A Thousand Naked Strangers

1. An Accidental Calling: Seeking Purpose in Emergency Medicine

EMS was an accidental third act.

Seeking a test. The author, having drifted through careers as a failed salesman and reporter, felt a lack of purpose and a desire to be tested in high-pressure, life-or-death situations. Witnessing the professionalism of fire-medics during a rescue operation sparked an interest in emergency medical services.
Impulsive decision. Despite knowing nothing about medicine and having a history of panicking in emergencies (like the Jet Ski accident), he impulsively enrolled in an EMT program at a local technical college. This decision was driven by a vague notion that it might be a "cool job" and a deeper need to prove his capability under pressure.
Initial doubts. The reality of EMT school, with its graphic textbook images and the gravity of the profession, immediately brought back feelings of anxiety and doubt. Surrounded by misfits and facing the prospect of dealing with death, he questioned if he had made a huge mistake, but ultimately decided to stay and see if he could handle it.

2. The Harsh Reality of EMS: Chaos, Inadequacy, and Doubt

I’m hot, dizzy, and my face is flushed.

Overwhelmed by the material. EMT school felt inadequate, with lectures veering wildly and a lack of practical scenarios early on. The author and his classmates felt unprepared for the intense pressure of real emergencies, constantly doubting their ability to remember and apply what they learned when it mattered most.
First exposure to death. Witnessing the first death, a quiet passing in a nursing home, was a profound and disorienting experience that highlighted his inexperience and the stark reality of mortality he would face regularly. This early encounter underscored the gap between classroom learning and the unpredictable nature of the job.
Practical skills gap. Early ride-alongs and the first days on the job revealed how much of the rigid classroom training was poorly suited for the chaotic, uncontrolled environments of actual emergencies. Skills like backboarding needed on-the-fly modification, and the sheer unpredictability of patient behavior was not adequately covered in school.

3. Navigating the Unprofessional World of Private Ambulance

The place looked near death, as though the building, the ambulances, the employees, everything needed to be put down.

Landing at FirstMed. After struggling to find a 911 job due to lack of experience, the author stumbled upon FirstMed Ambulance, a dilapidated private service that hired him without verifying his credentials. This marked a stark contrast to the professional image he had envisioned for EMS.
A chaotic environment. FirstMed was characterized by unprofessionalism, including employees drinking on the job, questionable hiring practices (rehab/jail graduates), and rumors of insurance fraud. The ambulances were often in disrepair, and the work primarily involved non-emergency transports, often for questionable reasons like helping nursing homes avoid scrutiny.
Absurdity and adaptation. Despite the chaos, the author witnessed bizarre events (Richard cleaning up blood without gloves, the stolen ambulance) and began to adapt to the low standards. Working alongside "Tourists" who had other primary interests, he learned that the job could be just another means to an end, allowing him to be present without being fully invested.

4. Finding Mentorship and Dedication in 911 Response

EMS is the greatest show I’ve ever seen, except it’s not a show, it’s all real.

Transition to 911. Escaping FirstMed, the author secured a job with Rural/Metro, the 911 provider for South Fulton County, a notoriously rough area. This move fulfilled his initial goal of working emergency calls and provided the intense, unpredictable environment he had sought.
Initial exhilaration. The first calls on the 911 ambulance, dealing with traumatic injuries like severed toes and self-inflicted stab wounds, were exhilarating. The feeling of being an insider, of being called upon to fix things, was electric and fueled a desire to constantly run calls and experience the raw reality of the job.
Mentorship and transformation. Partnering with Chris, a dedicated career medic and "True Believer," marked a turning point. Chris's passion, competence, and willingness to teach transformed the author's perspective. He began to see EMS not just as a job but as a calling, actively seeking out challenging calls and learning the nuances of street medicine and patient interaction.

5. Life and Death on Atlanta's Gritty Streets

It’s life and (hopefully) death, and unlike the general public, I’m invited and allowed to wander freely amid the debris.

Exposure to extremes. Working in South Fulton and later for Grady EMS exposed the author to the rawest aspects of urban life:

• Poverty and addiction (crack houses, homeless shelters, drug overdoses)
• Violence (shootings, stabbings, domestic disputes)
• Mental illness (psych patients, those hearing voices)
• Unusual medical issues (maggots eating a face, choking dog, masturbating back pain)
  Unpredictable environments. Calls took them into dangerous and unconventional locations, from abandoned buildings and housing projects to highways, strip clubs, and even rooftops. Each scene presented unique challenges and required constant vigilance for personal safety.
  Witnessing mortality. Death was a constant presence, often occurring in intimate, messy settings. From quiet nursing home deaths to violent traumas and unexpected cardiac arrests (like the "Death by Broccoli"), the job provided a front-row seat to the fragility of life and the varied ways it ends.

