Addiction Medicine Made Easy | Fighting back against addiction
Addiction is killing us. Over 100,000 Americans died of drug overdose in the last year, and over 100,000 Americans died from alcohol use in the last year. We need to include addiction medicine as a part of everyone's practice! We take topics in addiction medicine and break them down into digestible nuggets and clinical pearls that you can use at the bedside. We are trying to create an army of health care providers all over the world who want to fight back against addiction - and we hope you will join us.*This podcast was previously the Addiction in Emergency Medicine and Acute Care podcast*
Addiction Medicine Made Easy | Fighting back against addiction
Stigma 4: When Heroes Need Help
This episode is the fourth and final episode of a four part series on stigma.
This episode is done in collaboration with Central Coast Overdose Prevention (CCODP) and was made possible by California Overdose Prevention Network Accelerator funding from the Public Health Institute's Center for Health Leadership and Impact.
First responders face unique mental health challenges due to the high-stress nature of their work, but stigma often prevents them from seeking help when they're struggling. Dr. Casey Grover, firefighter/paramedic Jesse, and firefighter/paremedic Evan discuss the psychological toll of being the ones who save lives, including PTSD, addiction, and the struggle with vulnerability.
We also hear from Dr. Reb Close, who worked as an Emergency Medicine physician for over 20 years.
• First responders naturally prioritize others over themselves, often neglecting self-care
• "Normalization of deviance" occurs when first responders gradually develop unhealthy coping mechanisms
• PTSD is a permanent brain change that many first responders experience but fear admitting
• Female first responders face additional challenges and scrutiny in male-dominated professions
• The pressure to appear perfect creates barriers to seeking help, even when struggling severely
• First responders often judge themselves more harshly than they judge others
• Addiction can develop as a way to self-medicate trauma and stress
• Recovery is possible when first responders become willing to be vulnerable and uncomfortable
• Those with established careers have the social capital to break stigma by sharing their experiences
If you're a first responder struggling with mental health or addiction issues, please know that help is available and seeking it early can prevent tremendous suffering. You are not alone, and recovery is possible.
To Contact Dr. Grover: ammadeeasy@fastmail.com
Welcome to the Addiction Medicine Made Easy Podcast. Hey there, I'm Dr Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years I worked in the emergency department seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started.
Speaker 1:Today's episode is the fourth and final episode of our four-part series on stigma, specifically the stigma that healthcare providers face when they struggle with mental health conditions, fading confidence or even addiction. And I have to give two shout-outs before we start. This episode is done in collaboration with Central Coast Overdose Prevention, which is a nonprofit I helped found here on the Central Coast. Overdose Prevention, which is a nonprofit I helped found here on the Central Coast of California, focused on advocating for addiction treatment. And this podcast was also made possible by California Overdose Prevention Network Accelerator funding from the Public Health Institute's Center for Health Leadership and Impact. Now let me share the why behind this episode. Being a first responder is hard and it takes a toll on those in the profession. The suicide rate for firefighters and doctors is higher than that of the general population, and it turns out that in one study, about 50% of firefighters admit to binge drinking regularly, and we wanted to end this series on stigma with a discussion about how people who save lives as first responders often need help themselves, and it's really hard to ask for help when you're a hero. This episode is an interview with two of my colleagues Jesse, who is a firefighter and also the executive director of Central Coast Overdose Prevention, and Evan, who is a firefighter at the same station as Jesse, and if you remember the name Evan, it's because he spoke to us at the end of 2024 on this podcast about his addiction to opioids while he was a firefighter and how he got through it. The three of us speak about the mental health challenges of being first responders and how hard it is to ask for help and bonus. Dr Reb Close, the founder of Central Coast Overdose Prevention and one of my addiction medicine colleagues, shares her experience as a female first responder during the episode as well.
Speaker 1:Before we start, I just want to give you all a little more context to understand this conversation. Both Evan and I have been diagnosed with post-traumatic stress disorder from our work as first responders and just to be specific about the timeline, evan developed his addiction to opioids while he was a firefighter and he got treatment for it while he was a firefighter too. And Jesse and Dr Close share their thoughts and feelings about the stress of being a first responder in general To anyone working hard taking care of other people. I hope you will consider asking for help if you need it. And with that, here we go On this call. We have one doctor and two firefighters, right, we signed up to serve others.
Speaker 1:We are naturally empathic, we're altruistic, we want to give back and we're selfless. Right, you guys work crazy hours. I've worked plenty of crazy hours myself and what's really interesting is, I think it's that personality that's willing to give and wants to help that is so selfless sometimes that the self-care gets ignored. That sets us up to not build in what we need to stay emotionally well. I can tell you I was just chatting with my therapist this week and yes, I have a therapist, she's awesome I was chatting with my therapist that when I first started as an ER doc, I would never take breaks, would never take lunches, and about 10 years in I was like I should be a little nicer to myself.
