Spirituality in EMS
The dawn was like no other, distinguished not by a rescue gone right, but by the view from the end of a steel cable a hundred feet above Tennessee’s Roaring River. Paramedic Chris Masiongale marveled at smoldering sunlight piercing summer mist as he and Sean Buckley, a 23-year-old medic with the 50th Medical Company of the 8th Battalion, 101st Airborne, were hoisted toward the UH-60 Blackhawk, a helicopter whose military exploits overshadow its peacetime role as a medevac platform.
It had been a long night for Chris and his fellow responders. The search for hikers Ralph Hayes and his son, Joel, near the intersection of Jackson, Putnam and Overton counties in north-central Tennessee, started six hours earlier. Both men were found on the riverbank suffering from tib/fib fractures and hypothermia. Rough terrain complicated conventional transport, so Chris’s supervisor called the MAST (Military Assistance, Safety, Traffic) unit at Fort Campbell on the Kentucky border for assistance. After airlifting the injured to a local hospital, the soldiers returned to pick up Masiongale and Leon Harris, another rescuer.
As the Blackhawk hovered above, Buckley was lowered to the ground by a starboard-side winch. The Army medic advised Masiongale and Harris he could take only one of them at a time. The 29-year-old Masiongale, who’d never been in a helicopter, reluctantly agreed to go first.
Buckley and Masiongale sat facing each other on the penetrator, a three-legged lifting device resembling a blunt, inverted grappling hook. Sean’s legs straddled Chris’s torso in a minimalist arrangement requiring a mutual embrace for support. Superficial shoulder straps added psychological, more than functional, protection.
The 10-by-15-foot rock that was their launch pad receded beneath the medics’ boots as the shriek of two General Electric 1890-horsepower turboshafts overwhelmed the whine of the winch. At the treetops seconds later, Chris lauded the panorama afforded by the gentle rotation of the penetrator. “What a beautiful view,” he said. Sean didn’t respond. To Chris, he seemed preoccupied.
What is spirituality? My dictionary defines it as “religious devotion or piety; the rights, jurisdiction, tithes, etc. belonging to the church or to an ecclesiastic.” Most of the EMS providers I interviewed for this article disagreed that spirituality is necessarily linked to religion or houses of worship. “The side of personality that’s all good,” “the ability to connect to yourself and loved ones,” “the way you frame your world” and “how you live your life” are concepts of spirituality asserted by prehospital practitioners during eight hours of discussion. However, secular views weren’t the only sentiments expressed. “Showing your faith,” “going to church” and “belief in God” are other definitions of spirituality voiced by our colleagues. It seems there is no more of an EMS consensus on spirituality than on ambulance configuration.
Why, then, tackle a topic as subjective as spirituality? There are no practical exams to evaluate spiritual skills. The word isn’t even mentioned in any of my textbooks. According to my state’s prehospital protocols, spirituality is less of a concern than application of MAST suits, packaging of avulsed teeth and transportation of dead snakes. Is spirituality a subject best relinquished to clerics?
I might have settled for that outcome had I not read a story by commentator Robert Krulwich about Richard Feynman, an American physicist who helped develop the atomic bomb. Feynman was at the bedside of his terminally-ill wife when she died of Hodgkin’s disease. According to Krulwich, Feynman noticed the clock on the wall of his wife’s hospital room stopped at 9:21 p.m., the precise time of her death. The physicist saw no significance in that; the clock had been broken and fixed before. He reasoned someone had jostled the fragile timepiece, causing it to malfunction again.
Krulwich suggests many of us would see a link between the stopped clock and the death of Feynman’s wife. “I know how the story would feel to me,” he says. “It would be as though the universe had somehow noticed what had happened, that some invisible hand slipped into my world and pointed, as if to say, ‘We know. This is part of the plan.’”
As I continued my interviews, I heard repeated references to such a plan. Called “God’s will” by some and “a master plan” by others, the belief, “everything happens for a reason,” was nearly unanimous. I concluded, if so many EMS providers agree on that aspect of spirituality, most of the people we care for probably would, too. Spirituality, then, might be more than just a personal conviction; it could be a shared experience connecting caregivers to patients. I don’t know of any medicine that does that. I think that’s reason enough to explore spirituality in EMS.
One more thing: as I was editing the above paragraph, my watch broke. I’m not kidding. The band around my wrist separated spontaneously from the timepiece. No, it hadn’t been broken and fixed before. No, it wasn’t jostled.
