I'm not sure how long you have been on the job, but you make a good point. Having responded to far too many situations almost identical to the one you have described, it was my experience that most EMT's and medics either became jaded, numb, or simply fold under the pressure of the onslaught of emotions that come with dealing with death on a regular basis. Introspection is a good thing, but, don't let it overpower you. I'll relate an experience that shows a counterpoint to the situation you described, and shows that what you do, and what I did for so long, has just as much an impact on those that are left behind as to the patients we treat. In 1994 or 1995, (I'm a little fuzzy as to when it exactly happened.) my partner and I got a call for a subway job. Cardiac arrest at the Atlantic Ave./Flatbush Ave subway station in Brooklyn. We got on the scene, FDNY first responders were already doing CPR, so we started up our usual routine. I tubed the patient, a man in his 60's, my partner got the line, and we started running the usual arrest protocol and drug cocktail. We both knew this guy was not going to make it. He was decorticate when we found him, but, we also knew we weren't going to pronounce him in the middle of a subway train either. Then, a funny thing happened: He went from asystole, to v-fib....we shocked him twice, got back a borderline sinus rhythm, hung lidocaine and dopamine drips, and got him out of there. Fast forward 24 hours. We happened to take another patient to the same hospital we took the arrest to, and found out he made it up to ICU. I went upstairs, and went into the ICU room he was in. To this day I don't know what made me go there. Most times, I just would have nodded my head when I found out a patient made it, and that would have been that. As I entered the room, I saw that there were 3-4 men and women surrounding myself, probably his family. Their faces were seamed with obvious grief, and as they saw me, I quickly excused myself, not wanting to burden them with my presence. A man, that turned out to be the patients son, stopped me, and asked if I was the paramedic that treated his father. I responded with a weak yes, and then apologized that my partner and I could not do more. He smiled a weak smile and said, "No, please, we can't thank you enough. It would have been worse if we had to claim his body from the morgue. At least we get to say goodbye to him." I shook his hand, left the room, and almost broke down. For all the days that I wondered why I was doing the job, it took this one day to make me realize why I did it. Rule #1: People die. Rule #2: Paramedics and EMT's can't change Rule #1, but, we can still have an impact on those that are left behind.