Speaker 1:Maybe I should eat lunch, and I'm now having to start to build in breaks in my day just to be able to take care of myself. But I think that's why I wanted to be a doctor. I wanted to go 110 miles an hour and take care of everybody. You know, just like Jesse, you were saying you're going to go in and save every kid from the fire. It's hard because we're wired to want to push ourselves to do our best.
Speaker 2:Yeah, then you throw on top of our careers a family too. So not only when we're at work we're taking care of everybody. When we get home we feel like it's our duty, because we've been working so much to be that dad and be that father, be there for our families, that we always put ourselves last and we don't take care of ourselves. Another thing I was thinking as you guys were talking that popped in my head is an issue in our line of work is a normalization of deviance. So someone struggling with like PTSD might find ways to self-medicate and they slowly do it. So for example, say a firefighter.
Speaker 2:He is struggling with PTSD. He doesn't know what's going on. His mind's going crazy. His wife knows something's up with him, but he doesn't know why it's so hard for him. When he's at work he's himself, he's around his peers, he does the job, but when he gets home he's a shell of himself and he doesn't know why. So he starts drinking, and he's drinking at home and he seems to be happier. So then when he's drinking at home it becomes a little bit of an issue. But he's self-medicating. He starts feeling a little weird at work. So then maybe he starts, you know, one day at night he might have a sit, he gets away with it. So you know, that shift I got away with this, or maybe next shift I'll have a couple of sits.
Speaker 2:But then all of a sudden you come to work and you've had a little too much, so you've normalized that deviance and now you've overdid it. Instead of recognizing that you have PTSD and you have a substance abuse issue and getting the help, because you're so afraid of the stigma and what people will think you're self-medicating. And then it goes into work and then all of a sudden, people are losing everything. Then they lose everything. So that individual might've been getting divorced, that was one thing, but now you throw a divorce on top of loss of career. So then what's your self worth? How are you looking at yourself at that point? What happens then? A lot of people just shut down and it gets worse or, you know, they end up taking their life just off of stigma and undiagnosed PTSD from the job.
Speaker 1:So let's unpack that a little bit, evan, because I think you're spot on. It doesn't happen quickly. So I did 14 years in emergency medicine and something started to change around, like year 10. And I had a bad shift. Oh yeah, yeah, it was a night shift. I don't like nights. That's what it was and kind of like you were saying, it comes on slowly and then, yeah, you start pushing limits slowly and then, unfortunately, when it really comes to a head, it's months, if not years, of something growing and festering. That's a lot harder to fix. I mean, I will tell you, ptsd is a permanent change in the brain. It can get better, but it never goes away. And actually we have a doctor that is coming to our area in emergency medicine. I just was chatting with her colleague to colleague and I was like you have got to take care of yourself in this job. I didn't know this was going to do this to me, me.
Speaker 1:The other thing you mentioned, evan, that I want to talk about was stigma and around colleagues. Oh my gosh, having to admit to my colleagues that I had ptsd. I'll be honest, I lied about it for six months. I could not bring myself to tell my colleagues that I had ptsd. I was totally embarrassed. I was afraid I was going to be judged like, oh grover weak. I finally had to own it because I couldn't lie anymore. I just I ethically, wasically, was like I have to be honest.
Speaker 3:Yeah, I tend to wait until so a call like that and I'll share the one that Evan and I had in December. But you go through a call and you get PTSD. I tend to like suffer in silence because I don't want to admit that I am weak or less than or I'm anything but an alpha going to mitigate the problem, anything but a hero. I don't even want to admit it to myself that I'm a real person. So I'll suffer in silence and I'll shove it down and I'll just either be quiet or sometimes really happy to distract myself. Or my face is in my phone, just social media 24-7, bathroom, shower, everywhere, because I don't want my mind to just go like you know what I mean and like. So you just go, go and then you self-soothe with sometimes healthy stuff, sometimes social media, sometimes TV. Sometimes you take your kids and you embrace them and you just you do everything in the world that week with them. Sometimes it's with your wife, sometimes it's not. There's tobacco and alcohol and marijuana and maybe other drugs and whatever else we do. That's not good, but for me at least, like this call we had in December. It was full arrest in Pebble Beach, nothing gruesome. We all had really horrible calls. There was no blood, nothing like that, but it was a chaotic scene and we didn't have control and a patient. The outcome wasn't good and so you didn't feel good and he replayed it.
