A Real Emergency: Stories from the Ambulance

by Joanna Sokol

Introspective, complicated, and surprising, A Real Emergency is a love letter from a paramedic to the best and worst parts of her career.

For fifteen years, Joanna Sokol filled private notebooks with her confusion, humor, and anger about the strange world of American street medicine. As her career progressed, she found herself taking notes on scraps of paper, backs of gloves, and margins of EKG printouts. She read about the history that brought ambulances into their current role as the caretakers of society’s forgotten, and spoke to her colleagues about their own experiences and perspectives.

Those reflections are collected here, in a series of raw, powerful essays about the state of American medicine.

Sokol’s life as a paramedic took her to three different the casinos and trailer parks of the Nevada desert, the cozy beach town of Santa Cruz, and eventually the crowded tenements of San Francisco’s Tenderloin district. There are no clear villains or heroes in Sokol’s world, only a group of patients and medics who are doing their best in a deeply broken system. Sokol combines impactful research and the strong voices of her fellow paramedics to take the reader deep into the crumbling reality of the modern American ambulance.

Genres: Nonfiction, Memoir, Audiobook, Adult, Medical, Biography, Autobiography

464 pages, Paperback

Published June 3, 2025

Reviews

[midori · Rating 5 out of 5]

This was recommended to me by a work friend and I’m so glad I took the suggestion. Such a unique, fun, and often deeply depressing memoir on a profession that everyone respects, yet immensely takes for granted. From a policy standpoint, there are many what-the-fuck inducing anecdotes: the lack of wage and overtime oversight, absence of synergy between paramedicine and emergency departments, and what “options” marginalized folks truly have when there’s no place for them to go due to a lack of appropriate social infrastructure. To the paramedics out there — you are braver than the marines and God’s bravest soldiers. Bless 🙏

[CatReader · Rating 4 out of 5]

Joanna Sokol is an American paramedic; her 2025 memoir, A Real Emergency, recounts her decade-plus work experience in Nevada and California, brief vignettes from many of her colleagues, and historical perspectives on paramedics.

Sokol grew up in Northern California in a family of academics, though by college she realized that a traditional academic path wasn't for her; instead, she thrived in hands-on, action-packed, fast-paced activities, so becoming a paramedic was a natural career fit. While her career forged and dictated most of her identity for many years, she writes about how it's also extremely challenging physically, emotionally, and mentally, particularly when dealing with complex social issues, power dynamics in healthcare, and the recent global pandemic. In recent years, Sokol has struggled with physical injuries stemming from her paramedic work, as well as burnout that's common across the health professions. This was an interesting, thoughtfully-written memoir.

Further reading:
American Sirens: The Incredible Story of the Black Men Who Became America's First Paramedics by Kevin Hazzard - Sokol cites this book extensively; I've also read and would recommend it; see my review here
The Beauty in Breaking by Michele Harper, MD - a memoir by an emergency medicine physician that touches on many similar themes

My statistics:
Book 305 for 2025
Book 2231 cumulatively

[Rachel Martin · Rating 5 out of 5]

I laughed. I cried. My heart broke and then was repaired again. I felt angry and frustrated. Sokol not only writes a deeply engaging memoir (she narrates the audiobook which was incredible) but she brings a massive spotlight to the gross politics and capitalism that goes and has gone on for years, puppeteered by greedy people without the least bit of compassion for EMTs, paramedics, really all those in the medical field. It all becomes a web, a trickle down effect that is damaging to all except the corrupt people with all the money.

Oof, like I said, parts of this made my blood boil. Most of it was incredibly fucking touching and insightful. Human. Since I listened to the audiobook, it felt like she was talking to me if that makes sense. Living in the area she worked in made me feel more connected to the story having felt like just maybe we passed one another.

One of my favorite reads, I think ever.

[Kiera LeBlanc · Rating 5 out of 5]

I absolutely loved this book! what a powerful, entertaining memoir. I will think of these stories every time I see or hear an ambulance. What an incredible story.,

[jac]

vianne doesn’t miss!

