Hope Against Hope

Learning the difference between hoping and helping as a black market medic in Far West Texas

This is the second in a series of essays based in part on Zen teacher Joko Beck’s dharma talks about hope. The first essay, “Hope is Part of the Problem”, is available here.

I.

Shortly after I received my entry-level first responder certification in 2010, I got my first black market EMS¹ call: a quiet conversation at a party in the tiny, remote town of Marfa, Texas. It was the Chinati Weekend art festival closing party, the kind of wild party that only happened after a good chunk of the art tourists had gone home and everybody who’d been working all weekend was finally off the clock. I’d been living in Marfa for about a year, and had recently signed on with the city/county ambulance crew.

A friend of a friend sliced their foot open doing a chaotic piece of performance art. They were candy-flipping – tripping on LSD and MDMA or some mail order lab’s approximation of same – and while that wasn't creating any extra medical issues, it meant that nobody wanted to call 911. It was the first time that my friends and neighbors went with “find Chambo” because they were worried that cops might show up alongside the ambulance.

It was the start of what would become a long-running friendship, standing in the weird industrial bathroom of the derelict auto-shop turned artist studio, applying pressure to my friend’s friend’s bloody sole while they reclined in an empty bathtub, tripping balls and telling me how much they loved me. "You'll probably need stitches," I told them. "I love you too but stitches isn’t something I do." 

I delivered what would become my standard line on black market EMS² calls: "I'm not a doctor or a nurse. I don't have the ambulance at my house. I know how to do complicated bandages and stop some leaks, but I'd really like you to visit the ER or at least stop by the clinic when it opens tomorrow." 

Our entheogenic triage station was interrupted when the sheriff's deputies rolled up in force for no particular reason. It was the second time that night that friends came looking for me because I was a first responder. Soon I was outside the studio talking to "Deppity Junior," a young cop who looked all of 21 or 22, with the shitty attitude requisite to aspiring hard-asses. Like all of the other cops, Junior did not like me, the middle-aged Yankee beardy-weirdy EMT. But we had to work together, so at least we knew each other's names³ and he didn’t reach for his gun as I approached.

"What can I do to help your problem go away," I asked him with a big smile, while my friends hollered "fuck tha police" between swigs of Tecate⁴ and drags off Camel Crushes. 

I actually felt for the dude, a youngster who could be out having fun but instead signed up to harsh everybody else’s good time party vibes. We settled on a compromise of "go inside or go home," and people faded back into the former gas station, disappeared down dirt alleys, or coasted home on bicycles. I chose to work as a medic because I wanted to help, and I was starting to understand the many different ways a first responder can do that in a small, remote, low-income community that lacked easy access to medical care, yet suffered an abundance of militant cops and an occupying army of Border Patrol agents.

I leveled up to the lowest medic qualification – NREMT-Basic – and stayed with Marfa's city/county EMS service for three more years. I was on scene many times with deputies, troopers, rangers, game wardens, and Border Patrol douches all armored up in kevlar, strapped with Glocks, with an array of heavier weaponry stowed in their giant trucks. EMS was often in front of the cops, protected by our ill-fitting poly/cotton blend shirts, with maybe a Patagucci base-layer if it was cold out. My partners – mostly lifer paramedics in their 40s and 50s – made fun of my steel-toed boots: "somebody's gonna drive over your foot and amputate your toes." We didn't carry guns. It never occurred to me to want anything more than a slightly larger pair of trauma shears. 

II.

I think about my first responder days when there's war, disaster, police violence, or other mass casualty incidents – like the 2020 murder of George Floyd by Minneapolis police, or the brutal massacres of children, families, and other innocent bystanders in Buffalo on May 14, and Uvalde just a few days ago – in the news. I saw a lot on the ambulance, but thankfully never had to deal with that level of trauma. Marfa EMS is a rural service, with a different kind of intensity. There are fewer calls, but our sprawling geographic coverage area meant long transport times and hours of patient care.

