Having Difficult Conversations
“We are exceptional at connecting with others during their most difficult moments but hesitant to share the reality of our own struggles with the very people who would understand them best.”
Recognizing the Paradox
How often do you have a difficult conversation with a patient or their family at work? For many of us, it’s routine—part of the job, day in and day out. Whether it’s delivering bad news or helping someone process a life-altering event, we lean on our training and experience to navigate these moments with professionalism and empathy.
I think back to my first cardiac arrest after returning to EMS. It was overwhelming—30 minutes of trying to shake the rust off, to “get back in the groove.” My partner, an experienced EMT, was basically running the show while I scrambled internally to keep pace. When we called time of death with medical control, I knew the hardest part wasn’t over. I had to face the family.
I paused to ground myself, reminding myself to be direct yet compassionate. “We did everything we could.” It was tough. I felt raw, not just from seeing the family’s grief but from the weight of my own insecurities—wondering if I had done enough, if I was good enough. But in that moment, I stayed with the family. I stood by, not awkwardly but in a way that said, I’m here. That’s a skill we learn: balancing professionalism and empathy, being present without rushing grief or offering false comfort.
Our ability to handle these conversations is rooted in training, practice, and empathy. We’re taught early on to use direct language, particularly when discussing death—no euphemisms like “passed” or “gone.” Having a framework or script helps us stay focused when emotions run high. With experience, these conversations become smoother—not easier, exactly, but more manageable. Over time, we learn to filter out distractions, honing in on the patient or family in front of us. Empathy remains our cornerstone, allowing us to connect, anticipate needs, and provide the care people need in their most vulnerable moments.
But what happens when burnout and emotional fatigue creep in? They don’t necessarily make these conversations harder—they make them hollow. Burnout disconnects us from the very empathy that drives meaningful connections. Instead of engaging fully, we might rush through the motions, keeping things superficial to shield ourselves from adding more to an already-overflowing emotional box. We compartmentalize, stuffing away the impact of call after call until the box overflows and spills out in ways we can’t always predict.
This professional detachment isn’t unique to patient care. It extends to the way we interact with each other. While we excel at delivering difficult news to patients or families, we often avoid having those same honest and direct conversations with our peers. Why? Because the culture of EMS, healthcare, and public safety tells us to keep moving, to compartmentalize, to avoid vulnerability. It’s a paradox: we are exceptional at connecting with others during their most difficult moments but hesitant to share the reality of our own struggles with the very people who would understand them best.
The question is, what would happen if we started treating peer conversations with the same intention and care we bring to patients and their families? What if we stood by each other—not just in the field but in the quiet moments, when the weight of the job feels heaviest? The answers might just hold the key to fostering resilience and building the supportive relationships we desperately need.
Why We Find Peer-to-Peer Conversations Difficult
“We’re taught—implicitly, if not explicitly—that emotional responses are liabilities.”
What makes conversations about emotional struggles among peers so difficult? At its core, the answer lies in the tension between vulnerability and control. In EMS, healthcare, and public safety, control is not just a skill—it’s a survival mechanism. We’re trained to organize chaos, solve complex problems under pressure, and take charge of unpredictable situations. Control keeps us focused when our actions are critical for positive outcomes.
But this emphasis on control comes with a price. We’re conditioned to believe that emotions detract from our ability to perform. For many of us, the response is to compartmentalize—shoving emotions into a metaphorical box to deal with "later." The problem is, later rarely comes. Those unresolved emotions don’t disappear; they seep out in ways we don’t always recognize—irritability, emotional numbness, neglecting self-care. Over time, the box overflows, and we find ourselves overwhelmed by the very feelings we tried to suppress.
I used to think I could flip a switch to turn my emotions off during a call and back on afterward. But it’s not a switch; it’s a button that pushes those emotions into a box for later. And I pressed that button repeatedly without realizing I wasn’t letting those emotions back out. Instead of processing what I felt, I carried it with me, unaddressed. This lack of vulnerability became a kind of armor, but it was armor that weighed me down.
