The first thing you see in Dave Horowitz’s Medic: A Diary (Black Pencil Press) is a dead body. More precisely: an “unattended”—EMS shorthand for a person who has died alone. In Horowitz’s charcoal drawing, the man lies face-down on a carpet, an oxygen machine still whirring beside him. Behind him, Horowitz and his partner stand in the doorway, paused in that eerie stillness of discovering a corpse. “Unattendeds are easy; there’s nothing you have to do,” Horowitz writes. “On the other hand, they are the worst. Unattendeds are those last personal moments of a life, a frozen moment in time that only you, your partner, and maybe a cop or a couple of fire guys will witness.” The next panel shows him and his partner at a diner counter, eating breakfast, the ghost of the unattended sitting next to them.
Talking to Horowitz, you don’t get melodrama. You get someone who has internalized the ghosts so thoroughly he handles them like part of the gear list: oxygen, gloves, ghosts. When we speak, he has the quiet, taut demeanor of a man who has spent the last decade watching people at their most vulnerable. His memoir spans the hundred tiny humiliations and absurdities of commercial EMS work: helping old men with no pants on off the floor of a bathroom, gas-station dinners, and partners whose job fatigue has supernovaed into white-hot rage. The deadpan drawings mirror Horowitz’s own understatement as he takes it all in.
He didn’t begin in medicine. For many years, Horowitz, a Rosendale resident, was a children’s book author. “I’d burned out on picture books,” he says. (We featured an illustration by Horowitz, from one of his children’s books, on the cover of the June 2012 issue.) Before that, he was a climbing guide. He started volunteering at the Marbletown First Aid Unit as a driver, watching what the EMTs were doing in the back. In one panel early in Medic, a supervisor leans back in his chair, cigar in hand, and informs the newly minted EMT that he’ll earn $8.90 an hour—“welcome aboard.” Horowitz’s bug-eyed expression says the rest.
What he found instead was a baptism by ineptitude. In Medic, his orientation consists mostly of paperwork and billing—“Does the patient need an ambulance? Will their insurance pay us?” A training video instructs new hires to drive with “due regard,” and a quiz ends the entire driver-training curriculum. On his first day, his field training officer hands him a clipboard: every piece of equipment on the ambulance is either missing or broken.
Horowitz laughs about it now. “I didn’t want to point fingers at any one company [in Medic],” he tells me. “It’s the whole system. There are only so many chess pieces on the board, and there aren’t enough of us. You show up to the same job but wear a different shirt depending on which agency bought which agency this month.”
If the agencies change, the patients don’t. The book is full of the humanity most of us never see because we only call 911 on the worst day of our lives. There’s the elderly woman Horowitz visits repeatedly, always after midnight, always on the floor, unable to get up. There’s the man who stares at him and says, “I used to be gorgeous—would you look at me now?” There are the overdoses, which spike dramatically during Covid, as well as a wide selection of grim scenes: car crashes, gunshot wounds, and a horrific facial injury caused by a falling tree. “But as time went by, it wasn’t the traumas that made me drink more and sleep less,” Horowitz writes. “It was the relentless suffering: Nursing homes full of loneliness, bed sores, and the stink of urine. Even when the care was good—the care was terrible.”
What emerges through the smudged graphite and the matter-of-fact tone is a portrait of a health care system with holes large enough to lose a person in. “People making health care decisions based on what they can afford,” he says. “People whose doctor is the emergency room. The older folks stuck between home and the nursing home.” In Medic, these are not abstract problems—they’re the calls that shape a shift. The man who hasn’t taken his meds. The woman whose family can’t manage her care but can’t afford an alternative. The people who refuse ambulances because they’re afraid of the bill.
Horowitz’s drawings often end on a punchline, but the humor is both armor and exhaust valve. One sequence shows a truck barreling down the road, fast-food wrappers launching out the windows while the bass thumps—EMS as a low-budget road movie. Another shows Horowitz’s partner blasting “All About That Bass” while he wears the hollow expression of a man questioning his life choices. Laughing keeps you sane. “If you aren’t laughing with your partner,” he says, “you’re going to have a miserable time. It’s a coping mechanism. A Plexiglass wall between you and the emergency.”
He compares good partnerships to playing in a band. “On a bad call, with a good team, it just flows,” he says. “I don’t experience that in too many other things.”
But Medic is also unflinching about the breaks in the flow. The mistakes. The calls that go sideways. There’s a chapter where Horowitz reenacts a call that haunts him—fictionalized, he says, but rooted in real regret. In the book, he writes that “the unattended are the ghosts,” but in conversation Horowitz corrects himself. “The real ghosts are the calls you wish you’d done differently,” he says quietly. “You never get those minutes back.”
The average job lifespan for an EMT is around five years. High burnout, stress, low wages, and the job’s physical demands contribute to the brief career length. After a decade, Horowitz is still on the job. Why? “Duty,” he says. “I know I can do this job. I know I can bring calm to a situation. Until I find something better to be doing with my time, I’m going to keep doing it.”
The irony is that writing Medic brought him back to drawing with more clarity than he had when he left children’s books. “I thought what I’d always wanted to do was picture books,” he says. “But I achieved that and got tired of it. With Medic, I’m doing something that’s just for whoever wants it. If someone’s swearing, they’re swearing. If they’re puking, they’re puking.” The creative impulse came back not with whimsy but as witness.
And while Medic documents plenty of suffering—more than enough to fill a career—the book ends on a positive note. In the final pages, Horowitz draws the most hopeful moment of his career: delivering a baby. In life as on the page, it arrived at the right time. “Something really bad happened while I was drawing the ending,” he tells me. “I didn’t want that to overshadow the story. I wanted the good to stay in.” The baby arrived early in the shift; 10 hours remained. The rest of the day was unremarkable. But there was, he says, “a little spring in our step.” That’s EMS in a snapshot: the whiplash between horror and grace.
Horowitz hopes readers take away something simple. “Know who we are,” he says. “Know what we do. There’s no such thing as just an ambulance driver.” He wants people to understand who the person showing up in their living room is—what they’ve seen and what they carry.
The charcoal panels in Medic show the life behind the sirens. Horowitz’s voice—measured and steady—fills in the rest. And he’s still at it, ghosts and all.
Medic: A Diary is available from Bookshop.org.