“Something’s wrong,” Buckley screamed at Masiongale over the roar of the Blackhawk’s rotor.
“What?” Chris yelled back. More than hearing, he lip-read what his fellow medic said.
“Something’s wrong!” Sean shouted again.
Forty feet below the chopper’s skids, the counterclockwise rotation of the rescuers about the cable had become more pronounced. Chris didn’t know their coiled lifeline was fraying after repeated contact with the helicopter’s titanium hull. Sean realized they were in trouble and was trying to signal Chris over the cacophony of the engines. Masiongale looked up at the Blackhawk’s open hatch, saw the winch operator struggling to corral the cable, then grasped reflexively at one of the skids, which seemed no more than an arm’s length above. The crewman at the winch reached down toward Chris. Both knew the gesture was futile.
Spirituality and the practice of medicine are linked in Judeo-Christian literature. According to medical historian Henry Sigerist, Christianity began as a “religion of healing.” Christians were urged to tend to the sick, and to view the suffering of others as a greater concern than their own misfortunes.
Judaism proclaimed our bodies are God’s property, loaned to us. Protecting that property takes priority over every commandment except those prohibiting incest, idolatry and murder. The Talmud, Judaism’s sacred compilation of customs and laws, forbids Jews to live in cities that have no physicians.
Unfortunately, pre-medieval populations had little to offer each other in times of illness. Purveyors of oils, charms and chants competed with the earliest physicians for recognition as healers. Jews, Christians and pagans often turned to “magical” cures when primitive science failed to relieve disability and disease. Herbs, amulets and spells were no less effective than rudimentary medicine, which boasted therapeutics such as urine-spiked cocktails and bloodletting.
By the Middle Ages, the Catholic Church was becoming frustrated with practitioners of folk medicine who failed to credit God as the ultimate healer. Theologians, many of whom were serving as de facto physicians, urged medical professionals to evaluate patients’ spirituality before delivering care. Medieval patient interviews were as much about determining compliance with church doctrines as assessing chief complaints.
The Protestant Reformation sparked a shift in how the sciences, including medicine, were viewed. Martin Luther, a leader of the Reformation, favored inductive reasoning based on experience, over adherence to written rules. Luther, who suffered from numerous maladies throughout his adult life, urged doctors to learn their craft through fieldwork, yet reminded them faith and prayer were essential elements of their practice. “I have nothing but praise for the physicians who adhere closely to their principles,” he said, “but they shouldn’t take it amiss if I don’t always agree with them…”
John Calvin, another 16th-century Protestant leader, acclaimed God as the “great physician” while defending doctors against those who saw medicine as the enterprise of evil spirits. “Anyone with an ounce of brains knows (physicians) are gifts of God,” he wrote.
Calvin joined Luther in urging establishment of government-funded hospitals. The symbiosis of medicine and theology is further corroborated by the dual cleric-physician pedigrees of new-world Protestant reformers John Clarke (Baptist), Francis Makemie (Presbyterian), Henry Melchior Muhlenberg (Lutheran) and Samuel Seabury (Episcopal).
Masiongale and Buckley were 175 feet above the Roaring River when the cable hoisting them into the helicopter snapped just above their heads. Masiongale heard a loud crack! like a shotgun blast, accompanied by the sudden mushrooming of steel strands. “I was scared to death,” Chris recalls. “Then it got real quiet.”
According to Masiongale, the old saying about seeing your life flash before you is true. “It was like I took a deep breath and everything was calm. I was thinking about my childhood, my family, my kids, positive influences in my life and a disagreement I’d just had with my partner. I know that sounds like a lot, but it all went through my mind on the way down. For me, it was a very long fall.
“I figured we’d hit those same rocks we’d just lifted off of. I never expected to live through it.”
Why do bad things happen to good people?
That question is a test of faith for some caregivers and a point of contention for others.
“In May of ’81 we had a house fire in Cherry Hill (NJ),” recalls John Fleischmann, paramedic and Lutheran minister. “Four children died. I still have dreams about that.
“What do you say to people who lose all their kids in the blink of an eye? We can’t answer why. From my point of view, it just makes you want to trust God more. We can’t see the whole picture—we only see a little sliver every day.
“Just because you have faith, it doesn’t mean you’re immune from suffering. Everyone suffers—some more than others.”
EMT Karen Lambert and her paramedic husband, Rob, remember a horrific motor vehicle accident involving a mother and three teenagers.
“When I got there, (the first responders) were doing CPR on the mother,” Rob recalls. “All three kids were unresponsive, still in the car. I told (the responders) to stop working on the mother so we could try to save the others.
