Editor鈥檚 note: If you or someone you know is struggling or having thoughts of suicide, you are not alone 鈥� and help is always available. Call or text the 988 Suicide & Crisis Lifeline to connect with a trained counselor, or chat online at 988lifeline.org. Whether you鈥檙e seeking support for yourself or someone you care about, please know that it鈥檚 never too late to reach out. You deserve help. You deserve hope. Someone is ready to listen.
By Orlando E. Rivera, DNP, MBA, RN
I didn鈥檛 think I鈥檇 ever come close to quitting.
Not me.
Not the guy who ran into burning buildings, slept beside a defib in the rig, learned how to do chest tubes in a helicopter and taught med math to rookies on the tailgate of an ambulance.
But it happened.
And it didn鈥檛 happen on the worst call of my life.
It happened on a Tuesday.
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No major trauma. No pedi code. No multi-casualty scene. Just another routine shift that slowly crushed me in a way the bloody ones never could.
Let me explain.
The quiet cracks
We talk about burnout like it鈥檚 a fire.
But it doesn鈥檛 explode all at once. It鈥檚 slow. It鈥檚 invisible.
It鈥檚 the eighth time you hit the snooze button before a 24.
It鈥檚 the rig smell that clings to your clothes even after a shower.
It鈥檚 not remembering if you ate lunch or just thought about it.
It鈥檚 staring at your boots and wondering if you really want to put them on.
The day I almost quit, I was already brittle.
Too many years of skipped meals and crushed emotions. Too many patients who looked at me like a taxi with a stethoscope. Too many 鈥渇requent flyers鈥� with real needs and no one else to meet them. Too many chiefs calling for metrics while I was still rinsing blood off my forearms.
And then came the call.
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Just another lift assist
It was dispatched as a 鈥渨elfare check.鈥�
Elderly male. Neighbor hadn鈥檛 seen him in days.
We arrive. Doors locked. No answer. PD makes entry.
He鈥檚 alive.
Barely.
He鈥檚 lying on the floor in his own waste, half-conscious, too weak to crawl to the phone.
I kneel beside him, check his pulse, his pressure, his pupils. His lips move. He says, 鈥淚 didn鈥檛 want to bother anyone.鈥�
That one sentence cracked something in me.
Because we had taught people to wait until it was dire. We had trained the public to feel guilty for calling unless they were bleeding or blue. And now here was this man, dehydrated, infected, neglected, apologizing for not dying faster.
We got him packaged and transported. No bells. No whistles. No CPR. Just quiet suffering in the back of the bus.
The call after that
We barely restocked before the tones dropped again.
This time? A psych complaint. PD on scene. 鈥淐ombative male.鈥�
We roll up. He鈥檚 shirtless, swinging at shadows, covered in what I hope is mud. He鈥檚 screaming about the government and demons and his dead sister, all at once.
He needs help. Real help. But all I鈥檝e got is a stretcher and soft restraints.
PD looks at me like it鈥檚 my turn. And I鈥檓 thinking: I just left a man dying of loneliness. Now I鈥檓 about to strap this guy down and haul him to an ER that鈥檒l discharge him in 4 hours and bill him into oblivion.
And I ask myself: What am I doing?
Not just on this call but in this career.
The moment
We get back to the station after that one. My partner鈥檚 quiet. I鈥檓 quieter.
I go to the supply closet. Sit on a stepstool. Close the door.
And I cry.
Not loud. Not long. Just enough.
I cry because I鈥檓 tired of pretending it鈥檚 not getting to me.
I cry because no amount of IV skills or RSI protocols or trauma shears can fix what鈥檚 broken out there.
I cry because the system we鈥檙e propping up is failing the people it claims to serve 鈥� and we鈥檙e the ones left holding the line with duct tape and grit.
And in that tiny, sterile closet, for the first time in 20 years 鈥�
I think about quitting.
What kept me
I didn鈥檛 quit.
I wanted to. But I didn鈥檛.
Not because I鈥檓 brave. Or noble. Or some war-hardened medic from the glory days.
