Zibby chats with writer Joanna Sokol about A REAL EMERGENCY, an introspective, richly layered, and surprisingly hopeful memoir about the best and worst parts of her career as a paramedic. Joanna shares gripping insights into the realities of 911 calls, the broken systems behind emergency medical services, and the emotional toll and camaraderie that define life in the ambulance. They discuss everything from the beauty of always showing up—no matter who calls or why—to the burnout and low pay that plague the profession. Finally, Joanna shares how this memoir came to be, after years of collecting stories and needing to get them out of her system.

Transcript:

Zibby: Welcome, Joanna. Thank you so much for coming on Totally Booked with Zibby to talk about A Real Emergency, a memoir. Congrats. 

Joanna: Thank you so much. I'm really excited. 

Zibby: Oh my gosh, your book was so good. I've learned so much. I had no idea about the real state of affairs of this whole industry, and I'm, I'm like sort of shocked still.

But anyway, tell everybody what your book is about and we'll go from there. 

Joanna: Yeah. Okay. The, this is kind of the hardest question for me 'cause I have to think of a, a good 32nd pitch. It's, it's about ambulances and EMTs and paramedics. I spent 14 years as an EMT and then as a paramedic, um, about 10 of that in the 9 1 1 system full-time on an ambulance and I've always taken notes and kept journals. Uh, it's just kind of how I interact with the world. And so very early on in the career, all this crazy stuff was happening. You know, we see things that I've, you've never seen before and I found myself just forced to write it down. I was like, to the point where I was in the back of the ambulance, like looking for scraps of paper, just like, oh my God, I have to write that down.

That was crazy. You know? And so. Over, you know, a decade and a half. I just started collecting stories and thoughts and quotes and images. And then once I started putting them together, I realized it was actually very important to me after doing this work for so long, to include not just my voice, but the voices of some other EMTs and paramedics and to actually do some research and find out more about like how this industry works and why it got so crazy and how we got here.

And so I ended up putting together. An essay collection. It's a collection of voices, not just mine and, and stories and just like little paintings and snippets of what it actually feels like to do this work today, which as you seem to have noticed, is not what people think it is like. 

Zibby: Oh my gosh. Well, you start out by saying something, which I also hadn't thought of, which is just how crazy it is.

Lemme see if I have this. You start out by talking about how. Wait, isn't it crazy that you can just dial three numbers on your phone and anyone shows right up? And that's just a service that we all take for granted and you don't think about it and you don't have to like put anything else with your call other than like, Hey, please come.

Like, you don't have to defend it. You don't have to give any proof and someone shows up. And so what does that do to a community when so many people have no other option but to call 9 1 1 or are just lonely, or dot.dot. So talk a little bit about that. 

Joanna: Oh yeah, absolutely. It's, it's one of the fundamental sort of paradoxes and wonderful and frustrating things about 9 1 1 is that.

When you pick up the phone and call dispatch and say, I need an ambulance, they don't say, okay, what's your credit card number? They don't say, you know, where are you? How bad is your emergency? Does it really deserve an ambulance? Who are you? They just start sending one. 

Zibby: Mm-hmm 

Joanna: And so what that means, it's really amazing.

It's really beautiful, but we have really become, I. The last resource for a lot of people who don't have anyone else to call when you first get into the work, and I have several different medics talking about this in the book. It's really shocking and surprising because we get trained to think that we're gonna run on these like emergency life or death 9 1 1.

You know, everyone's always gonna be bleeding out or dying. The sirens are always gonna be on, every single call is gonna be like life or death, you know, save the airway. Shock the patient. And then once you get into the work, you find out that that's maybe four or 5% of the calls, 95%. And I've, I've actually looked at the numbers.

I kept my own notes and I researched this roughly. It's like 90 to 95% of calls are not code, what we call code three returns. Those like lights and sirens, scary life or death emergencies. It's the elderly, it's the chronically sick, it's the homeless, it's addiction, mental illness. Domestic violence. You know, it's, it's these, not that domestic violence, domestic issues is kind of what I meant to say.

Zibby: Mm-hmm. 

Joanna: It's people who have these long, ongoing problems. They have a tough quality of life and they just don't have anyone else to call and they need help with their blood pressure or getting their meds checked, or they need a ride to the hospital because they don't have another way to get there, or their tummy hurts and they're sort of confused and like don't really know what that means.

And so the vast majority of our calls are not these really scary emergencies and a lot of medics get into this work and they get really frustrated by that. They get really confused and they're like, I thought I was here for emergencies. You know, I don't wanna run on this like boring, challenging stuff.

