It’s an hour before your morning shift change. You’ve been called to the outdoor seating area of a drive-through coffee retailer for an assault victim. He’s evidently a heavy drinker who left a nearby bar at closing time a few hours prior to your arrival. Now you find him seated at a table, docile and weeping openly.

In the course of an attack sometime after 2 a.m., somebody really worked this guy over. He looks shocky. He’s grossly incontinent of urine. Looking past that and a lot of dried blood, his hygiene appears about normal. His eyes are swollen shut, his nose is lacerated and disfigured, and his dentition is a bloody mess. Crepitus is readily detectable in his left lateral chest wall, and he flinches when you try to palpate his abdomen. He’s answering questions, but he has no recall of an event. The cops are saying they broke up a fight involving him at about 3 a.m., and they think he looked much better then. They suspect he may have been in two separate altercations.

You initiate transport to a trauma center some 45 minutes away, and your partner Ray gets some things started en route: mask O2, a couple of IVs, a cardiogram, oximetry, capnometry and some support for those ribs. Ray’s a good medic, but he’s also a pretty religious guy, and sometimes he sees the bench seat as his personal pulpit. Sure enough, he illuminates his captive about the personal thoughts of God (He ain’t happy), predicts the eventual destiny of his soul (it ain’t good), and gets in some licks about the evils of alcohol. All according to the Book of Ray.

Q. I’ve asked Ray to ease up on the sermonizing and to stop being so judgmental, but he’s so passionate about his beliefs, we just get into these big arguments about religion. Don’t people have a right to a quiet ride to the hospital?

A. Seems to me they do. Nothing we learn in P school makes us theologians or qualifies us to judge anybody. Given this guy’s story, you pretty much have to see him as a victim and that’s all. Unfortunately, some people feel compelled to inflict their personal beliefs on others. In my opinion, there’s nothing palliative about that practice, especially when you’re in a position of power over someone who’s totally helpless. It’s arrogant and condescending, and it’s not part of what we’re here for. I think we really need to stop it.

Q. What’s a good way to convince Ray that he’s out of line? He’s so dogmatic, most people don’t want to work with him. If you just stop talking, he reads that as an invitation to continue. And he’s so self-assured, I usually don’t get a chance to interject anything.

A. I think a good partner might ask Ray for one uninterrupted minute to say something important. Tell him how he comes across, that he suffocates people, and that his approach seems more arrogant than kind. Remind him it’s our job to listen to other people’s problems and help them when we can, but not judge them. Tell him it’s no picnic working with him. And tell him something else he deserves to know: You’re not the only one who feels this way.

Q. Trust me, Ray’s no listener. His idea of listening is waiting for his chance to interrupt (as long as he doesn’t have to wait too long). I think he honestly believes he’s an agent of God, who expects him to proselytize to the rest of us low-lifes every chance he gets. And I think he’s convinced he has the definitive answer to every question.

A. If that’s true, you may need to find yourself a new partner. There are plenty of decent folks out there who just want to be good medics, and don’t feel compelled or equipped to fix the whole world all by themselves.

Q. Any suggestions to help Ray as a medic? He’s really not a bad guy. What could he be saying routinely to sick people that conveys his kindest feelings but isn’t intrusive or condescending?

A. I think most people understand that we all have spiritual lives, but I’m just a lifelong beginner in that regard. Speaking just as a caregiver, I don’t think there’s anything pretentious or arrogant about offering to keep someone in your thoughts and prayers. People generally understand that many of us pray quietly every day, without pretending to be anything we’re not.

Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail