“EMS is wild and imperfect. Just like our patients. It’s dangerous and a little mad and possibly contagious…patients don’t come to us… we go to them, and where and how we find them, well, that, too, is part of the story. once in the field, we should expect no help.” – Kevin Hazzard
“A Thousand Naked Strangers” by Kevin Hazzard is an enjoyable memoir that describes the author’s journey through Atlanta’s emergency medicine system (EMS) system. In the book, Hazzard breaks down the basic components and emotions of EMS, chews them up, and spits them back out in a creative non-fiction smorgasbord. Fear, happiness, excitement, despair, and hope all make appearances, and the reader finds it hard to stop with each successive story surpassing the previous. The book is divided into sub-books which helps to relay the path that Hazzard takes in chronological order.
Book One: A Change of Plans
This book is about the author’s own accidental rebirth. Through a combination of random internet browsing, an unfulfilling job, spousal encouragement, and searching for the ever-elusive meaning of life, he finds himself in an EMT class at a local community college. The fear of the unknown and self-doubt finds itself prominently at the head of the class during this section as Kevin struggles to come to grips with his newfound and perhaps serendipitous career path. He also introduces us to the “ecosystem” that is Grady Memorial Hospital and their affiliated EMS system.
Book Two: Fresh Meat
In this section, we watch Hazzard’s transformation from fresh meat to passionate confidant. He recounts incredible tales that only emergency personnel can begin to fathom, contrasting fear with humor and the somewhat dark desire to happen upon sickness and trauma while on the streets. Continuing his journey, he pushes forward and returns to school in order become a full-fledged paramedic, and in doing, accepts “the mantle of final responsibility.”
Book Three: Top of the World
The next book describes the author’s ascent with confidence as a Grady paramedic and the reader can see the beauty of a professional blossoming into his own skin. The downside of his growth – hubris and overconfidence – looms large in this chapter, leading him slightly astray. Throughout this time he also develops a close connection with his partner, and together they push each other to greater heights until they hit their peak. Tones of friendship and teamwork ooze through these chapters and stories. Unfortunately, summits are always followed by a descent, and when his partner and friend leaves, Hazzard begins to question his career and his motivation to continue on his work as a paramedic.
Book Four: The Fall
Without a parachute, our author slowly fades out of his life as a paramedic. From initial burnout and bitterness, followed by apathetic part-timing, we follow Hazzard through the doldrums of realizing his time has come and gone as a paramedic. This all comes a head when – much like in the beginning – Hazzard’s wife gives him the final push to do what he knows deep inside is the next step. Quitting. With soul searching and self realization, our author begins to understand what his wife saw coming long before him.
Analysis and Clinical Application
Hazzard provides a witty, full-frontal account of the wild-side of emergency medicine. His tongue-in-cheek patient stories vividly illustrate various aspects of humanity while also paralleling the metamorphosis of a medic. As emergency physicians, we can relate, as our own clinical vignettes stick with our psyche and shape who we become. Hazzard makes a point to address the scenarios that are likely to be the most jaw-dropping to those outside the medical field; these seem to hold the incredibly important dual purpose of acknowledging the somewhat skewed perspective that medical professionals may hold while giving us a moment to reflect on these schemas within our own minds. As we identify with his stories, we realize that we are not alone in our experiences. We are also reminded of the breadth of these encounters; from levity to tragedy to the seemingly fictional, we take part in the most real aspects of humanity and are forever changed.
Impressively, he manages to write in a comical tone while addressing complex themes of provider burnout, relationships, spirituality, bearing witness to death, provider safety, workplace politics, hubris, urban poverty, and the search for meaning.
Google Hangout on Air Discussion with Author Kevin Hazzard
- What role do we play as health care providers, especially those involved with emergency medicine, in the dying process? Is there adequate training in delivering bad news? Have you started implementing POLST forms in your department?
- How can we better address provider safety – especially those out in the “field”.
- Which of the following factors contribute most to burnout: The long hours or erratic scheduling? Feeling underappreciated or unsafe? A lack of connection with your patients and coworkers? Feeling inadequate to meet the social needs that may actually be the cause for many of our “frequent flier” calls?
- What steps can we take to prevent burnout?
- How can we improve the relationship between EMS and the ED, and why is this important?
- Chapter 17’s description of a disaster drill gone wrong is both a comical and truthful reflection of how many EMS systems and hospitals would respond to a real disaster. How can you implement or improve your institution’s disaster drills?
- In chapter 18, when describing his friend John’s death, Hazzard says, “He hasn’t passed away or gone to a better place. He simply died in the basement.” Do you have a spiritual belief practice that makes your witness of death less bleak?
- Hazzard equates becoming a paramedic with “accepting the mantle of final responsibility.” Becoming a resident, and then an attending, feels similar. How has your life changed now that you have accepted these higher levels of responsibility?
- In chapter 33, Hazzard describes how the types of calls he receives change as the economy crashes in 2008, demonstrating how emergency personnel are offered a unique vantage into medical anthropology and sociology. How do your patients’ complaints reflect the socioeconomic and cultural facets of your community?
- How has your witness to brutality and suffering affected your closest relationships?