It is 3 am, and you are the only man breathing in the room. After 8 hours of listening, feeling, rebuilding, the mortar doesn’t stick, and the blocks tumble. You can’t rebuild this one. If only the 20-something with the 15-out-of-10 stuffy nose, or the impatient 60 year old who couldn’t be bothered to call her primary could see you now. Maybe you could convince them to drop at least some small portion of their attitude and think of at least one person other than themselves. It’s not the death that frustrates me; it’s the clear sense of contrast to the living.

It’s the unwanted side effect of helping people at their worst; sometimes, it’s not the injury or illness that earns the superlative, it’s the behavior. You try your hardest, day in and day out, to be a healer, only to be an enabler. You’re someone to whine to, someone to take aggression out on, scream therapy for the people who make you need it yourself. They feed the black dog that rests his forepaws on your tired shoulder, and you feed them with a forced smile and apologies for something that you have nothing to do with, in some sick food chain-related analogy.

You’ll try to shake them off when you get home. You’ll drive down to that quiet lake you like to sit by, relax on your back porch with your bourbon and hypocritical cigar, spend a Saturday shooting skeet with your normal friends who don’t quite understand what you do at work. You grab your handy list of non-pharmaceutical antidepressant platitudes about hobbies, socializing and exercising every therapist rattles off, trying to shake that fat, lazy canine from your back, and you will return to work the following day feeling none of it.

Another earache, another sense of entitlement, another attempt at scoring some pain killers, another abscess secondary to shooting up that painkiller, etc. The day will drag on and on and on, until you walk into a room with two scared parents and a confused little boy. The little boy just ate the delicious cherry candy that was his dad’s 81 mg cherry chewable aspirin, and he’s probably going to need your undivided attention for a moment. Pharmacy sends down two tubes of activated charcoal, and you fail miserably to get him to drink it with a straw. After a heavy sigh and an expletive, you resort to spoon feeding him bit by bit. You sit him on your lap making stupid airplane noises and shoveling huge spoonfuls into his giggling mouth.

The charcoal is everywhere (luckily everywhere also includes his GI tract), and I’m grinning from ear to ear. My scrubs are stained black, the little boy has tried to fingerpaint my glasses with it, and I’m tickling his belly to get him to laugh and let me shovel in another spoonful. I may even be making some silly baby gibberish. There is no freeloading dog with obsidian fur, there are no impatient patients, no 15-out-of-10 stuffy noses, no fits over pain medications, just a charcoal-covered man in scrubs and the reason I chose medicine.

“Does it break my heart, of course, every moment of every day, into more pieces than my heart was made of, I never thought of myself as quiet, much less silent, I never thought about things at all, everything changed, the distance that wedged itself between me and my happiness wasn’t the world, it wasn’t the bombs and burning buildings, it was me, my thinking, the cancer of never letting go, is ignorance bliss, I don’t know, but it’s so painful to think, and tell me, what did thinking ever do for me, to what great place did thinking ever bring me? I think and think and think, I’ve thought myself out of happiness one million times, but never once into it. “

–Jonathan Safran Foer

Sam Goldstein is an ED Technician and Nationally Registered Emergency Medical Technician currently working in a large urban emergency department. He has spent the last several years working in both field and clinical settings for various agencies and hospitals, as well as with the US military.