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Any other time, and I’d have laughed at the joke. I recognize it for what it was; good-natured ribbing, just the easy camaraderie between professionals that know and respect one another. That’s why we’d rather bring patients to your ED, frankly. Yours is the only ED in the city where paramedics and nurses aren’t in an adversarial relationship. And most times, it’s us dishing out the gentle jibes, and you take it all in stride.

Besides, I know I’m an easy mark. I’m a big guy, and I sport quite an impressive crumb catcher. I eat most of my meals in the ambulance, too, and a good many of them are finished hurriedly en route to a call. Occasionally, some of those meals find their way onto my uniform shirt. Just like you said, you can indeed tell how my shift has gone by looking at my uniform shirt.

And any other night than this one, that would be true.

But you took my silence for offense, and hurriedly stammered an apology. It wasn’t necessary. I’m grateful both for the banter, and for the apology when you thought you’d gone too far.

But honestly, rather than your apology, I’d rather have your understanding. We shield you from a lot, you know. I realize you work in an Emergency Department. You deal in misery and human suffering every day. But you rarely get to experience it in the raw, like we do. If you knew from whence these stains came, you might know me better. You’d know why, right now, at 6:45 in the morning, I can’t muster a smile. And you’d know why sometimes, even when I can, the smile always looks tired, and never quite reaches my eyes.


There were seven cars in the accident, eleven victims in all. You probably saw it on the news before your shift started; a horse loose on the highway north of town, out there where the traffic starts to open up on the four lane.

The first car hit it at seventy miles an hour.  Six more followed in rapid succession.

It was a freak accident, really. No one knows how the horse got out. A limb down across a fence, or perhaps a strand of barbed wire that finally succumbed to the demands of time, tension and rust. Or it could simply have been a careless hand that forgot to latch the cattle gap securely after driving through. Any country boy will tell you that the real cowboy sits in the middle seat of the pickup, so that he neither has to drive, or get out to open the cattle gaps. So maybe it was just an inexperienced hand that forgot to securely hook that twisted wire loop over the post…

… but regardless of how it happened, on that long, straight stretch of highway north of here, a horse was in the roadway when it shouldn’t have been. In that no man’s land between suburbs and farmland, where the glow of city lights have faded into a starlit country sky, a roan horse is just a vague shadow until those dark legs loom in your headlights, too close to avoid. Just a moment of blind panic, and then the crunch of metal and bone, accompanied by the near simultaneous bang of deploying airbags. It’s disorienting, really.

And then you regain your senses, and turn to your right to check on your wife, only to discover she’s gone, parts of her carried out of the back window along with the carcass of the horse. And just like that, your life as you knew it, and the future you had planned, is gone, too.

As MCI’s go, it wasn’t too bad. Only one critical patient, and nine walking wounded. Half of those signed refusals.

Triage for you is a relatively simple matter of deciding who gets a room first. “Worst come, first served,” as the saying goes. When you run those drills once a year, we bring you simulated patients with triage tags neatly filled out already.

In my world, it’s uglier.

When it’s eleven patients and one medic, and the second-in unit is still five minutes away, you have to decide who can most benefit from your care. Reds are immediate, yellows are delayed, greens have minor injuries and a few of those will even sign refusals. Some of the sickest reds will be blacks by the time you get back to them.

And the blacks… well, the blacks are just inanimate meat between you and your viable patients. They just tie up resources, with little chance of survival. They get a quick check for breathing, repositioning of the airway, and checked again before you move on to someone you can help. And if necessary, you ignore her husband standing next to her, begging you to stay, begging you to check her again, begging you to do something.

And you wonder afterward how much of your humanity you’ve sacrificed to be able to make that decision so easily.

Later, when we pulled her shattered body from the car, her head lolled back on her broken neck, wiping her blood-smeared hair down the front of my shirt. The stain came out easily enough; a little peroxide and some scrubbing, and all that remained was a wet spot on the front of my shirt.

It was the stain of deciding her fate fifteen minutes earlier that made the shirt unwearable. At least the spare I kept in my truck didn’t have a visible reminder of her.


We bring you the wreck victims neatly packaged, and with as many injuries treated as time and priority will allow. And yes, sometimes not so neatly packaged, but packaged nonetheless.

But you only see the victims we bring you. You’ve never knelt in the remains of a back seat, huddled under a heavy blanket while metal and glass groan and pop around you, whispering words of encouragement and reassurance.

“Just a few more minutes, and we’ll have you out. Stay with me now, only a couple minutes more…”

And you’ve never had to dodge the desperate questions about the guy in the passenger seat, sitting less than a foot away. His fraternity brother and classmate. His best friend, inseparable since middle school, now sitting outside that blanket, fully exposed to the sharp edges of tortured metal and flying glass, because the dead need no such protection.