Speaker 3:And we have such lack of grace because we feel we have to be perfect on every single call and on spot, and at 8 pm and at 2 am and at 3 pm and whatever. And we're not, because we're human. And so I at least for that call I had serious PTSD about it. I was fragile, even ask Evan like he would dude, I was not in a good place and it was hard to like hide it because it was right here on my shoulder, my sleeve, my emotions, and I couldn't even understand the process, like why am I doing this?
Speaker 3:Even my wife no offense, she's like geez, doesn't sound like that big of a deal, but it's like you don't understand and that's not to her, she's not in the field. So what happened, okay, what happened, okay, did one get out of your way? Like how is that a bad thing? But it's just. I think sometimes even get our own family to understand what it is we do every day If they're not a part of this field I think is a struggle. But if there's a way we can have more grace with ourselves and self-soothe in a more healthy ways, then I'm all for that. But maybe it starts with talking about it and having the courage to be embarrassed that you're not that perfect hero, you know.
Speaker 2:Yeah, 100%. That call affected me as well and when I told my wife she was like well, you've had way worse calls, you've had like people's heads blown off and stuff. And I'm like okay, well, she doesn't understand that it affects you. Every call affects you differently. Like that one was more of emotional, emotionally taxing. We were prevented from doing our job and then the guy perished. When we have both been on multiple calls like this when people we were successful with resuscitation, and this one it was just totally different. So it affected us differently.
Speaker 2:And jesse was the paramedic on the call with another medic, but that's a whole different story. But this medic we were with is not the most proficient paramedic. So Jesse was taking the lead and then the way everything happened was just emotionally taxing. And then having to talk to PD after and then thinking about the outcome of like people that were there and family, like where is this going to go? And lead it was.
Speaker 2:It was really emotionally draining and when you try to talk to someone like a family member or anything like jesse's, saying they don't understand, like we would check on each other but you're just kind of deal with it and then you store up all these calls until something happens. And it really hit home when you said on your phone, jesse, because I don't even know why I'm looking at my phone half the time. I'm just scrolling through youtube or I'm like googling 49ers. Like for the 10th time a day I'm like I already know what's going on with the 49er. Why am I just doing this? Because I need to like have my mind off stuff. I'm just like staring at this phone so my mind doesn't think about things. It's just I don't know why.
Speaker 2:It's hard because no one really understands. And then we see, see it, because, like after we went on that call, multiple people came up to us personally and one guy was like dude, you know how many fights I got in on calls? Why did you snap his shoulder? And I'm like, of course, that's why we don't like admit that we're struggling or want to talk about these things, because we're judged by our peers and I think they could have done better even though they weren't there. So you show a sign of weakness in this line of work and it's like they pounce on it. So we're so ego driven to be these tough guys and these heroes, we're afraid to admit the weakness. And that goes into substance and alcohol. If we're afraid to talk about a call where we missed it, the last thing we want to do is admit we need help.
Speaker 1:Yeah, it's interesting that you mentioned that. So let's just again briefly unpack some of what's happening in our brains. So you guys have maybe heard me talk about big T's and little T's. So a big T is a really significant, difficult, painful, traumatic event. I took care of a young woman who hung herself and I see the image of her neck a few times a week. The ligature marks around her neck. I still get flashbacks. That was probably 11 years ago. I mean, I just saw it there. It's always on my right side, it's always right there. Anyways, that was for me. It was a big T, that was like a big, horrible case and the little Ts are the smaller stuff.
Speaker 1:And, Evan, that comes back to some of the microaggressions you were saying around things like colleagues really doing the opposite of giving support when we need it. You know, for me I really struggled from a little t standpoint, like a small micro trauma when patients would get angry with me when they came to the ER for chronic symptoms and I was like I don't know how to treat 12 months of abdominal pain. That's not in my skill set and I was like I don't know how to treat 12 months of abdominal pain, that's not in my skillset and they get in my face and get mouthy and you're a bad doctor and you could, you should have been helping me and that really went with me. And then they all snowball together over time and it adds, and it adds.
Speaker 3:You know, coming back to like this alpha male experience in the ER, the operating room, yeah, you have to be tough, you have to be strong, show no weakness and it's really toxic oh yeah, working in pebble beach is beautiful and we have, you know, just civilians or little kids will come up and want to check out the ladder track and some of the parents will ask, oh my gosh, are you ever scared climbing that track? And a handful of guys are like, oh heck, no man, I love being a firefighter. I'm on it, I'm 100% honest. I'm like heck, yeah, I'm scared, especially when you throw that ladder up in the middle of like nowhere and you're climbing that thing and the wind's blowing.