And a lot of it is really frustrating. You know, you're gonna run on the same guy three, four times in a day sometimes, because he's me and we, we have callers who call us a few times every day because, you know, they're lonely, they're addicted to meth, they're very addicted to alcohol. They like to drink a lot, and then trip and fall and hit their head on the floor and get stuck in the bathroom.

And we go pick 'em up and then they drink more and they fall down again and we go pick 'em back up. You know? And so it's very common to get really frustrated with these calls, but it's, I also try to find the honor in it and the virtue in it. That was one of the things that really kept me going because.

That's what it comes back around to is that the phone number is free and someone will show up every time no matter what. Even if it's your fifth time calling us today, and we're all super freaking mad at you and we're sick of dealing with you, we're still gonna come. We're still gonna get you off the floor.

We're still gonna be nice to you, and it can be so frustrating. But there's also something really beautiful in it. The fact that we do show up every time no matter who you are. No matter how frustrated we get with you, and so I, I really have tried to hold onto that, to the, the beauty and the virtue in that and the fact that that's actually like a really cool, amazing thing.

As you mentioned, we take for granted so. 

Zibby: Well until your book, I hadn't worried about it going away, but now I'm worried about that. Yeah, it's, it's sort of, not to say it will, I'm just saying like, because I had taken it so for granted. I'm like, well, what if, what if we didn't have it? What if. Yeah. You know, PE and people complain so much, like, oh my gosh, it took 10 minutes for the ambulance to get there.

Yeah. And from an operational perspective, I'm like, I can't believe this works. I mean, think about how hard it is to get anything done in this country at all, right. To get a driver's license, like how complicated that is. And here you're just like, Juju. It's like you, you just fly through the air. 

Joanna: So yeah, we show up every time.

It's. It is getting harder as, as the book talks about, our staffing is really rough these days. It's getting a lot harder to get ambulances there on time and there's a lot of reasons for that, which I don't know if you wanna get into or not. 

Zibby: Well maybe just touch on a couple that we should all know about.

Joanna: Yeah. Uh, our staffing is really challenging these days. Ambulances, depending where you are. Are run by a whole bunch of different services. Some, most of them are private, some of them are run by the fire department, or sometimes the police or hospitals. The, the most common one in the US is either privates or fire departments, and it's really tough to keep staffing up the ambulance sort of famously in healthcare does not make money. It does not create a profit. It actually loses a lot of money because of what I mentioned. A lot of the people that call us are elderly or poor, or homeless, or aren't gonna pay their bill for whatever reason. And so it's very hard to collect bills and to keep an ambulance service alive.

And so medics get paid really, really poorly. The median wage for a paramedic in the US is $25 an hour. I think it's 25 74, as of May, it's really hard to get people to go do this incredibly challenging work with really long hours for that much money. And so it's really hard to keep staff up and they get, and we get treated really poorly at most of the places we work, and so it's hard to keep ambulances.

Another big problem is that the ambulances get stuck at the hospitals. That's something that a lot of people find really surprising about EMS, but when we show up to a hospital, if our patient is really critical, if they're dying, we'll usually get brought straight into a room. But if we're not, we'll get, it's called wall time.

We'll go in, we'll greet the nurse and she'll say, grab a wall, and then we'll hold up on the wall and we'll wait sometimes for hours. For a bed to open up, and so you've got 9 1 1 calls going off in the city. There's no ambulances available because our staffing's already low, and then you've got half the ambulances in your system stuck on the wall of a hospital waiting for a bed.

And so those numbers, and so someone who's trying to call an ambulance. You know, hopefully we'll get one in a, and it's funny that you said 10 minutes. That's such a New Yorker thing to say. 

Zibby: Sorry. 

Joanna: Because, no, I love it because in a big city, yeah, the expectation is eight or 10 minutes. But in rural ambulances you might be waiting half an hour or an hour for an ambulance.

'cause the closest one is coming really far away. And that's some, that's a reality that a lot of Americans live with, so it's tough. 

Zibby: My spoiled New York existence here where everything is immediate and you're immediate if it's like five minutes long, but yes, 

Joanna: Totally 

Zibby: The ambulance. Postmates, where is everything?

Come on, let's go. 

Joanna: Yeah, I want my delivery Thai food and I want masks. 

Zibby: Yeah, exactly. Exactly. Oh my gosh, that sounds terrible. 