I picked up a stain in that wreck, probably grease from the rescue blanket, or hydraulic fluid from one of the extrication tools. Maybe by pre-treating with Dawn and Oxy Clean, I can scrub that one out, or fade it enough that it’s relatively unnoticeable.

But it won’t set in nearly as stubbornly as the name of the dead kid in the passenger seat, the one I couldn’t help, the one his best friend told me all about in those interminable twenty minutes while we tried to free his mangled legs from the wreckage.


There’s an ink stain on the front placket of my shirt, right where I habitually clip my pen, courtesy of a psych patient we were trying to restrain. Rookie partners… sometimes they forget their limb assignments when we take someone down, and the patient gets a leg loose. Kicked me right in the chest, the bastard, breaking my brand-new gel tip pen.

The stain will lift right out with a little hairspray. What is harder to remove is the guilt I feel whenever a psychiatric or intoxicated person call pops up on our computer, and I feel a flash of hate for a person I haven’t even met.


In an apartment just south of here, the police and coroner are probably just finishing their investigations. Reports will be written in dry legalese and sterile clinical prose, attempting to explain the unexplainable, as if an explanation were any substitute for an answer.

There will be an autopsy, of course. Such things are mandated by law when the victim is less than a year old. And a family’s grief will swell and linger interminably, hoping that the horror of a pathologist cutting their son open, weighing and dissecting his organs will provide the answer they seek.

And likely as not, it won’t. An explanation, maybe, but not an answer.

All I know is, at 0430 this morning, I had neither explanation nor answer they could fathom, and my faith ran away from me like a thief in the night, leaving me without even the solace that perhaps God had a purpose in mind.

For after all, what loving God takes a healthy infant away from his parents, without so much as a hint of sickness as a warning? Without so much as a reason anyone can discern? And what purpose is there in wrecking a mother, leaving her sobbing in the grass as we hustle her son’s lifeless body into the rig, doing futile measures along the way?

And why get me involved? If there is purpose in his death, then at least put me in a position to do something. Let me at least fight against it, using the talents I’ve always credited God for granting me. Why deny me my purpose?

And so I had no answers for her. All I could do was explain to her that her son was dead, and had been for so long that there was no point in even trying. Indeed, CPR at that point would have been a sin.

And so I just stood there mutely as she sobbed into my chest, her fingers digging into my arms, tears soaking through the fabric of my shirt, searing my soul like drops of acid. And there was not one Goddamned thing I could do to make it easier for her.

So yeah, that’s why I was in your Emergency Department at 0645 this morning with a big mascara stain on my shirt. I’m sorry I didn’t smile at your joke, and I promise the next time you see me, I’ll be wearing a clean uniform.

But the stains will linger still.

Comments - Add Yours

  • Just Me

    Wow…. What a sad but yet beautiful post. And how perfectly it paints an image of what we all go through. Thanks for this, AmboDriver.

  • Bob Mueller

    It’s posts like this that make me realize that even if I could pass the classroom requirements, and the practicals, and all that, I could never do your job. It’s posts like this that make me understand why I was so lucky to be a cop for the brief time and small department where I was, and fail to make it in every other department I applied to. I honestly don’t have the emotional capability that so many professionals like you do, and I’m glad beyond belief that people like you realize you have that capability, and those gifts, and you use them.

  • alexandria

    Thanks so much you guys for your service. You guys are the homefront heroes.

  • Bgmiller2

    I just got home from a ten hour day in the kitchen dealing with morons. (I’m a chef for a colection of corporate cafeterias) I have an hour and a half before I have to go back for the second shift of an all plant feed at one of the other units I support.

    I walked in to the house to find one of the dogs had had a massive case of the squirts.

    I thought I was having a really crummy day but I could squeeze in just a little reading of some of my favorite blogs before I went for round two.

    I read your blog first.

    I’m good. I’ve got no complaints what so ever.

    Just know that even if you’re never told or never find out for every one of those “dear God why?” moments there is another where you’ve touched somebodies life in a positive way.

    And there are those of us out here that appreciate you for being there to pick up the pieces when it all goes pear shaped.

    Be safe and thanks for the shot of perspective.

  • Jennifer

    Thank you for what you do. And thank you for the reminder. It helps give perspective to those of us juggling numbers all day.

  • Verworn

    Kudos! I don’t think this aspect of the job could be summed up any better!

  • EMTMagoo

    Gosh. This is really touching. I have been in some of the situations and the others, I do not envy you. It’s people like you and all the men and women out there that are busting their rear ends day in and day out that I strive to continue my education in EMS for. People like you are my true heroes. Thank you.

  • Dave Konig

    Right to the heart of the matter and on target as always.

