Confessions of a Trauma Junkie: My Life as a Nurse Paramedic

By Sherry Jones Mayo

Ride in the back of the ambulance with Sherry Jones Mayo
Share the innermost feelings of emergency services workers as they encounter trauma, tragedy, redemption, and even a little humor. Sherry Jones Mayo has been an Emergency Medical Technician, Emergerncy Room Nurse, and an on-scene critical incident debriefer for Hurricane Katrina. Most people who have observed or experienced physical, mental or emotional crisis have single perspectives. This book allows readers to stand on both sides of the gurney; it details a progression from innocence to enlightened caregiver to burnout, glimpsing into each stage personally and professionally.
Emergency Service Professionals Praise Confessions of a Trauma Junkie
"A must read for those who choose to subject themselves to life at its best and at its worst. Sherry offers insight in the Emergency Response business that most people cannot imagine."
--Maj Gen Richard L. Bowling, former Commanding General, USAF Auxiliary (CAP)
"Sherry Mayo shares experiences and unique personal insights of first responders. Told with poetry, sensitivity and a touch of humor at times, all are real, providing views into realities EMTs, Nurses, and other first responders encounter. Recommended reading for anyone working with trauma, crises, critical incidents in any profession."
-- George W. Doherty, MS, LPC, President Rocky Mountain Region Disaster Mental Health Institute
"Sherry has captured the essence of working with people who have witnessed trauma. It made me cry, it made me laugh, it helped me to understand differently the work of our Emergency Services Personnel. I consider this a 'MUST READ' for all of us who wish to be helpful to those who work in these professions."
--Dennis Potter, LMSW, CAAC, FAAETS, ICISF Instructor
"Confessions of a Trauma Junkie is an honest, powerful, and moving account of the emotional realities of helping others! Sherry Mayo gives us a privileged look into the healing professions she knows firsthand. The importance of peer support is beautifully illustrated. This book will deepen the readers respect for those who serve."
--Victor Welzant, PsyD, Director of Education and Training The International Critical Incident Stress Foundation, Inc
From the Reflections of America Series
Medical : Allied Health Services - Emergency Medical Services
Biography & Autobiography : Medical - General
Psychology : Psychopathology - Post Traumatic Stress Disorder

• Language: English
• Publisher: Modern History Press
• Release date: Sep 1, 2009
• ISBN: 9781615999897

Sherry Jones Mayo

Sherry Jones Mayo is a registered nurse and licensed paramedic with over two decades of experience in civilian and paramilitary emergency services, and an educator for critical incident stress management (CISM). Jones Mayo is the author of a blossoming "Trauma Junkie" anthology featuring personal and professional experiences, thoughts, and feelings of emergency responders from both sides of the gurney. Sherry's Paramedic experience in rural and urban emergency medicine and nursing in ER Trauma Centers merges with ground and air team training with the United States Air Force Auxiliary, Civil Air Patrol, addressing the growing need for posttraumatic incident response strategies for responders. As a Lieutenant Colonel with CAP, Jones Mayo was the key architect in the development of CAP's National CISM Program, taking it from concept to full program supporting the organization's 50,000+ emergency services and first responder volunteers. Sherry is an Approved Instructor for the International Critical Incident Stress Foundation (ICISF) and a Diplomate with the American Academy of Experts in Traumatic Stress (AAETS). Following achieving a Master of Science in Psychology specializing in Crisis Management and Response, Jones Mayo is pursuing a Doctorate in Education. After several years of living in Las Vegas, NV, Jones Mayo has returned to Michigan and lives in the Detroit area, serving as CEO of Education Resource Strategies, promoting emergency services education. Her most valued and impressive duties involve acting as "Nona" to her grandsons, "Mumma" to children of two and four feet, and "Wifey" to husband Gary. Learn more at www.SherryJonesMayo.com

Book preview

Preface: The Healer Within

If we accept the premise that each of us is a special creation placed on Earth to perform as well as our design would enable us, I believe there is an individual choice whether or not to act upon inherent capabilities and gifts. In this case and in this book, this reference points to the healer within. As such, I believe that all the secrets held since the beginnings of time are for each of us to explore. No special dispensation is necessary; we are given access to it all and the capability to understand and take action, we are granted permission to enter into a world of limitless possibility. We truly choose our own adventure.

