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Two faces of PTSD

September 2015 - Editor’s note: It’s not often a conference speaker silences a room and brings delegates to tears. That’s what happened in June in Penticton, B.C., and in July in Summerside, P.E.I., when firefighter Nathalie Michaud told fire officers her story about post-traumatic stress. The story is remarkable, ugly, even shocking. Wayne Jasper’s story is equally as compelling, that of a friend and fellow firefighter, connected by compassion but geographically more than half a country away. Here is their story.

Nathalie
I have learned what PTSD can do and how it can start. The simplest way I have found to describe it is this: PTSD is like the imprint of the emotion that stems from an event but your brain blocks it and locks it away because it’s too much to process. And, even though as time goes by, your brain knows the difference between what is real and what isn’t; it’s the emotional imprint that silently grows inside, just like a tumour.

On Jan. 30, 2010, Fire Chief Richard Stringer saw no way out. Depression, desperation and the presence of unrecognized PTSD got the best of him. That morning, Chief Stringer left his home while his wife slept and went to the fire department to face his last battle, his last demon – and hanged himself.

Chief Stringer had been my fire chief for the previous five years.

Richard Stringer was also my husband.

My world got turned upside down and changed forever the moment I found him. I shut down and no one saw it.

No one ever warned me of what was waiting for me in the future. When I closed my eyes at night, all I saw was the image of him hanging between the two fire trucks, the images and sounds of me running around in the hospital from department to department so I could officially identify his body; no one could really direct me as to where he was, so I had to ask at least five people in different departments. “Can you tell me where the body of my husband Richard Stringer is? I have to ID his body.”

The small town speculated; I was blamed. His suicide was in the media; there was nowhere for me to hide to grieve privately, to deal with rumours, wait for the official police report.

During this time, I felt nothing but shame and incredible guilt, and I had so many unanswered questions.

The day of his funeral, when the casket was carried out, two salutes took place: the first was a general salute by all firefighters, followed shortly after by a salute called by members of Chief Stringer’s Otterburn Park Fire Department. Even though I wasn’t in uniform, as his firefighter, by reflex, I saluted along with the rest of my department, clinging to my husband’s helmet. I was also his wife saluting my husband for the very last time.

This was followed by the wail of the Federal Q siren. To this day, that siren is a trigger and every time I hear it, I’m thrown back to that moment and I must deal with it.

Richard’s suicide and all that followed created PTSD that was finally diagnosed five years later. For those five years, I suffered in silence, not knowing that PTSD was slowly growing inside me ever so quietly and robbing me of who I was.

I can tell you what it feels like to follow the coffin of your husband clinging to the last thing you will ever have of him – his helmet; to never again hear his voice, his laughter, his touch, his comfort, his friendship. It rips you apart and all the million tiny pieces are scattered in such a violent way that even magic can’t glue you back together.

The guilt, the questions, the shame, the loss of who you are . . . they can kill you and it never really goes away. Richard’s suicide caused PTSD in me. His suicide, his death, also stripped me of my identity. I’m changed forever.

In my fire community, I’m forever Nathalie the widow of the chief who committed suicide. So to cope with all of it, I learned how to live dead inside. According to the police report, I missed him by maybe 30 minutes. I live with that every single day. Could I have stopped him?

In July 2013 in Lac-Megantic, I was prepared to do the job for which I had been trained.

As I got closer to the site, my heart sank, but my heart rate went up and so did my blood pressure; this was a feeling I recognized but chose to ignore. I kept pushing forward to get the job done.

That’s what’s expected right?

I felt OK until it was time to head back to the fire department for a break. Walking ahead of a group of firefighters, I kept looking back at the disaster site, wondering how it could be that a nearby church survived intact and how those streets and buildings, just on the other side of the railroad tracks, were reduced to dust.

My brain just could not compute the scene.

Then I realized that familiar crunching sound that I had been hearing all along was coming from under my boots. I stopped dead in my tracks, looked at my feet and got thrown back to 9-11, which had changed me forever. I could no longer tell where I was – in the situation from the past or in the present moment in Lac-Megantic.