  • Randompawses

    Jesus Christ, AD. I don’t even know what to say . . . other than a heartfelt thank you to you and your your fellow emergency responders.

  • Lookingforlissa

    You break my heart, AD. And I thank you for it.

    Some people were put on earth with souls that shine like stars but are made of granite. You’re one of them.

  • JenninPueblo

    Ambulance Driver: I have no idea who you are, but I love you as a person and an EMT. You have expressed so eloquently all the things most of us wish we could. I have sent this article to all my non-EMS friends asking them to read it. So many people I know have zero idea what we go through on a daily basis. I will search for you Facebook and proudly/humbly ask you to be my brother in EMS. Respectfully, Jenn Mitch, EMT-I

  • JenninPueblo

    Ambulance Driver: I have no idea who you are, but I love you as a person and an EMT. You have expressed so eloquently all the things most of us wish we could. I have sent this article to all my non-EMS friends asking them to read it. So many people I know have zero idea what we go through on a daily basis. I will search for you Facebook and proudly/humbly ask you to be my brother in EMS. Respectfully, Jenn Mitch, EMT-I

  • Hogdogs

    Having only been the guy in need of first responder care (minus a few times of applying my first aid at crashes etc). I not only respect your skill and ability, I feel I am in the top 1 or 2 percentile of patients. When the EMT tells me “I am sorry this is going to hurt a bit, I calmly tell them, I am cool, do what ever you need to do and grit my meat grinders… When I am told it will take a few minutes to get you out, I say “Take all the time you need, I got myself into this mess and I ain’t in a rush anymore…”

    When they tell me to hold still, I tell ya’ Buddy I promise I won’t move until you tell me to, should I also hold my breath…”

    And for all ya’ll do… I THANK YOU!

  • Befilz

    Thank You doesn’t quite seem to cover it. It takes a special person to do what you do. I know I couldn’t. I Thank God for people like you that can!

  • Dbailes_23

    Ad I tell u what if u wasn’t a medic u sure can be a writer. U no how to word a phrase and hook the reader on none thing but the truth. Please send me a link to ur book. As always I look forward to future. post. And just so u no I would be ur permit partner any time. Just tell me where u work. Lol

  • Mhoffatras

    I think you just wrote the words I have been searching for, for almost 23 years in EMS. Stay safe my brother or sister, and keep fighting the good fight! Medic in Vermont.

  • 40lizard

    Hugs to you AD- says it all!

  • Anonymous

    That they do AD, I still remember a few these 20+ years later… Thank you for what you continue to do…

  • MaddMedic

    Thanks AD.
    From one who understands all to well.
    From one who has dealt with many ER Nurses.
    Some I wish well.
    Some can go to……

  • LissaKay

    It’s been almost 10 years since my destiny took me away from my paramedic career, and I no longer wear the uniform. However, the stains remain … all of them. They are just as vivid today as they were 10, 12 15 years ago. No one see them but me.

    • Michaelkanako

      Hi LissaKay. I too was a paramedic up till 1990. As do you, I have memories that to this day, still cause my voice to crack and my eyes to water. I’m honored to have been there-at those fateful moments……..but the stains remain……….

  • Christine

    AD, thanks for digging into the depths of your soul and spilling some of your stains out on the blogosphere for the world to absorb. Few medics have the skill or ability to articulate these gut-wrenching moments in EMS. You are a priceless gem to this profession.

  • Mike



    Thank you – and all your fellow first responders – for your service.

  • Cheinsohn

    Your my hero.

  • Sandym7

    Very touching and very real, Thank You to all of the EMS and Paramedics that are out there everyday, doing the very best that they can, God Bless you

  • Jim

    I don’t envy you for your need for it, but just the same I admire your strength for doing a job like that willingly.


  • Flcracker74

    Damn brother, that’s some good stuff ! I’d rate that up there with some of your best writing. After a dozen years of bouncing around the ‘bolance bidness, I couldn’t say it any better myself. Love ya’ man.

    P.S. “Florida Man Assaults Crew with Bloody Limb”, yup, that’s my home town.

  • Christopher Rozman

    First off my heart goes out to you after a shift like that. The 0700 call for a hang nail after dealing with real problems all night and then getting a complaint for not being pleasant enough.

    Thanks for remaining human AD. More than the majority of the senior medics I work with are clinical and cynical. It’s encouraging to know not all medics end up like that!

    Keep on saving lives and stamping out disease… you continue to inspire a me to improve my care.

  • PhillyLT

    Damn, AD….just damn. I read your entry, and I remember. But you remember this,,,you remember the ones that did make it. Remember the 30 minute extrication that smiled at you through the blood on her face as you looked down on her from the captains seat. Remember the mangled leg that you packaged oh so carefully, sure that it would be lost once the surgeons go at it, only to find out he will walk again..hell…he’ll RUN! For each los, there is a win..and the losses are not yours, for you did all you could, but the wins…ah yes, the wins are worth smiling about.