I loved the scene where you had this incredibly long day and it was so terrible, and you wander around in this. Parking lot and come across a mirage, but actually it was true of an icy station, and you give it to your colleague and you're sitting like basically tailgating on your ambulance drinking these or eating these icy in scorching hot weather weather in Reno.

Talk a little bit about the payoff, right? And how little it is and how these tiny little things can sometimes make the day worthwhile. 

Joanna: Oh, I, I love that. I, I really love that story. I, I put it right up at the front of the book because. I wanted to sort of hint at one, one of the big themes of the book is.

Which is this job. It's, it's so tough. It's so soul sucking. It's so exhausting. And the thing that gets you through it is the camaraderie, the partners and the people that you work with. There is a real, real brotherhood and you know, I'm a girl, whatever, sisterhood, brotherhood among the EMTs and medics, the, the field crews that do this work that I've never experienced anywhere else in my life.

There's a sense of family and taking care of each other because we're really in the trenches together. And sometimes they are literal trenches. You know, we're like in the dirt, up to our knees pulling stuff out, and it's four in the morning. It's five in the morning. And so that scene that, that I wrote, I, I actually wrote that like a year or two.

It, it was much, much later. And I wasn't at work that day. I was on my day off and I was, I just kind of had that memory, like eating away at me and we had run, as you said, really tough calls. It's hot, it's sweaty, we're exhausted. And one thing about being around so much death and so much dying and so much illness is that it really forces you.

To cherish the small moments, and I know how cheesy that sounds, but it's so cool. 

Zibby: No, I get it. I get it. 

Joanna: You know, you get there and so we're, we're sitting in the back of this parking lot and I have to write my chart and it's busy and we're exhausted, but we have like five minutes before we have to go run another call.

There's no calls on the board for a couple minutes and yeah, I heard the sound of this guy selling icees and we sat there on the back and I, my partner I really cared for, and he'd been working really hard and I bought us two and we sat on the back in the hot, hot sun eating this like cold, sticky ice for five minutes.

And it was just such a beautiful, and it was like, these are the moments that this job forces you to take and that sense of connection to the partners that you work with. You know, the, the men and women I've worked with on the rig. Are just a real family to me in a way that I think is, is really incredible and they really have each other's backs, and you have to take those moments.

And so it's like, even though I didn't want the book to just be like trauma on awful, on depression, on frustration, on cynicism, even though that is sometimes what the job can feel like. Because right in those worst moments when you're just exhausted and you're cynical and you're full of trauma, then one of your buddies will come by.

And be like, dude, I got ice cream. You know? And then, and you'll just be laughing. You'll be laughing your freaking faces off at four in the morning. And so that scene, it, it was about. Trying to cherish the sweet moments, but it was really about the partnership and the comradery, you know, and, and having a buddy that you're going through this with.

And so we're sitting there on the tailgate, kicking our feet and kind of elbowing each other. And it's, and it's about that. It's about the teamwork and the camaraderie and, you know, I'm, I'm glad you like that scene. 

Zibby: I, I love it. I love that scene. I loved it so much. I feel like now I need to go out and get an cy, but that's okay.

I'll wait. You talked about how logically, this does not sound like a job that you talked about, how it's a tough sell, right? The, the lack of the, the low payment, which is, you know, just like teachers, right? It's like not commensurate with their value to society. It's, uh, demanding in every sense of the word, emotionally, physically.

What is it about you that made you wanna do it, drawn to it, continue to do it. Why, why you and who else? 

Joanna: It's really interesting. That was. That was a part of the book I initially didn't wanna put too much of myself in the book because I was kind of embarrassed, you know? I was like, I wanna write about this work.

No one cares about me. I'm like a random white girl with a job who cares? My editor, who I, who I, who I deeply love, she's incredibly talented, kind of forced me to put more of me and of the people that I work with in the book, she was like, readers wanna know who does this for a living.

Zibby: Mm-hmm. 

Joanna: You know, who would choose to do this?

And then who would keep doing it? 

Zibby: Mm-hmm. 

Joanna: So I was. I was young. I was in my twenties. I was full of adrenaline and angst and energy. I wanted to do something exciting and badass and cool. I had tried to go into science at school and I just couldn't sit still long enough, and I found this world where you got to use science, think quickly on your feet, help real people with your hands in a very immediate way.

And I just totally fell in love with it. I went in thinking like most EMTs and medics, young EMTs and medics, that it was gonna be all emergencies all the time. And then I found out that it wasn't at all, and it was really the people. It was the people that I worked with. I felt like I fit in somewhere.

