Former Army medic, firefighter grapples with PTSD but still tries to be of service
By JOHN KEILMAN | Chicago Tribune | Published: January 3, 2020
(Tribune News Service) — The morning sky was the color of lead, the air was barely above freezing and the only sound was the crunch of dead leaves as Ryan Mains began a 10-mile run through Crystal Lake’s Veteran Acres Park.
He has come here for years to build his stamina on the park’s steep hills, preparing for races that stretch well beyond a marathon. But he also treasures the stillness. When he runs, observed by a few placid deer and the occasional owl, the memories that trouble him vanish like mist.
They always come back, though. He can never run far enough to escape them completely.
Mains, 39, is a veteran of the Iraq war and a longtime Woodstock, Illinois, firefighter and paramedic who has been diagnosed with a severe case of post-traumatic stress disorder. The symptoms built slowly over years, ultimately becoming so pronounced that a few months ago Mains had to leave the job that he loved.
He’s now getting treatment while seeking worker’s compensation and a disability pension, but success is no sure thing: Unlike other states, Illinois does not treat PTSD as a “presumptive” condition, meaning firefighters must prove that their suffering is indeed the result of their work.
It’s a complicated and time-consuming process, and the bills don’t stop while it’s playing out. Though his colleagues at the firehouse have donated vacation days and sick time to keep the family afloat, Mains and his wife, Danielle, have had to cut their household budget to the bone.
“It does get to a point for a lot of injured people where it creates a financial burden,” said attorney Barry Ketter, who is representing Mains on his worker’s compensation claim. “Some of them never get out of it.”
But PTSD carries hazards greater than bankruptcy. Researchers have linked the disorder to an increased risk of suicide, and according to the Firefighter Behavioral Health Alliance, 124 firefighters and EMS personnel have taken their own lives so far this year.
That grim statistic is serving as motivation for Mains. On May 30, he plans to run 1 kilometer for every firefighter and paramedic who dies by suicide in 2019. So far, that distance works out to just over 77 miles — more than twice as far as he’s ever gone.
The event, which he has dubbed “Run for Our Lives,” is being spurred by twin goals: to raise money for an organization that aids Chicago-area firefighters in distress, and to put a face on a condition that is still cloaked in secrecy and shame.
“It’s really been cathartic,” he said. “People reach out to us all the time. I’ve had strangers send me messages via social media, sharing their deepest, darkest secrets because I put myself (out there). It makes me feel like I’m helping people while I’m helping myself.”
Son of a firefighter
Mains grew up in Burlington, Illinois, a village of a few hundred people halfway between Elgin and DeKalb. His father was a volunteer firefighter there before going full time with the Downers Grove Fire Department, and Mains spent plenty of time in his early years hanging out among engines and ambulances.
In 1999, a year after graduating from high school, he joined the Army to be trained as a medic, thinking it might eventually lead to a career as a first responder. But then came 9/11, and 18 months later, the invasion of Iraq.
Mains, a member of the 3rd Infantry Division, accompanied troops pushing toward Baghdad, patching up comrades, enemy forces and civilians alike who fell victim to gunfire and other violence. He said he had his own near-misses, from shells that exploded near his convoy to gunmen who took wild potshots from passing pickup trucks.
What affected him most, though, was the suffering of others, especially children.
He recalled one episode in Baghdad when a truck carrying an Iraqi family at high speed ran into the back of a Bradley fighting vehicle. When Mains tried to lift a young girl from the wreckage, he saw that her head was gone.
But there was little time to work through such experiences. He was in a war zone, so like many of his fellow soldiers, he pushed the shock and hurt deep into his mind and carried on.
“There’s a lot of pressure and a lot of stress,” said Thor Swetnam, who served with Mains in Iraq. “You do what you have to. When you’re doing it, you’re not going to process anything.”
Mains left the Army in late 2003 when his four-year enlistment was up. He took courses to get certified as a paramedic and firefighter, and in 2005, accepted a job with the Woodstock Fire and Rescue District.