  • Skip

    Got some ‘stains’ on my shirt too. Two of them are still there, one has washed out and just had a baby.
    Not a first responder. Just a guy in that tries to help.

  • Pitblonde

    You are one of the most caring people I know AD. The world needs more people like you. All I can say is remember we love you and are here anytime you need us.

  • Martucci

    powerfully and skillfully written

  • Philly FF

    I found this from a Lt (PhillyLt, likely) who shared it on Facebook, my first visit to your site. Definitely won’t be the last, but I do worry about being disappointed in the future. This is incredibly well written, and a tough act to follow. Thank you.

  • Daniel McCaffery

    I think we all have some ‘stains’, I know I do. Thanks for putting words to what Ive been trying to explain to my family.

    Let the knowledge that your words are helping at least one fledgling medic lighten the load for you a bit.

  • medicman

    Thanks for the post. I’ve been at this same thing for 24 years, working on a quarter of a century. Spot on descriptions. After a while, we all realize we’ve seen more than we ever signed up for. There is some solace in that I’m not alone in this realm of unbelievable actions people take against each other and themselves, mixed with life just, simply, happening. That doesn’t justify any of what happens, or make it easier or right. It helps to know someone else is out there fighting the same montrous fight trying, desperately, to make a difference or be some kind of positive answer to the ensuing melee. May your ‘stains’ be badges of honor that you, at least, tried to do something and may those who take you for granted, figure it out!

  • Dawn Hughes

    This is what we do. This is who we are… No, we do not expect YOU to understand, but please don’t judge…. we are still human. We do still care, we just HAVE to conceal our feelings or we could be no good to anyone….

  • The Flying Monkey

    Some stains wash out. Some stains, not so much.

  • Mandarenee18

    Well said, Kelly, as always. Thanks for being an honest, accurate voice for so many of us. ~Manda

  • Speakertweaker

    I really have no idea what to say, but I’m compelled to let you know that I read this post and was moved to the brink of barely controllable tears.

    Good thing the rest of the office is out to lunch.


  • Creek_medic_1034

    AD what an emotional post, it brings up memories for me of all the stains I too have had on my uniform. I am glad that you took the time to post this. Thank you!

  • JustaRookie

    Powerful and awesome! From those of us who aren’t as articulate, thank you!

  • Slwidell

    I know a special young lady that is an EMT and I pray for her often. I pray that she can handle all of the terrible things you have to do. I pray that it will not turn her cold from what she has to deal with. I pray thanks to all of you that have chosen this difficult career and admire you and all that you do. Thank you and may God truely bless you all~!!!

  • Monstermedic326

    after 26 years as a fire-medic it astounds me to see what i’ve just read, we all have stains, but you have written (in a beautiful way, in my eyes) what we all think about everyday… you keep rocking it out.

  • Brown Joyce56

    I have no idea if you will ever come back to read this or not, my heart just broke as I read what you had to say. If you do All I ask is to hear me through. You see God does have purpose and a call on your life, unfortunately you as many others believe that he is the one doing all of those things. I assure you he is not. I was a medic for over twenty years and have seen all of those things and some I don’t know that I could put on paper. One thing I have learned very well, God is not the author of sickness, disease and torment. He gets the rap for them often, You see he gave man the free will and man Namely Adam failed and gave it all to a sinister devil that takes great pleasure in pain and even more that people blame God for it. God told us in John 10 the thief comes not but for to steal, kill and destroy, but I came to give life and that more abundantly. I have read and studied the Bible through, and I see a loving God that people had at one time convinced me that he was behind all of these things after all wasn’t He in control?
    I submit to you this question Does God always get his Way? Is his Will always Done?
    He said It is not his will that any man perish yet they do every day. He said he wishes above all things that we be in health and prosper even as our soul prospers but how many have the reality of that? My Whole point is God has called you in the work you do and I commend you for all you do . He sent you in there to help didn’t he? We do have Authority to turn things around but unfortunately most do not know that either. Yes I am a Jesus Freak, he healed my body of cancer and gave my sight one hundred percent back so I have good reason to be.
    Don’t give up on God after I got into the Bible and found the truth of these things and began praying for patients I have seen some awesome Miracles! I pray God sustains you through all you see and hear because bottom line he needs people out there that do care! Hey Ambulance Driver ! Hey I always loved it when we were all Ambulance driver! Jesus loves you and Thanks you for your Work. Just take a look at the good Samaritan he put him in the Book!

  • James Rosse

    Those memories are the benefit of a career well served. Without those memories, you might as well have spent your time in a cube, writing TPS reports.