I didn鈥檛 quit because my partner came in, saw my face and didn鈥檛 say a word.
Just sat next to me. Quiet.
That silence said more than any peer support program ever could.
We sat there like that for 5 minutes. Then he handed me a Gatorade, stood up and said, 鈥淣ext one鈥檚 ours.鈥�
And it hit me.
We don鈥檛 stay for the calls.
We stay for each other.
The unspoken epidemic
The day I almost quit wasn鈥檛 unique.
You know how I know?
Because when I finally shared the story with other medics 鈥� some younger, some older 鈥� they all nodded.
Some said, 鈥淪ame.鈥�
Some said, 鈥淚 already did quit.鈥�
Some just looked down and blinked hard.
There鈥檚 an epidemic in EMS that doesn鈥檛 make the news. It doesn鈥檛 get tracked in annual reports or quality metrics.
It鈥檚 the quiet exit. The slow fade.
The burn out that doesn鈥檛 rage, it just withers.
And the worst part?
We鈥檙e too damn proud to talk about it.
The calls don鈥檛 break us. The silence does.
We鈥檙e trained to handle screams, blood, chaos.
But no one trains us for the moral injury of doing everything right and still feeling like we failed.
No one prepares us for the emotional whiplash of going from a SIDS death to a toe pain call with no pause between.
No one tells us that eventually, you will have nothing left to give, and the job will still demand more.
And if you say you鈥檙e tired, they鈥檒l say, 鈥淢aybe it鈥檚 not the job for you anymore.鈥�
That鈥檚 the betrayal.
Because the ones who feel the most are often the ones who cared the hardest.
What I know now
If you鈥檙e reading this and you鈥檙e close to your own breaking point, hear me:
You鈥檙e not soft.
You鈥檙e not weak.
You鈥檙e not failing.
You鈥檙e human. And this job chips away at that humanity every damn day.
You are allowed to feel. You are allowed to rest. You are allowed to say, this is too much right now.
What you are not allowed to do is suffer in silence.
Talk to your crew. Talk to your spouse. Talk to someone outside the badge if you need to.
And if no one鈥檚 listening?
Call me. I鈥檒l answer.
Because I鈥檝e been there.
Because I stayed.
And because someone once sat beside me and didn鈥檛 let me quit when I almost did.
The real heroism
We love to glorify the dramatic saves. The intubations in the ditch. The CPRs that walk out of the ICU.
But the real heroism?
It鈥檚 clocking in on your 100th shift of the year knowing it鈥檚 gonna be thankless.
It鈥檚 lifting another 300-pound patient with a ruptured soul.
It鈥檚 standing in the rain beside a broken addict and offering Narcan without judgment.
It鈥檚 holding the line 鈥� not because it鈥檚 glorious 鈥� but because someone has to.
That鈥檚 what makes EMS sacred.
Not the badge. Not the lights. Not the trauma drama.
It鈥檚 the quiet, relentless showing up.
Even when you don鈥檛 want to.
Especially then.
Final thoughts
I don鈥檛 know who needs to hear this.
But if you鈥檙e at your end, don鈥檛 make a permanent decision in a temporary moment.
You鈥檙e not alone in your doubt.
You鈥檙e not the first to cry in the supply closet.
You鈥檙e not broken for needing a break.
The day I almost quit EMS wasn鈥檛 the end.
It was the beginning of me doing this job differently.
With boundaries.
With honesty.
With support.
With a full heart but a protected one.
And maybe that鈥檚 the lesson we all need.
You can be strong. You can be brave. You can be the one they count on.
But you don鈥檛 have to bleed to prove it.
ABOUT THE AUTHOR
Dr. Orlando E. Rivera is a nationally recognized EMS leader, nurse and author of 鈥淵ou Can鈥檛 Chart Gut Instinct鈥� and 鈥淵ou Can鈥檛 Chart Moral Injury.鈥� With over 30 years in emergency and critical care, Orlando speaks truth to the silent struggles medics face and helps build the future of EMS with courage, compassion, and candor.