The culture of EMS reinforces this need for control and suppression, often in subtle ways. We’re taught—implicitly, if not explicitly—that emotional responses are liabilities. Phrases like “don’t take your work home with you” and the pressure to take the next call send the message that emotions are to be tucked away, irrelevant to the job. Even humor, a coping mechanism ingrained in the field, can become a way to deflect rather than engage with difficult feelings.
And then there’s the fear: the fear of being seen as weak or incompetent. This fear often feels like it originates from peer judgment, but in reality, it’s deeply internal, rooted in negative core beliefs many of us carry. We want to be seen as strong, capable, and reliable—not as someone who might falter or make mistakes. Ironically, I’ve seen colleagues show vulnerability and receive respect for it, not ridicule. Yet the fear persists, making us hesitant to open up, even to those who would likely understand us best.
This fear also affects the way we work together. The facade of overconfidence and control can shut others down, breeding defensiveness and isolation instead of trust and collaboration. The more we pretend we have everything under control, the harder it becomes to ask for help—or to offer it when we see someone else struggling. It’s a cycle that’s self-perpetuating, passed down through generations of professionals.
So how do we break free from this culture of control and suppression? It starts small. Vulnerability is not an all-or-nothing proposition. It’s a series of steps—admitting to a trusted colleague that a call affected you, pausing to reflect on your own emotions, fostering an environment of psychological safety. These moments of openness can build the trust and genuine connections that are often missing in our field.
If I could rewrite the narrative of our profession, I would make vulnerability a hallmark of strength. Genuine connections, built through honest and empathic communication, are at the heart of what we do. They’re how we truly help people—our patients and each other. Vulnerability doesn’t make us weak; it makes us human. And in a field defined by resilience and adaptability, embracing our humanity is one of the greatest strengths.
The Importance of Normalizing Mental Health Conversations
“How do you express a struggle when you don’t have the words for it?”
When I think about having a vulnerable conversation with a peer, a pit forms in my stomach. Uncertainty, nervousness, dread—they all bubble up, making the idea of vocalizing my struggles feel overwhelming. These emotions stem from deeply ingrained fears: fear of judgment, fear of rejection, fear of exposing myself as less than capable. It’s a heavy weight to carry, but one that so many of us in EMS, healthcare, and public safety share.
To navigate these emotions, I remind myself of a few truths: I am not my thoughts or feelings. My value as a person and professional exists regardless of the challenges I face. And just as importantly, the person sitting next to me likely feels the same. My colleagues wrestle with their own struggles and insecurities. That shared understanding—that recognition of our common humanity—helps me take those small but essential steps toward opening up. Vulnerability is easier when you know you’ll be seen and understood.
But our work culture makes those steps difficult. In professions defined by high stakes and fast-paced environments, emotions are often seen as liabilities. Admitting to struggles can feel like undermining our credibility. Shame compounds this perception. Struggles are equated with weakness, and in an effort to hide that weakness, we bottle up our emotions. We avoid conversations that would require us to admit we’re struggling, even to ourselves.
This aversion is reinforced in subtle but powerful ways. Consider the pressure to always have answers, to never say “I don’t know.” We are trained to be the helpers, the problem solvers. Admitting uncertainty can feel like a failure, like we’re letting down the very people who depend on us. And then there’s the dynamic of teamwork and hierarchy. Speaking to a partner about vulnerabilities might feel manageable, but with a supervisor? It’s a whole different equation. The weight of these conversations depends heavily on the specific environment and how peers or leaders view emotional honesty.
Fear of judgment and fear of being a burden often intersect in complicated ways. In our field, we take pride in being self-sufficient. We don’t want to impose our problems on others, especially when we suspect their struggles may be “bigger” than ours. We don’t want our problems to be judged as insignificant or unworthy of someone else’s time.
Personal barriers play a role too. A lack of emotional vocabulary, for example, can make it nearly impossible to articulate what we’re feeling or thinking. How do you express a struggle when you don’t have the words for it? For me, learning to understand my own cognitive processes and expanding my vocabulary has made a world of difference. But the barriers to vulnerability are as varied as we are. They’re shaped by age, gender, race, upbringing, and personal history, creating a complex web of influences that can either hinder or help our ability to engage in these conversations.
