The ups, the downs, the minutia

She sat in her chair, looking out the window, waiting for the end. Thirty-seven years old, less than a hundred pounds, tired, depressed and dying. She wanted to stay at home, but her condition required a trip to the hospital, perhaps her last. Stone cold eyes greeted me, eyes that had given up the fight and were resigned to stop seeing the world as a place where life happened, and satisfaction waited for those willing to see it.

“Joanne, we have to go.” I said.

A slight nod, a willingness to cooperate and nothing more. Joanne’s mother stood to the side and let us package her daughter for delivery. It had been a long battle, and the wounds earned from fighting it were worn on both women’s faces, heavy eyes, lips that hadn’t seen a smile in far too long, matching expressions of disappointment, fear and anger.


Russian playwright Anton Chekov said, “Any idiot can face a crisis – it’s this day-to-day living that wears you out.” Chekov knew that it is not the stress of action that will bring a person down, it is the monotony of inaction.

An often-overlooked part of the equation of stress in EMS is the repetitive nature of our calling. Most of the patients we treat and transport – or simply transport (after assessing vital signs) – do not need emergency care. But they still need care, and it is completely up to the provider how well that care is given and received. It is not the people we are called to treat who wear us down; it is ourselves, often from the inability to see through the minutia of protocols, reports and procedures.

Every patient has the potential to affect a provider in ways that go far beyond the obvious. Traumatic situations can have traumatic consequences for the patient and provider. Much more desirable is the positive outcome and subsequent exhilaration for the provider, and satisfaction for the patient that it brings. The rollercoaster of life in EMS is what draws us to it, what we want and what we hope for. It is up to us to grasp it, and to understand that it always presents itself, sometimes in ways we never imagined.


“Are you afraid?” I asked Joanne, once I made sure she was comfortable and stable.

“Terrified,” she replied.

Our eyes remained locked for more than what is considered normal, but it wasn’t uncomfortable. There is a special kind of intimacy that can only be shared by strangers who share no baggage, no expectations, no regrets. There is no fear of disappointing loved ones, or burdening them with grief. Honesty hurts sometimes, and the closer the persons sharing it, the more it hurts.

“Thank you for asking,” she said, and the tension that created her new look; the one formed by pain and worry, eased, just a little, revealing a hint of the person before the disease.

I stayed on the bench seat during transport, my knees on the edge of her stretcher; she closed her eyes and rested. It was a quick ride, a silent ride, but not a ride without significance. We are not in the business of transporting commodities; we transport people, all of them, every molecule, thought, experience, emotion and desire, and sometimes, their resignation. Her mother waited when we arrived, and I sensed a change in the energy between them.

Sometimes I wonder if I’m kidding myself, and that I imagine things that simply do not exist. Then there are those moments when I am absolutely positive that something can be drawn upon to make this difficult, heartbreaking journey that always, without fail, ends the same way for all of us, a little more bearable.

Any idiot can last a few years in EMS, it’s those who allow themselves to luxury to feel the magic who survive.

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