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      You're stationed in a downtown area where the temperature rarely drops below 45°F and rainfall averages nine inches a year. As a result, homeless people flock there in droves. It's a migration that has evolved in the past year as a feature of widespread economic recession. But some of those folks underestimate your nighttime temperatures, and now you're finding them frozen to death in cardboard boxes. You feel sorry for them and try to be nice to them, but secretly you find them repulsive. You have a couple of kids, and the last thing you want to do is come home with scabies or some other consequence of street life.

   In fact, you don't like working downtown, period. Your calls seem to involve nothing but low-lifes—the homeless, violent criminals and drunks. Somewhere, there must be some sick people who are…well, normal. You feel yourself getting cynical, despite the fact that you're a new medic. Unfortunately, without seniority, you're stuck downtown. It's a rite of passage in your system.

   Now, in the light of a street lamp and a million flashing lights, you're standing over a gang-banger bleeding from several gunshot wounds, courtesy of police who caught him and his friends beating the hell out of a couple they dragged into an alley. The victims are terrified. He's clearly not. Instead, he's spitting at you, threatening to kick your bootie and speculating loudly about your ancestry.

   Q. I feel as though I need to be on guard from the time I leave home until the moment I walk back in the door. This is just not what I expected. Aren't there any systems that are a little less stressful?

   A. Many urban systems have grown past the practice of automatically assigning their newest medics downtown. If yours hasn't, make yourself heard—or find a smarter system. But the habit of putting yourself on "yellow alert" when you leave home is actually a good one, and a lot of smart EMTs (and cops) use it. Combine it with a silent expression of love for those you leave behind and a promise to come home safe to them. Then, remember to "turn it off" when you return. It will keep you safe not only in busy systems, but also in nicer ones. (Remember, bad things happen in nice neighborhoods every day.)

   Q. What about that cynicism part? I really do feel myself changing, and I worry about it a lot.

   A. Cynicism is not inevitable, and it doesn't happen overnight. It evolves from a series of choices we allow ourselves to make. It's easier to become cynical in a system where you're surrounded by cynical people, but even working in a place like that is a choice. We've all read horror stories of EMSers who have yielded to the darkness around them. Their stories are widely circulated, thanks to the news media and the Internet. Many more generate no stories at all, as they quietly spend their lives serving others the best they can.

   Q. I'd like to meet just one person like that. I don't enjoy feeling this way about myself. But I have payments to make and a family to feed. Like it or not, I really need this job. Sometimes it seems impossible to balance my work with my personal life. How do I do that?

   A. EMS is a lot bigger than your job, and your life is a lot bigger than EMS. Your system is not the world. Even though it may be really inconvenient to move somewhere else, you can find a job that won't be so hard to balance against your personal needs. On the other hand, maybe you can take this job to the next level.

   Whatever you decide, try hard to avoid profiling people—any people. It's almost always a bad mistake, especially for a caregiver. Nothing in our training makes us judges. As for today's homeless, you pretty much have to presume they're anything but low-lifes. Ask them how they got where they are, and they'll tell you: It's very easy to end up on the street today. It's damn-near impossible to come back.

   Try this: Search the Web for Dorothea Lange. She was a famous photographer during the Great Depression who was fascinated by the faces of the poor. She lugged a big, single-shot camera called a Graflex Speed Graphic into the streets with her. Lange's work was amazing, but all she really did was document other people's misery.

   You can learn to do a whole lot more.

   Thom Dick has been involved in EMS for 39 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 EMS Magazine's editorial advisory board. Reach him at

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