I'm not surprised to hear stories about how little law enforcement does in these incredibly dire situations to actually help people. Like when the cops in Uvalde waited with military-grade body armor and automatic weapons outside the school while an 18-year-old was inside slaughtering children and the teachers trying to protect them. 

Nor am I surprised when – in spite of their failure to help people – cops are the first people to be praised by politicians, and the first agencies to receive more money to buy more guns and military hardware that doesn't do anything to help people. I worked with cops a lot, and they almost never helped me help people.

If bored deputies showed up unrequested when the ambulance was toned out for a medical call, it made our job harder. We'd be talking quietly to the patient and whoever else was around, trying to set people at ease, gather medical history, determine any allergies, and figure out if we were dealing with the uncomfortable but harmless gastrointestinal situation known to barbecue gourmands as a "brisket baby," or an actual myocardial infarction.

Conversation usually ground to a halt as soon as law enforcement entered the environment, scowling men nervously trying to do an entirely unnecessary threat assessment of a septuagenarian couple's double-wide trailer. Regardless of your politics, appetite for psychedelics, or immigration status, most people’s gut will say that the twitchy guy in body armor who won’t take his sunglasses off isn't here to help.

If deputies were first on scene on trauma calls they'd usually just be standing around looking frightened and confused, gawking at the damaged body laying on the ground. They might help for a while directing traffic, but eventually they'd get bored and wander off. One time they got so impatient with us for "blocking traffic" – in our town of 2,000 people with a single blinking red stoplight – that a deputy commandeered the ambulance and started to drive off as we were about to guide our patient off the stretcher and back onto the street.

We had a small crew and there were rarely more than two of us on duty.  On a heavyweight trauma call where my partner and I both needed to work on a patient, we might have to also take care of a hysterical deputy driving us to the hospital, freaking out and jamming on the diesel, slamming us around, nearly losing control of the ambulance. The deputies refused to listen to me, so my veteran partner would have to be the one to yell at him to slow down and kill the sirens for the 30-minute drive on empty highways to Big Bend Regional Medical Center. Shaving 90-seconds off our arrival time wasn't worth whiplashing our backboard-strapped head trauma patient a second time.

After we dropped the patient off the deputy awkwardly tried to show me the porn⁵ he was watching on his flip phone as I cleaned the ambulance. It would not be my strangest encounter⁶ with this person, but it was the grossest.

Or there was the time we ran on a patient who had fainted on a passenger train shortly before it passed through Marfa. By the time we arrived at the stopped train, the person had fully recovered. This was a well-known medical condition for them. We checked vital signs and hooked them up to the heart monitor. They were an adult, who could tell us their name, where they were, what time it was, and what happened. They did briefly lose consciousness, but they did not hit their head, as confirmed by a conductor. They didn’t want to go to the hospital, and had filled out all of the legal forms documenting their refusal of transport.

Everything’s copacetic until Deppity Junior comes roaring up in his truck, blazing lights and siren. He insisted that this person needed to be taken to the ER no matter what. He wanted to arrest this person, handcuff them to the stretcher, and deliver them as a prisoner to the ER staff. My partner and I had to wait around for nearly an hour – blocking traffic on the main Union Pacific rail line between Los Angeles and New Orleans – for a third EMT to confirm what I’d already explained to Junior: If he went forward with his plan, there would likely be a lawsuit. Any medical care the patient received – including the ambulance bill – could end up the responsibility of the sheriff’s department. Controlling the situation and helping out are two aims that are often at odds with each other. Forcing a solution on an unwilling person isn’t helping. It’s kidnapping, assault, and battery.

I worked with asshole macho medics with noxious politics too. That sucked, but we were a small frontier EMS service, and our director was a lifer paramedic dedicated to helping people. It's not always about the person. It's about the training, and the actions that follow. We arrived on scene looking to help. Cops arrive on scene looking for a problem to solve, and their toolbox and cargo pants are overloaded with guns and other implements of violence. 

III.

