Paramedic Sandy Macken's phone rang. She was never the same after that call.

Warning: This book extract deals with themes of mental health and suicide, and may be distressing for some readers.

I’m strolling along in the sunshine on another glorious autumn day in Sydney when the phone rings. My long-term workmate never calls me, so when I see his name come up on the screen I wonder if perhaps I should be at work. I look at the time; it’s midday, way too late to get that sort of call. I feel a vague reluctance to take the call but my curiosity gets the better of me, and I answer.

‘Hi Sandy, it’s Peter. Steven killed himself. I wanted to tell you before you heard on the grapevine,’ he says, straight to the point.

In typical ambo fashion he passes on the information clinically, not dressed up in any sentimental bullshit. Coming from this person, it lands soft enough. I appreciate he’s taken the time to call me and I know he’s been close friends with Steven for many years now, so this call was not an easy one for him.

‘Shit,’ I say. ‘Serious? When? How?’

‘They found him last night.’

‘Right,’ I say. ‘Shit, that’s pretty full on. Thanks for letting me know, I guess we will be in touch soon. Take care, hey?’ I respond, and as the words leave my mouth I become numb and a bit lightheaded.

I feel as though I might faint. I turn around immediately and walk back down the street, in the direction of a friend’s place; I feel as though I’m about to vomit. Something is imminent but I’m not sure what it is. My feet walk down the street towards her house. I feel like an animal that is wounded and about to die, in desperate need of a safe place. My instincts are walking me, like the instincts that walk you to the toilet before you are aware you are about to lose the contents of your stomach.

He is one of our own and he is dead. It feels like a dam is about to burst open in my heart. The fact that he was once my boyfriend and I knew it would come to this one day makes the moment even more intense.

I walk in through the front door of my friend’s place and I’m met with a face of loving concern; this is very out of character for me, to just turn up like this.

‘What’s wrong?’ she says as soon as she sees me.

‘Steve killed himself,’ I say as I sit on her couch.

‘Oh darling, I’m so sorry,’ she says, her words full of love and compassion. Like a wrecking ball, the love she offers me shatters my walls. All of my defences come crashing down. I drop my face into my hands and a wail erupts from the depths of my being. I start purging grief. My tears and screams are so forceful that my stomach muscles ache and spasm. Brief moments of respite allow me to suck in big lungfuls of air between pounding waves of desolation. I can barely hold my body on the couch as it twists and turns through the waves of intense emotion.

I can hear my friend’s quiet words of support. ‘Oh darling, I am so sorry. That’s it, sweetheart, let the pain come up, I’m here.’

I feel like I’m vomiting grief: it emerges from my body in great waves of uncontrollable emotion. It’s as if every single suppressed tear has seen the light and bolts straight for it. Millions of tears desperate for their own release rush to the surface and I scream them out. I have no control and my body is not my own. It is like a seizure; just like a patient with epilepsy who cannot control their seizures I cannot control my grief, and it pours out of me like a tsunami.

As a paramedic I have a well-developed ability to appear unaffected in the face of horrific events. I can pause, breathe and respond with the right words in a very calm way. A plane could fall from the sky and I reckon I wouldn’t flinch. I’d see it happen, pick up my phone and start making the necessary calls, then head in to the station and sign on for duty.

To be able to act in the face of intense trauma, I learned to dissociate from the feelings they induce. I used to think this dissociation was emotional mastery but I was wrong, of course. However, having that control over my emotions has certainly come in handy more than once during my career as an on-road paramedic.

Some say hearts don’t break, they bend; but something broke deep inside me on that autumn day. All that ‘mastery’ melted in an instant and I sobbed a million tears. Of course, all paramedics have seen many, many deaths, but it’s not about death. It’s the tragic irony of a paramedic choosing death when he had been devoted to saving the life of so many others. He couldn’t save himself.

Some may say that starting in the job at the age of twenty robbed me of my innocence. I disagree; it robbed me of some ignorance, perhaps. I like to think I’ve gained an incredibly positive attitude towards life as a result of this work. Street-wise a little before my time and a bit cynical on a bad day, but I’ve been granted a vision of
life that few can appreciate and from which many would run.

Dealing with suicide after suicide among my colleagues has been a different matter, however. There is a wound that is difficult to heal when these people we share so much intensity with opt out. The first one was shocking, the second distressing, the third had been my boyfriend and felt as if it broke me, the fourth a friend and it pissed me off. The next was unexpected and the fact he was attended by a colleague who would become another statistic himself only eighteen months later was utterly devastating. Another sad irony is that he was found by yet another colleague, who will now also be haunted by that same final image.

And so the bittersweet relationship between paramedics forms. On one level you trust your partner with your life. God knows, we’re aware of all their dirty secrets! But then you never know what dark thoughts they entertain – never really know if perhaps they will be the next one to make that final decision that will crush us all again. In the meantime we keep attending to the general public, knocking on doors, bringing them back from death, patching them up, sorting them out and mending their wounds. Letting them go and moving on.

Perhaps if we put enough people back together, save enough lives and relieve some more pain we will somehow mend our own hearts. Maybe we all just have one collective pain and we’re hoping to recover our own losses through resuscitating our patients. Maybe a little piece of ourselves comes back to us each time we get a heart beating again. And maybe every time we cry from laughing about a breastfeeding cat lady, another fragment of our broken hearts flies back to us and gives us the fuel to keep going in this crazy, passionate, painful and glorious world of the paramedic.

What I do know from my wealth of experience dealing with suicide is this: emotions are energy moving, and it is normal and natural. When I allow myself space to grieve, cry or sob like I am hyperventilating, I feel better afterwards. Exhausted, but better. This is something I resisted for too long, thinking it to be a sign of not coping. Now I know that on the other side of a good cry is often great relief.

I believe that at our core we paramedics are essentially the same, as each other and as the rest of humanity. Even though we might operate within a role that demands objectivity and pragmatism we also have feelings. How we appreciate and process these feelings in the moment and also in the aftermath of intense experiences can have a huge effect on our well-being.

Talking about it helps too. It’s okay to say you’re pissed off, angry, let down, exhausted, sad. Finding a mate you trust and letting them know what’s going on in your head can shed light on things and often alleviate a great pressure. If you ever entertain the thought that you want to self-harm or kill yourself, for goodness sake, tell someone.

This brings light into an otherwise dark inner landscape. There is always help available, and there is always an easier, softer way.

Sometimes people have particularly rough patches and nine times out of ten these times pass, but if you are concerned for a colleague, call them and ask, ‘Are you okay?’ Mention your concern. Be there for each other, speak kindly about others when they’re not there and always assume that you and everyone else always does the best job
they possibly can do.

Suicide is a permanent solution to a temporary problem. There is always another option.

If his has raised any issues for you, or you just need to talk to someone, help is available by calling beyondblue 1300 224 636 or Lifeline on 13 11 14.

Sandy Macken is the author of Paramedic: One woman’s 20 years on the front line (Rockpool Publishing, $29.99) now available at all good bookstores and online at www.rockpoolpublishing.com.au