The Things They Carry: PTSD in the Fire Service

Firefighters run toward destruction, injury and death, and it takes a toll on their mental health — particularly in Rhode Island, where a generation was touched by the Station nightclub fire.

Charlie Cornell, a fourth-generation firefighter, knew how to put a front on, too. He was a “suck it up, buttercup” kind of guy — a macho man doing a macho job. The Alec Baldwin look-alike loved the work.

“That’s why I didn’t talk for a while,” Cornell, forty-seven, says in a phone interview from an inpatient facility in Pennsylvania. “The stigma — it’s such a small state. The machoism will ruin us. I’m guilty of it also.”

For the last five years, Cornell has been in and out of treatment centers locally and in Texas, Florida, Massachusetts, Vermont, Pennsylvania and Maryland — the latter, a union-supported facility modeled after a firehouse — to treat complex PTSD and suicidal ideations. Cornell served under Jerry Tellier in West Warwick and was a year into his career when the Station fire struck. He covered the firehouse while his brothers-in-arms battled the blaze and counted victims, including friends of his who died there that night.

Cornell carried survivor’s guilt, along with a string of tragic calls involving children, with him for a decade. But his breaking point came when the department moved from a ten- and twelve-hour schedule to twenty-four-hour shifts, which younger firefighters and the town supported. Longer shifts meant firefighters would call out less, saving the cash-strapped town when, at the time, it neared junk-bond credit ratings for a grossly underfunded pension plan.

Cornell developed sleep apnea, which required the use of a full-face sleep mask. In the dead of night, it felt like a firefighter’s respirator. He began having vivid nightmares and, recognizing the mask was triggering him, switched to a smaller design. It didn’t do any good; the nightmares worsened and, not long after, they became full-blown hallucinations. His wife would be startled awake to find him performing CPR in bed. The episodes frightened his two young daughters.

Cornell began binge-drinking himself to sleep, often in the morning after a shift. As he tried to suppress bad calls of the past, new ones accumulated. He remembers responding to a baby who didn’t make it, returning to the firehouse and brewing a pot of coffee.

“Anne [Balboni] would come to the station, and I blame us because we’d sit there and not say anything,” he says. “We’d yes them to death because it’s not a thing to do.”

PTSD

Kristen, Emmerson and Madison Cornell at their home in Bristol. Photography by Michael Cevoli.

His wife, Kristen, a fourth-grade teacher in Tiverton who was, at the time, recovering from cancer, reached her breaking point. Per the recommendation of Cornell’s union president, she “put him on a plane” — a common euphemism in the fire service, she says — to a rehabilitation facility in Texas. His providers told him the drinking was a symptom of complex PTSD, a form that develops in response to repeated traumas and is treatment-resistant. Traditional medications did not work for Cornell, but transcranial magnetism, which uses magnets to stimulate the part of the brain damaged by stress, has.
 He eventually went out on an on-the-job injury for PTSD and, after eighteen months, he was forced to retire. In and out of facilities he went, often for thirty days at a time. He would do well, come home and spiral.

The town required Cornell to get preauthorization from human resources for all treatments, a process that’s West Warwick-specific; preauthorization is not mandated by Blue Cross/Blue Shield of Rhode Island or the Rhode Island Interlocal Trust, an insurance broker pooled by many local towns. The process could take days, and there was no way around it; they never received an insurance card.

When her husband was in crisis, Kristen says she resorted to using her own insurance to cover his treatments, expecting reimbursement from West Warwick. She realized quickly the town wasn’t paying the claims to his insurance or her requests for compensation. Thousands of dollars in medical debt accrued in their mailbox and the family eventually filed Chapter 7 bankruptcy.

This summer, after a promising stint in a Florida behavioral health facility, the Cornells met with West Warwick officials to sign a memorandum of agreement, which holds the town liable for treatments billed up to Cornell’s retirement in April of 2018. (As of press time, Kristen says the town has not responded to requests for payment on a single past-due bill. West Warwick town manager, Ernest Zmyslinski, declined to comment on personnel matters.) The Cornells will need a lawyer for the rest, including a golden retriever they paid for out of pocket but cannot afford to train as a service dog.

