heady blue flavours cut with pine bark chippings, softening tarmac and chip fat drifting out from the kitchen windows.
I say goodbye to the others and climb into my car.

Never has it felt so safe, so musical, so mine.


loveinvienna said...

Nice shiny controlled world v. Real World in one short blog entry. Excellently done, Spence.

I'm sure the HR Manager meant well but honestly, going around the conference room, asking people what they did at the weekend? Sounds more like pre-school than team-building. I wonder what would have happened if you had taken her out and confronted her with some "real world" situations... I doubt her experience in HR would have been much use whilst seeing you bandage someones sliced arms whilst they chatter happily about their niece.

P.C. Jail Time (as my Dad once called it) means naff all in the real world. I'm not saying diversity and equality etc aren't important, they are, but there MUST be better ways of getting it across to people.

And Frank, once again, gets it bang on target :D Burst into sniggers at that point as, I suspect, did you and most of your colleagues ;)

Liv xxx

Ben said...

Words fail me. The poor management of frontline staff by people who dont understand the frontline. At least the absurdity of the contrast made me smile!

I just finished reading 'Generation Kill' (Evan Wright) where a similar distance between people at the front and their higher ups is much more serious. Very good book and great adaption on TV recently; David Simon (writer of Gen. Kill for TV and the wire) has used this a common theme throughout his work.

Sorry if thats a little bit off topic, good writing as ever!

Terri S said...

I hope Jeannie one day finds the right person to help her. It happens sometimes.

I've never found an HR person who is any help, for anything, ever. I wonder if she actually thought she had done any good, or perhaps she's as disillusioned as so many other people.

Great writing as always.

Spence Kennedy said...

Hi Liv
Trying to see the other side, I suppose it must be difficult for the HR manager. She has to provide sessions on these subjects in order to fulfill the terms of the Trust's service contract - so it's the system that's really at fault. Having said that, it would be nice if the person leading the session had direct experience of the job. I think we'd have taken what they said a lot more seriously.

I find these box-ticking exercises deeply frustrating!

Frank and a lot of the other paramedics / techs handled the session better than I did. They let the whole thing bounce off them - and stacked up on the free biscuits.

Hey Ben!
I think the moment that I found the hardest was when she asked us our best coping mechanism - and when we said having a mess room to relax in and talk with our compatriots, she said it was being done away with so think again! (Difficult situation for her to handle. She can't be unaware of the political heat surrounding many of these issues.)

I liked the department better when it was called Personnel. The phones seemed to have someone on the end of them then.

Hi Miranda
We see so many self-harmers. I've lost count of the number of scarred arms I've cleaned up. At least Jeannie seemed to have a good relationship with her brother. I wonder what his take on her condition is?

As far as the HR manager went, if she was disillusioned she hid it well. Not an easy position for her, and not a job I could do. However unpleasant the ambulance can sometimes be, you're always fairly clear that you're making a positive, practical contribution.


Thanks very much for all your comments!

Anonymous said...

My favorite bit of these "professional developement" training sessions comes right at the end... when we get to fill out an evaluation form. I usually write a little essay on mine. Very theraputic.

samrad said...

I thought franks grill comment quite perceptive, if your toaster breaks and you have a grill then if you want to kill yourself it's a different situation from someone who only has a toaster to cook food

Spence Kennedy said...

Hi Anon
You're right - filling in the evaluation does feel like payback time. I wonder what they do with all those forms? (And how long they take to feed through the shredder?)

Hi Sam
I thought Frank's question was right on the money, too. Practical as ever.

I think he should've led the session. At least we'd have been out of there quicker.

:0) SK

petrolhead said...

I think Mrs HR Lady should have kept her job at the other place! Sometimes I think HR is a department invented purely to infuriate people. They're not much use in my Service, that's for sure! Respect to Frank though - has he considered a new career with the Samaritans?

I hope Jeannie's OK, and gets the help she needs. Although looking around, her bedsit sounds a lot like my room...I really should tidy it up!

Wren said...

"The HR manager’s words drift out across the room of paramedics with the enervating creep of carbon monoxide."

Once again your creativity has made me smile with delight. Amazing, wonderful, well-crafted post, Spence.

I do have a question: Self-harm/cutting is very widespread and even common, but am I wrong in thinking it's a relatively new phenomenon? I just don't recall hearing of people doing that -- slicing themselves, etc. -- until perhaps the mid-90s. Was it just a hidden illness?

I don't expect you to have an answer, but I figure you might know, given that you have far more experience with this sort of thing than I do. I'm just ever curious, is all.

Spence Kennedy said...

I can just imagine Frank on a helpline switchboard,headset on, flicking through a copy of Heat whilst periodically saying: 'And how did that make you feel?' Maybe he'll volunteer a few shifts when he retires.

