Book Review: Riding the Lightning

I wish I could tell you about the last few pages of Riding the Lightning, Anthony Almojera’s unadorned account of a bad year in EMS. I can’t—not without spoiling a well-crafted ending that’s vivid and unsettling.

The rest of the book is pretty powerful too.

Almojera, a FDNY paramedic lieutenant who works exactly where I did in Brooklyn, New York, has written a compelling account of 12 consecutive months before, during, and after the worst of the COVID-19 pandemic. The title is a contrived idiom for defibrillation, the inevitable bridge between decompensation and death for many of the critically ill patients profiled by the author.

Contrary to prepublication buzz, though, infectious disease plays less of a role in the book’s broad appeal than Almojera’s firsthand impressions of urban strife. He catalogs the everyday irritations of citizens and civil servants while lamenting their failure to find common ground: truth, healing, mutual respect. His prologue, which previews a top-heavy municipal government unable to manage a modern medical crisis, made me want to read Riding the Lightning now instead of later.

Almojera’s narrative wastes no words. He’s not trying to impress us with his vocabulary or experience. He’s certainly not the first to write about life and death on city streets, but he does so with the poise of a professional commentator. Readers aren’t force-fed self-congratulatory heroics; instead the take-home theme is the vulnerability of EMS providers and their customers. There’s no better example of that than these lines from page 151:

I responded to 14 calls in 16 hours. I traced a miserable zigzag across Brooklyn. Almost every patient presented with symptoms of COVID.

Every patient died.

He doesn’t mean they died eventually—he pronounced them. Think about that: 14 “failures” in one day. No wonder Almojera labels himself “pretty unsteady” during the pandemic.

The author, an 18-year FDNY veteran, balances supervisory responsibilities and a writer’s eye with a street medic’s in-your-face views on workplace inequities, system malfunctions, and social injustice. On the job he’s Anthony the paramedic, Anthony the lieutenant, Anthony the union rep; with us he becomes Anthony the storyteller, a role few in our profession perform well enough to attract traditional publishers. Almojera succeeds by assuming less about what readers know than what readers want. He pivots seamlessly between 2 potential audiences—clinicians and the curious—by offering abridged explanations of clinical lingo for the latter while sharing call-related frustrations with the former.

Riding the Lightning’s topical content includes subtle aspects of EMS that even some of our colleagues don’t get:

• Mentors are a critical, underrated resource. I don’t mean quasiqualified FTOs paid to watch new recruits; I’m talking about experienced, compassionate partners like those the author credits for his own development.
• Being an aggressive responder doesn’t mean emptying a drug box; it’s about owning outcomes in your district on your shift. To use a baseball analogy, there are 2 types of players: those who want the ball hit to them and those who don’t.
• Acute occupational injuries can be more of an obstacle than chronic disability, especially if the victim lacks sick leave or family support.
• Impoverished patients are often treated by dedicated EMS workers who can barely cover their own subsistence-level expenses.
• Not all paramedics and EMTs burn out on the job; some were that way before they signed up.

Almojera can be entertaining, too. Having spent many years in and around New York City, I enjoyed his plugs for local eateries and his use of Brooklyn slang (fugazi rhymes with crazy and means fake or messed up). Most deserving of applause is his frank assessment of ineffective leadership at the federal, state, and local levels.

Riding the Lightning is an easy, informative read. You can put it down and pick it up again without losing track of the straightforward narrative. It’s a top-10 book on my EMS shelf. Just be prepared for some uncomfortable truth.

Nashville paramedic Mike Rubin is the author of Life Support, a collection of EMS-oriented essays, and a member of the EMS World editorial advisory board. Contact Mike at mgr22@prodigy.net.