Wayne
I consider myself fortunate to have met Nathalie several years ago while our respective organizations worked to honour Canada’s fallen firefighters in Ottawa. We had become friends over the years and in the fall of 2014, after a meeting, we had the chance to talk about presumptive legislations governing workplace illnesses for firefighters, and the subject of PTSD came up. After a brief conversation, Nathalie indicated to me she had been recently diagnosed as suffering from PTSD. This caught me a little by surprise initially as I wasn’t sure what to say next. I wondered if it was even OK to ask her about it or if some of the things I would say or ask would make it worse.

I have to admit, I was one of those people who didn’t realize what it means to try to deal with PTSD on a day-to-day basis, but after Nathalie talked about it for a while, I felt she was reaching out hoping that maybe I would talk about it with her more. The more she said, the more I realized I had to ask her.

I wanted to know how PTSD affected her job, how it affected her life off the job. Will it ever go away or even get better? How do you get PTSD? How does PTSD get you? Is there anything I can do to help? That’s a ton of stuff; would all these questions overwhelm her?

What did I really know about PTSD as it affects emergency-services workers other than what most of us have heard, which is that people with it are prone to severe depression and in the worst cases, committing suicide? Even tougher to digest were the next questions: had suicide crossed her mind? And how in the world do I even approach discussing that with her?

I decided to take that chance and ask her if she wanted to talk about her story. I was willing to listen and I really wanted know what she was going through.

And then I listened . . .

And I have to say that some of what I heard, including several incidents to which Nathalie had responded, hit me very hard, especially the affects the PTSD was having on her. Little did I know I was one of very few people who crossed the line and spoke with Nathalie about her PTSD. I also didn’t know it at that time, but the conversation we were having about PTSD that evening would eventually help to save Nathalie’s life.

The conversation wasn’t about just the events that caused Nathalie to develop PTSD, but also what was happening to her mentally and physically because of it. I was not expecting to hear how much PTSD disrupted her life or the extent to which it had changed her abilities to do what would appear on the outside to be normal, easy, everyday tasks that most of us take for granted.

I remember on one occasion I chatted on the phone with Nathalie while she grocery shopped so I could provide a distraction from others who might encroach on her “bubble” at the checkout, so she would know there was someone with her whom she trusted. I remember thinking how horrible it must be to live that way, wondering if you are going to get through the day. Surely there must be some coverage and help available, I thought. It quickly became clear that it wasn’t that easy.

Nathalie
Wayne was one of the few people who dared ask or talk to me about PTSD and I felt that 100 pounds lifted off my shoulders because finally I could talk to someone.

Being asked questions and talking made me lose some sense of loneliness and isolation.

I’ve learned that there are two ways PTSD can kill you: the first way, you’re alive, slowly dying inside as PTSD controls the every essence of you; the second is suicide.

Living with PTSD and not knowing or understanding what was happening to me was extremely difficult and frightening. However, once I was diagnosed by qualified medical personnel, my life became easier to manage.

When I got the diagnosis I didn’t do a happy dance in the doctor’s office, but the diagnosis gave me hope.

I have PTSD.

PTSD does not have me.

PTSD does not define me.

PTSD is not about what’s wrong with me, it’s about what happened to me.

After proper diagnosis in summer of 2014, I went in November to a private therapy centre called La Vigile. It was also there, that because of a trigger, I discovered I had PTSD from Lac-Megantic. One of the biggest things I learned was that with each traumatic event in my life, I was stripped of the feeling of safety; this changed how I see the world and I now constantly watch over my shoulder, which is known as hyper arousal.

The following is my day-to-day life, before and after diagnosis.

My first battle is realizing that my eyes are open and I have to get up and face the day. I’m always scared of what the day will bring – or do – to me.

Sleep

• I have insomnia, but when I do sleep, I get cold sweats so badly I need to change my clothes and sheets.
• I keep lights on all over the house; darkness is now frightening.
• I self-medicate with prescription drugs but when this was not enough, my best friend became tequila and then more alcohol took over.