Sometimes the search for (and development of) talents takes one on diverse paths of self-discovery. I hold in memory a crystal image of my own day of realization, etched with full-spectrum coloration, when the dark curtain of ignorance fell away and the door to where answers are found was flung open before me. That moment prompted exploration into the mind/body connection where psychology and medicine merge. I’m still wading in that pool, taking it all in and learning as I go along. While I learn, I laugh a lot because lunacy abounds and I cry sometimes because humanity suffers so much pain. In that place between lunacy and sorrow, I grab a home-made water pistol (30cc syringe with a 22-gauge plastic IV catheter), and take aim.

This book is a peek into the world of EMS and ER folks from those who do those jobs daily. It is comprised of essays and quotes—all true though sometimes compiled—from EMTs and RNs around the country (names and some details occasionally changed to protect the guilty). This is your opportunity to share in the pain and laughter (not just the patient’s, but our own) while we go through life trying to keep from succumbing to whatever evil presents itself. We fight the enemy (death) with everything we have and try to keep a sense of humor while doing it. There are many more stories to be told… this is just a handful of them written by a Paramedic RN who has worked rural, country and city EMS as well as an urban trauma center since 1989 and continues to play in the ER pond today. That said, please don’t take offense—some of the items shared are less than politically correct, but that is to be expected when stories are relayed between those who do this work. Walk a mile in our shoes and we’ll talk about what truly offends. Walk two miles and you’ll have stories of your own and a greater understanding of the sights, smells and experiences of those who expertly do what nobody should ever have to do.

How we have (in medicine) separated the mind from the body baffles me. We know that our cells have an innate intelligence and somehow group with other cells that hold a common desire to sustain growth and continue life; similar cells combine to develop tissues, related tissues become organs, systems form and the infinitely small parts together become a functional whole. Our bodies are composed of energy and information; there is intelligence in each of the cells as there is intelligence in the organism (human being), directing and guiding toward the collective good and development of the entity.

By the end of one year, 98% of the body’s atoms are exchanged for new ones, which is a built-in mechanism for change, renewal and regeneration. Unifying the body and mind toward positive and forward growth is sometimes a challenge when either stumbles over pebbles (or boulders) in their paths; balance is interrupted and intervention is necessary (from internal or external sources) to recover physical and mental homeostasis. What we don’t know is what happens in that moment between thoughts, the moment between desiring and directing a physical action and its ultimate implementation; even when we do discover some of the mysteries of the mind we continue to tread water in their interpretations. Despite intellect, education, desire and experience, how we communicate is a mystery, too, as any married couple will tell you.

Life is a journey of discovery; learning is a relatively permanent transformation in an organism resultant of experience or acquired information. Working in the world of medicine (and mental health) provides multitudes of opportunity for education and change. I am emphatically not the person I was before becoming involved with medicine in the streets and in the ER, nor could I have known where searching for answers to the pain I witnessed in others as well as myself would lead. A gateway has been opened and I’ve stepped across a threshold to a new plane of existence that in the past appeared only fleetingly in the back of my consciousness. I am not an independent creature who can trek through life loving selectively and denying my affiliation with humanity or the universe; we are joined with each other. I am a spiritual being encased in a physical body—over which I have tremendous influence despite my immature denial in years past—who maintains a conscious walk into self and cosmic awareness.

The quest for answers and direction in response to emotional pain also led me to Jeffrey T. Mitchell, Ph.D., C.T.S., George S, Everly, Jr., Ph.D., ABPP, Dennis Potter, LMSW, CAAC, FAAETS, and my dear friend and mentor, Victor Welzant, PsyD, all from the International Critical Incident Stress Foundation (ICISF), who have provided a program of interventions that I have utilized and seen successfully applied countless times to thousands of people. I thank these brilliant and caring gentlemen for their unwavering guidance as I continue to learn from them.

From my family, of course, I have learned the most. From my children I have come to know and appreciate (and hopefully apply) unconditional love; they have gone from being my students to showing me wonderment I could not have imagined and I continue to learn from them daily. Topher, my sweet and generous computer genius son (programming at age six) has always had a vision that others couldn’t see or understand; still, he patiently points toward those unseen things that are beyond common comprehension, good-naturedly teaching concepts from the complex to the simple, like an introduction to the Mandelbrot set or showing me how to build and maintain a fire. Sometimes the mother but certainly always the devoted daughter and comedian, Michele Denise (named after her Grandfather Michael Dennis) lovingly keeps me from embarrassing myself in public (sometimes), attempts to influence my wardrobe and shows me how not to grow up. Grandson Sean is the new Topher, his and Angie’s son, who looks at me with the eyes of a very old soul as did his father.