Speaker 3:It is scary, but you know we're not supposed to be scared, right? We're supposed to go and just handle biz, and we would. When you know it matters and adrenaline's rushing, we're not even going to question it. But it doesn't mean it's easy, you know, or less scary. Just strive to be perfect on every call and come home and then be able to turn it off and then be with your kid, be present with your kids and present with your wife, and you know that's a hard transition to do. Have you ever driven with no radio, just nothing. The window down, try it for 15 minutes, like if you forget your phone. You'll be like either needing to get check in to rehab or feel real therapeutic, but your mind goes everywhere and I think we do that a lot as firefighters.
Speaker 1:Yeah, I have an interesting question for the group. So obviously the three of us are men. Do you guys have a sense of what the experience is like for female firefighters?
Speaker 2:Yeah, I haven't worked with too many female firefighters I think three in my career but I did in my old department.
Speaker 2:One of the females I worked with really struggled with fitting in.
Speaker 2:She wasn't the best at the physical part, so from my experience she was just overly nice to everybody to gain their friendship.
Speaker 2:But she struggled with the physical side and then that made her kind of like an outcast as far as like all the men could do all the physical side, and then that would have made her kind of like an outcast as far as, like all the men could do all the physical stuff. She struggled with it but people failed to realize that like we're all a team and she brought a key component to the team and that she was really good at writing grants and she was a very good paramedic and she was very good at writing PCRs. So like, as time went on she became more of a part of the team. How I look at it as a company officer is like you have someone that's on your team that might be weak at some things but someone's good at at least something right. So whatever they bring to the team, utilize your team to accomplish the task. That's been my experience, at least with my old department, which this individual had struggled fitting in.
Speaker 3:I worked with a firefighter in San Diego and she was a fantastic firefighter. But I asked her that same question and this was a few years ago. It's still, I think, very much a man's world a little bit. But I asked her I'm like so how is it, how is it being in the fire service as a female? And she's like I know that I got hired because I'm the right person for the job, but I questioned that a lot Like. Sometimes she's like did I get hired because I'm the right person for the job? But I question that a lot Like. Sometimes she's like did I get hired because I was a female, but she was the right person for the job? On top of that, she had the extra added burden of questioning if she should even be there and she should. She was baller, she was one of the best firefighters I've ever worked with. But I think it's harder for females in the fire service. Just my opinion. I'm not one so I don't know, but I think it's harder for females in the fire service.
Speaker 1:Just my opinion. I'm not one, so I don't know. Yeah, and I obviously can't speak for my lovely bride and partner in crime, the very beautiful Dr Reb Close. But I have to say I learned a lot about the experience that female physicians have being different from mine and that there's an extra level of scrutiny At the like oh, does the female doctor really know as much? She was very honest that when she came in as a new female physician at her hospital she got extra questioned. She got more people making sure she knew what she was doing. It took her quite a bit of time to really feel like she wasn't the new doctor anymore and when we've gone back and compared our notes, you know I was a new doctor too. It seemed like I was accepted faster and granted that's an anecdotal case of two physicians in the same hospital.
Speaker 1:I read a piece written by a female ER doctor talking about imposter syndrome. I hadn't heard the term and she wrote a very beautiful piece about I know I'm here. I know I went to medical school. I know I did my residency. I know I'm here. I know I went to medical school. I know I did my residency. I know I know my stuff.
Speaker 1:But sometimes people question me and I question me. And when people question me it makes me question me even more and it was this like vicious feedback loop that this poor doctor was in of really struggling with. You know, is she the right person for the job? And it sounds like for the firefighter colleague that you have she was, and for my lovely bride, she was absolutely the right doctor for our emergency department. She served 20 years there.
Speaker 1:But I think it's interesting and it'd be interesting to get some female voices in a future discussion around this. But you know, the three of us are, you know, strong, strapping men and we have this more experience of being afraid to be vulnerable. I'd be really curious to see how it is, as a woman in a male-dominated field, like being a firefighter, that they are even more scared of being vulnerable because they're already under scrutiny to your point, evan because biologically they're going to have less muscle mass and be built differently and they might be not as tall. I'd be really interested to see if female firefighter struggle in a different way, and I think the answer is yes and it would be very interesting to explore that perspective.
Speaker 2:Yeah, I agree. Yeah, the lady that I worked with in my old department is now an administrative chief, so she used her strengths. She had the weaknesses with the physical part and she'd expressed it to me. I'd work out with her and try to like help her, like, for example, throwing ladders or starting a chainsaw. We just kept doing reps and she got the physical side down. But she was so smart, like I mentioned, you know she used her strength and she's a battalion chief now with one of the departments.
Speaker 2:So very nice I remember talking to her about that and she was friends with my wife as well and tried to help her. But like you come in, like you said, with that scrutiny, you're already like at a disadvantage in some people's eyes, because some people automatically think this is like a man's job and then so they start out with a couple points down in some people's eyes. So they're already having to prove themselves not only being a new person, but also like are you the right person for the job? Like jesse lady jesse worked with and she happened to be and then same in my situation. But yeah, it's got to be tough to start out like that.
