There is a lot already happening on scene by the time we set down and step off of a medevac helicopter. All the major rescue services are already in place: police, fire rescue, EMS; all deep into their work. As a medical flight crew, we are often the last to arrive, as the call for the highest level of patient care available takes place after the seriousness of the scene has been determined.
Tonight, the seriousness was staggeringly obvious as soon as we walked up.
An SUV had struck a stopped tractor trailer from behind at a traffic light on a local highway. The SUV was halfway under the rear of the trailer, pinned in an almost unbelievable wedge of sheared metal and glass. The roof of the vehicle had already been removed, chains and stabilization braces in place. Emergency lights everywhere, strobing the entire scene in red and blue. A dozen responders were surrounding the SUV, working to free the still entrapped driver. Then I see the sheet draped stretcher, just to the right side of the vehicle.
This is already a fatal scene.
I’ve lost count of the amount of times that this profession has really, really grabbed me.
Maybe you know the feelings I’m about to describe. The chill that sweeps over our skin, the involuntary tremor across our shoulders, the sudden twist in our guts, the sensation of hyper-acuity that feels like we are absorbing some kind of emotional shockwave. Only, the emotion had nothing to do with us, directly. It is all about what we were sensing before us: the sights, the sounds, the smells, the frigid cold, the deafening silence after ear ringing chaos; the people in the middle of it all.
My partner and I split around the vehicle and approach, I climb up into the vehicle to make contact with the crews helping the driver and assess where to begin.
If I could describe any sensation that is most consistently with me, at this point on a call, it is tension. Not tension in the negative sense, like stress or anxiety, but rather an eagerness; a mental and physical electricity similar to standing at the starting line of a race.
I see the driver for the first time, and despite the awful avulsion of her scalp and the already dried blood across her face, I can see that she is about my age; my wife’s age. The shudder rolls across my shoulders.
She is pinned in her seat, steering wheel against her chest, dashboard across her lap, both of her arms stuck raised above her head almost in surrender, the shattered windshield rolled up like a glass carpet in front of her. No further than 12 inches from her face was the cold steel of the trailer her SUV had slid under. The way she is trapped against her seat by all of this twisted vehicle, and the rescue collar that had been placed on her made it so that she could not turn her head towards me. She could not directly see me or the empty passenger seat I was kneeling in next to her. So I lean in, where she can see my face and I give her my name and ask for hers. I then routinely ask if she knows what happened and where she is, to assess her mental status, standard.
She then begins to sob out her next sentences, her eyes huge with the weight of the moment.
“I fell asleep, Jim. I fell asleep.” She broke, releasing from the adrenaline that had kept her stoic and composed until this conversation. Hearing my name from her so quickly after meeting her - another shudder.
Then, the next questions that changed the entire moment, maybe even my life, since.
“Is my daughter ok?” Able to only move her eyes, looking straight at me, “No one has told me if she is ok, you would tell me, Jim, right?” My name again. We have known each other for 90 seconds. My gut twists.
Another provider leans in and whispers in my ear, confirming the sheet covered stretcher that we saw as we walked up is her deceased teenage daughter, pulled from the wreckage before we arrived.
She doesn’t know.
She’s looking right at me.
I need to answer her.
Here comes the hyper-acuity. A very innate sense of falling back on something other than our training or protocols. The feeling of setting your feet into something solid, something stable. I like to believe it is our values; protective, instinctive, humane. The stuff that makes us human. The stuff that says we’re all in this together, get to work.
This is where we make a withdrawal from that depository of all our prior human experiences.
I tell her that her daughter has already been taken out by another ambulance crew. I assure the woman that we’re all here for her, right now, and that we have a lot of work still to do to get her out of the vehicle safely.
She is the mission.
Stay with me, focus on me if you have to, talk to me.
We work on her injuries as the rescue company continues their incredible work, cutting and prying the twisted frames. The conclusion is a heavy wrecker tow vehicle pulling the tractor trailer forward, off of the SUV while a huge fire engine held the vehicle in place with chains.
Inch by inch the vehicles were pulled apart, all while we had constant radio contact to the driver of the wrecker. We had placed the woman in charge, the moment she felt anything wrong, she called stop; then the whole operation would pause until we could ensure she wasn’t being injured further.
She is the mission.
The sound of metal unfolding, plastic snapping, glass tinkling to the pavement; here come the chills. This has been a horrific scene.