    There is one more gift that you can bring to the dead and dying that they need, that their families need, and that is dignity in the face of calamity. You bring them to the hospital where they can be cleaned up, and made presentable before they face their loved ones.

    –Jim Rosse

  • Oklandes

    i must say thank u i am a er nurse and i try very hard to appreciate and respect the medics that come through my door. but i falter i know. and at one time in my life i wanted to be a medic but a tragic accident in my family caused me to change my mind because i was afraid i wouldn’t be strong enough to see and do what must be done. so i give Gods speed and blessing to those of u that are. to those that walk in with stains seen and unseen never able to share the pain with others. thanks are feeble but it and a smile and kindness when u walk in my er door is what i can offer u. u did your job u fulfilled your calling and save a life, and u brought a new outlook to my world. thank u! God Bless u for all u do!

  • MedicMom

    Thank you for all you do.

  • Snow_medic42079

    Thank You

  • Oklahomagram

    Oh wow… That is an article that I will never forget. Moved me to tears… And I don’t cry easily anymore. It just said it all so well. Thank you for sharing it…and I will add, as a volunteer, more often than not, I know the people in that car… I know the parents of the infant… I know the grandchildren of the lady who didn’t wake up this morning… Sometimes we may smile and trade jabs in the ER… But sometimes… No matter how deep you dig, there’s no smile there. Thanks again for the post.

  • MaryLynn

    Thanks for your post. There are days I come into work…my 40 hr a week normal job…and I look like hell from being up most of the night, as I am a volunteer EMT…they have no idea what we may have been through….but, I wouldn’t have it any other way…I hope I can continue for many more years.

  • MaryLynn

    Thanks for your post. There are days I come into work…my 40 hr a week normal job…and I look like hell from being up most of the night, as I am a volunteer EMT…they have no idea what we may have been through….but, I wouldn’t have it any other way…I hope I can continue for many more years.

  • Medic1144

    33 years in the field…couldn’t have come up with a better description if I tried. Thank you. And yes…this is my actual certification number..

  • Paco

    On Christmas Eve almost 30 years ago. We ran a MVA with 5 fatalities. Christmas wrapping and toys over the intersection. A 4 year old, his mother and both grand-parents died. The drunk’s uncle died. The drunk lived. I started IV’s, intubated the “patient” and assisted with putting him on the helicopter. I can still tell you what they were wearing. There was another patient who was unharmed. Sitting on the trunk of her car was a Bible. No one knew where it came from. ” The stain” never goes away. An Old Paramedic Named Paco

  • Roryrobinson4

    Thank you, you’ve summed up a lot of feeling and emotion in this blog, I wish I could write as elequantly as yourself. We all have stains and as someone else has said said some wash out and others just fade. Please keep writing. Love your work.

  • T.F.

    You’re a hero. Thank you.

  • DocCletus

    God Bless ya Brother.Eloquent words that this medic has felt but could never express. Thank you.

  • Karengb007

    Very powerful. Remember also that many of us ER Nurses came from where you come from and have stains of our own. Sorry for those who don’t have a clue. Karen RN, NREMT-P

  • Kat

    I’m glad someone could put into words what I’ve always felt after a 12 hour shift on the bus. Thank you for sharing what so many of us in EMS feel.


  • Moose

    You are always an amazing writer and can make people almost see what you do on a daily basis.

    This post should be hanging on the walls of the hospitals where the ED people don’t get along with the paramedics. Maybe a little more understanding of what the other side sees and goes through would help bridge the gap.

    You may have one of the hardest jobs in the Universe. Thank God you’re as good at is as you are.

  • Rock Morris

    Trying to find the words to describe what I feel after reading this. I know that feeling, as a lot of us do. I so appreciate this. Thanks for putting it into perspective! I would invite all of you young Medics to read this.

  • ViolentIndifference

    “And why get me involved? If there is purpose in his death, then at least put me in a position to do something. Let me at least fight against it, using the talents I’ve always credited God for granting me. Why deny me my purpose?”

    You’ve found why. You’ve reached out and touched us. And we are here to share your pain.

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  • Erica R Morris

    I’m sitting here studying for my NREMT, starting to doubt it all, getting scared for my practical coming up in a week. Then I read this post. Thank you for reminding me of the moments that will make me cry and want to crawl in a hole, and for the moments that will remind me exactly why I’m doing this job. Thank you for all that you do.