My sweet Italian Mama, who always believed in her children regardless of obstacles, taught us that anything was possible; you just have to find the way and there is always a way to be found. Dad, now gone and terribly missed, was a Marine who gave me a strong sense of patriotism which translated (for me) into community service, an idea of giving back and learning that in giving I receive so much more than I could ever give. Sister Nonie, who is my second mama and also a writer, educated me in the ways of Suzy Homemaker and how (eventually) to stand up for any living creature in need, including myself. Finally and most dearly there is Gary, my sweet and loving husband, who can hug me and relieve any pain the world may heave upon these ever weary shoulders, a rock when my knees threaten to buckle, who holds me gently in his arms and keeps me safe. Most of us have someone in our lives to offer love and caring, even if our support systems are animals (like our uncharacteristically affectionate and attentive kitty, Izzy). Our supports offer friendship, love, a sense of presence in times of need, and refill our emotional tanks when those reserves threaten to run dry; they hold us up and sustain us when we cannot walk alone.

For all the EMTs, firefighters and police who have or are still working the road, you are my heroes. You are doing the best job that I have ever loved and I pray for you often. You are my family and we share a bond, even if we have never met, that cannot be explained or broken. Emergency Room staff, you and I stand together to bear the lunacy and sorrow, to fight our enemies (death, injury and illness) while trying to educate people and keep a sense of humor (as well as some level of empathy) intact. To you I say: keep your 16 gauge needles handy, remember the value of a B-52, and never, ever turn your back on a patient, however cooperative they were just a moment before. Keep your chins up, chests out, and remember that you do the impossible every day, in numbers no one could imagine, at a speed that rivals Olympic champions (regardless of your age, and the over-forty nurses especially will understand). Keep up the good fight, my brothers and sisters and hold each other up when it gets tough… we need to nurture that bond between us because no one, however much they see or read or witness, understands what we do. It is our private world, and this book will hopefully let outside folks see a little more of what we are made of and how we are trying to do the impossible every day, and win competitions where there is sometimes no clear winner. Most of all please continue to love what you do and if you don’t have the same passion you started with in emergency medicine, consider finding another avenue in which to channel your energies to keep your soul and your sanity intact.

When it is least expected, an Emergency Services worker can get the call that will change his life. We know that Critical Incident Stress Management (CISM) is the way to appropriately handle emotionally traumatic types of circumstances and experiences we live through every day, so that we might keep our sanity and prevent becoming a second set of victims after witnessing trauma. Unfortunately, CISM is not practiced (or appropriately applied) everywhere and a lot of folks may be emotionally lost after a call that is so soul stirring they cannot mentally escape, causing the worker to become a secondary victim of the trauma himself. No one is immune.

This essay is about a medic who still carries an ambulance call clearly in her mind, heart and soul; although the emotional wounds have mostly healed, the memory remains and she is forever changed. Angel is now 26 years old with several years experience as an ER Tech in a Trauma Center; the medic became an ER nurse who worked with her daughter in that same hospital. Apparently, the apple doesn’t fall too far from the tree—what a legacy.

Sweet Dreams, Angel

The telephone’s ringing was an unwelcome intrusion into the night, breaking our silence into a thousand shards reflecting bits of dreams and pieces of reality mixing into an unreachable moment.

Station nine, Cheryl,* I mumbled, feigning coherence and attempting to ground myself in the moment and comprehend the directions I was about to be given.

Priority one, said Ronda,* the EMS dispatcher. I need you on the air right away.

I shook off the last remnants of sleep and called out to my partner in the bunk beside me. Bob*: priority one. Ronda sounds a little edgy—we’d better move it.

Sometimes the dispatchers have to use creative management skills when the crews on twenty-four hour shifts rebel at being allowed only a few minutes of sporadic and often interrupted sleep. Working a double, this had been one of those shifts; we were trying to grab a quick nap and hadn’t had time for lunch or dinner. Company policy dictated that we had three minutes to get into the ambulance and report on the air after being contacted by dispatch. Instead of using our time to freshen up, we each popped a piece of chewing gum into our mouths and immediately headed out the door. We assumed that Ronda was in a mood of some kind and didn’t want to incur any further wrath—we still had ten of the forty-eight hours left to work and alienating the affections of a dispatcher can never result in anything positive for EMS crew members.