It felt like a perfect match. He enjoyed the firehouse camaraderie and the bursts of action, and for years, all was well. The Iraq memories rarely surfaced, and even calls that ended sadly didn’t seem to leave a mark. He married Danielle, and they had the first of their two children.
But then, in 2012, came two especially tough calls. First, he responded to a hit-and-run in which a 6-year-old boy was killed. It was the first time a child had died under Mains’ care as a civilian paramedic, and it was shattering.
Then, on his next shift, he was called to attend to the 83-year-old woman who had just learned that she had killed the boy (she had thought she hit a tree branch, according to news reports). Witnessing her anguish, he said, was as hard as working on the dying child.
From there, repressed horrors leaked out. His sleep grew troubled. He became snappish over minor irritations and hypersensitive to the slightest possibility of danger.
Mains tried to pull himself out of it. He participated in “critical incident stress debriefings,” in which firefighters try to process emotionally taxing calls, and went to counseling sessions on his own.
“I thought I was doing the right things,” he said. “I thought I was checking the box. But I was never really opening up. I don’t think I realized that until I hit rock bottom.”
High risk of trauma
There are no definitive numbers about how many firefighters suffer from PTSD — estimates range from 6% to 37% — but experts agree the rate is far higher than that of the general population.
Brad Schmidt, director of the Anxiety and Behavioral Health Clinic at Florida State University, has researched the phenomenon. He said while it’s not clear why trauma hits some especially hard, almost everyone will show symptoms if the events are frequent and intense enough.
“Most of these guys will begin to experience stuff, but they’ll try to manage,” he said. “Not infrequently, it becomes too terrible to compensate on their own.”
Mains’ coping mechanism was running. He had learned to enjoy it in the Army, and after years of doing 5K and 10K events, became drawn to ultra-marathons — races that exceed the 26.2-mile distance of the marathon.
“You just find out how far you can push yourself,” he said. “It gives me time to be out there, just chasing that runner’s high. I don’t want to sound cheesy, but it’s a form of spirituality.”
But ultra-marathons also appeal to those grappling with demons. Mains’ coach, Denise Smith of Smith Physical Therapy and Running Academy, said Mains’ running gradually seemed to become a self-inflicted punishment instead of a pleasure.
By April, what had bubbled for years beneath the surface burst into a crisis. At work, his colleague Jake Biederer noticed that his eyes were sunken and miserable. At home, he was lethargic and despondent, ignoring his family to scroll through his phone for hours on end.
Finally, he couldn’t get out of bed. Thoughts of suicide swirled through this mind. He had become a problem, he thought. Wouldn’t everyone be better off if he were no longer around?
He said nothing, but his wife knew something was wrong.
“He had called in sick the day before and was still in bed that day,” Danielle Mains said. “I couldn’t shake a weird feeling that something was going to happen.”
She called Illinois Firefighter Peer Support, an organization that assists first responders in turmoil, and a former firefighter got Mains on the phone. Mains denied he was suicidal, fearing his colleagues would find out if he were hospitalized, but agreed to accept help.
Two days later he was on a plane to the East Coast, bound for a treatment program created for people just like him.
The International Association of Fire Fighters Center of Excellence for Behavioral Health Treatment and Recovery sits in the woods of Upper Marlboro, Maryland. It opened in 2017 to give firefighters the help they have a hard time finding elsewhere.
Doug Stern, a spokesman for the association, said the setup is meant to mirror life in the firehouse, including sleeping areas that look like a bunkhouse. The idea is to create a sense of fraternity that will help patients engage with their problems.
The program combines psychotherapy with approaches such as meditation and art therapy. Supported by his fellow firefighters, Mains finally was able to admit what he had been going through.
“I fully supported ending the stigma (against PTSD) until it was me,” he said. “Once I realized that’s what I was doing, it helped me stop doing it.”