  • Tina

    I was 11, opened up from my collar bone to somewhere just above my bottom rib. Even though my mouth was closed I could feel weird air inside of my face. All I wanted to do was sleep, right there in the middle of the concrete.
    Many a time I have thought about the man who scraped that scared girl up, Who held me upright while trying to stop the blood that flowed freely, how, when I reached up to my chest, he helped untangle my hand from the skin hanging there, not allowing me to drift off. I remember the small talk, the man telling me that although he was not handsome, I had to keep looking at him. I remember the encouragement to “stay with me”. I do not remember the accident. However I remember the moment the man came into my vision. I also remember his smile.
    Unlike many others including my parents and a few of the hospital staff, he never gasped nor hissed “Jesus” under his breath.
    I still have scars bisecting my torso, I also have a family, and a life that I may not have had if it had not been for a man who was not afraid of the stains that I left on his shirt.

    • Karranir

      I was told once in a class about psychiatric patients (but this applies to every patient!) that they probably won’t remember what service your ambulance is from, they won’t remember what you look like, or what your name is. What they will remember is your additude, what you say to them and the care they receive.

  • guest

    well I thought I’d had a couple of shitty weeks- what with 4 deaths in 6 shifts- one a suicide- and I’m a volunteer- but your post has put some stuff into perspective, not stains but marks of honour- thanks bud!

  • MarkHB

    AD, thank you. Thank you despite the tears coursing down my cheeks. Thank you despite feeling effing hopelessly inadequate as a human being in face of what you keep doing, day after day after day. Thank you despite feeling like nothing I do will ever really matter. Thank you despite making me realise how effing trivial my everyday labour is. Thank you for putting things in such perspective for me. And thank you for your service. I will remember you in my thoughts every Veteran’s Day.

  • InsomniacMedic

    And there you have it. Everything we love, and everything we hate about our job… Thanks for writing it so eloquently!

  • Brenda Matthews

    I have alot of people tell me they could never do what I do, I agree it takes a special kind of person to do any particular job. I simply explain to them it is a different way of thinking. Most people would freak out when they see blood of any kind let alone a vehicle that doesn’t have any resemlance of ever being one and as you pull up your brain is trying to make sense of what you are looking at. As we are enroute to a call we immediately start going through our head a plan and what we need to do, most times the info we recieved is wrong and that plan goes out the window. We get in, asses the patients do what needs to be done and deal with the aftermath after the call, we can’t stop and look and say OH MY GOD! because we would never be able to focus and do our job. We may look strong while doing our job but we anylize every decision we made afterwords, including ( what was described in this article) choosing how much time to spend with one patient (according to how we prioritize) and how the family or friends feel. To all my fellow EMT’s and Paramedic’s I APPRECIATE what you do everyday!


    Thank you for this post. It speak so well to so many things we can’t express.

  • Ray Leblanc

    Thanks for the insight. Although i don’t work in your field, I’m oilfield trash, my wife works antepartum in a labor & delivery unit. Her speciality is handling the demise cases. I can always tell when she has had one. It is in her voice when we talk on the phone, it is in her touch when i finally get to see her and it is in her eyes when i look at her beautiful face.

    People like her and you spend your time helping others unravel an answer to an unanswerable question. Ya’ll help them find peace and acceptance at a low point in their life when they mentaly cannot fathom any reasoning at all. My hat is off to you, her, and all the others out there doing their best to help those of us who are in need.

    I will pose the same question to you as i posed to her; what are you doing to help ease the burden that you carry? You must have an out, a way to unleash the burden you carry and maybe ask someone to help you with it. I wish i could help you brother, Peace.

  • Marymeline

    My personal belief is that God put us here, gave us free will, and took His hands off the wheel. What happens down here is the net result of a million choices He didn’t make, we did. So much of it is terribly unfair.

    With the enormous burden you carry of those memories, keep this in mind. What those people will remember is that you were there. You stayed when so many would have turned away, unable to face their pain. That is what you can do, AD, what you do so well. You don’t feel it that way; as a first responder you remember the pain, the fury, the helplessness. They will remember that you were there.

  • Terrjon

    I spent thirty years in the field and have been on the sidelines for the past ten.
    I still remember the ones that didn’t make it more than the ones that did. From my father who had a heart attack at 56 and didn’t make it to the 8 year old riding his bike in the path of a tractor trailer, to the one month old infant that the mother rolled over onto it in the middle of the night smothering it to the 19 year old driving a t top camaro with no seatbelt that hit a telephone pole, you never forget. I train new EMT’s to fill the void that I can no longer fill. Good luck and God bless you even when the smile is difficult to show.

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  • Harriet Engle

    Wow, AD. Once again, you’ve got me by the heartstrings. Thank you for being able to put these things into words for all to see. I am in the midst of finals for EMT-I, heading into clinicals next semester. Haven’t been in the field yet, except by riding along in your shirt pocket (trying not to step in the ink…), but you remind me why I am getting into this field, and fill in the gaps that the textbooks leave. I think it all boils down to “We can’t NOT try and do what we can, no matter the outcome.” Whenever I have doubts about why I’m doing this, I read your blogs and ones on your blogroll. No bullshit, no rainbows, just a solid dose of reality whether it’s a bad day or good day. Keep up the good work.
    Like the song says, “the scars remind us that the past is real”. Thanks for keeping it real.