Alpha 255 is on the air.

255, priority one for Dearborn Park. Make northbound Southfield ramp to I-94 westbound. Child hit by a van. Your D-card number is 3472, time of call 2209h.

Alpha 255 copies that.

We understood the edginess in Ronda’s formerly calm voice; the big three in dreaded EMS calls are those involving family members, friends and children. Normally I drove and Bob navigated, but this was a race against time. Bob jumped in the driver’s seat and I hopped into the back of the rig to set up the advanced life support equipment. We knew before we pulled the ambulance out of the bay that when a pedestrian takes on a motor vehicle, the vehicle usually wins.

Spike two lines, normal saline and lactated ringers, yelled Bob over his shoulder, straining to be heard above the screaming sirens. I knew what to do, but Bob’s calling out orders and my responding as I completed each step began the process of communication that was vital to our success as a team. Pull out the drug box and set up the (cardiac) monitor. Don’t prepare the paddles or leads until we see how big this kid is.

I hung the bags, though it seemed to take an interminable time; my hands felt big and especially clumsy as I tried to pull the packaging open and bleed the IV lines. The overhead strobe lights cast eerie red intermittent bursts inside the patient compartment, ticking off the seconds in our patient’s golden hour. It triggered an almost comical mental image of a wino, sitting in a cheap hotel room chain-smoking cigarettes with eyes transfixed on a small black-and-white TV screen. In this image, a red hotel sign flashed just outside his window, giving momentary peeks into the red, smoky glow of his reality. At that particular moment, my own reality was just as undesirable. I tried to free myself of those images and steered my mind back toward accomplishing the tasks at hand while taking a deep breath to reduce my anxiety and approaching panic.

Both bags are hung, the tape is ripped and hanging on the overhead bar. Catheters are in a box on the bench seat with the pulse oximeter and the oxygen is on. Do you want the intubation kit left in the jump kit or opened and set up back here?

Leave it in the jump kit, said Bob. We might have to tube him on the ground.

It was hard for me to monitor the radio communications from the back of the rig, so I asked Bob if the fire department was on scene: his response was a brusque, Affirmative. We knew that if fire-rescue workers were already there, they would stabilize our patient and perform whatever basic life support measures necessary. The fire trucks were a welcome sight as we rounded the curve toward the scene of the accident. My anxiety reduced slightly as I mentally checked off items in the victim stabilization process that I hoped would have been accomplished by the firefighters on scene, reducing our basic workload tremendously so that we could leap into the advanced trauma and life support steps that we hoped would make a difference in our patient’s chances for survival.

In that moment before stopping the rig and beginning our own tasks as paramedics, I switched to a more emotional appraisal of the situation. It isn’t our job to judge patients or their circumstances, but maintaining that particular level of professionalism is extremely difficult when you see something like severe trauma to a child. You can’t help wondering what prompted the child to be in such a dangerous place, especially at night… and where were his parents? Did they not care enough to monitor his whereabouts or bear any concern about his safety? Did they just assume that he had the appropriate judgment at his age to take care of himself? Somehow, I had switched into an empathetic mode for the child and anticipated the grief and loss that would be coming very shortly; in my own denial of the situation as it was announced by our dispatcher, I allowed a moment of anger to enter in before I even saw the boy’s face or condition. Inwardly, I prayed for this to be a salvageable situation where the boy may be injured but would live. We stopped the rig and the doors, pulled open by the firefighters, revealed a scene I had hoped not to see.

Looking at our patient, it didn’t seem like anyone would ever have the opportunity to question his judgment, or take away some privilege as punishment for his playing in traffic. The boy was obviously paying a pretty big price for what was probably an impulsive act. Instead of worrying about things that normally concern kids—like cool clothes, catching something awesome on the tube or getting the latest computer gadgetry—this kid was struggling to breathe.

The fire department rescue crew had already applied MAST pants to stabilize lower extremity fractures and secured our patient to a long backboard. He appeared about ten or eleven, blonde hair, about five feet tall, maybe 95 pounds. There were multiple abrasions on his head and face, matting his blonde hair into bloody clumps, with bruising around both eyes. Blood oozed out of the boy’s nose and mouth, staining the cervical collar placed by the firefighters around his neck. He was in labored, agonal respirations as we approached him.