Speaker 3:It's also, though, equally tough when they're not the right person, and it doesn't matter if they're male or female, if they're not the right person for the job. If you can't physically do it or emotionally do it, then don't do it. But some, I think, get hired and talk about the fake it till you make it, and I think it just when rules are bent, or sweep that on the carpet a little bit, just get somebody through. I think that's where it's difficult to see that, because that's a safety thing. And then we take that personally, and you know, we all want to go home at the end of the shift to our family. That's the goal is to go home at the end of the shift to our family. That's the goal is to go home at the end of the day. And so if we feel like there's anything that could stand in the way of that, like incompetence or just not being able to do the job, it increases the anxiety, at least in my perspective.
Speaker 1:One quick interruption from me. Jesse Evan and I spoke about our experiences as male first responders and how women can face challenges in male-dominated jobs. I wanted to hear from a female first responder on her perspective, and so I asked my colleague and spouse, dr Reb Close, who worked as an emergency medicine physician for over 20 years, for her perspective. For over 20 years for her perspective. So I realized that I actually have a female first responder that I can ask about this. The very lovely, very beautiful Dr Webb Close Happies to be my spouse. Reby, what did you experience that you felt was unique being a woman as a first responder and emergency physician? You felt was unique being a woman as a first responder and emergency physician.
Speaker 4:So I think for me what really stands out is that I always had to prove that first I had to prove I was the doctor. Like I literally had to wear a white coat, or nobody assumed that I was a physician. I mean, I'm only 5'2" I, you know I just I don't command the prowess of an older man. And so, truly, especially when I first came to Monterey I mean some of the surgeons, some of the internal medicine physicians that I worked with at the time, literally I had to prove myself. Literally I had to prove myself, and you know I would call them for consultations and, wow, I better have my stuff on point, or they, just they were going to blow me off. And so I got very comfortable with learning that it was an uphill battle just to have somebody believe that what I had to say had any relevance, there was anything behind it that mattered.
Speaker 1:I remember you talking about in residency. You were trying to really, you know, get guts and I'm going to be tough and I'm going to see the hardest patients. How did you feel when you were done with your training?
Speaker 4:Well, it was kind of the same. I had to carry my weight. I had to make sure that I, you know, was seeing as many patients as everybody else was. Really pushing myself was I'll take it, I'll go. I got it, the ambulance was coming and I got it, and you did. You had to show that you were worthy of being in that position.
Speaker 1:How did you feel it was different for you as a woman versus a man? How did you feel it was?
Speaker 4:different for you as a woman versus a man. Well, and again, I think this goes back to just you know. I mean, I'm little. When I started I was young, which is funny. You're still very beautiful, Thank you. It's really easy not to take me seriously. I have a really kind of casual attitude and I had to prove that I could hang, I mean and truly, at some points that would involve foul language and saying things that were really off the cuff and very crass, to kind of prove I could hang with the boys.
Speaker 1:Yeah, did you ever have a time that you felt like you couldn't keep up?
Speaker 4:Yeah, it was near the end of my career, to be honest, in emergency medicine. That was part of it. It wasn't a male-female thing, it was just when I felt like I wasn't pulling my weight. That's actually when I left emergency medicine. I was like you know what? This uphill fight? I had been on it for essentially 20 years and my job and truly this is how I felt is my job could be better done by somebody else, and so I stepped out. I stepped out before I was forced out, for lack of a better way to put it. I took myself out of the game because I felt I didn't have what they needed and fortunately I found a specialty that needed me.
Speaker 1:Were you disappointed when you felt like you couldn't keep up anymore? Oh gosh tremendously.
Speaker 4:I always had a lot of trepidation going into my shifts. I was worried I wasn't going to be smart enough, I wasn't going to be fast enough, I wasn't going to, I was going to miss something, I wasn't going to do it right. I needed to do more. I always had that minute one in the career, but at the end it was I'm going to let down my colleagues, I'm not going to carry my weight, I'm not going to be what they need me to be, and so that's why I left.
Speaker 1:Yeah, just if you're wondering, the ER staff still speak very highly of you and miss you.
Speaker 4:Well, and it's the thought process I have regarding the aging process and it's would you rather go out too early or too late? And that was part of my thought process with leaving emergency medicine when I did is I wanted to leave when people still liked me before they found me to either be a hazard or an annoyance, or dragging the department down. That was my plan.
Speaker 1:Did you ever struggle at all with your mental health while you were in the emergency department?