  • Pete

    AD, Nicely said. All ER staff should spend a couple of months in the field on a busy service. Although if I “try” I can remember every detail of every (most?) messy, heartbreaking, disturbing call, what I usually remember and what I always tell when asked are the “good” calls: My first high speed rollover. I approach the vehicle praying it’s not too messy. The car is on its roof. When I get down and look in I hear “Hi can you get us down from here?” The driver and passenger were still in their seats, nicely buckled in head down. Not a scratch. How about Car Vs Moose? It was tick season and the moose was COVERED with ticks. The collision ripped the roof nearly off the car. The impact knocked hundreds of ticks onto the passengers in the car. Four transports. Four ambulances. Eight EMS providers. More time was spent dealing with ticks everywhere than pt care (I’m kidding, I think). Days later we were still finding those little buggers in the bus. Oh, the ER staff thanked us too. ;)
    Thanks for the post. Stay safe.

  • grateful RN

    I worked in a 200 patient per day ER for 17 years and have my share of stains, but thanks to you guys, most of what I saw was neatly packaged. One day I got a glimpse of your world and was first upon the scene of a MVC with an injury that ended up being fatgal. I felt more overwhelmed than at any point in ER. Mostly due to not being able to do much due to lack of equipment. Thanks for all you do and making the job of ER nurses much easier. Great medics are priceless.

  • Cameracrazy1

    I’m a 911 operator and even though I don’t have the physical stains, I have them none the less. The officers, firefighters and paramedics I dispatch are near and dear to my heart and I silently cry right along with you. I too, dread some of the calls I have to send you on, knowing that there will be nothing you can do, knowing that helpless feeling and dreading the day when I take the call of someone I know and love and then have to send someone I know, love and admire to have to handle it. I hate the “taxi ride calls” and the other non-emergency, non-necessary calls I have to wake you up at 3 in the morning to take, but it is our job. And by golly, no matter what, we will do it to the best of our ability and take what comes in stride. If that means making light of some situations while crying along with those left behind in other situations, then we do it willingly because it is what we love and it is the special job that God has entrusted us with for whatever reason. Just know that there are those of us who know that we will never be able to repay you for what you do. That is why you have a special place in heaven and in our hearts.

  • Lana Killingsworth

    I am a 16 year volunteer EMT who loves what I do. No we cant “win” them all. We have no say in who will live and who will not. Thats Gods decision. We can only do what we are trained to do nothing more. God will handle the rest. And Sir, you did do something. You allowed her to lean on you as she wept, the tears soaking in, leaving the mascara stain on your shirt while her fingers dug into your arms. You could have pushed her away. But you didnt. You were there for her needs at that moment. Don’t think that you did nothing hun, cause you did more than you know. Thank you for all you do.

    Now a little story of my own….A few years ago some teens were parked on the side of the road at night 2 were at the back of the car and 1 was just getting out og the drivers seat when another car hit their car. The girl who was a cheerleader at our school got both her legs crushed between the cars. The boy who was just coming out of the drivers seat ended up under the 2nd car. The 3rd person was not hurt.
    The 2 patients were hospitalized of course and had to have several operations. I didnt know these kids but I wanted to show that I cared and I took a balloon bouquet to each patient. The parents were very thankful and I left not wanting to intrude because I didnt know them. I hever heard how they were doing after that and didnt really expect to but I hoped all would work out ok for them. Well, it was probably 3 or 4 years later that I talked with someone who knew the female patient and I was told she was doing good and that she really appreciated the balloons that I had delivered to her at the hospital. In face she appreciated them so much that when she finally got to go home from the hospital she deflated all of the balloons including the latex ones and she hung them up on her bedroom wall. Said it meant the world to her for someone she didnt even know to show such love and care for a total stranger.
    Now that really touched my heart and so makes it worth experiencing the things I have to experience to do my best to help people who depend on me. God put me in this line of work/volunteering for a reason. He knew that I truly care about people. Here is a poem I wrote. I hope you like it.

    Care For You

    I have a burning desire,
    A yearning to fight fire,
    To douse the flames, put ‘em out,
    I’ll do my job, have no doubt.

    Concern shows upon my face,
    A yearning to keep you safe,
    I love to help, that is me,
    I love being an EMT.

    If it’s flames needing water,
    Or care for a man, woman, son or daughter,
    That is what we’re trained to do,
    We’re here because we care for you.

    Within life we found our place,
    We do our best to keep you safe,
    Please know that we do care,
    We’re there to help, anytime anywhere.