Eating

• I had little or no appetite because of my high level of anxiety.
• I rarely dine in restaurants because I can’t stand crowds and noises. If I go, my back needs to be against the wall so I can see all around me at all times. I have to have at least one direct route to an exit and I always have two exit plans that I go over and over and over in my head during the dinner. You think I enjoy dinner like this?

Hyper arousal

• Anxiety.
• Outbursts, anger, irritability, lashing out, over reacting, guilt, shame, insecurities about my own mind and actions.
• am constantly watching over my shoulder and am jumpy.

Triggers

• They can come up and bite me in the behind and there is never ever a way to prepare.

Flashbacks

• On a daily basis.

Reviviscence

• This starts with a trigger, then a flashback and then, something happens and brings me back so deep inside that I’m disconnected from reality. During that time I’m reliving the event all over again and I have no control. There is a window of about 10 seconds to get me out of that state, if I’m lucky. Sometimes it can be so strong that I spiral down very quickly and don’t even have time to realize what’s happening and then, well, the outcome is not good.

Symptoms

• Due to hyper arousal, I get very impatient and can be aggressive when there is too much noise.
• I avoid public places and or crowds or any kind, clothing stores, malls, restaurants and even grocery stores.
• I have short-term memory loss and my cognitive abilities are reduced. Thankfully, they are returning due to continuous therapy.

Other symptoms that appeared as PTSD and got worse before diagnosis

• Lack of concentration.
• Lack of interest in anything.
• Detached from surroundings and avoiding people, including friends and family.
• Depression hit. This led me to think about suicide and the “how.”
• Suicide became more and more present in all thought process and a plan took form.
• Suicide became a beautiful “life.”

On that one night, I was intoxicated, got in my truck and drove to a specific train crossing. I sat there in my truck, waiting for the train to end it for me.

Today, I know why the train tracks were the best way for me:

1. I saw and know the destruction a train can do and the chances of survival are slim.
2. I didn’t want my parents to have to identify my body like I had to ID Richard’s body. I needed to ensure there would be nothing to ID.

Coming out in public and talking about PTSD openly, I had to fight my fears of being judged by my peers, never getting a promotion and not getting hired elsewhere within my fire community because I am labeled.

Darkness and silence are the two killers that wait for PTSD sufferers.

If you feel anyone may be showing signs of PTSD, it’s extremely important that you do not wait for him or her to come to you but instead go to your friend or colleague as soon as possible and be ready to listen without judgment.

Most of all, follow up. Never leave that person’s side, because if they trust you enough to share their darkest fears, they need you there throughout the healing process too.

As emergency workers, we always work as a team. In a fire, it’s always two in and two out, and this is no different.

In July 2014 when I was told by my doctor and psychologist that I needed to enter a detox or therapy program, my response to them was, “F--- off! I don’t have a problem!”

In mid-October, while having a dinner meeting with a trusted and respected friend, he asked me how I was and waited for an actual answer. Then he asked, “How’s my favourite firefighter really doing?” I collapsed.

He had noticed signs back in April, but I was closed when he approach me. He strongly suggested a centre that helps only emergency first responders, a 30-day closed therapy program that also deals with PTSD. I told him, “Call now before I change my mind.”

He called La Vigile. A staff person stayed on the phone with me for two hours and there was a follow-up call every day until I went in on Sunday, Nov. 2 – the day my new life started.

Wayne
As I took the time as a friend to be there for Nathalie, something else became very apparent to me about PTSD – it doesn’t just affect the person suffering from it. In fact, someone suffering from PTSD can bring on much mental pain and anxiety to those who are close to them as they try to figure out what that person is going through. Inevitably, their friends, loved ones and co-workers can be affected by the actions of the person suffering from PTSD and may need assistance dealing with that aspect of it – they may start to struggle just as much while caring for someone suffering from PTSD.

Through our conversations, I know firsthand how hard it was to listen to Nathalie talk about what she was going through and not know if I had the ability to help her get through a triggered emotion, or even whether I might say the wrong things and make it worse.

