Politico story on Medicare and electronic medical records take us to UMass Med and it’s “Patient Ping” program. Normally when a patient like Pressley shows up in an ER, what follows is as confusing to the doctors as it is to the patient. Health records tend to be scattered through the many offices and hospitals…
Surgeon Atul Gawande’s sat down with Harvard Divinity School Dean David N. Hempton last week to talk about writing, health care and mortality.
He said he is not someone who came naturally to writing. He grew up in a home with academic journals, not novels, as reading material. But a friend asked him to write for a website, which led to a gig at Slate. He said the stories of the people around him “seemed bigger” than policy questions.
“It became my way of thinking out loud,” he said.
On his work in serious illness care, Gawande said it is not necessarily about helping people face. death. It’s about finding out what is important to patients as they face mortality. One patient told Gawande he wanted to stay live as long as he could eat chocolate ice cream and watch football on TV. Gawande called that “the best living will ever…It’s not about a good death. It’s about having a good life along the way.”
The HDS has posted a video of the talk.
The Cambridge Chronicle has a nice story on the hospital’s history, along with some photos of the nuns who worked there.
Shortly after its founding in 1948, Sancta Maria Hospital earned the nickname “the Red Sox hospital” because of the number of players who received care there. Initially located on Memorial Drive in Cambridge, a little more than a mile across the river from Fenway Park, the hospital provided a convenient place for treating players’ injuries and ailments.
The nuns on staff, members of the Daughters of Mary of the Immaculate Conception, would receive a call from a team doctor or trainer asking, “Is our room empty?”, according to a 1949 Boston Globe article. The nuns would start preparing “the Red Sox room,” described as a “pleasant, blue room with large open fireplace and cheery floral hangings.”
Students are rolling back into town, and many of them will already be stressed out. Some will try suicide; some will succeed.
As the CDC reported this summer, suicide rates are rising.
Can suicide be prevented?
A top researcher asking that question will be in town Thursday. It’s a bit of a hoof and in the middle of the day, but Maria Oquendo. of UPenn will be at McLean Hospital for a talk on on “Suicidal Subtypes: Delineating Phenotypes to Identify Underlying Biosignatures.” Noon, Service Building, Pierce Hall. Details.
Her effort dovetails with that of Matthew Nook of Harvard, who was described in an NYTimes article as “the suicide detective.”
Suicide is a leading cause of death in the US. Suicide rates increased in nearly every state from 1999 through 2016. Mental health conditions are often seen as the cause of suicide, but suicide is rarely caused by any single factor. In fact, many people who die by suicide are not known to have a diagnosed mental health condition at the time of death. Other problems often contribute to suicide, such as those related to relationships, substance use, physical health, and job, money, legal, or housing stress. Making sure government, public health, healthcare, employers, education, the media and community organizations are working together is important for preventing suicide. Public health departments can bring together these partners to focus on comprehensive state and community efforts with the greatest likelihood of preventing suicide.
Probably won’t wear long sleeves but…
Not at the same time. Two Boston items.
Public Citizen argues that a clinical trial of a new approach to sepsis is unethical. One of the lead investigators is at BIDMC. From NPR:
A consumer advocacy organization is asking federal health officials Tuesday to halt a large medical study being conducted at major universities nationwide.
Public Citizen says that the study, involving treatment for sepsis, puts patients at risk and will at best produce confusing results.
The CLOVERS study seeks to answer a key question about sepsis, which is a common and life-threatening response to infection. Sepsis kills more than 250,000 Americans a year, often by triggering the failure of multiple organs. As patients’ blood vessels get leaky as a result of sepsis, it becomes difficult to maintain safe fluid balance and blood pressure.
NPR reports that Dr. Nathan Shapiro, a professor of Emergency Medicine at Beth Israel Deaconess Medical Center and one of the principal investigators for the CLOVERS study, stands by it. He declined to talk to the reporter and instead issued a written statement.citing the input of “expert clinicians” who produced a study that “follows a well-accepted design.”
Public Citizen also had a written statement on a letter sent to Office for Human Research Protections at HHS.
An ongoing clinical trial involving seriously ill sepsis patients is deeply flawed, riddled with serious regulatory and ethical lapses, and must be stopped, Public Citizen said today in a letter (PDF) to the federal government.
In the experiment, patients are being given one of two treatments for sepsis, both of which are risky and neither of which is considered standard treatment. Because no other group of patients in the trial is receiving the usual treatment for sepsis, researchers can’t ensure that the experiment isn’t causing increased deaths and organ failure. Sepsis is a life-threatening condition in which bacteria or their toxins get into the bloodstream, causing shock and organ failure.