[Emily Burt · Rating 3 out of 5]

Parts of this memoir are moving with strong commentary on the intersection of healthcare with social welfare issues, but it is repetitive and the essay structure feels disjointed. I'm left feeling a bit underwhelmed and frustrated that it didn't pack the emotional punch that it could have.

[Shelby Pitts · Rating 5 out of 5]

4.5 rounded up
I don't really know what I expected from this book but I know I didn't expect to love it as much as I did.
The author did such a great job of conveying the wide range of emotions that would come with a career in emergency services.
I really appreciated the way she sprinkled the history of the job throughout the book in a way that was really engaging and relevant to her own personal story.. the history of emergency medicine isn't something I thought I'd be interested in but she had me hooked.

At some point in the book, Joanna mentions not resonating with the military types often associated with emergency services and I think that's what made this book so enjoyable for me. Honestly, before reading this, I also kind of viewed people in the field that way. Joanna is compassionate and empathetic and understands the systemic flaws of society in a way that I think is crucial for people working in these positions. I only wish everyone in this field was a little more like Joanna 😊.

[CJ Opal · Rating 4 out of 5]

3.5 stars, rounded up. Sokol's memoir is full of dark humor and sincere hope for the world of emergency medical services. It's clear that she's done the work, both internally and externally, to try and present a full picture of how her decade of service was shaped by all that came before her. Interspersed with stories from other EMS providers, Sokol maps out not just her career, but her path to understanding the history of the ambulance in the USA. It would be a five star read, but the structure wasn't consistent and it was often confusing to remember where the story was taking place. It would probably be easier to take in on paper, I'm not sure I would recommend the audiobook. It's a good read for anyone interested in EMS history, and it's full of references to other books about the subject.

[Irene · Rating 5 out of 5]

I can't tell you how much I loved this book. I listened to it on audio (thank you Libro.fm!), but I can tell this is one I would have enjoyed reading traditionally too. Gut wrenching, poignant, and at times laugh out loud funny, I would recommend "A Real Emergency" to anyone who loves medical nonfiction or nonfiction with a political/humanitarian leaning. "A Real Emergency" has that expanding your mind quality of the best nonfiction while also being easy to connect to. I have a deeper understanding for what EMTs do and certainly greater empathy, but I also came away from reading this feeling things had shifted in my heart. Can't recommend this enough!

[Cara · Rating 5 out of 5]

I've found I love a deep dive in a niche subject, this book being the life of a paramedic.
The incredible work medics do made this all the more incredible to read.

It was interesting and heartbreaking to hear about the folks EMS continually encounter - the seeming hopelessness that comes from drug use & homelessness. There are no easy answers. Thanks to all medical professionals who keep our communities going.

[Chloe · Rating 5 out of 5]

I lovedddd this. Eye opening and well researched. You get to know the writer as well as hear stories about other EMS providers. I love that she discusses patient experiences as well as sheds light on issues within healthcare

[Michelle Rittenhouse · Rating 5 out of 5]

Fantastic read that so many healthcare workers and first responders will relate to. The author clearly outlines current gaps and problems with the EMS system, and the fatigue anyone dealing with the general public can relate to. While the language is pervasive, it feels authentic to the experience. And a few sections had me laughing out loud.

[Alex Bowman · Rating 5 out of 5]

Incredible. The story telling was encapsulating and very informative. It really makes you appreciate the EMTs, Paramedics, and healthcare providers even more.

[Melissa Murdock · Rating 5 out of 5]

“And that overwhelmed feeling? That feeling that nothing we are doing is working, that this battle is bigger than us, that we are very small and looking out at a very large fight? That’s just a normal day at work.”
Brutal and funny and so real

[Alison Kat · Rating 4 out of 5]

This was so, so good. Everyone should read this.

[Kate Granstrom · Rating 5 out of 5]

Highly recommend wow! Entertaining, informative, critical, compassionate, heartbreaking stories from the front lines of the 911 response system

[Isabella Laurens · Rating 4 out of 5]

“Would he nod, half asleep in the fog? Would he pass the pipe?”
“When elephants fight, it’s the grass that suffers”
“I followed protocols as well as I could. I think I did my job. My mask is itchy.”