It was heart-wrenching for me to process Nathalie explaining to me how the nightmares and depression brought on by PTSD were getting the best of her, that she couldn’t see any other way to make the pain stop other than the worst-case scenario we were trying to prevent.

As Nathalie underwent her 30-day closed therapy session at La Vigile, she was able to communicate only briefly with friends and loved ones on the outside. Through these very brief periods of contact, it felt like I was drowning and I was only able to break the surface long enough to get a taste of how she was doing, but not long enough to get the full breadth of how her therapy was progressing. This made it extremely hard for me as Nathalie’s friend to make it through to the next phone call, not having a full understanding of how she was doing until the next time we talked. It was very difficult to determine at what level the therapy was helping Nathalie.

As Nathalie went through her therapy, I found it extremely difficult to stand by her throughout all the changes she was experiencing, but I refused to turn my back on her. There was no way I was going to let her down when she needed the support of a friend she trusted as she went through this learning process.

Inevitably though, realizing the PTSD sufferer is being given the necessary support and treatment can lift a great burden off the shoulders of family, friends and loved ones, which makes it much easier for them to cope as well.

What I have learned in talking with Nathalie about PTSD is how important it is to stand beside a person through the darkest moments just by listening without judging; it may be the single most important thing you can do for that person. And be prepared to listen a lot, because once a PTSD sufferer finds that comfort level and trust in talking with you, he or she can sometimes talk for hours as everything comes to the surface. Allow the person space but always be aware that someone suffering from PTSD may spiral downward unexpectedly and sometimes just being there without saying anything can do the most for that person. Do not put any pressure on someone to get over it or suck it up, but instead be there while he or she makes adjustments to come through a triggered emotion; doing so can make the world of difference.

I am very fortunate to have some good friends on my department with whom I have been able to share a lot of this; one of them asked me a question that I did not expect. Surprisingly, several days later with no knowledge that I had been asked this question already, Nathalie asked me the same question. I’m sure I had a deer-in-the-headlights look as I fumbled for an answer.

It was clear to both Nathalie and my colleague that I made a very serious commitment to help her get through the hardest moments in dealing with PTSD, and to be that trusted friend she could call on and talk to at any time of day or night, to help her get through the crippling moments. So far so good.

The question: What did I think would happen to me if all the efforts to help Nathalie failed and she took her own life anyway?

The question haunts me. I had thought about it but never really accepted the fact that it might happen, and I still don’t want to. But the question made me think, and with what I know today about how PTSD can affect friends and families, it made me wonder how her PTSD was now affecting me.

PTSD is a horrible illness that can take its toll on more than just the person suffering from it.

Nathalie
Since my therapy at La Vigile I’ve learned to better understand my symptoms and what causes them.

The hardest part of the therapy was Nov. 29, 2014, the day I came out and had to live my new normal in a world that had not changed.

I constantly have the haunting thoughts, “Will I get triggered? Will I be able to control it? Do I tell? Will they judge me?”

Another question is how and when do I tell someone I just started to date that I have an illness, an injury that is so taboo and judged? Will he run with his feet glued to his behind?

The man who chose to not run after I told him I suffered from PTSD asked why I wanted to speak out. Why put myself out there and risk it all – my reputation, my career, the goal, the big picture?

It’s time to talk, to change things. My voice will be heard.

But our voices together will be louder.

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Nathalie Michaud has been a paramedic, firefighter, fire-prevention officer and fire investigator during her 15-year career in emergency services in Quebec. She is on the board of the Canadian Volunteer Fire Services Association and has been its Quebec director since 2012. She is also on the board of the Federation quebecois des intervenants en securite incendie since April. Nathalie is a master instructor for St. John’s Ambulance. Contact her at Nmichaud1102@videotron.ca
Wayne Jasper has served more than 32 years in the fire service, 30 as a career firefighter with CFB Esquimalt Fire Rescue in Victoria. He has also served nine years on the board of directors for the Canadian Fallen Firefighters Foundation as LODD application-committee chair. Contact him at  wayne.jasper@icloud.com.

September 11, 2015 
By Nathalie Michaud and Wayne Jasper