STAT also has a story on Public Citizen’s action, as well as a great video explaining the hard-to-explain condition.
Another item, this one in the Times:
This little noticed approach to post-acute care is apparently delivering nearly $5 billion. Amy Finkelstein of MIT was one of the authors of a study that concluded:
There is substantial waste in U.S. healthcare, but little consensus on how to identify or combat it. We identify one specific source of waste: long-term care hospitals (LTCHs). These post-acute care facilities began as a regulatory carve-out for a few dozen specialty hospitals, but have expanded into an industry with over 400 hospitals and $5.4 billion in annual Medicare spending in 2014. We use the entry of LTCHs into local hospital markets and an event study design to estimate LTCHs’ impact. We find that most LTCH patients would have counterfactually received care at Skilled Nursing Facilities (SNFs) – post-acute care facilities that provide medically similar care to LTCHs but are paid significantly less – and that substitution to LTCHs leaves patients unaffected or worse off on all measurable dimensions. Our results imply that Medicare could save about $4.6 billion per year – with no harm to patients – by not allowing for discharge to LTCHs.
The New York times reports on the study here.
Story below came out this summer from ProPublica. Relevant to first responders to the Marathon bombing in Boston — and first responders everywhere.
You correspondent covered a session with the Orlando hospital workers who received the wounded More on that here:
This article below was produced in partnership with WMFE, which is a member of the ProPublica Local Reporting Network.
This is an ongoing project: We want to understand the magnitude and the experiences of PTSD in first responders — not only how many are out there, responding to calls and struggling in silence, but the specifics of what they are going through.
It’s why we’ve created a questionnaire for first responders and the people closest to them. Your stories will help fuel our reporting and broaden our understanding of the trauma in a group that feels it.
We recognize that these stories are sensitive and hard to talk about, but we are listening — and we will do everything in our power to protect your privacy. Our reporting is only as strong as the people who come forward to share their stories.
The story:
On the morning of June 12, 2016, police officer Omar Delgado pulled his cruiser up to his two-story townhome in Sanford, Florida, and sat in silence for 15 minutes, trying to process what he had seen during 3 1/2 hours inside the Pulse nightclub.
He stripped his bloody uniform and gear off, put them in a trash bag, and took a shower. Then, he shut the door to his bedroom, locked it and tried to sleep.
That same morning, firefighter EMT Brian Stilwell walked back to Orlando Fire Department Station 5. Working at the station just 300 feet from Pulse nightclub, Stilwell was one of the first on scene hours earlier.
In the dawn’s light, he saw a pool of coagulated blood in front of the station. It was from a Pulse patron who had been shot in the stomach and dragged to that spot. Stilwell wondered if the man survived the night. Then, with a bucket of bleach and water, he helped clean the blood off the concrete.
Down Orange Avenue, Alison Clarke and a fellow Orlando Police officer walked into a McDonald’s to use the bathroom. The restaurant had a TV with the news on, streaming live video of the scene she had just come from. People looked up from their coffee and breakfast, glanced at her and her partner, then back to the food. She used the restroom, washed up and bought two coffees. No one said anything. It was surreal.
Josh Granada and his partner drove their ambulance back across town to their Orlando Fire station. They spent the night ferrying 13 people who had been shot at Pulse to the hospital. Before showering, they threw away their uniforms.
“We were covered in just sticky, nasty — just covered in blood,” Granada said. “I’m not gonna put that much blood in the washer.”
Orlando Police officer Gerry Realin was called in from vacation on June 12 to work a 16-hour shift the morning after the shooting. He spent four or five hours of that inside the nightclub, preparing bodies to be taken to the morgue, and it wasn’t until 2:30 a.m. the following day that he came back to his home in New Smyrna Beach, an hour northeast of Orlando. He looked in on his two sleeping children. In the shower, he started wailing. Outside the bathroom, his wife heard him saying, over and over again, how sorry he was for the victims.
“I never saw myself in this position,” he would later say. “I’ve never been the same since, and I can’t go back.”
Pulse was one of the nation’s largest mass shootings, where 49 people died and at least 53 others were wounded. The invisible injuries to first responders represent another toll of the catastrophe.