At its heart, the struggle to open up is a universal one. Vulnerability is uncomfortable—there’s no denying that. But it’s also necessary. If we can learn to push past the fear, to navigate the emotions and barriers that hold us back, we’ll find something powerful on the other side: connection, understanding, and a way forward.
Practical Strategies for Supporting Each Other
What would a culture that normalizes peer-to-peer conversations about mental health look like? It would start with us—individually—being able to acknowledge and verbalize our emotions. By being honest with ourselves, and sometimes using our peers as sounding boards for that honesty, we can create a ripple effect. Vulnerability tends to invite reciprocity. If one person opens up, it signals to others that they can, too.
But it’s not just about individual effort. Normalization requires an environment built on psychological safety—where colleagues can admit to struggles without fear of judgment or gossip. Trust, respect, honesty, and vulnerability become the key virtues. Leaders and teams must prioritize these values, cultivating a culture where it’s not just okay to struggle but it’s expected and supported.
I think back to a moment when a supervisor modeled this spectacularly. After a particularly rough call, he opened up about how much it had affected him. He didn’t shy away from acknowledging his struggles, but he also made space for me to share mine. He encouraged me to take care of myself, even if that meant stepping away from work for a bit. At the time, his words didn’t feel monumental, but they planted a seed. Slowly, I began to realize that vulnerability wasn’t weakness—it was a pathway to support and connection. Even now, years later, I know I could reach out to him, and he would still be there. That’s the kind of impact normalizing tough conversations can have.
The language we use plays a crucial role in creating this kind of environment. Sometimes, a simple phrase like, “Wow, that really sucked,” can break the ice. It’s direct, relatable, and immediately signals that it’s okay to acknowledge the emotional weight of a situation. By putting yourself out there first, you invite others to do the same.
Humor, a cornerstone of our coping mechanisms, also has a role to play. Used thoughtfully, it can release tension and make difficult topics feel less daunting. A well-placed joke can lower the barrier to entry for tough conversations, but it’s a fine line. Humor generally should not be used to avoid emotions or deflect the need for an honest dialogue. The key is knowing when to shift from laughter to listening.
The setting for these conversations matters too. Small, private environments—quiet spaces where people don’t have to worry about being overheard—are ideal. Timing is also important. While stepping back after a tough call can be a good opportunity to decompress, these conversations shouldn’t be forced. The most critical aspect is simply creating space for them to happen, if and when they’re needed.
This is where peer supporters and mental health champions come in. They model vulnerability and empathy while offering practical knowledge about mental health struggles and available resources. They show that it’s okay to not have all the answers, but they also guide their peers toward support systems that can help.
Normalizing these conversations isn’t about making every interaction a deep dive into emotions. It’s about creating a culture where honesty and vulnerability are met with understanding rather than judgment. It’s about knowing that when the weight of the job gets too heavy, there’s someone there to share the load. And it starts with us, one conversation at a time.
Creating a Supportive Environment in EMS and Healthcare
Supporting others through emotionally difficult times can be both deeply rewarding and incredibly challenging. It requires genuine listening, validating their experiences, and knowing your own boundaries. Here are practical strategies for offering meaningful support to your peers while maintaining your own emotional well-being.
For Peers: How to Be a Supportive Colleague
1. Show You’re Genuinely Listening Active listening is the cornerstone of supporting a colleague through a tough conversation. Start by eliminating distractions—put down your phone, turn down the radio, and give them your full attention. Ask thoughtful questions to encourage them to elaborate, but don’t push. Tap into your empathy and try to view the situation from their perspective. The goal isn’t to solve their problems but to create a space where they feel truly heard and understood.
2. Validate Their Experience Without Minimizing or Fixing Holding space for someone—simply being present and letting them express themselves—can be incredibly validating. Acknowledge their challenges from their perspective, rather than layering your own experiences or solutions onto the conversation. Avoid saying things like, “I know exactly how you feel,” or immediately offering unsolicited advice. Instead, if you feel compelled to share something that worked for you, ask permission first. Present it as an option, not a directive. Validation comes from showing respect for their autonomy and their unique experience.