[Mark · Rating 5 out of 5]

My goodness.

When my niece was a paramedic, I would tell people "My niece is a paramedic" and didn't think much more about it. She didn't talk much about her work, but I remember her saying she used to run out of air for the air horn by leaning on it trying to get idiots out of her way, which both did and did not surprise me.

I have a good friend who has been a paramedic for 22 years so I knew a little bit about the job, but I really had no idea what Joanna went through. This shocking memoir exposes the often flabby, scabby, infected, reeking underbelly of emergency healthcare in Santa Cruz, Reno and SF as seen through the compassionate eye of a paramedic. It's foul, infuriating, hair-raising and PTSD-inducing, filled with the kinds of things you just don't think about, or want to, and a firsthand, non-academic assessment/indictment of a broken system in an increasingly broken country.

The book raises important issues of class, poverty, loneliness and systemic dysfunction in a capitalist society that hasn't figured out how to adequately take care of everyone.

It was only when I was about half way through that I finally understood the title and its double meaning.
Following a reading she did at a local bookstore, I texted my sister saying that for-profit healthcare is of itself a sickness (she did not disagree). It is also very well written, and the dark poetry evoked for me Celine and Burroughs. Who knew that she was such a writer?

I have no idea how many books have been written on the subject but I am convinced this is not only an important contribution to the canon but a very accessible one, deserving of a wider audience. Through her skill as a writer, she turns a depressing subject no one wants to think about into something engrossing. But, gentle reader, be warned: a lot of what happens in this book is gross. There are many parts of this book that are hard to take and will make your head spin, but that's a good thing.

But it flows, well. I gotta say that I soon as typed that I thought of the steady flow of blood, urine, feces and vomit from her many patients. (If I think I have minor PTSD from reading this book, imagine what she went through.)

This is an honest and unflinching work written by, dare I say it, a kind and caring person who genuinely wanted to help people and who, probably like many paramedics, had a love-hate (or like-dislike) relationship with the work. But reading her book, you come to understand why. And when you understand why, it should make you as mad as it made her.

I am obsessed with Utopia (or at least a better world) and this book is in many ways dystopian in nature. It's an example of how things should -not- be. Like Joanna, I would love to see a healthcare system (emergency or otherwise) that is adequately funded so that no one has to wait for treatment or shelter, either immediate, short term or long term. I would also like to see an end to poverty, homelessness, substance abuse and isolation/loneliness, all of which factor into this fine work. This country is fucked up, and I believe it's only going to get worse.

Patients (especially the indigent) and paramedics alike need a vast improvement in how they are treated. This book should be required reading by the heads of every public or private emergency health care entity in the country: ambulance, hospital, shelter, treatment facility, Department of Health etc. The entire system needs an overhaul 'cause it clearly ain't workin'.

What also isn't working are the socioeconomic conditions and drugs like Fentanyl and meth that break and destroy people, causing them to
abuse the system (and paramedics).

A copy of this book should be also be inserted into the rectums of the CEOs of AMR and other private ambulance companies who go through EMTs and paramedics like disposable razors (see p. 354).

Perhaps I am biased but I think this should be on the New York Times bestseller list.

Truly eye-opening and very well done.

[Lucy · Rating 4 out of 5]

Really good memoir about the life of a paramedic and the complexities of the healthcare system. Sokol does a great job conveying these different experiences and questions of humanity and death, poverty and addiction, burnout and PTSD, the limits of the healthcare system, CAPITALISM and all of it's casualties. It's honest and depressing, but not without hope.

I didn't know that the majority of 911 calls are non-emergent - a lot of the time for confused and scared people who have no one to turn to, people have nowhere to go. To see what they [paramedics and EMTs] see -death, murder- but in majority, people who cannot take care of themselves (whether due to poverty, mental illness, age, addiction), and having to turn many of them away due to limited resources or lack of true options; for them to still have joy and hope, is a beautiful thing.

I like how she called out those who think "they just need to..." to fix the entire system. And she's right! It's so easy for me to say this and that, but these issues are so much deeper than one simple fix. I join her and like to believe that little by little things will change, but it really does come down to capitalism.