6. The Absurdity and Dark Humor of EMS

Look for the weird and take time to laugh.

Coping through humor. Faced with the constant exposure to trauma, suffering, and bizarre situations, EMS workers develop a dark, often inappropriate, sense of humor as a coping mechanism. This humor helps process the unprocessable and find moments of levity amidst the grim reality.
Bizarre calls and characters. The job presented a parade of unforgettable and often absurd characters and scenarios:

• Richard, the homeless man who cleaned the ambulance for cash.
• Darryl, who nailed himself to a wall over a domestic dispute.
• The choking dog, JJ, and the partner with ornithophobia.
• The naked woman with back pain from masturbating.
• The man whose face was being eaten by maggots.
  Inside jokes and shared experiences. This shared exposure to the extreme and the absurd creates a unique bond and an "inside language" among EMS crews. Jokes about bursting bodies, lost dentures, or specific types of calls are only truly understood by those who have lived them.

7. Inter-Departmental Friction and the Fight for Respect

Though we work together—same mission, same calls, same patients—for some reason, medics and firefighters can’t get along.

Hierarchy and contempt. EMS often felt like the lowest rung on the public safety ladder, facing contempt from police and firefighters who sometimes saw medics as mere ambulance drivers or support staff. This led to constant friction and a feeling of being overlooked or disrespected.
Specific conflicts. Tensions manifested in various ways:

• Firefighters abandoning EMS crews on-scene (like the near-drowning).
• Disagreements over patient care decisions (like the hyperventilating dispatcher).
• Police treating ambulances as taxis for non-criminal nuisances.
• Medics being called for minor injuries to police/fire personnel.
  Retaliation and hubris. Frustrated by the lack of respect, the author and his partner Marty engaged in petty acts of retribution (like misdirecting fire crews or burning sauerkraut). This escalated into a period of "para-god" hubris where they ignored protocols and authority, believing their ability to save lives put them above the rules, until a dangerous situation brought them back down.

8. The Psychological Toll: Burnout and Transformation

I’m angry and miserable and I almost don’t even care.

The grind wears down. The relentless pace, long hours, missed holidays, and constant exposure to human suffering and unprofessionalism gradually took a toll. The initial excitement faded, replaced by exhaustion, cynicism, and a growing indifference.
Loss of partnership. The departure of trusted partners like Chris and Marty exacerbated the burnout, leaving the author feeling isolated and stuck with a succession of incompetent or difficult coworkers. This "partner roulette" made the already challenging job feel unbearable.
Signs of transformation. The burnout manifested in a loss of empathy, a detachment from patients (seeing them as tasks rather than people), and a growing resentment towards the public and the job itself. The author recognized he was drifting towards becoming a "Killer," one of those medics who had lost their passion and become lazy or mean.

9. Moments of Profound Impact: Saves, Deaths, and the Search for Meaning

What I feel is pride.

The power of a save. Despite the overwhelming exposure to death and suffering, moments of successfully saving a life were incredibly powerful and validating. The first time the author participated in bringing someone back from the brink (the crack patient who died and was revived) was intoxicating, fostering a sense of invincibility and purpose.
Defining moments. Certain calls stood out, shaping his understanding of the job and himself:

• The first death witnessed.
• The first cardiac arrest (Broccoli).
• Violent traumas (shootings, car wrecks).
• The search for the "Perfect Call" – a chaotic, challenging scene where their skills would be pushed to the limit.
  Existential questions. The job constantly forced contemplation of life, death, and human nature. Events like the needle stick scare or witnessing extreme suffering prompted reflection on the value of the work and his own mortality.

10. The Cycle Continues: From Burnout to Field Training Officer

I accept the job without hesitation.

Hitting bottom. The burnout reached a peak, marked by indifference, unpreparedness (leaving equipment floors away), and even the absurd event of his ambulance being stolen. He felt ready for it to be over, expecting to be fired or quit.
Unexpected opportunity. Instead of being fired, the author was asked to become an unofficial Field Training Officer (FTO) due to high turnover. Despite his visible burnout, he accepted, perhaps seeing it as a new challenge or a way to find renewed purpose by shaping new medics.
Passing on the experience. Becoming an FTO forced him to confront his own jadedness and teach others the realities of the job, including the chaos, the need for hustle, and the psychological toll. This role placed him at the beginning of the cycle for others, even as he navigated his own complex relationship with the profession, influenced by his personal life events like his wife's difficult pregnancy and the miscarriages he witnessed on calls.

Last updated: May 12, 2025