Paramedic returns to duty serving on the front lines of the COVID-19 pandemic

Nearly two years ago, Joshua Fish was steadily making progress in his recovery from alcoholism that he decided to get a tattoo on his forearms with a phrase befitting the 34-year-old. On his left forearm are the words, “My story isn’t over,” and on the right, “It’s only just begun.”

“It’s been my mantra for most of my life,” Fish said of the tattoo. “I mean from all the different sh—t that I’ve gone through, here I am — still pushing forward, still making new stories.”

​​Fish came to the attention of the Gary Sinise Foundation last July. Years spent in New Jersey’s EMT paramedic corps took a devastating toll on his mental and physical health: he drank alcohol to excess and was abusing methamphetamines to dull the incessant pain from repeatedly witnessing disturbing and traumatic situations. ​

Fish quit his job in January 2019 and enrolled in rehabilitation for drug and alcohol abuse and therapy to treat post-traumatic stress disorder. The decision, he said, saved his life. Yet for each month that he was in rehab, he was missing rent and car payments to the tune of over $6,000. The foundation wiped his slate clean.

Looking from left to right or right to left, the black ink on Fish’s forearms tells the story of his past — the hardship and struggle — but it purposefully foretells what’s to come.

​Instead of taking a critical care paramedic position at a Philadelphia-area children’s hospital this summer, he could have quit the profession outright for fear of contracting and succumbing to COVID-19. He wouldn’t have been the first — increasingly, health care workers and first responders are quitting citing burnout, stress, and mental health attributed to coronavirus.

His story may have ended before his 35th birthday when he was diagnosed with leukemia. Even after subjecting his body to ten months of chemotherapy, doctors prepared him for the likelihood of death. Fish beat cancer last November.

In middle school, Fish was bullied and targeted with nasty epithets because of his sexual orientation. He battled depression and anxiety, and suicidal thoughts; horseback riding and showing horses became his outlet and relief.

Time and again, he told himself: My story has just begun. It’s only just the beginning.

Fish became an EMT while in high school. In the last decade, he has been through hell and back, the accumulation of highs and lows of the profession’s sweet twists and deadly turns. Today, with COVID-19 infections surging and deaths rising across much of the U.S., front line health care workers and first responders like Fish find themselves yet again waging an all-out fight against an indiscriminate, unflinching foe.

“Covid really hits home,” explained Fish, who went back into therapy earlier this year. The devastation leveled by the novel coronavirus and the speed at which it strikes on seemingly healthy individuals took him by surprise. “It hit hard.”

Wearing protective gear like an N95 facemask or P100 respirator mask with a Tyvek protective suit and gloves, he explained, did little to alleviate his worry about possible infection. “I was just scared. I was scared to bring it home. I was scared to get it because I was watching people my own age just drop dead for absolutely no reason at all, and we had no idea what was going on.”

But thanks to lessons he's learned in rehab and ongoing therapy, he no longer dwells on what he could have done to save a life. Faces of patients he cared for no longer keep him up at night. When he is having a bad day, he reaches for his phone, not a drink or illicit drug, and texts or calls his support network. “Seeing the issues I had, dealing with the issues I had, and putting them past me,” Fish said, “that’s allowed me to not keep reliving them.”

Openly communicating with his peers and others about how he feels, particularly after a traumatic experience, has been the difference from a trajectory that once saw him binge drinking and using methamphetamines to bury the bad feelings and recurring demons that drove him into a downward spiral. “If you deal with it when it first happens, then you don’t have to deal with it in the future.”

His progress was nearly derailed in the first two weeks of orientation at a Philadelphia-area children’s hospital (Fish requested the hospital’s name remain anonymous for employment reasons) when he found himself one day at the bedside of a cancer patient.

While doctors and nurses treated and ran tests on the girl for four hours, he comforted her. She was so brave, he remembers. Unlike his diagnosis, the patient was past the point of help. Her cancer eventually prevailed.

The experience was upsetting: a helpless young girl and medical teams' tireless efforts to save her. He confided to his boss that maybe the job just wasn’t right for him. When he got home later in the day, he phoned his support network, telling them that his job and working in pediatrics wasn’t right for him. It’s not what I want to do, he said.

In the past, these experiences would have pushed him toward drugs or excessive drinking. Instead, Fish explained, “I was able to go talk about it — take the power away from it — and move forward and continue with a job that I really like to do.”

“I was ok with it after two days,” he said about the therapeutic conversations. “I was like, ‘you know what, this was that kid’s path. Maybe I needed to see that really early on to see if this is going to be something that I could do.’”

Fish moved from his native New Jersey to Philadelphia in July. Despite coronavirus upending any semblance of community, he has welcomed the change of pace in the City of Brotherly Love. He walks the neighborhoods in Center City and has taken to bike riding the wooded trails outside of town.

“Where I am now,” Fish said, “I absolutely love my job.” He’s sober and drug-free, putting the finishing touches on this current chapter, knowing it’s only just begun.