Capt. Mark Strickland, EMS supervisor for the Charleston Fire Department, said he sleeps on his left side. Another firefighter and medic, Capt. Craig Matthews, said he normally faces north when he sleeps.
At least, those are the smart-aleck answers they give when asked how they sleep at night.
Steven Hicks, another Charleston firefighter, will tell you though, about how often he wakes up.
Hicks recently responded to the overdose death of a pregnant woman. She was six months along.
"That really messed with me," he said. "I just had a baby. I didn't understand how somebody could do that."
"I'll get up sometimes and check on my kid. ... Ever since that baby died, I get up more often now," he said.
Hicks has been on the job less than two years. Overdoses, by now, are "pretty much second nature."
"We don't even talk about it anymore," Matthews said. "Twenty years ago, if we had to give Narcan, we'd talk about it for a week."
"There's no ending to the story," he said. "You never see anyone get better."
Hicks and a more senior firefighter, Lt. Jason Whiting, recently sat in a common area at the Morris Street fire station, talking about being fathers and how a child "should not know what heroin or an overdose is."
"It's a pebble in a pond," Whiting said. "That ripple goes and goes, and that child will live with that."
They all have different coping mechanisms.
"I pray about it," Hicks said. "I'm a Christian. I believe that praying releases stress."
For Whiting, it's three things: "Fishing, family and, most importantly for me, faith."
They rely on each other for support. They may talk about the cases that bother them over a pot of coffee. They use gallows humor. They mock each other.
"Because we've all been down that road," Whiting said.
They're less likely to open up to outsiders.
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Richard Goerling, a police lieutenant in Oregon, developed a training on first responder resiliency and performance. He'll bring that training to West Virginia in late fall by teaching mindfulness to first responders - including police, fire and EMS - from Cabell, Kanawha and Putnam Counties."We see so much human suffering that doesn't make sense, and we try to make sense of it," Goerling said. "Our sense-making creates stress."
Dr. Michael Brumage, executive director and health officer for the Kanawha-Charleston Health Department, and Brittany Canady, a health psychologist at Marshall University, applied for the $49,000 grant to get the training. They said they hope to bring what they learn to other agencies across the state.
Goerling is also a co-investigator in National Institutes of Health mindfulness research and its impact on police officers, and he holds an affiliate assistant professor appointment at Pacific University in the Graduate School of Psychology.
He will hold trainings for 35 people each time. Organizers will recruit participants, primarily from Kanawha and Cabell counties. They haven't announced a location.
Goerling has held similar, eight-week trainings out of state, but this one will be an immersion training, meaning responders will be focused on it for two-and-a-half days straight.
"This is not about talking at people, but having them experience what this is like through practice," Brumage said.
More information on the training is available at www.mindfulbadge.com/training.
First responders don't have to attend if they don't want to. And many are already showing resistance - some oppose it and don't think the training is needed. Some think it's outright comical to even suggest it's needed.
"Ignoring emotion actually makes us more weak," Goerling said. "Typically today we wait until first responders are broken, and then we try to fix them."
Goerling said he started working in the field 14 years ago because he was worried about excessive use of force among police officers.
"It's really not about trying to help first responders feel better," he said. "On some level, I don't give a s--- how we feel. I give a s--- about how we perform."
It's unclear whether the training could reduce preventable injuries, such as unwarranted use of force or distracted-driving crashes.
"I think we can speculate that, yes, it does," Goerling said. "Do we have data that suggests that it will? Not yet."
But research suggests it improves sleep, he said, and reduced fatigue, in turn, reduces cognitive errors.
West Virginia Clinical and Translational Science Institute will conduct research on the training based on standardized self-assessments and stress hormones in a person's saliva before and after, Brumage said.
The idea came from meetings of the Great Rivers Harm Reduction Coalition, a group of public health professionals, first responders and academics from Kanawha, Cabell and Putnam counties. Burn-out and compassion fatigue - common among people whose work frequently exposes them to trauma - often came up.
"When repeatedly exposed to people who are overdosing, especially those who have repeated overdoses, we're facing cynicism, and some of the older law enforcement officers expressed a kind of detachment from both work and personal lives," Brumage said. "They just became so cynical over time. They weren't as effective as they could have been - either professionally or personally."
Brumage has worked on similar programs with the military and with some members of the West Virginia University football team.
"If you're facing a life-and-death event, you need to be fully present for that event to be most effective," he said. "If you are either burned out, and therefore dull in your response, or you're hypervigilant, then you're not operating in your optimal zone.
"Emotions are going to arise whether you like them to or not, as well as distractions. The key is to recognize them and to let them pass to be able to focus on the task at hand and then later to be able to have a healthy way to deal with those things."
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Mark Strickland, EMS supervisor for Charleston Fire Department, responds to high-priority incidents. He works 24 hours at a time, then he takes the next 48 hours off. He gets sleep when he can. Strickland is an advocate for the training.
"Meditation has never been one of those things we've sold to the fire department," he said. "The fire service also didn't use to run ambulance calls, so things change."
He admitted, "It's a tough sell."
But Strickland said he takes every training he can because he wants to be prepared for any situation. He started as a part-time EMT in 1994, the year he graduated high school, but he has been in his current position for about 12 years.
His first heroin overdose patient was in 2001, on Seventh Avenue.
Someone told him to remember, "This is what a heroin overdose looks like. Now remember this, because you won't see one of these for a long time."
The next time, it was a Vietnam veteran. Soon, using Narcan became just another part of the job.
First responders revive someone, and the next thing they know, they're in a fight because the patient thinks they're cops, he said. The anger builds up.
"You could have been dead, and you just cussed me," Strickland said. "I don't want people taking that anger to the next call."
Strickland has three kids at home, and he tries to teach them drugs are bad.
"Then I dress up in navy blue and go to work, and I'm supposed to hug you and tell you it's OK you have an addiction problem," he said.
Hodges, the director of EMS operations, said he, too, struggles with the repeat patients.
"They cheated death, and they walk away," he said. "Years ago, we would take care of a sick person, and they were appreciative of it."
"The next call, the middle-aged man that has a heart attack - his family loses him," he said.
Hodges began his EMS career in Whitesville in 1998. He became a firefighter and paramedic in 2004. The first overdose he ever responded to was in Kanawha City.
"I'm from a remote area of Boone County," he said. "I was like, oh my god, there's heroin. That's the worst. This person's really bad off. We need to get them some help."
Now, he said, "I'm not going to focus on this one guy, when there's 100 more out here in the city that are addicted."
Lt. Ryan Pennington was one of the firefighters who gave an honest answer to that question: "How do you sleep?"
"I don't sleep, ever," he said. His rhythms are off, from chasing overdoses all night.
He said his support system helps him. But as for the training, he said, "Well I hope these young guys will go do it."
"I think the older guys have learned how to compartmentalize it more," he said.
But in his early days with the fire service, they used to spend more time at each other's houses. They don't do that as much, now.
"All of a sudden," he said, "you're yelling at your wife that you saw a dead baby that day."
Reach Erin Beck at erin.beck@wvgazettemail.com, 304-348-5163, Facebook.com/erinbeckwv, or follow @erinbeckwv on Twitter.