Bob checked for pulses and found a faint radial pulse at a non-life sustaining rate of about thirty. The boy’s pupils were fixed and dilated, his skin cool and pale and his lungs were already filling with fluid. We popped an oral airway in his mouth and began bagging with 100% oxygen. Lifting him onto our stretcher, we welcomed him into our world: a guaranteed, miracle-making, emergency room on wheels, prayers administered copiously at no extra charge. Come one, come all, see the happy ending, just like on TV. No one dies; no one is permanently impaired and somehow, just before the final scene, the heavens open, music sounds, and all are made well.

After loading, we again checked for a heartbeat. Finding absent pulses and confirming that the boy was not breathing Bob muttered an expletive and called for CPR to begin as a firefighter jumped in the front seat of the ambulance to drive. While the firefighters on board continued compressions and bag-valve-mask ventilations, we got the intubation equipment ready. A quick look on the cardiac monitor showed an AMF rhythm (Adios, Mother F—r), also known as asystole—flat line. Firefighters continued CPR with hyperventilation while Bob intubated and I looked for a site to gain IV (intravenous) access. We knew the prognosis was not good, which only encouraged us to fight harder; neither of us was any good at accepting failure or at seeing a situation as impossible. We had the skills and the toys; somehow we would make it work… we had to, as defeat and loss were not acceptable options.

The firefighters had already cut the boy’s rather thick left coat sleeve. I assumed they had prepared an opening for me to start the IV line and I grabbed the boy’s arm with both hands to look for a good vein. The upper left arm bent quickly in half like a rag doll, mid-shaft. Apparently his humerus had sustained a complete fracture and the arm bent grotesquely and flopped off to the side. I shuddered, took a deep breath to decrease the nausea I immediately felt, grabbed my medic shears, and cut away the thick coat sleeve exposing the other arm. Finding an acceptable vein, I muttered an audible and brief prayer—something to the effect of, Dear God, please let me get this first try,—and popped a needle into his right antecubital vein. I taped the line down as Bob secured his endotracheal tube and started preparing the drugs while Bob established a second line in the boy’s left external jugular vein.

Things moved smoothly and efficiently, like a well-rehearsed movie scene, but it felt like an aberration of time to me as sounds and movements achieved a slowing distortion. Our on-scene and en route times would later prove exceptionally brief, but as we performed our duties it felt as though we were there for eons. Every thought and movement was muddled, feeling thick and expanded as one might view the world through the feverish eyes of illness. Despite perceptual conflicts, we did manage to get weak pulses back after pushing the epinephrine and atropine which gave us momentary hope to pull this child out of death’s clutches and hopefully back into his mother’s arms. As we worked against time and mortality, the monitor showed an ever-hopeful sinus tachycardia at a rate of 120, but it didn’t last.

During the call we pushed all of the appropriate drugs and performed our protocols flawlessly but the boy, whose name we later learned was Scott,* died shortly after arriving at the hospital. His skull exhibited profound crepitation and his abdomen was rigid and distended with spilled blood. My partner wrote the report as I cleaned our rig with Big Orange, a delightfully fresh aroma designed to replace the smell of blood and other spilled bodily fluids with a more socially acceptable citrus scent. When we had both finished, I went back into the room and held onto Scott’s cold foot for a moment, trying one last time to consciously will life back into him. Our training concentrates on producing positive results and saving lives; nobody ever told us what to do when our advanced skills and expensive toys don’t work. Nobody ever explained that you can be completely successful in applying all of your talents and still come out with the worst result. Nobody ever walked us through how to handle it emotionally when a child dies. Nobody seemed ever to be there to hold the hand of the medic feeling lost, hopeless and helpless as they watched the spirit of a child fade into the universe.

Bob and I didn’t talk about Scott, or the call, except to critique the procedures we performed. There was nothing we could have done additionally or differently, but the boy died. I reminded myself that God performs miracles in His time and on whom He decides to confer them. Scott just wasn’t to be a recipient. My partner and I finished our shift and without another word, went home.

I spent the next several hours cuddled up with my daughter. I phoned my son and told him I loved and missed him. The ambulance call, every detail perfectly preserved—a video without end—played itself continuously in my head reminiscent of a promotional loop. It was like a song that keeps repeating itself in your consciousness, getting louder and louder and you can’t escape from it regardless of how hard you try.