All the while, she continues to tell me that they had been traveling, that they were on a long night drive home. She again began to cry over the likely fact that she had fallen asleep while driving.
I learned that they lived in an area that I knew well, in my home state of New York.
They had been visiting colleges.
Her daughter is my son’s age.
Now, the sensation in my chest feels like the air was taken from my lungs and was replaced with sand.
Have you felt it?
Maybe we’re holding our breath. Maybe we’re fighting a gasp or a cry, maybe all of it.
Either way, that is empathy.
The powerful sense of what another person is feeling, and it is ok.
In fact, it is good. It means we are human.
It means we are not just alive, we are really living.
“We are not thinking machines. We are feeling machines that think.”
— Antonio Damasio
We have previously described first response as the human experience, amplified through rock concert speakers. The emergencies that we respond to, all of them, every single one, involve people. When we encounter those people in highly charged, emotional scenarios, the result is the involuntary transfer of emotions. Like resonating tuning forks, we receive a whole spectrum of other’s experiences.
This is compassionate empathy. Again, it is ok, this is part of being what we are.
Babies are born with this ability, as a daycare full of infectious laughter or a nursery full of crying newborns can attest.
Along the way, our families and communities nurture or neutralize this empathy. Like an emotional radar dish, some people naturally read another’s emotional state, and it’s an amazing gift. Some of us have to work at it, unless it is such an obvious shockwave of emotion like I had described above, one that almost knocks us over when we experience it.
If there was ever a profession that faces this kind of involuntary empathy, (as in look out, here it comes) it is first response.
To be present in that experience is a privilege not everyone will know in their lifetime. Do not turn away from it, do not be overwhelmed by it. Be fueled by it. Turn it into passionate, attentive service that you give right back to those in front of you. Make that deposit into the emotional account that will serve you on yet another amazing human experience.
There is another kind of empathy, cognitive empathy.
This is the voluntary kind. Cognitive empathy is exclusively human, as it requires a more complex, logical brain that can visualize and create.
Cognitive empathy is what we experience when we meet another person and with intent, place ourselves in their situation. We can see ourselves in their experience. We recall how it felt when something similar had previously happened to us. We can imagine and visualize what it would feel like if it did happen to us.
We parallel the experience. We choose to understand.
However, as first responders, we face a lot of situations that are difficult to understand. Cognitive empathy is the value that we need to channel when we face those emergencies. When we find ourselves asking - why?
A drug overdose, a reckless driver, a shaken baby, a drunken criminal act, domestic violence; all of the terrible decisions that lead to massively tragic life events. They frustrate the hell out of us.
But in the end, there is still a person there in front of us that needs help.
So, we work to imagine: What circumstances in their life led to this? How is this person like me? What happened to bring them to rock bottom like this? What does this person need right now, that only I can bring?
This kind of thinking takes patience and courage. As grateful or hateful as they may be, empathy brings the beginning of what they need in that moment - understanding.
When we practice empathy, we are being better versions of ourselves. We are all, as a profession, better for it.
“Empathy is about finding echoes of another in yourself.”
Unfortunately, we have an empathy crisis in our world today, across all generations. Our current generation especially, the one that was nearly raised on communication technology. Twenty-four hour news, celebrity culture, standardized testing, high stress competition in school and sports, obsessively counting likes and shares - we have, in many ways, become all about ourselves.
I’m not sure how we fix it.
Maybe it begins by looking up from our phones and more outward.
Becoming aware of what is around us, being accountable to the fact that our decisions, our actions and even our inactions, impact everything in our environment.
Maybe we acknowledge and compliment empathy when we see it in others. Be grateful when we receive it.
Maybe we resign to the idea that life does not always follow the ‘Golden Rule.’ We can’t wait around to see how others are going to first treat us.
Empathy is about others. It has to start somewhere. Send it.
Also important, empathy is not sympathy. Sympathy is a feeling that we have internally, all to ourselves, over another’s misfortune. Sympathy is sorrow, pity even. It ends there.
Empathy is much different. There is no empathy section at the card store, because empathy is more about presence, reception, understanding and action.
This is why we consider it a responder value.
Empathy follows awareness. When combined with accountability, it brings compassion and then, perhaps the ultimate value - kindness.
Need it in a nut shell? Empathy is when we choose to give a damn.
Would you want anything else in the responder that comes for your family?
Is empathy a naturalIy occurring value? Yes, sometimes.
Is it easy? No, not always.
That’s why we’ll talk about the next value: grit.
See you next time. Stay safe.
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