There are some nights that I wonder how I ever got myself into this career. There are other nights that I wonder how I ever thought I had a meaningful job before I got into EMS. Most nights are a blend of both extremes. Toned out in the middle of the night for an MVC on the interstate. A drunk driver has crashed his car into a guardrail. He’s up walking, but his passenger is pinned in the front seat, the compact car impossibly crushed in around her. As fire/rescue works to cut her out of the wreckage, my partner and I work to keep her calm, protect her from the glass and tearing steel, get vital signs, establish an IV, give pain medication, all while keeping our heads on a swivel, watching each other’s back, listening for the almost inevitable tell-tale sound of screeching car tires as a secondary wreck happens. 10 minutes goes by. 20. Finally, the door popped, the dash rolled, and the roof peeled back, we extricate the patient from the car. For all of the cuts, scrapes, blood, crying, and screaming – her only major injury is a broken ankle. She’s in a lot of pain, but hopefully some day she will realize what a miracle of modern engineering it was that their little compact car protected her so well.

Earlier in the day, a child at school having an anxiety attack is in the nurse’s office. They have a history of anxiety, and it’s not even the first time that I’ve personally met this student. The nurse rolls her eyes, says the parents are on their way…. again. The boy, about 10 years old, stares at the floor, breathing rapidly, holding himself in a kind of seated fetal position, knees to his chest. I talk to him, trying to calm him. Ask him about school, about what happened when he started feeling like this. He admits to being bullied. I share with him that I was bullied in school, too. It’s part of why I put so much of myself into helping other people now. He looks up from the floor as his parents walk in, makes eye contact with me. I can see that he’s not as upset as when we first walked in the door. His mom hugs him. He tells her about what we were talking about, she smiles at me. He asks me how old he needs to be to be a paramedic. I tell him he’s gotta finish high school first, and he seems dejected at the idea of waiting. I tell him it’s worth the wait, and he’ll make some friends along the way, and that it gets better. He smiles at me over his shoulder as they’re walking out the door.

Clearing from the hospital after a police request for transportation for a drunk and disorderly subject, we’re called for an assault. A grandmother was cut and stabbed by her own daughter. We arrive after police have secured the scene. The daughter is gone, ran out before police got there, but she left her 5 month-old baby girl. The grandmother won’t go to the hospital to get her wounds looked at until her granddaughter is taken care of by another family member. The baby is in her bouncy chair, crying, reaching out at everyone who walks past. Strangers in uniforms stop and make smiley faces at her, cooing noises, trying to help her. I pick her up and hold her in my arms. She grabs my ID badge, pulling it from my epaulet, playing with it, laughing as it retracts on the badge reel and shoots over my shoulder in recoil. I find a bottle for her in the kitchen and feed her, cradling her in one arm as I hold my flashlight to see to avoid blood on the floor with the other hand. In the middle of all of the police, fire, and EMS radio traffic, all of the yelling and discussing and questioning, all the pictures being taken, for a moment, it’s just this beautiful baby girl and me. She’s staring at me, watching everything I do. I find a stuffed animal for her and she grips it tight. Eventually, family arrangements are made, and I hand over the baby. She watches me as I walk out the door with her grandmother, bandaged, bloody, but still walking. She’s lucky. They both are. This could have been much, much worse.

Later that evening, we’re called for a fall with possible head injury. A woman is out in front of the house, frantically waving us down. She says her boyfriend fell and hit his head and there’s blood everywhere. She leads us to the back bedroom where I find a gentleman in his late 70s on the floor, laying on a blood-soaked comforter. I ask him what happened, and he admits he was trying to find his way in the dark without his glasses, tripped over the bed, and hit his head on the night stand. He’s got a pretty decent laceration on his forehead, but the bleeding has mostly stopped. He says he doesn’t want to go to the hospital. I assess for other injuries, and finding none, help him to sit up. I help him put on his glasses. He laughs and says that he falls so often, he might end up being my best customer. I have to choke back some tears, as this is what my Gramma, who passed away not even a month ago, used to tell the paramedics who would come scoop her up whenever she tripped and fell. My patient is a nice guy, and we joke around together. He intimates that he’s afraid to tell me he doesn’t want any treatment because I have an “imposing presence” (a nice way of saying I’m a bigger guy) but while joking, quickly changes to being able to tell me that if I miss the IV I’m starting, he’ll slap me upside the head. We develop a rapport, and I tell him he needs to go to the hospital, if for nothing else than to appease his girlfriend, who is worried about the amount of blood he lost. (Even though, given his size, it’s not really all that much blood, people just watch a lot of TV and see a little blood in real life and they get worried, mostly.) He agrees to transport, but insists “no lights and sirens! I’m embarrassed enough already!” It’s a quiet, enjoyable ride to the ER. He thanks me and my partner multiple times for the care we provided. After it was all said and done, it was probably one of the easiest runs of my shift, but to him, it was a big deal. We shake hands, I tell him goodnight and wish him well.

I look at my watch and realize it’s already after midnight. I’m starting to feel tired. We’ve already hit 10 runs today. My wife is already asleep at home, I missed my chance to call and say goodnight. I’ve been working 24 hour shifts for the entire time she’s known me, but sometimes it’s hard being apart and not having a chance to talk. My current job is by far the busiest EMS system I’ve ever worked in, sometimes pulling as many as 16 runs in a 24 hour shift. After cleaning up the cot and restocking the jump bag, I get in the front seat and work on finishing my narrative. I look up and see other EMS units pulling in. Some of their patients are critical; bloody traumas, cardiac arrests. Some are less-critical; abdominal pain, sprained ankles. Others are time-wasters; drug-seekers, arrested criminals hoping to avoid jail by asking to be taken to the hospital. As I sit in my little mobile emergency room on wheels, and think about how many people I’ve talked to, touched, helped, held, and interacted with today, I realize; even on my worst day at work, this is still the best job I’ve ever had.

I take a drink from my coffee mug and key up the radio. “Dispatch from Medic 38 – we’re clear from the ER, send us our next call.”