Speaker 4:Mainly just my confidence. You know the imposter syndrome of am I enough? Am I fast enough? Am I smart enough? Can I do this? Could it be done better by somebody else? I am very fortunate to have never had what I consider serious mental health issues but the imposter syndrome. I would literally at times go into the restroom and look myself in the eyes and give myself the mantra to remind myself that I deserve to be there and I could do it.
Speaker 1:Do you think my colleagues judged me when my PTSD became an issue?
Speaker 4:In my heart, the answer is yes. I know they kept anything under wraps because they know you and I are, you know, tight at the hip if I get to pick. So, in other words, nobody's going to tell me.
Speaker 1:They were courteous to you because we were married.
Speaker 4:Yes, a hundred percent, which is smart, because I wouldn't have responded really positively knowing what you were going through.
Speaker 1:No, and I, some of my colleagues sent me really heartfelt notes of oh my gosh, I'm so sorry, and some of my colleagues said nothing. Notes of oh my gosh, I'm so sorry. And so my colleagues said nothing. Thank you so much to Dr Close for her thoughts and input. And now we'll go back to the conversation between myself, evan and Jesse. So I want to ask you both a question. So I remember as a new doctor in the emergency department at my hospital I felt like I could not make a mistake. I could not ask a question, I just needed to figure it out myself for everybody. I was going to assume I was the incompetent new guy and I wonder how much of that culture of we're all tough, the ER is hard, get going. See patients, we just got three ambulances. Why are you taking a break? I wonder of how much of that we all just assume is normal and we probably should reconsider. I'm assuming it's the same as a firefighter. When you're new, you know you just got to power through the shift yeah.
Speaker 2:And then when you get experience too sometimes like jesse and I and the fire service aspect, we have some years under our belt and some people are afraid to admit they don't know something, because if you already have this experience, you don't know that. But I've gotten to the point now where I'm like, yeah, I don't know, but we could learn it together, look it up, and that's so much easier on my mind and like faking it or saying something that's not correct, and then they find out later that you're just making stuff up. That just goes back to stigma as well. You're so afraid to look like a failure in front of your peers that you're willing to make stuff up. It's like we don't know everything. As a ER doctor as well, there's no way you can know everything. We're so tough on ourselves because we're expected to just perform and do this job at a high standard that when we fail or just make a simple here's an interesting question for the group.
Speaker 1:Do you think we as first responders and I guess the emergency department we're kind of continuation of first responders? Do you think we judge others more when they are struggling, or do you think we judge ourselves more when we are struggling?
Speaker 2:And that's a good one. I'm guilty of judging others. I try not to, but I think maybe it might be like a slight insecurity I have, and I think everybody's guilty of it, and it's really bad in the fire service that when someone's messing up or can't perform, to talk about them or point your finger at their mistakes, or that I can't believe that guy can't do his job. When you know someone that you're judging, you might not be able to do the certain tasks they're doing either, but you weren't called upon to do that task and perform in front of everybody and you weren't the one that felt so. It's easier to judge someone else, but I am kind of tough on myself too. I've relayed that to Jesse before and he's like no dude, you're doing great, you're fine, but I think I'm like 50-50, which I need to be better about not judging others 50-50, which I need to be better about not judging others.
Speaker 3:Think about all this stuff, and I couldn't even imagine as a physician at CHOMP. But think about all this stuff just being on the truck Water rescue, paramedicine, fire tactics, wildland tactics, confined space, trench rescue, low-angle rescue, high-angle rescue, rope rescue there's so much. If I had a pediatric full arrest, I'm a hundred percent going to be in my phone looking at the Monterey County EMS app confirming that the medication I'm giving is correct, cause I don't run a lot of those calls. But if I mess up in the slightest to answer your question, doc, I'm harder on myself. I have more grace on my colleagues than I am.
Speaker 3:A judger by like my Myers-Briggs personality is an INTJ and I judge like crazy. But I judge myself even harder, even my colleagues around. I saw one guy was doing something and he made just one little mistake setting up the outriggers and he's like oh God, stupid, I can't believe you did that. I'm like, bro, what do you do? You got out of order. You're all good Like you did 20 million things right and one little thing was off, but we just beat ourselves up to the point where it's almost debilitating. To be honest, it's too over the top. We do not know how to give ourselves grace.
Speaker 1:Well, I mean, it's hard because when we talk about giving ourselves grace, the three of us hold people's lives in our hands. I mean, you guys told me a little bit about that one call that went so badly. I remember, jesse, you reached out like what was I supposed to do? And yeah that's. I think one of the things that's so hard about being a first responder or being in the medical field is when you actually make mistakes. People's lives have real consequences and you know, I had oh I had one really bad case and I was working in the emergency department.