Late one night my partner “Benji” and I completed a routine medical run from Marfa to Big Bend Regional Medical Center in Alpine, about 30 miles away. I was cleaning up the ambulance while he was writing the report, when our radios blew up. Marfa Dispatch knew we were out on a run, so they were trying to reach the EMS crew in Ft. Davis, a small town about 30 miles north. There had been a 911 call in Marfa about an "unresponsive infant." Local deputies had been alerted, but guns and kevlar aren't much good to a dying baby.

Benji was a weathered veteran paramedic and firefighter, with the shape, density, and disposition of a boulder. He had decades of experience, but a dead baby will fuck anybody up. He came running out of the ER’s sliding doors as I started the engine. "Ft. Davis isn't even out of bed yet," he said. "We'll beat them if we run like our ass is on fire." 

He stopped and looked me in the eye: "Are you ready to do this?" 

I let the rush of adrenaline overwhelm my urge to burst into tears. "Yes." 

I called dispatch on the radio to tell them we were responding, and begged them to send us updates from the deputy on scene ASAP. All they could tell me was that he'd arrived at the location, and we should see his truck at the address. Ft. Davis was also responding. Usually we'd tell them to stand down, but most EMTs that I know aren't going to exercise restraint when the call is "unresponsive infant."

And so we drove through the darkness, speeding over the high desert highways and mountain passes between Alpine and Marfa, both of us scared shitless, juiced on adrenaline. We quietly ran through procedures for infant CPR, and I reassured myself that I'd stocked all of the rarely-used equipment custom-made for tiny bodies. I checked with dispatch again: The deputy was on scene but was unable to provide any more information. Ft. Davis was en route.

As usual, Benji crossed himself and inserted a wad of dip into his lower lip as we came to a halt in front of a small adobe with the front door hanging ajar, the deputy's truck out front. He looked me in the eye again as I slung a bag of medical equipment over my shoulder. "We might be walking into a nightmare. But I know you've got my back. You know how to do this work."

I nodded and again tried not to burst into tears. "And you've got mine." 

"Always. Let's go."

We walked into the house to find the deputy slouched on the couch looking bored out of his mind. A baby was crying in a back room, where we helped two frightened young parents to administer their kid’s newly prescribed medication. The Ft. Davis crew was also on scene by this time, all emergency medical personnel in the region occupied and deeply shook over a minor medical call because a deputy couldn't properly assess the situation, or be bothered to report that the kid was alive. No violence was required, and he took no action.

There was no need for transport, so I walked out to wait in the ambulance while Benji put his remaining adrenaline to good use by emphatically discussing the importance of adhering to inter-agency communication protocols with our body-armored combat-ready colleague. 

It's not about the person. It's the training. Tons of medics, firefighters, cops and other first responders crave adrenaline. In EMS that sometimes manifests in the pitch-black humor of "trauma junkies." But the job is only about helping people: “do no further harm” is the directive. Cops aren't trained to help. They're trained to control situations with violence and protect themselves. Firefighters were usually cool but they also get super geeked out over all their wild equipment and forget to follow safety protocols, which is fine unless you’re the medics on scene at a grass fire and hoping to get home without a two-hour round-trip run to the hospital for smoke inhalation.

IV.

Not all of the calls had such easy endings. As they told us in EMT training, every time you’re on duty there's a chance that you'll be meeting people on the worst day of their life. We didn't get much mental health training, for ourselves or anyone else. But there was a basic instruction to be honest and clear with people about what has happened. If splinting a broken bone is going to hurt a lot, tell them it's going to hurt a lot. If a person has died, tell their people that they're dead. "They didn't make it," only postpones the grieving process for a few confusing seconds.

As I've said many times before when talking about EMS, we didn't tell people "everything's going to be okay." We only came to work when things weren't okay. Sometimes hope is a form of avoidance. We could tell people "we're here to help" even when we could see they’d soon be beyond help.

I once had to tell a man that his little girl was dead. I was the lowest-ranking medic and the other EMTs on scene were working desperately to save another person involved in the same horrific car crash. I stood on the hot tarmac of a tiny regional airport waiting for an air ambulance and felt sick as the man asked "where is my little girl." I choked back tears and told him “she didn't make it.” His face became a question. I said "your daughter is dead" and watched the confusion turn to profound grief and spread through his body like poison.