Earmarked pages - whoops, really long segments:

"There's a drunk homeless man with a cut on his head, called in by a tourist who didn't even stop her car, just reached for a cellphone and drove on by. Then an elderly man with neck pain that has been bothering him all month. Then a ninety-one-year-old Russian woman having a breathing episode, which is more or less resolved when we show up. Her son is worried, though: she lives alone, he can't stay the night, and they can't afford a home care nurse to stay with her.

All of these patients face serious issues with housing, food, basic life skills. The 911 call is less about an emergency and more about an inability to provide for themselves. Lack of access to basic human needs like food, water, and hygiene will eventually become medical if ignored for long enough. Bare fridges lead to malnutrition, broken plumbing creates infection. Addiction becomes overdose. Some folks call us hoping for a trip to the ER when they just don't want to spend another night alone." (138)


[The creation of Street Crisis Teams, in response to George Floyd's murder: special unarmed squads formed by the fire department to "respond to behavioural and social calls for service and assess community members for behavioural and social needs"]
"The goals of the program are admirable. But by the end of our first month, we are confused and overwhelmed. Ambulance crews and firefighters call us for patients suffering from all kinds of mental health and economic issues. Police call us for homeless folks they have known for years, hoping we can offer something besides jail or an ambulance. Locals see us and say, "I'm so glad to see you guys, there's such a need," with a knowing sigh. People tap on our shoulders in Starbucks and tell us about a particular homeless person living in their neighbourhood for months. Shopkeepers point at someone sleeping on their step and grunt as though to say, "Here's one. Deal with this." A young lady leans out of the rear window of a still-moving Tesla and tells me to "check" on someone a few blocks back who "looks like they really need help." No description, nothing further. She waves and shouts, "Thank youuuuu" as the car speeds away." (278-9)

"Both business owners and homeowners imagine we will 'clean up the streets'": that we will sweep away all of the poverty and addiction on the sidewalks with our calming words and our six-seater van. The Street Crisis units are a fantasy, I realize, about protecting our mentally troubled patients from police while at the same time making them gently disappear." (279-280)


"My time on the Street Crisis team is tough. In attempting to improve a narrow but real issue facing American EMS and police work, we find ourselves butting up against profoundly big questions about human rights, the role of the government in society, and the ability of individuals to determine their own fate. Can we 'fix' the challenges faced by modern paramedics without systematically solving every single social determinant of health? Do we have to cure poverty? Is that where this conversation is ultimately headed? (311-12)

[Theodore] "He has left or been kicked out of all of the services that we have tried to provide. At what point do we force him to accept care? Do we tie him to his bed, if that's what's required, and lock the door, and tub-feed him twice a day and tell ourselves we have saved his life? Or do we let him shiver outside in his urine-soaked hospital scrubs? Which, in the end, is more cruel?"

"Where is the line between mental illness and personality? Who decides what constitutes 'normal,' and what is allowed in public view versus private? What role does the government have in all of this? What even is free will, anyway"? (312)



[P2P meth]
"A Los Angeles Police Department officer, Deon Joseph, spent twenty-two years on Skid Row. 'They'd be okay when they were just using crack. Then in 2014, with meth, all of a sudden, they became mentally ill. They deteriorated into mental illness faster than I ever saw with crack cocaine.'" (295)

"He [Sam Quinones, author of The Least of Us] tells me that we are witnessing a large-scale unofficial experiment in real time: what happens to the human brain when exposed to previously unheard-of amounts of unadulterated speed. 'These changes in people that used to take seven or ten years, now you see them in a week.'" (295-6)