For these five first responders — and many others — June 12 was the first day of their new lives, one in which they would confront post-traumatic stress disorder. Even though most had responded to gruesome scenes of murder, suicide and car accidents, that didn’t prepare them for the psychological injury of PTSD. Going forward, they would relive that day in flashbacks and nightmares, see danger behind every closed door, and become irritable and impatient with spouses and coworkers.
“There are just some events that are so horrific that no human being should be able to just process that and put it away,” said Deborah Beidel, a University of Central Florida professor who runs a clinic called UCF Restores that treats first responders with PTSD.
Some of the five also would face indifference, resistance and harassment from the departments they served. One said he was fired because of PTSD, another was fired for a mistake on the job, and a third was never cleared to return to work. They said they were subjected to retaliation for speaking up. Those three have each filed lawsuits asserting they’ve been mistreated.
The other two were offered work reassignments to seek treatment and reduce stress, and said they were satisfied with their agencies’ responses.
Orlando Police Department Chief John Mina said he’s been through counseling himself, and that officers dealing with PTSD can come forward to get treatment and request a change of assignment without affecting future promotions and transfers. Orlando Fire Department Chief Roderick Williams likewise said his department provides resources to help firefighters confronting PTSD.
But if employees disclose that they’re dealing with PTSD or mental health issues, they can be given a “fit for duty” test, both Mina and Williams said.
“We wouldn’t want someone out on the street who was having issues,” Mina said. “We may be held liable because of that, because we knew about that. But again, I’ll go back to the fact that they don’t have to come forward. They can receive treatment anonymously.”
In his bedroom alone the morning after the shooting, Eatonville Police Officer Omar Delgado had his first nightmare: He’s back inside Pulse, bodies stacked on each other on the dance floor. He’s dragging one of the victims out when the rapid gunfire starts again.
“And I’m yelling, get down, get down, get down!” Delgado said. “Not knowing if he’s shooting at us because we’re pulling bodies out, he’s maybe upset or whatever. Not knowing where the bullets were making their way. When you’re trying to pull somebody and you slip and fall and now you’re on the ground, trying to take cover because you don’t know where the shooting is coming from.”
Even though two years have passed, Delgado says he often has that same nightmare. Delgado stayed inside Pulse for more than three hours while the shooter was barricaded in a bathroom. When the smell of gunpowder, blood, death and liquor got to be too much, he tried to breathe through his mouth. Then he tasted it.
He now has flashbacks. One of his triggers: The default iPhone marimba ringtone. While Delgado was inside Pulse, phones rang and rang and rang. Sometimes he could see the caller ID. Mom, sister, friend. He saw one phone vibrate and slide away in a pool of blood.
“I hear an iPhone ring and I freeze. I pause. I’m back there a quick second,” Delgado said. “Then I realize, OK, I’m not there, I’m here, I’m OK.”
In August of 2016, Delgado told his department that he couldn’t keep working as a patrol officer. His bosses ordered him to report to the University of Central Florida’s Restores clinic.
The clinic was originally funded by the U.S. Department of Defense for post-9/11 combat veterans with PTSD. It uses virtual reality, sounds and smells to recreate the scenes of war — exposure therapy in which participants relive the events that caused their PTSD and the triggers that provoke flashbacks and nightmares. Such therapy has been shown to reduce symptoms for some, and is combined with group therapy for anger, depression, guilt and social isolation.
After Pulse, UCF Restores opened its doors to first responders. So for three weeks, Delgado sat and recounted, in vivid detail, everything that happened inside Pulse.
Near the end of the third week, his counselor took him on a field trip back to Pulse. They pulled into the Einstein Bros. Bagels parking lot across the street from the nightclub, which was used as a triage site the night of the shooting. Delgado didn’t want to get out of the car.
“I got angry,” Delgado said. “Where you’re standing, there were nothing but bodies laying around here.”
The counselor wanted him to start at the intersection of Orange Avenue and Kaley Street, where he first pulled up to the scene, and recount what happened. To walk across the street and get close to the club.
“The icing on the cake was when I heard an ambulance or a fire truck with their sirens going off, and I couldn’t take it anymore,” Delgado said. “I dropped to my knees and started crying like a little 5-year-old on the corner of Orange and Kaley. A hundred plus degrees outside, I didn’t care. I just got overtaken. It was just way, way too much for me.”
The UCF Restores program typically lasts three weeks. Delgado spent 10 weeks going through the program. He said it was hell repeatedly reliving Pulse.
“Did it help? I don’t know. Did it make it worse? I don’t know,” Delgado said. “But I’m not well. And when you’re not well, is something working?”