You know, a lot of us, we joke all the time, we call ourselves the, you know, the Valley of the Broken Toys and like a team of angry misfits. And it, it, the people were just hilarious. They were so hardworking, they were so dedicated. They were so funny to be around. And I just felt, I felt like I had found my people.

And like I said, that's really what kept me in it. And the work is exhausting, but it can be really rewarding. And the whole time I was doing it. Even as burned out as I got, and as bad as my physical injuries got, and you know, the emotional trauma I was piling on, I still felt like the work that I was doing was worthwhile.

You know, I still felt like I was helping people. I still felt like it was a worthy thing to do in the morning, and I found that was a really common theme. With all of the medics that I talked to, they were, all of us have faced some level of exhaustion and burnout and frustration, but they were all like, yeah, but you know, we love it.

What else are we gonna do? It's, it's an amazing work. And on a more negative note. A lot of medics do not have college educations, and a lot of them do not have a plan B. You get a a two year certification. There's one of my favorite muses in the piece, an old park or mine, Mikey. He says, I was a high school dropout.

I had a certification that allowed me to do one job and I didn't. And a lot of us, we get in, we build up all this trauma and this exhaustion, and then we don't really have anything else to do. Most medics will either go into nursing or fire at some point once they get, you know, physically broken by the system.

But there's really not, in some senses, you kind of get stuck in it. And so that can be really tough and that's one of the things that I really wanna talk about and want more people to know about because I want there to be options. I want medics to have more options to move up, to specialize, to do things once they reach that point, uh, where they physically aren't able to work in the field anymore.

And so it's, there's, I don't wanna end on the bad note, you know what I mean? I wanna end on the joy and the comradery, but, but those are both, uh, those are both definitely parts of it of why people do this work for so long. 

Zibby: Is there something that people who will one day be in an ambulance or be a partner of someone who is in an ambulance?

What, is there some insider knowledge that we all should have? I mean, I, now I see what it's like from your point of view. So that's like value what, that's like priceless information to put myself in your shoes. But for everyone else, if, if before they've read it, what should we know? What should everybody know?

Joanna: About medics? 

Zibby: Yeah. Or just like what should we be prepared for? What should we say? Like how should we interact? Like what expectations are there that should be met? Like everyone's in that moment at their most vulnerable, right? And we're depending on the people in the ambulance. Alay are our biggest fears in the world, but you know what it's like on the other side.

So what is it that we should carry with us? 

Joanna: That's such a, that's such a compassionate question. I really like that. I mean, the first thing that comes to mind is another one of the medics that I interviewed, longtime paramedic, amazing clinician. I asked her what she would wanna tell the world about being a paramedic, and she said, I want them to see us as people.

Zibby: Mm-hmm. 

Joanna: You know, I want them to understand that we have good days and bad days. You know, we occasionally need to eat and use the bathroom and sleep and. We are out there. We're trying as hard as we can, I promise. But we are. We are actually humans. We cannot be perfect heroes all the time. And if you are partners with a paramedic, understand that we will be tired and hungry a lot because our sleep is really messed up.

So having lots of snacks around is really helpful. But yeah, I think the biggest thing to the members of the public, if you're scared, that's okay. That's our job. We're very good at dealing with people that are scared and upset. That's, that's kind of our, our wheelhouse. And whatever you're feeling, it's okay.

We have seen it all. We will not be shocked. Um, it is very, very challenging to shock a paramedic. Don't be embarrassed about whatever's going on. We've seen it before. We're happy to help. And, uh, yeah, just try to. There was this theme, almost all of the medics I spoke with said something along the lines of, to just be nice to us, to just understand that we are human.

You know, we see a lot of people in their most challenging moments, and sometimes they take out their grief on us, and that's okay. We get it. It's part of it. But try to understand that we are people too. 

I think. 

Zibby: So sad. You have to even say this, but it's true. 

Joanna: I mean, it's, you know, it's the only thing I could think of.

Zibby: No, it's a, it's a good point. And I think that it's something people are just so accustomed to the fast service and getting what they want and, you know, when a, when a flight doesn't take off, like yelling at the people behind the desk, like people just don't know how to interact sometimes and they don't imagine like the person behind the desk.

Getting up and wake, you know, waking up and getting dressed and going to work and turning on their computer and like, what are they gonna do? Turn a plane around. So anyway, uh, yeah. 

