A Thousand Naked Strangers: a Paramedic's Wild Ride to the Edge and Back

Salvation comes through repetition. This I can do because I have done it before—it's half prayer, half truth, a whisper in a hurricane of self-doubt.

Invited as we are into their disparate lives, we'll not only treat them, save them, and pronounce them dead; we'll also learn from them.

But as always, lessons are drawn from mistakes, not victories.

Medicine's great magic trick is how it convinces us we're here saving lives when more often what we're doing is witnessing death.

Life is a series of cycles—each nothing but new people, new memories, and eventually, a new ending.

How bittersweet it is to have found what we've been looking for, only for it to be dead on arrival.

It's all so new, so foreign, so much like that period of childhood -first or second grade, maybe- when you're old enough to know you're alive and one day will die, yet young enough to still believe that a thin vein of magic runs just beneath the surface. Everything crackles with the electric charge of wonder.

Disturbing as it may be, the raw truth is that often enough, the people showing up to your medical emergency do so because this was the only respectable job they could get with a GED and a clean driving record.

We're nothing but meat, and if circumstances allow, we'll end up no different than a possum lying on the roadside.

Dogs are loyal, humans are a pain in the ass.

EMS is medicine as modern anthropology.

[...] we can't just treat patients; we must study them. Learn their language, their habits, their streets and houses, their peculiar beliefs, tears, and failings.

I miss the madness. I miss being out at night, running through streets alive with the dead and dying, the drunk, the crazy, the angry, those in need, and those who only think they are. I miss the distant pop of a pistol and the long fading howl of a dealer who’s spotted a cop. I miss fighting meth heads in seedy motels, I miss the crack houses and flophouses, the chaos of a shooting scene. I miss the projects after dark. I miss the sense of duty, of honor, of humor, the sense of having lost myself somewhere, somehow, in a very strange world. I even miss the fear of mistakes. Whatever it was that brought us here, it’s everything else that kept us around.

Death cracks inside jokes that only we emergency workers—with our practical knowledge of the postmortem human—will ever laugh at. I

Medics don't have to be heroic or tough or even good people. They simply have to enjoy the madness.

Counted among those killed in the World Trade Center of September 11, 2001, were forty-three paramedics and EMTs. Godspeed.

So why are medics here? Because panic and death, near death, even your own, is a peculiar drug, and whether or not it’s what the injured and the sick and the desperate want to hear, the people who show up do so because they like it. Disasters, even the small ones, mean freedom. Freedom to bend the rules, break the rules, disregard the rules. Maybe I don’t even know the rules, just make them up as I go along. The people who stay are the ones who like those moments and all that comes with them, even the hard parts.

Medics don’t have to be heroic or tough or even good people. They simply have to enjoy the madness. The normal reaction to gunshots or screaming or house fires or someone collapsing in a messy heap is to get away, to back off, not necessarily to ignore it, perhaps, but not to stumble in half-cocked. And really—aside from a driver’s license and a high school diploma—that’s what this job takes. A willingness to walk in unprotected when we clearly should walk away. A desire to take part but just as often to bear witness.

Everyone who sticks around and anyone who’s ever left and considered a comeback knows that there are better places—and better money—in almost any other aspect of the medical field. So why stay? Because the modern world is orderly and practical. The sun goes up, the sun goes down, bills are due, the carpool line starts over there. But it’s not so for everyone, and once I realized that, it was hard to walk away.

Those who return are labeled retreads. Asked to explain why they’re back, they’d say it was because they missed the medicine: the IVs and the drugs, the competence, and the unquestioned confidence they earned through years of experience that did them no good anywhere else. Turns out in the real world, you don’t get to snake a breathing tube down a dying woman’s throat. When you have a regular job, no one gets shot dead in the clay or has back-to-back seizures in the county jail. No one hands you their limp child and places not only their trust but their entire world in your hands. Which is too bad. There’s a strange exhilaration not just in having done those things and done them well but in knowing that eventually you’ll be called on to do them again.

Medicine’s great magic trick is how it convinces us we’re here saving lives when more often what we’re doing is witnessing death. Over time, shock wears thin, empathy recedes, and a human being becomes nothing more than something I carry home in the tread of my right boot. This is my new normal, the resting heart rate of my psyche. It’s my state of mind as I wonder whether this job’s worth it.

For years now, during my workweek, we’ve been ships passing in the night, our interactions reduced to handwritten notes—at once sarcastic and quotidian—scribbled on a pad and left on the counter. Each one is equal parts to-do list, love letter, and death threat: a conjugal visit in imperfect cursive.

if you spend enough time around lunatics, their normal slowly becomes your normal.

We drive to a place where we can stare through the windshield and watch the world pass by. All the while, the radio chatters, it never stops chattering—the dispatch radio is like a thirteen-year-old girl at a sleepover. Tonight we’re lucky; everyone else is getting the calls.

One: Know your protocols. Two: Don’t second-guess yourself. Three: Never let ’em see you sweat.

The shithole he’s referring to is an area known locally as the Bluff—five square miles of drug houses, flophouses, abandoned buildings, squatters, drugs, violence, desperation, and the constant woop-woop of sirens. The Bluff is Atlanta’s answer to Compton, to Chicago’s South Side, and to the Heartland’s countless and nameless meth-riddled trailer parks. It is where all of Atlanta’s heroin is sold and most of its crack is consumed. People here live in aging projects or derelict bungalows; when they aren’t getting into trouble, Pike says, they’re calling 911.

Grady Memorial Hospital looms large in Atlanta’s consciousness. To many, it’s a place of horror stories and ghost stories, of lawless halls teeming with the poor, the crazy, and the critically ill. My first close view of it comes in the dark of a June morning as I await the start of a four A.M. ride-along. The giant lighted cross atop the hospital glows red in the dark sky, and steam from a pair of smokestacks slowly rolls out like a blanket of fog. There is a large moon in the otherwise empty sky. Somewhere in the distance, a lonely siren wails.

Are you choking?' Seriously. That's the first step of the Heimlich...

Those who know the lessons of decomposition are condemned to witness them repeatedly.