Several years ago, I wrote a piece about my experience of personal grief while working as an emergency physician in Australia. The grief I experienced was due to the untimely death of my older brother Martin — a high-achieving lawyer and sportsman — who slowly withered away as he lost his battle with a rare and aggressive lymphoma. It is fair to say that his death broke me, but as I’m sure Oprah would say, it also broke me open. I can honestly say that I had a career before he died — aimless and floating — and one that is full of value and joy afterward. This path was formed from having to find out how to survive life (and thrive) with this weight alongside me, plus having a newfound empathy for patients or other medics struggling through their own tragedies.

For this piece, I spoke to several of the wonderful paramedics I work alongside in my other career as an aeromedical specialist physician. Several of them were kind enough to share with me their experience of personal grief and how it changed their roles forever.

Our job as medics, especially on the front line, is incredibly unique. We all find ourselves with an enforced, ongoing relationship with death. After my brother died, I suddenly knew what it was like to feel the agony of grief. I found it too easy to get involved with my patients and their families. I took on their pain alongside mine. It meant my grief was constant and ongoing. I did a lot of crying! On the plus side, it did mean that, while previously, I would shy away from those patients in side rooms or nearing their end, I would now fully embrace them -hoping to ensure they felt like humans, hoping they wouldn’t feel alone.

One day when driving in our ambulance, I asked one of my paramedic colleagues how he felt his role had been affected by grief. Initially, he said he wasn’t affected that he could recall — before saying, “0h except for hangings!” as if it had simply slipped his mind.

He described how several of his paramedicine friends had tragically ended their lives in this way. A horribly common reality for Australian frontline workers. The day after his close friend died, he went to work regardless because that is what we do; we just carry on. He couldn’t believe that his very first job was indeed a hanging.

“You just need to get on with it,” he told himself on the way to the scene. He persevered, trying to ignore his internal agony before breaking down. He recalls being shouldered off the scene by his supervisor. He was mortified as he was new to the job, and “everyone had seen it happen.” He felt weak. Years later, he was again called to confirm the death of a body in the dense Australian bush. He felt that he needed to be the one that got to the body, to show himself he could do it. As he got close, he realized he couldn’t bare it and cried.

He also described attending a job where he was very confused as to why the attending senior paramedic — who was normally so great at his job — couldn’t even do the simplest of tasks and refused to stop CPR on the patient despite doing all they could. Afterward, that paramedic admitted that he was, at that moment, not resuscitating a random patient but his mother, who had recently died.

Another dear friend told me that his problem is the exact opposite. After all the tragedy he has seen, he has lost the ability to feel. He couldn’t feel the joy of his child being born or the grief of his father dying. His job has robbed him of his emotions.

One of the most experienced paramedics I know feels that even if you think that what you see doesn’t affect you, each event is slowly but surely building little bits of architecture onto your being. He compared it to the Brazilian favelas with their complex jigsaw of buildings hanging off each other in a mind-boggling manner. He reported that recently, with one more piece stuck to him, he was suddenly unable to drive a road he had driven millions of times before. He now drove a huge detour to avoid that road. One more patient death finally filled him up.

Having these reactions show that we are all just human beings. No one else in this world would be expected to deal with these situations in any other way. It is just that on the front line, we are constantly put in these situations, and our grief is recurrently raw.

We shouldn’t be ashamed of these emotions or try to hide them. And I have learned we must never judge a colleague for how they have reacted to a situation; we often have no idea of the pain they are hiding inside.

Finally, I include a quote I received from another fabulous paramedic. One who has truly seen it all in his long career. It followed a story of a young woman who died in a car crash that he can never forget and the night he said goodbye to a dear friend who went out on a mission into the mountains and never returned.

Grief is a complex beast. It can appear predictably during a time of sadness, but it also lurks in the shadows of my memories and strikes with a randomness that I can’t always fathom. The best remedy for grief is time and a poor memory, and luckily as I grow older, my memory deteriorates.

Caroline Macari is an emergency medicine physician in Australia.

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