Are you getting cold and calloused?

Our emotional response to cumulative stress changes as the fear factor lessens with experience


Cumulative stress, critical incidents and the emotional weight of our work are familiar to all of us whose jobs involve caring for people in crisis. We know how important it is to be deliberate about having a life outside of work, tending to our personal relationships, eating healthy food, exercising and getting enough sleep.

So it may come as a surprise when we begin to notice that we’re not bothered as much by difficult cases as we used to be. An experienced EMT told me about having clear memories of a call he was on more than a dozen years ago, while the details of a more recent, equally challenging call were not so clear. He asked, “am I getting cold and calloused?” “Should I be concerned?” These are common questions.

The frightened brother of a patient who was coding in the ICU noticed that I was able to be at the bedside without appearing to be in much distress myself. He commented, “I suppose this kind of work gets easier over time.” Easier? No, I told him, it doesn’t get easier, but it does get more familiar.

There will be times when your ability to cope gets stretched, and I encourage you to take advantage of support resources. But there will be other times when you recognize that you do feel sad about the situation, but it’s within the scope of your normal work, and you’re going to be OK.
There will be times when your ability to cope gets stretched, and I encourage you to take advantage of support resources. But there will be other times when you recognize that you do feel sad about the situation, but it’s within the scope of your normal work, and you’re going to be OK. (Photo/Getty Images)

Growing into your position

One of the things I’ve come to recognize is that our responses to critical incidents involve more than one emotion. A normal response to loss is to feel grief or sadness. A typical response to trauma is to be afraid – all of that intense emotion can be overwhelming. With experience, the fear factor lessens over time. Situations that used to scare me aren’t so scary anymore. I still experience some initial anxiety as I make the mental shift necessary to respond to a crisis. I notice a heightened sense of awareness, faster heartbeat and other physical responses, but I’m not as frightened.

I believe that, with experience and support from coworkers, family and friends, we can increase our skill at coping with stress and trauma. The fear element is reduced. We have a broader base of experience to draw on, and even when the current situation isn’t exactly the same as something we’ve seen before, we gain confidence in our abilities. It’s not easier, but it is more familiar.

Should you be concerned if you don’t get emotionally exhausted by a challenging call? I don’t know. One way to explore your emotional health is to ask: do you experience normal emotional responses in other areas of your life? Do you tear up at sad movies, laugh, cry and care for your loved ones in appropriate ways? If yes, this is healthy and you’re probably doing OK.

Others may interpret our lack of fear as meaning that our jobs get easier over time. We may still be sad, but not afraid. If you notice that you’re able to be in the midst of a very tough situation without feeling overwhelmed, take it as a clue that you’re growing into your profession. There will be times when your ability to cope gets stretched, and I encourage you to take advantage of support resources. But there will be other times when you recognize that you do feel sad about the situation, but it’s within the scope of your normal work, and you’re going to be OK.

Additional resources for mental health and wellbeing

Learn more about how to cope with cumulative stress and measure your emotional health with these resources:

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