The service entrance doors glided to the right, and as Molly Humphreys and I departed from the Berkeley Medical Center, we stepped into an unusually warm evening. “It’s the golden hour,” Molly remarked while we took in our surroundings and took off our masks, revealing flat faces adorned with creased noses. Behind us loomed a cold, serious hospital, and we found ourselves surrounded by an empty parking lot, bathed in brilliant sunlight. My perception of time had become so distorted by the COVID-19 pandemic that the date, Friday, November 6, 2020, had slipped my mind. We had been conducting interviews for Healthcare is Human and, after several hours of this emotionally draining project, we craved fresh air. I inhaled deeply, and before I knew it, two women were sizing us up, curious about our presence at the back of the hospital, one of us clutching a microphone, the other wielding a camera. Angel Poe and her EMS partner had just delivered a patient to the ER and were leaning against the shining hood of their ambulance as it sparkled under the sun. We struck up a conversation, and in the moments that followed, Humphreys captured a candid photograph of Angel, an image that continues to resonate with me. I glanced over to see that, across Interstate 81, the sun had dipped behind North Mountain. The helipad on the hilltop glimmered like a firefly as I shifted my gaze southward into the quiet Shenandoah Valley. As the camera clicked, I rubbed my nose, pondering how this photo would turn out.

In the resultant image, Angel gazes directly into Humphreys’ lens, and a cascade of rusty hair flows down her back, against her mask and the ambulance’s striking white hood. Her expression remains somewhat ambiguous; however, she exudes wisdom, and while her eyes convey compassion, an undeniable weariness of the world lingers. Since 2020, Humphreys’ portrait has raised numerous questions, most of which I cannot address. I often find myself curious about what, precisely, EMS workers observe while serving night and day in Berkeley County, West Virginia. Even though I have been an internal medicine doctor in Martinsburg, WV, for two decades, I’m certain I don’t grasp even half of it.

Last year, Berkeley County received 15,795 EMS calls, with the Berkeley County Emergency Ambulance Authority covering 321 square miles, an area comparable to New York City. For 9,100 of these calls, patients were so ill that they were taken directly to the hospital. The Berkeley Medical Center, situated along Interstate 81, boasts the busiest emergency room in West Virginia, with 55,000 visits in 2024. A truly equitable enterprise, 911 does not concern itself with your identity. Upon answering the phone, their response is “911, what’s your emergency?” This emphasizes their dedication to the profession, acknowledging the risk and urgency involved. Locally, nine crews operate daily with a workforce of over one hundred field staff. A remarkable public service, 911 is something many of us take for granted until we find ourselves in dire need of it.

Sixty-three percent of local EMS transports in the past year encompassed advanced life support services, boasting an average response time of less than eight minutes, delivering 3,323 individuals to our local emergency department for chest pain and 2,603 for vomiting and abdominal pain. For field clinicians like Angel, these illnesses and injuries are, in a very tangible sense, routine occurrences. Yet, I can’t help but ponder whether they ever become “normal.” Is such a thing feasible? Can you envision a profession where you regularly come across deceased individuals? Last year, our local EMS pronounced 187 individuals dead upon arrival. In those moments, eyes like Angel’s sought to provide solace to the living, those unfortunate ones left in distress beside their loved ones who lay motionless and lifeless in the driveway. Some had succumbed to bleeding from a car crash along the roadside. Others had been shot in a parking lot by a handgun-wielding assailant. And too many had overdosed on a living room couch, the television still flickering. The persistent chronic illnesses and sudden tragedies of West Virginia often share a common, agonizing 911 call. EMS workers’ eyes intake all these images, and their bodies absorb this pain.

How many of our neighbors have sought answers in these eyes, desperate to understand what just transpired and why? Despite a workday filled with a procession of illness, injury, and suffering, in this photo by Humphreys, we encounter the most feminine representation of physical strength. We observe a woman attired for driving a truck and physically lifting patients into her ambulance, all while administering medication and communicating with the hospital. This lifting, pushing, pulling, driving, and loading is carried out by women in healthcare every day, yet this labor is frequently overshadowed by what is deemed “expected.”