3. Recognize When to Refer to a Professional While being a good peer is vital, there are moments when professional intervention is necessary. Look for signs like ongoing struggles weeks after an event, significant behavioral changes, or expressed thoughts of self-harm or harm to others. If you’re unsure, ask your colleague if they’d like help finding someone to talk to. Be proactive by familiarizing yourself with available resources, such as your organization’s mental health programs or hotlines like 988 (the national mental health crisis line). Knowing when and how to refer can make all the difference.
4. Respect Your Own Emotional Limits Supporting others doesn’t mean neglecting yourself. If you’re struggling with your own challenges, recognize that you may not be in the best position to help someone else. Start small—offer support to colleagues you know well and feel comfortable with. Be honest with yourself about what you can and cannot handle. Sometimes the most supportive thing you can do is acknowledge your limits and help connect them with someone better equipped to assist.
5. Avoid Common Pitfalls There are a few mistakes to watch for when trying to support a colleague:
Avoid turning the conversation into a discussion about your own experiences.
Don’t pressure them into talking if they’re not ready—respect their timeline.
If they prefer to speak with someone else, don’t take it personally.
Resist the urge to think you have all the answers. Support isn’t about fixing; it’s about being there.
For Yourself: How to Maintain Your Well-Being
1. Cultivate a Strong Support System Having a trusted group of colleagues, friends, and family to lean on is crucial. For me, this has been one of the most important strategies for maintaining my mental health. I prioritize balance by making time for loved ones and hobbies outside of work, pursuing personal goals unrelated to my career, and focusing on a healthy lifestyle. Exercise, eating well, and finding joy in small moments all contribute to building resilience.
2. Choose Your Confidants Wisely Not every colleague needs to be part of your inner circle. My closest support system includes just two or three colleagues—people I’ve worked with for years, who know me well, and whom I trust completely. They’re honest with me, even when the truth is hard to hear. For more casual conversations, I look for colleagues who are caring, discreet, and willing to reciprocate vulnerability.
3. Develop Small, Impactful Habits After tough shifts, I rely on simple, effective strategies to decompress. Physical release—sweating it out, crying it out, or even just hydrating properly—helps me process stress hormones. Simple breathing exercises can also help regulate the nervous system and shift out of “fight or flight” mode.
4. Reframe Guilt and Shame When I struggle, I remind myself of a core belief I’ve cultivated: even if I made mistakes or the outcome was poor, the situation was better for having me there. This doesn’t erase the grief or difficulty, but it shifts my mindset toward one of growth and self-compassion. For me, this has been a powerful tool to move past guilt and shame and focus on what I can learn and improve.
5. Prevent Burnout with Boundaries If you feel like you’re burning out, consider speaking with a mental health professional. You can’t support others effectively if you’re overwhelmed yourself. Take small steps to help your colleagues without taking on their burdens. Focus on self-care first—your well-being is the foundation for being able to assist others.
Supporting others is both an art and a skill. By practicing empathy, setting boundaries, and prioritizing self-care, we can create a workplace culture where vulnerability is met with understanding and respect. These small but meaningful steps can help us all feel a little less alone in the challenges we face.
Small Steps Toward Change
As you’ve read this post, I hope you’ve felt validated—recognized in your experiences and struggles. This field is demanding, and it’s easy to feel alone in the emotional weight it carries. But you’re not alone. There are people who care about your well-being and want to support you, even if it doesn’t always feel obvious. And if you’re unsure about opening up or skeptical of the impact, I hope this post has sparked a sense of curiosity about what might happen if we took the risk of being vulnerable.
The change starts small. Today, try taking a little extra time to listen to a colleague. Not just casually, but intentionally. Ask a follow-up question, something that encourages them to share a little more. Focus on deepening the conversation—nothing major, just a small step toward building trust and connection.
Vulnerability reciprocated. That’s what success looks like. It’s the moment where one person’s honesty and openness is met with understanding and support. It’s not immediate, and it’s not easy, but those small moments are how we start to shift the culture. Over time, these ripples of change can grow into waves of deeper connection and resilience.
Take care of yourself first. Start small, with manageable steps. Change begins with you and radiates outward. We need to be more open to having tough conversations. Vulnerability—shared, reciprocated, and supported—is how we move forward, both as individuals and as a profession.
Be Safe Out There
-Andrew