In total, 26 Pulse first responders have been evaluated by or treated at the UCF Restores clinic, including the five interviewed for this story. Another 96 first responders have gone through the program for events not related to Pulse.
The clinic says that 60 to 70 percent of the people who complete the program no longer meet the diagnostic criteria for PTSD, meaning their symptoms are no longer disabling. Police and fire departments like the clinic because it’s nearby, effective and free — funded by state and federal governments. Many first responders say they like the program because it’s a neutral place to get treatment without tipping off their departments.
But some first responders like Delgado worry the clinic isn’t enough. Until this year, the UCF Restores clinic didn’t have a psychiatrist available to see patients and write prescriptions. In the first year after the shooting, the therapy was provided by a psychologist leading a team of doctoral students. With more state funding, the therapy is now done entirely by licensed, full-time clinicians.
Moreover, exposure therapy can worsen symptoms if it’s done too soon, said Beidel, who runs the clinic.
“We don’t want to do treatment in the first couple months,” Beidel said. “That can make people worse in some cases. Three to six months is the sweet spot. We want to get people into treatment before patterns of avoidance set in, before patterns of using too much alcohol to sleep set in.”
After Delgado’s 10 weeks in the UCF Restores program, the Eatonville Police Department gave him a “fit for duty” test and put him back on the road. Afterward, a citizen complained that when Delgado and his partner arrested her, Delgado told her, “I’m emotionally disturbed right now.”
In December 2017, Eatonville terminated Delgado. During a press conference that month, city officials said Delgado was terminated because of his behavior during the arrest. But in his personnel file, obtained by WMFE under Florida’s public records laws, officials cite medical reasons. Delgado says department leaders told him it was because of his PTSD. Eatonville’s mayor, chief administrative officer and the police chief at the time declined to comment for this story through the town clerk.
“I believe they [the city of Eatonville] should have stepped up and found more therapy for me,” Delgado said. “There are so many programs out there now. They looked at one and that was the end of it and they thought it was gonna be the cure for all, and it wasn’t.”
As the first anniversary of the nightclub shooting approached, Amber Granada woke up at 5 a.m. to her husband Josh searching, angrily, for a bloodstone bracelet.
He was slamming drawers. He asked if the dogs took it. He asked if Amber took it.
Then, Josh walked out of the bedroom and kicked the couch. It slid into the coffee table, knocking the glass coasters to the ground and shattering them. The couple’s two dogs scattered. Amber started crying. She handed Josh a different bracelet and told him to leave the house.
His face was red. His eyes were bulging. He screamed: “It’s not the bloodstone!”
“And I’m looking at him like, I have no idea who this is,” Amber said. “He ends up just leaving, slams the door. He leaves and I’m sitting there on my hands and knees like mopping up this shattered glass that’s all over the floor in tears because I have no idea what that was.”
This was the first time Amber realized something was wrong. Right after Pulse, Josh Granada had trouble sleeping and nightmares. His coworkers at the Orlando Fire Department also noticed his temper flare in ways they hadn’t seen before. That didn’t stop him from putting in for a promotion and being elevated to an engineer. Granada and his partner Carlos Tavares were among Florida’s firefighters of the year in 2017 for their response to Pulse.
But as the first anniversary approached, journalists sought out Granada and Tavares to ask about what they saw that night. The anxiousness he had right after the shooting returned, along with the nightmares.
Around the same time, Granada drove his ambulance by Pulse for the first time since the shooting. He looked over at the nightclub, which had become a makeshift memorial of flowers and mementos to the dead. Then he looked across the street, at the Einstein Bros. Bagels.
In his mind, he saw blood running down the driveway and into the storm drain.
“And I knew it wasn’t there, but I saw it plain as day,” Granada said. “And that’s what it was that night. The night we were there, that’s exactly what it looked like. There were so many people dying and bleeding behind Einstein that it was literally a pool that was coming down the driveway … and running into the gutters … and I just remember that image. And it still sticks with me. I can still see it.”
That night, survivors grabbed Granada, begging for help, and slapped the windshield of his ambulance when it was full. There were so many patients, Granada used a penlight and gauze to make tourniquets when the supplies ran out. Two patients died at the triage site and had to be placed off to the side with a makeshift curtain around them.
“I saw a guy crawling and take his last breath,” Granada said. “It was horrible.”
Granada’s home life and professional life suffered as his PTSD symptoms grew worse. The other responders interviewed for this story described similar problems.