When I go into rooms like Jeannie's I have a terrible urge to whizz round with a hoover and to say: 'You might feel a bit better if I just clear a bit of space'. I certainly can't think straight if things are all over the place. But I know that's maybe a rationalisation of a situation that's somewhat out of control and irrational, so probably best that I resist! ;0)

Hi Wren
Thanks v much. I have to admit I had to go back through that post (in the spirit of balance and fair play) to weed out the more vitriolic descriptions. That line about carbon monoxide made it through, though, because that was how it felt - and the line about Gort, because that's how she seemed to stand in front of the class!

I was thinking the same thing about self-harm the other day. The first time I think I came across it was a photo of Richey Edwards from the Manic Street Preachers in the New Musical Express, after he'd carved 4 real in his forearm. It must have been going on before then, but I just wasn't aware. It certainly happens a lot now. In fact, psych cases make up a huge part of our caseload. Drink, psych, falls - they're our cash cows! Heart attacks and Horrible H'accidents Hardly ever Happens (but now I've said it, I'll probably get slaughtered).

Thanks for your comments!


Anonymous said...

Some years ago I was sent for a counselling session to help me "cope" with the consequences of being the medic present at a fatal crush incident.

An APC rolled on its side, pinning a trooper from the waist down on concrete-hard earth. He wasn't killed outright and was conscious, but it was obvious he was not going to make it.

If the APC could have been moved, the sudden drop in blood pressure would have killed him immediately and that would have been a mercy.

With no recovery vehicles nearby, I spent a very long time holding the trooper's hand and talking to him while waiting for the inevitable.

To say it was ******* hard would be an understatement.

Some weeks later, I found myself in an office with a civvie psychologist who was going to help me "develop coping strategies".

One of the first things he asked me was the same thing your HR manager asked: "so, what did you do at the weekend?"

I told him about my Sunday, when I'd treated a squaddie who'd been shot in the left deltoideus by a 7.62 NATO blank, how it looked like a sandblasted piece of beef sprinkled with black pepper, about being covered in blood to my elbows, about it being a blisteringly hot day with sweat pouring into my eyes, about the black clouds of flies clustering on every bit of moisture, and about the combined taste of sweat and blood in my mouth—the result of unthinkingly wiping sweat off my face with bloodstained arms.

The psychologist blanched and said "I meant what did you do for relaxation."

I never did another session. There was just too big a gulf.

Spence Kennedy said...

I suppose they mean well, and it can't be easy for anyone to really understand what it means to go through the traumas you describe so graphically.

It does make you wonder, though. Surely it would be better to have counselling from someone with direct, relevant experience. Having a civilian do the debrief is just asking for trouble.

I hope you're okay and things are good with you.

Thanks very much for your comment, and for reading the blog.

All the best


Jenny said...

Spence, i always feel that ambulance staff have a lot more patience & understanding when it comes to self harm, but how are you patients received in A & E? I have never felt judged by ambulance staff & have even had one crew stay with me, aged 17, while i was seen to when i scared myself with an injury that didn't want to stop bleeding. however i know many who have felt badly treated but it always seems to be staff in A & E.

in response to wren's question, i started self harming in 1998 and i know others who were self harming back hen, but i met them in the noughties via the internet on message boards, so i think the internet has a lot to do with the issue of self harm being brought to peoples attention, and bring people to open up to others. But also by bringing it to peoples attention possibly means more people are self harming now.


(P.S My RSS feed has just decided to catch up on the last 6 months, hence the delay!)

Spence Kennedy said...

Hi Jenny,

I have to say that I think it depends on the individual member of staff. I've come across incredibly patient, helpful and understanding ambulance and A&E staff with regards to self-harm. But I've also had the alternative experience. There are always reasons why someone would go one way or the other. In terms of A&E staff, I suppose they're so crammed and stretched for so much of the time, they unconsciously resent anyone who puts themself there deliberately, OD, self-harm or A.N.other. It's frustrating, from our point view, spending time reassurring a self-harmer on scene, only to be met with a dismissive response at A&E. But mostly it's more enlightened than that.

I think the internet has helped more than exacerbated the problem. It's so much better, feeling that you're part of a community rather than acting in isolation. If anything, it's revealed the extent of the problem. But I suppose it can also be said that by legitimising the self-harming ethos it could be said to be encouraging it. All in all, I think the internet's a good influence, though. Propagating an insightful and reasoned response.

Great to hear that your RSS feed has caught up. I wonder what the block was? I'm hopeless when it comes to tech issues. (and cars - just ask Wendy/dreaming of size 9)...

Hope you're well