    By Lana Killingsworth

  • Guyondrums16

    Damn AD, im 19 and new to the EMS field. I have faith in myself to learn the road and the way it treats those trying to act as a tool to undo Gods will, I have seen a few GSW’s, and the rest, well i guess you can just call bullshit, drunks and those with toe pain looking for a ride to the hospital hoping to get in the back just to be placed in triage. I do remember this little girl that got clipped by a car, there was a huge crowd watching my partner and i as we worked, she was so scarred, her favorite color was blue lol. I can remember holding her hand in the rig trying to keep her and her grandmother calm, that was just one pt that was aaox4 with no life threats, but i know my day will come where it is an instance like yours. I just hope to God that i’m ready… wish me luck

  • Willb

    Very eloquent, AD. Brought me back thirty years. But we still keep at it, no?

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  • Jeremy

    Wow. I am a paramedic in a rural east Texas area. I chose to work at a busy station, 6 years ago for “the good calls.” I now fight falling asleep on my short commute home after a 24 hour shift. Mostly angered because I spent my night dealing with the upstanding citizens of my community. Sure, occasionally you go on the car, upside down, in the tree, under water… in the pouring rain. That got my adrenaline pumping… the first couple of times. I cannot explain to you how amazing your blog was. I wish everyone who calls us ambulance drivers would have this understanding. I wish every single er nurse and physician for that matter could see our work at it’s finest (which usually is at the cost of someone else’s future). But, that’s not why I do it. I do it because I care. Just like I think you do. I absolutely freaking sucks ass to have to tell someone their family is dead, or explain why you can’t “just shock them back” it sucks. But to run a cardiac arrest on an a person, and 6 months later be invited to dinner with someone who would have been a statistic if not for the skill God allows to have… THAT is why I do it. Oh, and for any non EMS folks reading these blogs, most first year medics or emts are luck to make more than minimum wage… We don’t have fancy things, we don’t take immaculate vacations around the world, but damnit, we have the ability to make a difference. That is why I love being able to call myself a Paramedic. That is what all makes not sleeping for 24 hours worth it. Thank you to anyone reading this who services in EMS, Fire, Police, or the Military. If it weren’t for your true passion for what you do, life would not be… God bless you all!

  • kid

    reading this took me back to my first stain. i both hate you and thank you at the same time.

    i was 13 years old, walking back home along a small road beetween th town i had been shopping in, and the village i lived in. a young man was driving down that lane (looking back, i am damn sure he was speeding, but i dont know) and a stray dog distracted him. he swerved. he hit the only wall in 3 miles. he was thrown through the windscreen/windshield. he was laid across the bonnet/hood. on the floor, in the passenger footwell, there was paperwork from the driving test centre. he had passed that day. i still remember cutting my hand on the glass as i pulled him off the mangled bonnet to the ground. i still remember finding no signs of life. i still remember the pops and cracks as his ribs broke under my tiny hands. i can still hear the paramedic’s voice when he turned to me, and told me there was no hope. i sat for almost an hour, silently holding that stray, and the dog just letting me cry into him. i told my parents the blood was from falling and cutting my hand. they still don’t know the truth. very few people do.

    to this day i still hear that moment of sheer noise that hit me like a wall.
    to this day i still feel the ribs in his skinny torso break.
    to this day i hear the paramedics voice as he told the techs to stop.
    to this day i wonder who he left behind.
    to this day i see that boy’s face in my sleep.
    to this day i ask myself why i failed.
    to this day i want to become a doctor or paramedic and be the chance that that boy didn’t get.
    to this day i long to help others learn to be the difference beetween death, and a future. but i know its not always an option. there is no training to prepare you for the emotion. so few realise this, untill it happens, hey, i know i didn’t.

  • Cjradioman

    Thanks, AD. WIth the grace of a surgeon’s knife and the power of a chainsaw, you just hacked into the underbelly of what every paramedic, EMT or First responder will feel at one time or another throughout his career…. it really opened it up so that others could peer into the really nasty, gross humanity that is the EMS world…

    Worse than that, you made me want to get back on the box again so I could experience it all over… thank you for that!

  • Burnedoutmedic

    god, i just got one step closer to my breaking point.

  • Cmwalters1967

    amen brother

  • Aimeetcrum

    I am left speachless. Beautifully written.

  • Lauren Rose

    This is absolutely incredible. It puts things in perspective like nothing I’ve ever read before. I felt your anguish through every scenario, and tried to place myself in your shoe but I couldn’t. All I’ve ever really studied or read about is the experience inside the ED, the perspectives of the doctors’ and nurses’ who care for the patients you bring in because that’s what I’ll be doing in the near future. Seeing things from your eyes has completed the picture for me, and I thank you for that and wish you the absolute best.