I didn't offer to "stand with him," because he was crumpled on the ground and wailing. I didn't offer hope or prayers. I offered to help, even when there was nothing left to help with. Help is what matters, even when it can't stop the suffering.

I stopped working EMS many years ago. I love my comrades from those days, but it's hard to talk with them and I’ve fallen out of touch since leaving Texas. We live very different lives, and our brotherhood was formed in real-world blood and tears. I sometimes wonder if I overemphasize the work that I did back then. In a culture that often prioritizes war and violence over peace and kindness, an Army veteran tank mechanic that never deployed outside of Alabama gets the Applebee's discount and the first class upgrade. While people assume that my job was "ambulance driver," or some kind of trauma janitor. A nurse once told me, “nurses are educated, EMTs are trained.”

But that's why cops become cops and medics become medics. "People usually aren't gonna thank you," they warned us in EMT school. "They're not gonna bring cookies to the station, or put you on an EMS calendar. They might look away when they see you around town. They don't want to remember the day they met you." 

Small, tight-knit communities like Marfa are different though. I question the validity of my experience in part because I didn't carry a gun like the cops and soldiers that we’re supposed to annoy with “thanks for your service” while they’re housing discounted jalapeño popppers. Many of our calls were taking care of our neighbors. The handful of times that shit went sideways and somebody said "find Chambo" is more of a reward than I can explain. Despite what the right wing ghouls in the NRA might tell you, it’s a lot easier to be a good guy when you don’t have a gun.

I understand my EMS experience better now that my focus has turned to Zen practice. This is why the teacher Joko Beck's dharma talks about giving up hope help me find rest. My work as a medic and my work as a Zen student is to sit with the pain of life as it is. Both practices are about continuing to try and help, even when there's no hope of solving the problem. 

---

Daniel Chamberlin is an artist and writer living in Muncie, Indiana.

Special thanks to Seth Werkheiser of Heavy Metal Email for encouraging me to tell stories. Gratitude to my friends on the anxiety bird website for not unfollowing while I shouted these ideas out in 280-character increments.

And thank you for being here.

It’s such a pleasure to know that you’re opening this email, subscribing for free (amazing!), subscribing for money (extraordinary!), visiting the website via RSS feed reader (classic!), or smashing that unsubscribe rather than becoming resentful (self-care [nods wisely]).

If you know anyone who might enjoy this writing, please pass it along. This newsletter has a diverse readership: long-time friends of the Inter-Dimensional Music community radio broadcast, deeply missed Big Bend kindred, art world dirtbags, aging Champions of Californiana, metal festival goat yoga people, confused but curious meditation workshop attendees, and fellow slop-style practitioners and seekers worldwide.

We don’t do much publicity because whispers and nods between those who know is how the good word spreads.

1. These stories are based on real events, but names, pronouns, and other details have been changed to protect the privacy of people involved.

2. I knew a lot of chefs who got real creative when they were stoned. Careful with those deep fried donuts, fellas. De-gloving is a helluva thing. Also think carefully before image-searching “de-gloving.”

3. I did not call him Deppity Junior.

4. As one learns by doing highway cleanup projects in West Texas, Lone Star and Shiner are more publicity campaigns for Texas tourism than anything else. Our trash bags overflowed with Tecate and Bud Light.

5. The only law enforcement guy that I liked was an absolutely gigantic park ranger and wounded Iraq War combat vet who dealt with his extreme PTSD by doing nude hikes in the desert and telling border patrol agents to fuck off. That guy rules, nude hiking kicks ass.

A story for another time, so be sure and subscribe, yeah?

6. Another story for another time but for now I’ll leave it at “if you’re making small talk with a creeper cop at 3am while ‘agave-flipping’ on tequila and the dread lysergic, play it cool, but absolutely do not invite that cop back to your house for a beer.”