Shannon Burke’s novel Black Flies is a stark, intense account of rookie paramedic Ollie Cross’s first year at Station 18 Harlem, where he finds himself on the front line of the crack wars. Cross, a Midwestern idealist, joins the EMS to “do good things for people who needed it most”—in this case, the poor, the homeless and people injured in violent crimes. But the daily catastrophes he encounters—a diabetic with a sock full of rotted toes, a knifed kid holding the blue coils of his own intestines, an addict cutting her newborn’s umbilical cord with a crack pipe, the routine sight of his partners abusing patients—transform his biggest challenge from saving lives into saving himself.

Cross’s philanthropy gives way to shock, concern, indifference and eventually irritation, a shift in response that Burke, who worked as a Harlem medic in the ’90s, relates with matter-of-factness. Quickly dispensing with the naive mantle of the do-gooder altruist, Cross adopts the various personas of his coworkers, trying to determine which would best armor him against the emotional fallout from the job.

It would have been easy for Black Flies to slip into slumming mode, or a voyeuristic inventory of gruesome catastrophes and macho heroism. But Burke’s gripping prose, as unadorned as the book’s burned-out backdrop, calmly builds toward a larger conundrum: What happens when horrors become commonplace? A gifted stylist, the author makes a thoughtful stab at showing what constant danger can do to an ambulance worker and to a neighborhood’s inhabitants. He also knows when to step back to provocative effect, prompting readers to grapple with the horrors as if they were experiencing them firsthand.