Reviews for Confessions of a Trauma Junkie

[crazypsychobooklover · Rating: 4 out of 5 stars]

I've always had an extreme interest in the field of medicine. And emergency medicine, especially. Needless to say, I was immediately drawn to this book, based only upon the title. I discovered that it totally lived up to everything the title promised. Thinking about emergency medicine, you realize that the only "routine " in this field would be the non-routine, ever changing situations. Sherry Jones Mayo has the ability as a writer to draw you into the stories, you feel an affinity for both the workers and the patients. In truth, you do feel as if you are a passenger in the emergency vehicle with her. I can honestly say I felt the rush of adrenalin, the nervousness, the dread, the anxiety, and the humor of each situation. Emotionally, I was draw to each story, feelling drained by some, giggling at others, and actually feeling for every person in each story. I couldn't put this book down. Ironically, 2 days after I read it, my elderly father fell at his home. My Mother telephoned me, I rushed to their home, and made the decision to place a 911 call for help. As I watched the paramedics and emt working with my father, I was able to realize what they were feeling, and know how much they wanted to help him and ease my Mom's anxiety. I felt a new respect for these people, and the tenderness and compassionate care they show strangers on a regular basis.I have since passed this book on to four other people to read. All of them have enjoyed it tremendously, and agreed that it gives the non-medical person a rare view of the daily world of emergency medical personnel. I would consider this a must read for any one remotely considering entering this field of work, as well as anyone with an interest in medicine and the world of medical treatment. All patients would probably have a new respect for the emergency medical personnel who care for them after reading it. I look forward to reading other books written by Sherry Jones Mayo. Her storytelling abilities are excellent, and she has a real grasp of personality, plot and writing

[readerbynight · Rating: 5 out of 5 stars]

You may never have the opportunity to read a book like this again. This true life documentation is an interesting look into the quality and care presented in the most traumatic incidents. Sometimes sad, sometimes humorous, the first part deals with Sherry Jones Mayo's time served as a paramedic. Vignettes of life, injury and death on the run. As with all traumatic jobs, there must be comic relief, and so there is, the "gallows humor" method of retaining one's sanity in an insane world. I do not use the word "insane" to mean anything degrading, simply as that is how the world appears in chaotic, traumatic incidents of life. You will find all of these in this honest non-fiction book.The second part gives the reader insight into who Sherry is, what inspired her, what obstacles she had to overcome in her own life, and where/how the breaking point can suddenly appear. No holds barred, this is again a very honest approach to her life at several stages, her love of family, and how incidents in the ER can impact her concerns for her family. She has seen it all. It is extremely difficult not to interpret what is happening at work with what might be happening to her own family. Separating family and work is definitely not as easy as in other occupations.The third part could well be called survival of the staff from the patients in the ER. It is, for the most part, lighter and a definite theme of how to survive the abuse of the patients. Told with tongue firmly planted in cheek, it is a day-to-day list of patience above and beyond when it comes to receiving patients who are not really sick or are just simply demanding. The people who are "too sick" to tend to themselves but can manage well enough to treat the caregivers like servants. Then there are the "regulars", people trying to get drugs by acting out pain and telling the doctors what they need. Here, too, "gallows humor" reigns from necessity.The fourth section covers in part living with grief, accepting it, healing, and remembering the positive. I found a personal connection in both getting through grief and, further in this section, the result of delayed grief. With delayed grief, it is an entirely different feeling and can hit at any time, even decades later. It lays buried, waiting until some trigger leaves a person reeling and not understanding why. The content of this section was very helpful to me personally. I highly recommend the book on the merits of this segment especially. Referring to grief, Sherry is not only talking about the need for families of patients, but for those attending to the patients, and their families too.Hurricane Katrina brings Crisis Intervention to the forefront and demonstrates just how important this is. So little could be done by the rescue teams and yet the need to have done more haunts them. This puts a great burden on these people and consequently on their families. This distinct section is a very important read, and it explains a lot of delays that occurred at the time. This portion and the following deal mainly with the very real problems facing even seasoned ER personnel and the need for crisis intervention.All told, this book will bring a greater understanding of just how much these very special people are capable of, how caring they are, and why some burn out so soon. I definitely recommend this book on many levels. Who has not had some connection to this field at some point in their lives? This is how it is, written faithfully and dealing more with outcomes and feelings than a gory tale.The book is very well written with a nice balance to hold the lay person's attention. There is also a glossary at the end of the book, although most terms are either recognizable or explained along the way.