Granada’s wife Amber told him to ask the department for help. Granada decided his family life was worth more than his pride. In June 2017, he told his lieutenant at the fire department about the flashback when he drove by Pulse.
On July 19, 2017, Lt. Gregg McLay wrote an email to the district chief in charge of health and safety at the Orlando Fire Department, recommending that Granada be given an excused absence with pay to go into the UCF Restores program.
Then, Granada waited. And waited.
Finally, in August, McLay told Granada that he had been told that a top Fire Department official had said, “PTSD is bullshit. These pussies need to man up,” Granada said.
“And the second I [was] told that, I got really depressed and stressed. I didn’t really tell anybody… but that’s when I started having suicidal thoughts.”
On August 17, Granada broke the chain of command and wrote an email directly to deputy fire chief Gary Fussell, the man he believed was blocking his access to care.
“It has been well over 2 months since I reached out to the department for help,” Granada wrote. “Two long months of waiting for something to happen while our administration has no sense of urgency or care.”
Three hours after Granada sent the email, McLay sent another email to the district chief in charge of health and safety, copying Granada. McLay seemed frustrated — both that Granada broke chain of command and at the administration’s slow response to Granada’s request.
“I will be totally honest with both of you,” McLay wrote. “Our department [takes people off shift] all the time. If a person was to ask [for] help for a substance abuse problem, he is immediately taken off shift and offered help. In this case, Josh is seeking help and the licensed mental health professional that he is seeing is recommending a beautiful opportunity for him to be with fellow workers and military to share stories and coping skills.”
But Granada wasn’t taken off duty. Instead, 10 days after that email, he made a mistake that would cost him his job.
It was a routine medical call. A woman didn’t check out of the penthouse suite at the Doubletree hotel near the theme parks, and she was unresponsive. When paramedics woke her up by rubbing her sternum with their knuckles, Granada says she started yelling. Granada pulled out his iPhone, started the audio recorder, and put it back in his pocket.
The patient refused treatment and everyone left. Back at the fire station, Granada played the recording for his coworkers at the dinner table before he deleted it, a possible violation of federal and state privacy laws.
The next day, an internal investigation was started. The patient he recorded was Orlando City Commissioner Regina Hill. Granada wrote an email admitting what happened and apologizing, saying it was “not a smart idea.” Hill filed a complaint with the Orlando Police Department, alleging Granada violated her privacy.
Granada was put on light duty while internal affairs investigators spent three months looking into what happened. During that time, he was finally able to go to the UCF Restores program for PTSD therapy.
Ultimately, Granda was fired for violating two department policies and for violating state law by recording someone without consent. He is currently suing the Orlando Fire Department in the Ninth Judicial Circuit Court in Orange County for wrongful termination, and alleging that the city violated a state law that protects people who file worker’s compensation claims from retaliation. The department has denied wrongdoing, saying in a pleading in response to Granada’s lawsuit that the city “is not liable because it also had valid, legal reasons for taking the adverse employment action.”
McLay, Granada’s boss, told a reporter that he would be not be able to speak without permission from the Orlando Fire Department. The department refused, citing the lawsuit. In court documents, the city denied that an official had said “PTSD is bullshit.”
If Granada is unsuccessful in court, his firing will have very real consequences: He will not be eligible for any kind of pension.
“The second I raised my hand and said something’s wrong with me in June, they should have pulled me off shift,” Granada said. “I should have been getting help. I never should have been allowed to run those calls, day in and day out, my head was not right, I can admit. My head’s still not right.”
In a job evaluation less than a month before Granada was fired, obtained by WMFE under Florida’s public records laws, McLay wrote that Granada was “without a doubt one of the department’s sharpest medics.” But he was having spontaneous outbursts, and McLay wrote that Granada “started to unravel” when there were delays getting into treatment.
“I do not think this is a true character of Josh,” McLay wrote. “I believe he is struggling inside and needing some guidance to get past this hurdle.”
Unlike Delgado and Granada, Gerry Realin didn’t arrive at Pulse during the shooting or its immediate aftermath. He worked inside the club after the shooting ended, when many of those first on scene had gone home.
He was part of a small Hazmat team within the Orlando Police Department that placed bodies and body parts into bags to go to the medical examiner for autopsy and identification. The building had no air conditioning, and the smell was choking. Wearing a white hazmat suit without a helmet, Realin spent four or five hours inside the nightclub, his boots turning yellow and then red from the blood and gore.