Speaker 1:I was the only doc working. I had probably seven, eight patients. I was taking care of them, three of whom were really sick and needed me, and then we got a full CPR in progress and I totally mismanaged everything and the CPR in progress ended up dying. I think the person was probably in the process of dying and there was nothing we could do to stop it, but a couple of the nurses filed a complaint. We're, like Dr Grover, absolutely mismanaged this. This person is dead because of me and I didn't actually realize it was a part of my PTSD from the ER and I was journaling about it the other day and, man, my nervous system lit up like crazy and I was like, oh okay, time to talk about that with my therapist, so I probably need to bring it up with her. But yeah, I think when the stakes are so high, it's really hard.
Speaker 3:I think about a pilot. You know someone who has this super high stress. The risk is super high. If you mess up, you can't mess up.
Speaker 3:There's no grace for a pilot Like you are correct, right, right, and they come home and then they're gone for long periods of time, so their marriages are just going on without them and they get home and you're almost like a guest in your own family when you get home, but you're trying to integrate and turn it off. And who are you? I don't know the answer. I just know that that stress is so high. But you're right, lives are at risk. If we have a bad day at work, people are going to die. That's a real thing. We really do not sleep at night because of that and you get better at your job and more confident and maybe you don't to look at your phone as much and you have a good working camaraderie with your crew. So you got each other. But you never know what you're going to get. And that kind of stress to perform at your best and if you don't, someone will die. Man, what happens when we don't? Because we don't all the time, it's impossible.
Speaker 3:So how do you handle it? You keep it inside. You maybe go for a pill, you go for a bottle, you go for a. I don't know. I think you do all of that and some are healthier than others, but that stress is real, and I think we just have a really hard time admitting how hard the job can be emotionally. We want to help others, but we got to help those that help others, but we don't even admit that we need help ourselves, and so we're just. It's like this man, I'm going to just go until I'm like sliding into, you know, home and just giving it my all, because you know I'm not being thoughtful about my life, my longevity, my sustainability, my family, because I'm just trying to survive. And you can only go so far with that before you start looking for other stuff. And I think our colleagues have done that in many realms, like police, san Jose fire, whatever we go for stuff that's not healthy and we want to stop that, but we just don't know how. Yep.
Speaker 2:The stigma is so bad that we have peers in the medical field and in the fire service that are so afraid to admitting to their colleagues and their family that they have a problem. And a lot of our families when I was going through my family all knew but I was so afraid like the people I love the most and care about the most know about my issue but I was so afraid for people at work to find out. That was like the end of the world for me and guys get to the point where they would rather die, take their own life, than to admit to their peers that they're struggling and get help and sober up and everything would be fine. But they're so afraid of that stigma because they hear about another guy that got in trouble and around the kitchen table everybody's talking smack about what he did to his family, just like when I got in trouble and everything happened and I heard people, what they said about me and what the comments they would make to me. People are so afraid of that stigma that they're willing to take their own life.
Speaker 2:And if we could come up with some kind of program or just to get out and talk to people like I think that idea of trying to reach firefighters or paramedic school, firefighters in training and get that into their head before they get into the field and experience all this PTSD and because I mean it's a high percentage of people in the medical field and fire service that have it and then recognize these signs when they come up and not be afraid to ask for help and reduce that stigma, even if we saved one life.
Speaker 2:You know it's happening all the time, like all over firefighters taking their own lives, medical personnel taking their own lives, ambulance paramedics are. If we could just like plant that seed in the younger generation of upcoming people that are in this career path. If we could plant that seed, that seed in the younger generation of upcoming people that are in this career path. If we could plant that seed that it's going to get help. It's not worth taking your life Like there's resources out there and there is a light at the end of the tunnel and I've lived it. You know you've lived it. Jesse's been through stuff and we've lived it and we're better now. We understand, but you can get the help you need.
Speaker 1:It doesn't have to be the end. Yeah, I mean, you think about it. At its core, addiction is when a person loses control of using something to try to change how they feel. Right, evan, you were doing it with opiates. We talked about it on my podcast and you know we've talked about colleagues that have struggled about it on my podcast, and you know we've talked about colleagues that have struggled.
Speaker 1:It's so interesting because somebody asked me once what's the best predictor that someone's going to get sober and stay sober, and my answer was a willingness to be uncomfortable and be vulnerable and in our line of work, that is the antithesis of what we are taught to be right. When you are ready to actually listen to the fact that we can't sleep because we get bad memories from bad calls all night, and when we drink five drinks they go away. When we are willing to actually confront that, that's when the healing happens. And, jesse, you were saying as we were getting started, there's so many vices that distract us. It's Netflix, it's pornography, it's sports betting, it's alcohol, it's cannabis, it's nicotine, it's compulsive shopping. There are so many ways that we numb as humans, and my patients tell me about it all the time and I hope I don't offend anyone by this comment. It's a lot easier to numb, get back up and go to work and pretend that nothing's wrong than to actually face it.