By the time of the meeting with the town, Cornell was already strained by an incident on the Fourth of July, when a motorcyclist was struck and killed in front of his mother-in-law’s house in Bristol. He heard the bang from the backyard and sprinted to the street in his wet bathing suit. His family had to pull him back inside. The meeting sent him over the edge, and he returned to Florida for inpatient observation and treatment. When his thirty days were up, he transferred to a facility in Pennsylvania.

“I’ve learned that it’s an injury, but it’s something that’s bothered me for a while because I don’t want to walk around with that label,” Cornell says. “Firemen don’t like to go out on mental injury. I’d rather fall through a roof or break my back. If I had a broken back, they’d be paying for it.”

Kristen, who met her husband before he was a firefighter, says he never talked about what he saw. Then, during a recent joint session with a therapist, he described the scenes that replayed in his mind. She says she ran from the room to vomit.

“It kills me that this job took my husband from me,” she says from their home in Bristol, a pretty Colonial the couple built when they were first married. She and her two daughters have been diagnosed with secondary PTSD and, at age thirteen, their youngest, Emmerson, says she never really got to know her dad. Their oldest, Madison, wrote her college essay about her family’s experience — a “beautiful nightmare,” she wrote, that has inspired her to pursue a degree in neuroscience. In early January, Madison earned scholarships to URI and Stonehill College, both of which cited the essay as a factor in her acceptance.

In December, Cornell came home. He’d been stepped down from inpatient treatment to an outpatient program, which would cost the family $600 per week in room and board — a sum they couldn’t afford. Cornell, who thrived in the inpatient setting, jumped back into the family’s routine and didn’t want to go for treatment in Providence. He spent Christmas with unsympathetic relatives — also first responders, Kristen says — and he had a breakdown. He was losing hope that he’d ever get better and decided self-medication was the only option. He told his wife he wanted it all to be over. But after two weeks of police wellness checks, suicidal thoughts and an emergency room stay, he reached out to the Pennsylvania facility and surrendered himself to treatment.

In spite of it all, Cornell — who, to this day, sleeps with one foot on the floor — says being a firefighter was still the best job in the world.

“I will never complain about it, and I’d do it again if I could,” he says. “I would just do it a different way. It caught up to me, that’s all.”

 

Kathleen Carty, a therapist specializing in trauma, substance abuse and mental health based in Warwick, says if more firefighters got treatment immediately, there would be fewer cases of severe PTSD and suicide. Acute stress disorder — the precursor to PTSD, with symptoms including avoidance, hyper-vigilance, negative moods and flashbacks or nightmares — can be contained, she says. But, if left to fester, acute stress opens the door for PTSD, which is long-term.

It’s not just stigma that prevents early treatment. Carty says some benefits gatekeepers have tried to negotiate her recommended six weeks of intensive therapy for acute stress down to three.
“This isn’t ‘Let’s Make a Deal,’ ” Carty says. “I think it’s ignorance. They just don’t know.”

Recently, a town official told her a firefighter couldn’t have PTSD because he wasn’t in the military. She waited a few hours — “so I wasn’t just spewing hellfire,” she says — before emailing the Diagnostic and Statistical Manual of Mental Disorders’ criteria, which do not denote profession. Carty says the towns’ and cities’ resistance doesn’t make sense.

Firefighters want to return to work. Plus, PTSD is more common in firefighters with a decade or more of experience; training their replacements would take time and money.

“When people mock or belittle firefighters and say, ‘Oh, I saw them sitting on a lounge chair outside,’ do you know what they did an hour before?” she says. “When that guy shows up at your house, are you going to be like, ‘Were you the one on the lounge chair?’ No.”

State Representative Stephen Casey says he expects to confront the same ideas on Capitol Hill. At press time, Casey and his legislative counsel were assembling a bill that would guarantee workers’ compensation benefits to first responders who have been diagnosed with PTSD. Each town and city handles PTSD claims differently; the bill would leave little room for pushback. Five states have passed such legislation, including Florida and Connecticut.

“I expect the public backlash and that’s okay,” Casey says.

When asked for comment on the bill, Governor Gina Raimondo said, in part, “Our first responders face unique challenges due to the nature of their jobs, and it’s critical that we recognize their needs and ensure access to support services.”

The bill hits home for Casey, who works as a firefighter in Woonsocket and whose union president died by suicide in June.

