Two Wilted Flowers: Rescuing Emergency Medicine

Note: David’s name has been changed. His story was written and shared with permission.

My phone buzzed twice in quick succession. I paused in my dinner prep to read the message from the EMT I’d had coffee with a few weeks prior: “Both of the flowers I kept have wilted away, yet they remain in a vase on my desk. I am thinking about buying another bouquet.” I scrolled back to the photo of the flowers he had sent a month before and blinked back tears. I said a little prayer for him, and for the lives that the wilted lilies represented.

I am part of a team of chaplains at a large ambulance service in Minnesota. My job is responding to the first responders. I had met David in person a month earlier, but my initial introduction was via a supervisor’s log. “Responded to fatal vehicle accident with multiple units. Truck vs. SUV. 1675b first on scene,” the log read. “1642 arrived to patient in arrest. Completed transport for 1675b.” My heart sank—1675b was a basic life support ambulance. BLS trucks, typically staffed with EMTs, aren’t usually dispatched to critical calls like this. These crews are skilled but legally limited in the interventions they can perform compared to the medics that staff ALS trucks. Until recently BLS crews at our agency mostly handled scheduled transfers but staffing shortages and budget constraints led to the creation of a tiered-response model allowing them to respond to routine 9-1-1 calls. When the call was initially dispatched it had been routine. Once on scene, the patient’s heart stopped. To make matters worse, the patient was five months pregnant. When the ALS truck arrived, it was too late.

There’s always going to be the first hard call. Emergency responders show up to some of the worst that humanity has to offer and it’s tough to prepare a tender, young heart to watch a pregnant woman die. We all remember the first “hard call,” chaplains included. If you’re fortunate the call is hard in predictable ways; unambiguous even if impactful. David’s call was not like that. I reached out to both crews 24 hours later. I spent significant time debriefing the ALS crew, not personally traumatized but angry about the circumstances that had put two EMTs barely old enough to drink in such a painful situation. David took two days to respond. “It was a terrible call. I wasn’t doing too hot on Monday, but I’ve talked with some people and I’m working through my feelings,” he replied.

David’s next text came at 3:30 AM six weeks later. “I think I need help. I was studying OB and found myself crying into my coffee.”

Empathy crashed over me. As a cancer survivor, I know the wash of post-traumatic grief and anxiety that hits your body and races up your spine like an ice bath, forcing memories and tears to seek some repository other than the hidden crevices within the body. It hurts my heart imagining these EMTs and medics grappling with such agony because of the work they do, but the work I do is wading into the turmoil of moral and post-traumatic injury, and so I wrenched myself free of my own reaction. We planned to meet after the long weekend.

He found me in the cafe, a slender young man with glasses and shy smile. He was tense as I invited him to sit outside because the whirl of the barista’s frother was too loud for me to hear his soft, deep voice. Taller than me by a head, his youth still shocked me. The older I’ve gotten, the more I’ve struggled not to see anybody under 25 as one of my kids. Something in his face reminded me of my six-year-old son: thoughtful and sensitive, with a heart too kind for this work. The double-edged sword of emergency medicine is that all the hearts doing this work are too kind for this work.

We made some small talk about classes and cafes, but soon the dam of his anxiety broke. He explained about some of the hiccups he’d had on scene—worrying about spinal cord injury, wondering if someone more experienced would have moved faster, feeling like the firefighters were frustrated with him. His pain was palpable. If longing could save lives, I think David’s would have resurrected his patient. I certainly don’t carry the same burdens of shift work, back pain, and medical decision making, but to say this work doesn’t impact me would be a lie. I hated that he was hurting. I was angry at the other driver, and furious at the system that put this young man, so much like my little boy, in the position to wonder if he had killed a pregnant woman.

We squinted into the sun as it sank lower on the horizon. It was unseasonably warm, but the leaves were changing. His body was tight as a bow string. “I keep thinking about her husband. There’s a roadside memorial at the scene of the accident.” He took a deep breath.

“Have you gone?” I asked him.

He glanced up at me. “I wasn’t sure if it would be appropriate. I just don’t want to make it worse for the family.”

I told him about a recent pediatric case where several of our crews donated to a funeral fund and the family publicly thanked them. He relaxed a bit.

I continued, “I know this seems tangential, but are you spiritual at all?” He admitted to being lapsed.

“That’s common. I’m not advocating for religion, but one helpful thing it offers is ritual. Ritual has a way of making material the immaterial. If you feel up to it, I think visiting the memorial is a great idea. Maybe something to mark this is exactly what you need. This experience certainly changed you. And it changed something existentially, right? A life—lives—were lost. I always think that death changes the trajectory of the universe, at least in small ways. We should mark it somehow.”

“I’ll think about that,” he said.

The topic circled to lighter things. The sun was hanging just under the edge of the big umbrella. I started the Minnesota goodbye, then paused. I don’t know what compelled me to say it, but I knew I needed to let him know that what he offered had been enough. “If it was my spouse,” I started, then hesitated, groping for the right assurance, “I would be comforted knowing that at least my beloved’s last moments had been with somebody who cared so much.”

After I spoke his shoulders hunched; the bow-string snapping. Tears spilled from his eyes, and I sat in silence while the words sank, I hoped, deep into his heart. Tears spilled from my eyes too.

This work breaks hearts, including mine. I strive to be broken open by the pain I dare to touch, as theologian Henri Nouwen wrote, where the fissures of my heart become a wellspring through which grace can flow. In breaking open we become a source of divine love, offering healing and being healed. I prayed that David’s heart wound would also one day become a source of wisdom and love for him and others. The next day I received the picture of beautiful white Peruvian lilies and a note that said, “I visited the memorial today. I wish I had done it sooner.” I don’t know what David’s future holds, but I think this soul wound won’t destroy him.

Unfortunately, these devastating emotional injuries are all too common and have far-reaching effects. Although they happen individually, they also impact organizations collectively, affecting mental health, retention, and patient safety. David was lucky, in the end. On one level, his story is a sobering example of why robust employee well-being protocols must be an integral part of operations. At the same time, the best resiliency training and the most compassionate chaplains in the world can’t fix deeply broken systems. And so, I find myself broken open and called to advocate for the brave helpers I love so much.

Without major reform EMS will continue to wilt. Since this incident our 9-1-1 BLS program has only grown in response to call volumes and staffing shortages. Our well-being team has improved our new-hire education but the necessary operational changes are unlikely to come in the near future. Moral and emotional injury prevention require comprehensive mental health support and a stable, healthy system—and the money to create that system is not there. EMS providers are excellent at making heroic sacrifices and improvising under the worst of circumstances. For too long we have asked our emergency responders to operate on bare bones budgets, bludgeoned by assault, long hours, relentless call volumes, unbelievable trauma, and a minefield of ethical and moral stressors. EMS should not be budgetary afterthoughts to municipalities and hospital systems. Healthcare is a human right, and its price-tag should not include moral trauma to clinicians. It’s time to imagine a more sustainable system.

Last time we met, David looked happier. He weathered this storm and has started working as a paramedic. Still, he remains unsure if, or for how long, he will stay in the field. David is one flower in this withering garden: without changes we will see more providers injured by operational failures, excessive overtime, and lack of preparation for the level of care required by an ever-sicker population. There is astounding beauty, courage, and ingenuity in this world of emergency medicine, but if states, municipalities, and private healthcare organizations don’t prioritize the health of their first responders by investing in operations and wellness they may one day make the call on their “worst day” and find no one left to answer. We can choose how we cultivate this garden. Will we grow, or will we leave only wilted flowers?