Joanna: No, sometimes when people get mad at us for, for being late or for taking so long to show up, it's like, I'm sorry, I was doing CPR on a baby, you know, it took a minute.

Like, we got here soon as we could, I promise. You know, as, as much as I com I don't wanna sound like I'm complaining. Most of the people that we deal with,.. 

Zibby: You don't,.. 

Joanna: Are, are really, um, are very nice to us. Most of the people, honestly, a a lot of our, a lot of our interactions are cool. You know, a lot of people understand that we're there and we're trying to help.

Zibby: Well, if I have the presence of mind. Should I be in an ambulance or should someone I love be in an ambulance? Let's hope not. I am gonna grab a bunch of snacks to throwing around and say it's because of this book. A real emergency. 

Joanna: Yeah. We don't, we don't get breaks. We don't meal breaks, so we love snacks.

Zibby: So how, in the midst of this totally pressure filled job, why write a book in addition? 

Joanna: Oh yeah. Um, well, I did actually take time off of work to write the job, or sorry, off of work, um, to write the book, which is something that not a lot of paramedics are able to do. This is something I've actually thought about a lot because I've, I've read a ton of Dr. Memoirs, and don't get me wrong, I love Dr. Memoirs. They're really fun to read. Um, I've, I've read a lot of memoirs by doctors, by professors, by scientists, um, by people who have. Unfortunately who have the financial resources to take time off to write a memoir, and most nurses and medics just don't have the option.

I spent probably a, about a year and a half doing research interviews, going to the library, looking up old newspaper clips, writing and rewriting and rewriting and writing and rewriting, and I was really, really lucky to be able to afford to take that time off. And so it's, that's part of the.

Responsibility that I feel to try to represent this in an authentic way and hopefully in a way that will help people. But yeah, like I said, over time, I just collected all of these stories I had. Hundreds and hundreds of pages of stories, journal entries, notes, quotes, descriptions of things, my own feelings, and I was incredibly lucky.

I just really got this sort of lightning bolt series of circumstances. I had the financial bandwidth to do it. One of my very oldest. Closest friends works in publishing and helped me put together, and she was actually the one who became my editor on this. I have to embarrass her a little bit. The wildly talented Haley Cunningham, if anybody is listening, who knows her.

And so we were able to work together on this thing. And when the book deal finally came through, I was at a stage. Where I was really, really physically damaged. Um, I have injuries to my back, shoulder, and wrist are the big ones. And so I just, I still liked the work, but I couldn't really physically do it anymore.

And so I was kind of making choices about, okay, am I gonna rock a desk for the next 20 years or am I gonna try to take the time to write this book and move in a different direction? And so for me, it worked out that I was able to take the time off and as for why I wrote the book, at a certain point I felt like I was carrying it around inside of me and it was becoming really heavy.

Haley told me something that I, I think might is common in writer circle. She said, they say you write your first book when you can't, not anymore. 

Zibby: Mm-hmm. 

Joanna: And I got to this point where it honestly felt like carrying this book around inside me was really heavy and it was getting in the way and I like had to get it out of me.

And so. Like I said, I got to a point where I physically couldn't work in the field anymore, and so it was time and again, I got really, really just dumb lucky to, to have to know the right people and get the book deal. So that's kind of how it came together. 

Zibby: And so what, what's your plan now? 

Joanna: Oh, I hate this question.

Um, that's a great question. I, I am teaching, I'm teaching EMTs and paramedics at a couple of community colleges in the Bay Area. I really love that work. I find it really fun and really rewarding, and I have. I'm picking away at prereqs to potentially go to nursing or PA school or move forward in the medical field.

But right now, between the book and the teaching and, you know, just breathing a little bit, I, I would like to get back into the field and do patient care again at some point. But yeah, turns out writing a book is hard and it takes a lot of work. When I first left, it was like, all right, I'm gonna bang out this book and then go back to school.

And it turns out that that was not realistic. So yeah, I'm, I'm writing the book I'm teaching right now, and I have no idea what's coming next. I really don't. 

Zibby: Okay, well I'll be rooting for you in whatever you do. I'm so glad you wrote it. I really, as I said, have a new understanding of, of the whole thing.

And every time I hear a siren going by my window, which happens, I feel like every two minutes, all think that that's actually only 5% of the time and it could be going nonstop and just imagining who's inside and what you all are going through. So anyway, thank you for all the work you do to help so many people.

Joanna: Thank you so much. I, I really appreciate it, and I, I love the podcast, so.. 

Zibby: Oh, thank you.