In the weeks that followed, Realin had nightmares, flashbacks and panic attacks. He tried to work but often called out sick or left early. After about two weeks, a doctor at a walk-in clinic diagnosed Realin with “acute post-traumatic stress disorder” and wrote that he couldn’t even work a desk job. The doctor referred him to a psychiatrist.
Realin, burning through his sick time, filed a worker’s compensation claim, and in August started doing interviews with the press about his struggles. He was relieved of duty with pay, meaning the department kept sending him a paycheck as long as he kept up with paperwork. (It didn’t legally have to do this under Florida’s worker’s compensation system at the time.)
Going public, though, came with a price. His wife, Jessica Realin, said the rumor among police officers was that her husband was a faker trying to game the system. Two psychiatrists wrote in their reports that the department’s treatment of Realin likely worsened his condition.
His union warned Realin that he could be put under surveillance, so he should be careful not to do anything that would appear to contradict his diagnosis. A union official wrote that he was worried Realin was getting bad advice that could cost him a disability pension.
The department got involved in Realin’s clinical care as well. Realin’s deputy chief, Orlando Rolon, met the Realins at a gas station in early September 2016. Rolon gave him a copy of a memo: It was a direct order to report to the Restores clinic for treatment.
“Gerry, as you know, the members of the law enforcement profession are exposed to horrible situations during their careers,” Rolon wrote in the memo. “I am confident that this program, that has helped many, will address some of your needs and for this reason I’m ordering you to participate. Your wellbeing is our top priority!”
At the gas station, Realin said he told Rolon he had already been to the clinic and didn’t want to go back. Things escalated. Rolon asked Realin if he was a threat to himself or others and, according to allegations in one of Realin’s two civil lawsuits against the city, threatened to have Realin involuntarily admitted to the hospital on a psychiatric hold.
Rolon told him about responding to a scene in which a 12-year-old had hung himself in a closet. Realin “needed to get over it and move on,” Realin said Rolon told him.
Rolon did not return phone calls or text messages for this story. Asked in an interview in September 2016 whether officers with PTSD should be eligible for worker’s compensation, he said, “I think it’s tough to be able to justify that when you are already expected to be exposed to so much that the average person may not be able to handle.”
In March 2017, Realin was ordered to report back to work for the city of Orlando. He would monitor city cameras for drivers who drift into bike lanes. Realin’s psychiatrist worried that Realin could witness fatal pedestrian accidents and recommended that he not report for the new job, so he did not.
That decision grabbed headlines: Orlando police officer with PTSD ordered back to work at City Hall — but he’s not going.
Dr. Noel Figueroa, Realin’s psychiatrist, wrote in his medical chart that, in his opinion, Realin was not able to work “at any job at this point. As far as I’m concerned, the patient is permanently unable to return to full duty.”
He continued: “The patient has been feeling ‘prosecuted’ [sic] by his employer throughout this process. The behaviors by the employer in the last 72 hours only have enhance [sic] his perceptions.”
Figueroa’s notes were included in one of Realin’s lawsuits against the city.
A year after the shooting, Realin said he hid from his children so they wouldn’t be traumatized by his rage or depression.
“It’s exhausting, physically and mentally,” Realin said. “But then there’s the moments you can’t control. The images or flashbacks or the nightmares that you don’t even know about, and your wife tells you the next day you were screaming or twitching all night.”
Realin’s fight with the city came to a head before Orlando’s Police Pension Fund Board in July 2017. Realin was asking for a line-of-duty pension, which would entitle him to 80 percent of his salary for the rest of his life.
Dr. Herndon Harding, one of the doctors hired by the city to perform an independent exam of Realin, wrote that Realin had a “dramatic, perhaps histrionic element to his presentation” that could have been “an attempt to demonstrate his pathology.” But he also wrote that one of the factors leading to Realin’s inability to function was “how much the role of OPD has contaminated this treatment.”
Steve McKillop, an outside attorney hired by the city of Orlando to fight the pension, argued that Realin never really wanted to get well. Getting a pension was his goal all along.
“Rather than accept the hand that has reached out to him, at every turn he’s utilized all means necessary to suit his goal of obtaining permanent, in the line of duty benefits so that he does not have to return to work as a police officer,” McKillop said to the board.
Ultimately, the board approved the disability pension, writing that Realin was permanently and totally disabled from police work in the line of duty because of PTSD. He was given 80 percent of his pay for the rest of his life: about $41,000 annually, after health insurance costs.