“All our guys were on shift and went to his house and subsequently to the hospital after the pronouncing, so to speak,” he says. “It was very difficult.”

Casey, who’s been in the fire service for fourteen years, says he’s seen it all, from fatal boating accidents and motorcycle crashes to suicides by hanging. The call that stuck with him the most involved a little boy who died on the kitchen floor as Casey tried to revive him.

“You discuss it amongst yourselves; it’s part of the protocol,” he says. “But at times I think there’s that machismo that everyone wants to say they’re okay and not talk about it.”

Nobody, he says, wants to be the one who went down at the fire — or after it.

“I think we all have a slight sense of invincibility,” he says. “There are people who think we are heroes, and I think we feel in the back of our minds that we have to uphold that.”

 

Despite everything he’s been through, Jerry’s still a fireman.

Last June, Jerry, Ann, their two kids and their daughter-in-law traveled to Portugal for vacation. On their first day on an island in the Azores, the family set out on a guided car tour. They ascended a bluff to a lookout, walked around for fifteen minutes, returned to the car and, on the way back down, passed a woman screaming and crying. Jerry and his thirty-two-year-old son jumped out before their car came to a full stop.

They ran to the woman who, in translated Portuguese, said her husband fell off the cliff. Father and son scrambled 100 feet down and hit barbed wire. Then, sixty-year-old Jerry kicked out his legs and slid the rest of the way.

“He was screaming from 200 feet down, ‘I’m alright,’ ” recalls his son, also named Jerry, from the kitchen table in his parents’ ranch-style house in West Warwick. His dad clicks around on a nearby computer searching for photos from the day.

It turns out, the man didn’t fall. He jumped 300 feet to his death. Later, they learned he was a cop who’d been out of work for two years on mental injury. He’d turned to his wife, with whom he was walking, said “I’m sorry,” and sprinted toward death.

In spite of the day’s tragedy — eerie in its coincidence, the family’s private nightmare played out before their eyes — Jerry was okay. He’s in a better place than he was a year ago, five years ago, ten years ago, twenty years ago.

“I don’t think we’re necessarily at the end of the rainbow…. But we’re here together,” says his son.

These days, Jerry’s PTSD manifests in different ways — protective ones, like the complaints he filed about blocked emergency exits at a toy convention in Raynham. Everywhere he goes, he must see an alternative exit. He looks at the woman with a walker and the man with a cane and wonders if, in an emergency, they’ll fall and initiate a ripple effect, trapping everyone inside. And he’s passed this worldview onto his kids and wife.

“We went out to dinner one night,” Ann says. “I looked around and said, ‘Hey Jer, how are we gonna get out of here?’ ”

He pointed to little doors leading to a glassed-in window display. They weren’t marked exits, but Jerry would put Ann through one of those windows if he had to.

Jerry’s experiences are his own; firefighters can be on the same call and have different reactions, he says. Even now, as a retiree, he’s triggered by things that wouldn’t bother everyone. Pyrotechnics are an obvious one. In 2010, legislators and then-Governor Donald Carcieri lifted the ban on Class C fireworks, a decision that infuriates Jerry to this day.

“Everybody’s looking at the almighty buck,” he says. “It’s a personal thing.”

In general, he says, people don’t understand. Not friends of his, who told him to his face that he’s a fake. And not the general public, who wonder why so many firefighters are out when there are fewer fires. Since 2017, more firefighters have died by their own hands than in the line of duty. As one advocate put it, we know how to protect their bodies; we just haven’t figured out how to protect their minds.

He’s seen the worst-case scenario. He’s thought, nothing can top that. But Jerry wants to know: What are you scared of?

Chances are, it’s not a nightclub fire. Chances are, it’s Sandy Hook or Pulse or Aurora.

“You’re out with your spouse. You’re at a nice party. Someone loses their mind and shoots up the place,” he says. “The world’s changing. If you don’t think it can happen here, you’re wrong.”

If it does, firefighters will respond. And, have no doubt, Jerry says: They’ll carry what they see with them. “And it’ll be,” he pauses, looking down at his clasped hands, “it’ll be ’til the day we die.”

 

If you or someone you know is experiencing a mental health crisis or thoughts of suicide, call the 24/7 BH Link hotline at 401-414-LINK. R.I. union firefighters can call 1-833-RISAFF1 for confidential referrals.

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