“The daughter died before we could get her out of the car. The son and his friend were in bad shape. I didn’t expect either of them to make it.
“A couple of years later, we were called to the home of a wheelchair-bound patient with sepsis. It turned out to be the son. According to his father, the boy hadn’t been able to do much since the accident. I felt terrible, thinking we’d made a mistake trying to save his life, but his father thanked us and said, after losing the rest of his family, his son is all that keeps him going. That made me feel better.”
Dealing with misfortune is “a major concept in Judaism,” according to Rachel “Ruchie” Freier, who founded Ezras Nashim (Hebrew for “assisting women”), a Brooklyn-based EMS corps composed entirely of Chasidic women. “God has a master plan. We’re not always privy to it. It’s like life is a color picture we’re seeing in black and white. That doesn’t diminish my belief in God. I know I’m here for a purpose and I’m going to do the best I can.”
Some dispute any presumption of purpose to hardship. Consider this anonymous comment: “Shortly after becoming a paramedic I had a bad call where a child died because of neglect. I asked several religious people and even the pastor at my church why God would allow such a thing to happen. He said God works in mysterious ways and has a plan for each of us. He also said bad things happen to good people for no reason. I know that. I didn’t need him to tell me that.”
My wife, Helen, who just retired after a long career in the essential services, has a different take on the topic: “Bad things happen to all people—not just good people. Good things also happen to good and bad people. It’s up to us to make the best of all situations.”
Less than four seconds after their cable broke, Buckley and Masiongale landed between jagged rocks in a 40-square-foot pool of water not more than two feet deep. They fell at over 70 miles an hour. “I can’t tell you what it was like to hit because I don’t remember,” Chris says. “I think God spared me that experience. Whenever I woke up, I was underwater.”
Leon Harris, the rescuer left behind who would have been evacuated after Chris, was facing away from the helicopter when the line snapped. Harris felt water on his back, turned around and realized Sean and Chris had made that splash. He jumped in the river and grabbed a medic in each hand, struggling to hold their heads above water. The swift current tugged at Buckley and Masiongale. Harris knew he’d soon have to decide which one to let go.
Spirituality in EMS is as much about patients as providers, according to colleagues.
“Lots of times people forget the spiritual part of first aid is just as important as dressing a wound or starting an IV,” Fleischmann says. “I think everyone has the capability to put patients at ease. Some are better at it than others, but it’s something we can all work on.
“Just take the risk and start a conversation with a patient. You can be spiritual without getting into technicalities about faith.”
Kentucky paramedic Kevin Hurley thinks honesty is an important part of spirituality. “I had this young girl who got run over. She tried to commit suicide by lying in the middle of the road. When we got there, she was all busted up.
“‘Am I going to make it?’ she asked. I said no, I don’t think so, but it’s not up to me.
“‘What should I do? I think I made a mistake.’ I told her to make her peace with God; He’ll decide the next step.
“She prayed out loud and calmed down. Then she died in the OR.”
Fleischmann agrees it’s not our job to judge patients. “We’d get calls almost every night for a guy supposedly having a seizure. He’d be talking when our crews got there, so everyone assumed he was faking. Turns out he was having a dystonic reaction to his medication. Nobody realized that because they were so busy judging him.”
We shouldn’t underestimate the therapeutic value of kindness, according to this anonymous account:
“My mother had a major heart attack in ’98. During the trip to the hospital, her heart stopped twice. The EMT not only resuscitated her, but kept talking to her, reassuring her while she was unconscious. She heard it all. When she recovered, she wrote him a letter to thank him for all the encouragement.
“Several years later, after mom had moved a couple hundred miles away, she had another heart attack. Who showed up? That same EMT! He had moved, too.
“Mom passed away last week. There were two eulogies—one from my brother and one from mom’s ‘favorite EMT.’”
Leon Harris was spared the toughest decision of his life by eight members of the Overton County Rescue Squad who had not gotten an earlier message to return to headquarters. They helped Harris pull the semiconscious medics onto the riverbank and did what they could to stabilize grave injuries: Buckley had bilateral hip, femur and tib/fib fractures. Masiongale’s back was broken in three places, all of the ribs on his right side were shattered, and every bone in his face was fractured. Pain isn’t what he remembers, though.
“I was angry,” the Byrdstown, TN, native says. “Angry at being hurt, angry at being alive. I’d already accepted the fact I was going to die. I thought, ‘This doesn’t make any sense.’”