[Sending firefighters and EMS services to a scene for non-fire-related calls]
"The utility of having a fire engine on every medical call is dubious. Firefighters are able to start CPR right away, which in a cardiac arrest, is lifesaving and invaluable. They can provide extra support if a patient is trapped in a vehicle or too large to move with only two people. But they are not able to transport, which means that in calls where speedy movement is of the essence, like strokes, heart attacks or traumatic injuries, this model wastes resources and time. And the logic is deeply circular: cities shuffle money away from EMS services into fire so that fire can help out with the perpetually underfunded EMS system. If the call is low-priority or located at a medical facility, the ambulance will occasionally respond "sole responder," that is, by ourselves. But the standard for almost all of our runs is to send both an engine and an ambulance."
...
"It has undoubtedly saved the lives of some patients who went into dangerous heart rhythms while the nearest ambulance was halfway across town. But it has also prompted cities to promise their citizens that a paramedic would arrive within eight minutes, for example, knowing full well that the engine paramedic would not have a way to get them to a hospital. This white lie has allowed private ambulance companies to keep their staffing levels homicidally low while still turning a profit." (130-1)

[Zibby Owens · Rating 5 out of 5]

This memoir is both introspective and hopeful, exploring the ups and downs of the author's career as a paramedic. She provides insights into the realities of 911 calls, the flawed systems behind emergency medical services, and the emotional burnout and low pay that affect the profession. Despite these challenges, a consistent sense of hope, humor, and camaraderie prevails, highlighting the bonds forged in crisis and the humanity shared during the most vulnerable moments.

I appreciate how the author invites readers into the back of the ambulance, revealing the often-overlooked world of emergency medical services. This book is not just a behind-the-scenes look at emergency medicine; it's a tribute to the resilience of first responders and a call to confront the issues that leave these workers vulnerable, overworked, and underpaid. Most importantly, it serves as a powerful call to action, urging us to examine the broken systems that neglect the emotional and physical sacrifices of these individuals. It challenges us to ask a fundamental question: How can we better support those who dedicate their lives to caring for us during our most urgent and life-altering moments?

To listen to my interview with the author, visit my podcast at:
https://shows.acast.com/moms-dont-hav...

[jess e 🪐🎱 · Rating 5 out of 5]

this was a stellar book, I picked it up on sheer morbid curiosity in the way that one would love reading about true crime. Sokol’s work delves into her 15 odd years in the field of paramedicine. I enjoy the quote that she gives

“you don’t actually require a true emergency to dial the phone. All you need, really, is a situation that you can’t handle by yourself.” Sokol provides a paint on paramedics that almost describe them to a liminal quality - they are the ones who will help, at all costs.

Her mini essay styled book is full of the aching raw parts of the field, the dingy sides that most people don’t think about. The PTSD, the mental health side effects of being in an emergency profession, etc. it also covers the aspects that most people don’t think twice about, about how a large portion of society treats unhoused, “invisible” or patients struggling heavily with substance abuse.

I found myself tearing up in some points (especially the chapters covering elderly care and patients), and snorting with laughter in others (the patient they had who didn’t have pants was a favourite of this laugh).

As a non-American, the chapters delving into the history of the American health care system were well done and intriguing to read from a providers side of the line, and one who wrote with compassion and grit to the f*ckery that is the system and its bureaucracies.

[Tiffany · Rating 4 out of 5]

I can't remember where I heard about this book but I'm so glad I put it on my to-read list. Sokol is an excellent storyteller who brings deep empathy (and humour and appropriate frustration) to the story of working as an EMT and paramedic. I appreciated her insights on the realities of this work, the explainers about its history, and the personal reflection she offers from the field (and from the effects of a rewarding and physically- and emotionally-demanding job). This is an important read, both for its compelling depictions of the everyday work and the people she encounters and for its ability to offer a bird's eye view of the state of the system (her story is a window on what happens when emergency response is allowed to be guided by profit rather than patient care or decent working conditions). Highly recommend.

[Kelsey Pope · Rating 5 out of 5]

Without a doubt, the most impactful book I have ever read. I wish I could meet Sokol and thank her for writing this book. As a medic that is so overwhelmingly burnt out, this book felt like a heart to heart with a loving big sister who GETS IT. So incredibly well written with so many angles incorporated so well. The history of EMS that makes the current system make sense. The emotional toll of being a woman in a male dominated field. The political aspect and capitalism. The Poverty. Drugs. Alcohol. Mental Health. Homelessness. Whose responsibility is it to “deal” with all that? Society? Community? EMS? Hospitals? Family?