Speaker 2:Sure, and it's almost like something drastic has to happen to open your eyes, cause I remember being in the deepest of my addiction my marriage is in the rocks, I'm about to lose everything. But I thought, well, I have a career, I have a house, I don't need help. Like I lose everything. But I thought, oh, I have a career, I have a house, I don't need help. Like I'll just keep it rolling for a couple more months.
Speaker 2:And it's like it took me getting arrested to open my eyes and then, finally, I was willing to get the help I needed. And that's when I was like, oh, wow, oh, there is a light at the end of the tunnel. I really did have an issue, because we get into denial and also, like we said multiple times, that stigma of everybody finding out we think you know, I don't need help, we're always helping everybody else. So for us to admit we need help is we've failed failed as a husband, I failed as a father, I failed as a firefighter, you know, even though I was already failing at those things. But I was in denial because I was somewhat holding it together.
Speaker 3:I don't know how, but can I ask you a question, evan? You mentioned and I thought it was really you hit it on the head Like we can barely even admit if we didn't run a call 100%, how are we ever going to admit if we're really struggling with a substance use issue? And so my question for you and your experience because I'm sure there's opportunities that you had to say something but you didn't and it took you hitting rock bottom. We want to avoid our colleagues from hitting rock bottom, yeah, but how do you instill in someone who's going through that, before they hit rock bottom, to have the courage to get and ask for help and admit weakness? And I think we would struggle to do that. And I'm just curious on what your experience or thoughts are on that.
Speaker 2:You know, when I think back of my personal experience, I could have easily just went into my chief's office and I could have said I'm admitting to a problem right now and they could have not got me in trouble. I could have went and got the help. I could have took a leave of absence from work or even continued pay, like I did Went and got the help that's paid for through our insurance and the union Came back, kept my job. Everything would have been great. But instead I pushed it until I was dealing with a criminal case. I was dealing with my license for work, so I had a lawyer for my license, a lawyer for the criminal case, a lawyer for work.
Speaker 2:Everybody finding out, getting arrested. You know, everybody would have found out anyway. But if I would have just known that it would have been that easy just to go get some help, I would have avoided all of that and going to jail. But it's just that. That was my biggest fear.
Speaker 2:So I don't know the right answer to how we can reach our colleagues, but I feel like going and speaking and all three of us having different points of view on it and different life experiences, if it's not only ourselves and friends and colleagues and everything that's going on I know it's a hot topic right now because it's going on everywhere and if we could go out and speak our own experiences and just really set a foundation, I really like the idea of, like I mentioned, the younger generation, or even speaking to people that are struggling now and that there really is help.
Speaker 2:Because I know people know there's help but they're worried about the consequences, not only the peers finding out and then admitting they need help, but the consequences of their license, of their career, you know, and some of them might be even hiding it from their spouses. But I think, just starting with something small and laying a foundation and see how that works, and then you know, maybe if we go speak, do a little eval after to what we can do better or what people got from it or if they even liked it at all, and if they didn't we could change. And then the next time we go speak somewhere we can ask them again. I kind of like that after we take fire classes they want an honest eval to make the program better. So to make the program better. So maybe we could do something like that, build off of it.
Speaker 1:So well, gents, we're going to have to start wrapping up. My wife keeps wandering into the kitchen to get snacks, which means I need to start making dinner, but what?
Speaker 1:I will say Evan, you and I, when people look at us, they don't see PTSD I'm going to try to be funny here they see your fabulous mustache and the fact that you're like six, three, and then they see Dr Me with all the accomplishments and leadership roles I've had, and they see your rank in the fire service. Right yeah, we have the social capital to be vulnerable, to break down that stigma and allow others to say that guy's super successful and if he can be vulnerable, maybe it's not so scary for me. And we've met the three of us have met a couple of times now. I think that's where we're going to make a difference is when we ourselves are willing to be vulnerable, to inspire others to say when I need help, I'm ready to ask for it.
Speaker 2:Yeah, then getting the stories out there of what we went through and how our lives are better than ever now. If you're struggling, we went through that and we got the help we need and our lives are better. There is a light at the end of the tunnel and, like you said, you coming in as a doctor, jesse, coming in me, coming in with just the way we look and our careers and our families and everything that's going well for us there is help and you can actually get help and everything can be better. You just have to want to. You have to want it and be willing to get the help. Well said.
Speaker 1:To those healthcare providers out there treating patients with addiction. You're doing life-saving work and thank you for what you do For everyone else tuning in. Thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Thanks for listening and remember treating addiction saves lives. I'll see you next time.