Then Masiongale heard a voice next to his right ear.
“Chris, it’s okay.” The pitch was male, the tone clear and reassuring. “Everything’s going to be alright, but you have to decide whether you’re going to live or die. There’s no shame in either.”
Masiongale didn’t want to have to choose. “I’d already decided on the way down I wasn’t going to live. I’d made peace with that. Now I was in every kind of shock you can think of and just wanted to let go. But that voice called me back. I still don’t know where it came from.
“I started bargaining with myself: ‘Well, let’s not make the decision yet, because there are some people I need to talk to.’”
According to the Lamberts, spirituality in EMS extends to personal lives. “Rob and I have been through a lot in our marriage,” Karen says. “EMS takes time away from us. Sometimes it tests our relationship. But in the long run, I think it makes us stronger.”
Larry Zacarese, a New York paramedic and third-generation police officer, seconds the importance of family support.
“I was a new medic when one of my partners committed suicide. One day she switched tours to get supplies for a lidocaine/potassium drip. The next day she killed herself with it. It was a shock. It ran against everything we’re supposed to do.
“I’m lucky my wife is in the field. You need to have outlets. You need to be able to talk about (bad calls).”
Fleischmann sees balance as a key to spirituality. “It’s important to have a life outside of EMS, to be able to turn off that built-in ‘duty to act’ we all feel.
“To be a good EMS provider, you have to be a whole person.”
Wendy Holt, a Tennessee EMT-IV, says she’s not the same person she was before EMS. “I had nothing. I never thought I’d be able to provide for my family. EMS made me stronger by making my faith stronger. If you have faith, you have everything.”
Jim Morgan, Masiongale’s usual partner, had been off duty but close by when the medics fell. He rushed to the scene and found a path through the brush for the responding vehicles. Chris was carried to a waiting ambulance, then had a moment alone with Beck, the medic he’d argued with earlier. “It was very quiet in back—just the two of us. I grabbed hold of her hand and said, ‘I have to tell you, I’m sorry. I want things to be okay between us.’ I could tell it upset her, but she stayed professional and did her job.
“I don’t remember any pain on the way to the hospital.”
Fifteen minutes later Chris was in Trauma Room 1 at Livingston Hospital, surrounded by ED staff. “They were having trouble starting IVs. I’d lost a lot of blood,” Masiongale recalls.
Chris’s wife, Malissa, was by his right side. “I still didn’t think I’d survive. I said my goodbyes. Then they brought in my little girl (two-year-old Kaylee). She looked down at me and started crying. I reached up and grabbed her hand. That’s when I decided I was going to live. I told her I’d be okay.
“Then I started hurting.”
Chris Masiongale was flown to Erlanger Medical Center in Chattanooga, where he received eight units of whole blood, four units of platelets and four of plasma. Doctors expected him to be hospitalized for several weeks, at least, but he was discharged in six days. He attributes his rapid recovery to prayer and “wanting to get back to Kaylee.”
“There’s no medical reason a man who’s lost every bit of blood in his body should still be alive,” he says. “I don’t know why. I don’t think I’m supposed to know why. I’m just thankful for the chance to enjoy the world around me— my family, the sky, opening presents Christmas morning. I’ve learned to appreciate the little things. I try to share that feeling with my patients.”
Masiongale’s tale highlights the message of colleagues, theologians and historians: that caring for others is the essence of spirituality. EMS providers can demonstrate that spirit by embracing our roles as caregivers, strengthening ourselves through faith and showing compassion to anyone having a bad day. These are principles, not protocols; they aren’t stowed like boots or bags after shifts. Spirituality in EMS is an extension of spirituality in life.
Consider the following incident:
An elderly female stumbles and falls in front of a strip mall. There are many witnesses but only one responds: a retired EMS worker, who finds no major injuries. The patient refuses an ambulance; her chief complaint is broken eyeglasses. “How am I going to get home?” she wails. “I can’t drive without my glasses.” None of the woman’s family is available, so the ex-EMT offers to drive her to a nearby optometrist. The patient gratefully accepts. Forty minutes later her eyeglasses are fixed and she’s back in her car, bruised but mobile.
The good Samaritan in that story is Helen, my wife. I think her self-imposed duty to act is as spiritually vivid as any services we can hope to provide on the job. When we put EMS aside—at the end of a day or a career—our bias to care offers spiritual continuity. Procedures and policies become less important than remembering what it feels like to be a rescuer.
Mike Rubin, BS, NREMT-P is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at email@example.com.