What do you do when you love a job that is slowly destroying you?

We’re not monsters. We are human.

“I have no regrets choosing this line of work, but I am not sure I have what it takes it continue. I will return to the field when my leave ends, but I know it’s time to start looking for a way out.”

[audrey · Rating 5 out of 5]

I’ve never experienced a story about paramedics and EMTs from paramedics and EMTs’ perspectives. Truly mind opening, flabbergasting, and a breath of fresh air. This has pushed me to learn about other occupations and lives also warped by the media. I don’t read a lot of memoirs, but this felt as if I was right in the dingy ambulance, like a slice of life.

One of the best books I’ve read, genuinely. It’s made me think a lot while reading and think a whole lot more after reading. Hey, since I read it before going to bed, it probably enhanced my dreams perchance 😮‍💨.

But seriously, this memoir does a fantastic job in hitting the intended topic from all sides. The EMTs and paramedics, context, the ambulance itself, opioids, regulars, humor, government, and everything above. Packed with everything, but so easy to consume. Highly recommend to everybody👍👍

[Stacey · Rating 5 out of 5]

Absolutely loved this memoir. Read it on the recommendation of a friend who is an EMT and has worked with the author and wow. Highly recommended reading for everyone. I knew folks working in EMS had it rough, but damn. The memoir tackles issues like homelessness, addiction, mental health, and all the ways in which our systems are overburdened and stretched too thin and absolutely failing human beings and society. The author did a really good job tackling such big, overlapping issues, and highlighting how they’re connected. Especially important read for folks living in San Francisco or other places facing similar issues around poverty and additional and mental health. Or if you know anyone working in EMS, it will help you get a clearer picture of their struggles.

[Ann Listen’s · Rating 4 out of 5]

Nevada and California

An intimate collection of stories and perspectives about life as an EMT/parametric.

If you have zero experience in the medical or first responder field - this book give you a first hand perspective on what that career path is really like. If you are familiar with this field - you would probably appreciate the candor.

I found it real and raw and the author comes with solutions too.

I suppose no one really knows what most jobs really entail. We make assumptions based on experience and that's about what we know.

The difference with EMTS is we depend on them in our time of need. They might touch us or our loved ones. They are an important step in life and death.

[Mary Beth · Rating 5 out of 5]

I loved listening to Sokol read her book. She opened my eyes to the parts of our world that are broken. Her love and heartache for her job reminded me so much of my own thoughts and feelings teaching at Provo Canyon School. I appreciated her curiosity at the history of paramedics and how these broken systems came to be. She sees and points out flaws while wishing she could place all her blame on one evil thing. But she understands that society is too complex to blame one thing. While she writes about heavy topics she doesn’t leave you feeling hopeless and I appreciated her view and hope that small improvements can continually make our world better.

[Lynn · Rating 4 out of 5]

Thank you to Penguin for my advance copy (although it arrived after the publish date! [crying emoji]). Nevertheless, it provided great insight to the struggles that emergency medical professionals have to deal with, as well as the frustrations they face when it seems bureaucracy and policies seem to actually impede them from doing their jobs properly.

Here's a link to my full review:
https://www.theepochtimes.com/bright/...

[Bailey Marie · Rating 5 out of 5]

I really enjoyed this and what I learned from it. It’s a really interesting look at the day-to-day lives and experiences of medical first responders as told by a paramedic. There was also some history of emergency medicine sprinkled throughout to help us see how the current ambulance/911 system developed. I found her stories of her time on the crisis response team to be especially interesting. The author does a fantastic job with the narration, so I highly recommend listening to this one on audio.

[Jocelyn Crumpton · Rating 5 out of 5]

I enjoyed this book more than I expected. The author does a great job of portraying the harsh realities of our fractured healthcare system while remembering and honoring the humanity of people.

I appreciated her perceptive about street outreach teams and how even progressive policies and intervention continue to fail the most vulnerable.

The author sprinkles in some brief history of EMS, including the Freedom House Ambulance Service in Philly and the first female ambulance surgeon, Emily Barringer.