He was at the center for a month, and when he came back, he returned to work. His first week back was rough, but when he got through it, he thought he was fixed.
He wasn’t. As the months went by, things he once shook off festered in his mind. In October, “halfway between having a grip and being a sobbing mess,” he went to see a therapist.
She told him it was time to stop. He was no longer fit for duty.
He resumed treatment, this time at AMITA Health Alexian Brothers Behavioral Health Hospital in Hoffman Estates. There, patients work through their PTSD with exposure therapy, talking about their traumas with increasing specificity.
“Basically, while the person repeatedly confronts the trigger, they begin to learn different and more healthy ways of coping with the actual experience,” said David Ferenciak, a clinical therapist working with Mains.
One recent afternoon, the two sat across from each other in a small office while Mains talked about the first U.S. soldier he saw killed in Iraq — an Army private caught in an ambush. Mains had barely started working on him when an officer told him the man was too far gone to save.
“I kind of felt guilty,” he said. “I didn’t agree with the decision to not try. I understand now, I probably understood then, why the decision was made. There wasn’t anything more we could have done. He’d been bleeding far too long, far too much, that there wasn’t anything we were going to do.”
Ferenciak asked Mains to put a number on the level of distress he was feeling.
“Probably like an 8.”
“Are there any physical sensations of anxiety occurring right now?”
“Uh, yeah, I’ve kind of got that awful pit in my stomach.”
“OK, got it,” Ferenciak said. “Obviously it’s important to allow that feeling to be there. Don’t resist it. Let it run its course.”
The exercise lasted about 30 minutes. Mains’ distress level slowly decreased, but at the end he was exhausted. Ferenciak said that reflected the hard work Mains has put into his recovery.
“Right off the bat, Ryan displayed this tremendous amount of motivation and determination,” Ferenciak said. “He was going to do whatever it took.”
Despite his improvement, Mains said he won’t be able to return to firefighting; until recently, Danielle Mains said, he couldn’t even drive through Woodstock without being triggered. So he is seeking a disability pension that will pay him 65% of his salary and allow him to move on from the fire service.
Tom Radja, his attorney in the pension case, said three doctors will ultimately evaluate whether he is entitled to benefits.
“In a PTSD case, it really comes down to the opinions of the medical providers,” he said. “It’s really difficult to say at this point how it will go. What I know about Ryan and the incidents he’s been involved in, I’m confident he’s entitled to a line of duty pension. But I’m not a doctor.”
The Woodstock Firefighter’s Pension Board referred questions to its attorney, who did not return a message left by the Tribune.
Matt Olson of the Associated Fire Fighters of Illinois said the union might ask the General Assembly for help with the issue, noting that other states, such as Minnesota, have eased the way for first responders seeking benefits for PTSD.
“We need to get our arms around it before it gets much worse,” he said. “The truth of the matter is we hire people who care. … We can’t continue to be surprised that they hurt.”
Mains said he has accepted that he will never be fully cured of his PTSD, but he sees progress. When anger flares for no reason, he meditates until it subsides. He no longer hides his condition from his children, but talks with them about his emotions and treatment; his 8-year-old son calls the Alexian Brothers program “calm-down school.”
Running has been a big part of his recovery. As Mains prepares for his solo ultra-marathon, which will raise money for Illinois Firefighter Peer Support, Smith says he appears to have recaptured the joy of the sport, noting a photo he posted on Instagram earlier this month of a random Christmas ornament he came across during a training session.
“Finally, the Ryan who appreciated the small things about the beauty of running was back,” she said.
About halfway into his recent trail run, he paused at a ledge overlooking a broad vista bristling with pines and denuded oaks. The panorama was as pristine as the dawn of time.
“It’s by far my favorite spot in the county,” Mains said. “You can see forever, or at least as far as McHenry County goes. I don’t know. There’s just something about it. The combination of the trees and the elevation — it’s really peaceful.”
He lingered for a few minutes and then headed back down the path. The day was still young, and there was still so far to go.