In one of Realin’s lawsuits against the city, filed in December 2017, he alleges that the way the department treated him worsened his condition and that the city violated a state law protecting people from being fired or threatened because they file worker’s compensation claims. In the other, he claims the city should cover his health insurance costs because he was disabled in the line of duty. The city is contesting the first lawsuit and hasn’t yet responded to the second, which was filed in May. Both suits were filed in the Ninth Judicial Circuit Court in Orange County.
In an interview with WMFE, Orlando police chief Mina wouldn’t comment on Realin’s case because of the ongoing lawsuits. But he said when an officer is injured, officials never worry about the financial burden on the city.
“No, any time an officer is injured or can’t perform, the financial aspect of that is never taken into consideration,” said Mina, who is a candidate for Orange County Sheriff this year. “What’s taken into consideration, by our pension board, which handles that, is was this an on-duty injury, did this happen in the line of duty, can this person go forward performing the job they were hired to do.”
In early 2017, firefighter EMT Brian Stilwell had requested a meeting with Orlando Fire Department Chief Williams to encourage him to commission an after-action review of the Pulse nightclub shooting and the department’s response to it.
Stilwell, as well as leaders of the firefighters’ union, thought the department needed an outside expert to come in and evaluate whether anything could have been done to reduce the death toll.
At the end of the conversation, Williams told Stilwell to take advantage of the city’s employee assistance program for free counseling if he needed it, or to go through the UCF Restores clinic. Williams said that if Stilwell needed time on light duty to go to the clinic, the department would work with him.
Stilwell was already going to the clinic. Sometimes, he’d wake up in the middle of the night and couldn’t get back to sleep because something would jar a memory of the shooting. At work, he would be shorter with patients. At home, he was curt with his wife, and would lose his temper.
“And I was like yeah, I’ve already been going to UCF, which he was kinda taken aback,” Stilwell said.
On the night of the shooting, Stilwell was one of four men inside Station 5, about 300 feet from Pulse nightclub. On any given night, they were close enough to hear the music and see the club from the dinner table. On June 12, they heard the gunfire and saw a flood of survivors running for their lives down the street.
The gunfire was so loud, the lieutenant working that night wouldn’t let them out to start treating patients until a few minutes passed and a police officer was out in front of the club with an assault rifle.
The firefighters and EMTs went to the triage area across the street, and helped the paramedics already there sort patients. Green tags meant a person was walking and stable. Yellow ones went to those who had serious injuries, but who were stable and could wait to go to the hospital. Red tags were for those people who needed to go to trauma surgery immediately or risked death. Black was reserved for those considered too far gone.
“Some of the people changed from being stable but serious to critical in front of us,” Stilwell said.
Stilwell had been open with his coworkers about getting treatment for PTSD, but he hadn’t formally told the department. In part, he says, that was because there’s no clear protocol on what happens when a first responder comes out and says he or she needs help. He wondered: If you file an injury report for PTSD, are you taken off shift to go into treatment?
Stilwell also worried about how peers would view him. If someone in his department had a heart attack six months earlier, no one would worry about whether he or she was still physically able to do the job.
“No, you go in, you fight the fire, you do whatever you have to, never crosses your mind,” Stilwell said. “But if you know a guy that had a mental breakdown or had some mental issues, the stigma is still like, ‘Oh, this guy’s weird.’”
Stilwell said the meeting with the chief was productive and didn’t lead to any negative consequences at work. He completed the Restores program and says he’s doing better.
Officer Alison Clarke with the Orlando Police Department is going through the Restores program now. She also was working the triage scene at Einstein Bros. Bagels. Clarke, an openly gay female who had previously worked at Pulse as an off-duty security officer, saw a flood of survivors knock down the fence outside the club.
“Of course, they were traumatized, screaming and crying, and not knowing where they were going,” Clarke said. “At that point I started asking for ambulances, and there weren’t any ambulances that were responding at that point. So we just started loading up patrol cars and [fellow officer] Jimmy Hyland’s pickup truck and started running people to the hospital.”
Clarke was able to work through her PTSD with a counselor provided by the city’s Employee Assistance Program. She stopped working the night shift, and had gotten to the point where she was only seeing a counselor sporadically.
But then trauma hit again. In January of 2017, her boss Lt. Debra Clayton was tracking a man in an Orlando Walmart who was wanted for killing his pregnant ex-girlfriend.
Clarke heard the gunshots over the radio as her lieutenant was shot. When she got to the Walmart, she held Clayton’s hand while others performed CPR. Clarke escorted the ambulance to the hospital, where Clayton was pronounced dead.
Afterward, the anxiety and agitation came back, with a new symptom — hypervigilance. Clarke would think the worst was going to happen on each call. Knocking on a door for a noise complaint, she’d worry that someone on the other side would shoot her through the door. She went to a psychiatrist, who prescribed Prozac.
“Now I’ve seen it twice,” Clarke said. “My first look at evil was Pulse, and then my second look at evil was the day that Debra was killed. So I know it’s there. I’ve seen it. I’ve experienced it. So now my brain thinks the worst thing’s gonna happen when you’re out on the street.”
In February of this year, she responded to what she came to believe was a man who wanted an officer to shoot him, sometimes called “attempted suicide by cop.” The man was holding his hands behind his back, acting like he had a weapon. Clarke drew her pistol. He kept yelling: “You know you want to shoot me, you know you want to shoot me.”
Ultimately, the man was subdued with a Taser, and no one was seriously hurt. He was found to be unarmed.
“The moment the handcuffs went on and I was able to take a deep breath and realize that the situation was safe, my anxiety, I just full on had just a like a huge anxiety, panic attack. I couldn’t get the adrenaline and my anxiety to calm down,” Clarke said.
As she was walking to the patrol car, she thought: This was it. I can’t be an initial responder. It was her last shift as a patrol officer.
Clarke asked to be put on light duty while she went through the Restores program, and the department agreed.
“It came to a choice where I could either keep suffering and ruin my home life or step forward and take the help being offered by the department,” Clarke said. “Not just the department, the whole community.”
Josh Granada has been teaching classes for paramedics and EMTs since he was fired from the Orlando Fire Department. He and his wife are having trouble making ends meet, so they’re planning to sell their house and move in with Amber’s father before they fall behind on the mortgage.
He leans on his therapy dog, Jack, which he got from the Pawsitive Action Foundation, a group that provides service dogs for veterans and people with disabilities.
Omar Delgado got a dog from the same group: Jediah.
On the days when Delgado has trouble getting out of bed, shaving or brushing his teeth, the dog gives him the motivation he needs, he said. Since he was terminated from the Eatonville Police Department, Delgado has been living off the proceeds of a GoFundMe campaign. He’s stuck in limbo, waiting to see if his disability pension will be approved. Once that happens, he’ll be able to decide what’s next.
“We cut back on everything humanly possible,” Delgado said. “It’s rough. We gotta keep going. What else is there?”
Alison Clarke has accepted a position as a police department liaison to the LGBTQ community. She no longer works on patrol, and when she’s ready to put a uniform back on, she plans to finish out her career at the Orlando Airport. To help cope, she drives her Mazda Miata with the top down, or takes an hour at the driving range, hitting golf balls with her headphones on.
After policing, she plans to work as a counselor to help other officers.
“I’ll never be the same [as] before Pulse,” Clarke said. “You can recover to a certain extent. At least for me, I can recover to a certain extent. But I know that I’ll always have some type of small anxiety issue. It’s just learning how to live with it and function with it.”
To cope, Gerry Realin goes out paddleboarding and fishing. Walking ankle deep in saltwater in Webster Creek, north of Mosquito Lagoon and the Canaveral National Seashore, Realin casts out into the channel with a lure, hoping to catch redfish, jack and trout.
He sleeps better on the nights he fishes.
“I used to have pressure in my mind. I better hurry up and heal,” Realin said. “But how? How do you hurry that up? With some physical injuries, you kinda know. Tear a hamstring, you’re out six months. Sprain your ankle, couple weeks. But for this? I don’t know.”
Realin’s wife has become a crusader. After realizing that Florida’s workers’ compensation law didn’t cover lost wages for PTSD and mental conditions, Jessica Realin set out to change the law, and is running for local office. Under a law signed by Gov. Rick Scott in March, first responders will soon become eligible for these benefits.
Brian Stilwell has found healthy ways to cope. He rebuilds classic cars and plays drums. He still works for the Orlando Fire Department, but he’s been transferred away from Station 5. Now, he’s at a small station in an old Navy base, what he calls “the last stop on a trip to nowhere.” He wants to go back to Station 5.
That station, so close to Pulse nightclub, feels like home to him.
“I feel a bigger connection to that area and that community now because of that,” Stilwell said. “It feels like the station is a part of me now, not something I want to leave.”
As the two-year mark for the shooting approaches, Stilwell says he may go back to UCF Restores for more treatment. The anniversary, he says, is bringing things back to the surface again.
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