(AP) — John Montell “Monty” Mitchell was reeling last year. He heads into next year, though, freshly certified as a paramedic, committed to fatherhood and nurturing a dream that ends in the letters “M.D.”

Between high school graduation in 2021 and today, he’s lost a sister to murder and his best friend to an accident. That’s a lot to carry.

He’s been helped, though, by something his late sister shared with him: A video explaining, through animated ducks, the obsessions common to those on the autism spectrum.

“The type of duck that I am? A little bit of a special duck,” he said as he sat in the lobby of the Community College of Allegheny County (CCAC) Boyce Campus.

This year he’s waddled through a curriculum of academic study and practical training that he’s eager to demonstrate. “There’s two types of cardiac arrest protocols you follow, for v-tach and v-fib, which is ventricular tachycardia or ventricular fibrillation,” he began, and for 10 minutes quacked nonstop about the symptoms and emergency procedures for each.

He’d like to work as a paramedic, pronto, and an ER doctor eventually. Though his anxiety sometimes brings him near tears, he’s not stopping. “The quote I like to live by is: ‘I’m scared all the time, but every day I get out of bed and put one foot in front of the other,'” he said.

It’s a scary time to step into the job market. It’s unclear how rising unemployment will affect people with disabilities, who in the last few years reached historic levels of employment that have yet to be tested by recession. Adding to the uncertainty: ongoing changes to federal disability programs.

This year, Pittsburgh’s Public Source has shared the journeys of people with disabilities into and through the work world. As Mitchell starts his career, local and national experts we’ve interviewed see reasons for both optimism and worry.

Mitchell’s challenges are of the sort that make everything difficult without necessarily drawing attention that can lead to support.

Remembering facts is second nature for him. Interpersonal stuff, though, can be tricky on his part of the autism spectrum. “It is hard for you to, you know, sometimes see how other people are feeling,” he said. “Sometimes it is hard for you to even understand what you’re feeling.”

High school in Penn Hills was tough. “I never really fit in, and I could never understand why.”

He got through it without an individualized education program, finding himself in a heating and air conditioning vocational program. It didn’t excite him. He graduated high school into the “depressing era” of COVID-19 shutdowns.

“At that point I’m like, what am I gonna do with my life?”

Mitchell comes from a family heavy with firefighters and medics. His mother nudged him into an emergency medical technician program. He began volunteering with the Rosedale Volunteer Fire Department in Penn Hills.

Just as he was getting started, his sister, Amari Mitchell, was murdered in Homestead at age 18. She was rushed from the scene to a hospital but died three days later. Mitchell’s closest friend later died in a vehicle accident.

“I haven’t sat down and had the time to fully grieve,” he said.

He couldn’t focus, and failed a key test. For around a year he drifted. He was finally certified as an EMT in late 2023, and he started applying his training with the fire department.

“And then after a few months, I said, you know what, this is easy.” He could do much more.

The news that he’d be a father prompted, in Mitchell, an internal gestation process.

“It warps your brain just a little bit,” he said. “And then once your child is actually here, OK, that’s when it kicks you in the teeth, and that’s when you say, excuse my French, shit’s gotten real.”

He said he needs his daughter, approaching age 2, to feel supported, and to see that “she can accomplish anything that she desires.”

He vowed to demonstrate that.

He told his fire chief that he planned to attend paramedic training at CCAC Boyce. Chief Dave Sanford told him about a full scholarship program for firefighters.

“And I was like, free college?” Mitchell recounted. “Heck yeah.”

A year ago, Mitchell started paramedic training. He had to take a mid-year break, and occasionally tapped the campus cupboard to supplement his groceries. Despite distractions, he was able to absorb the material and recall it at will.

“I would say that’s John’s superpower, and it always kind of shocks me when he can recite verbatim,” said Anthony Kane, the campus’ dean of students for student advocacy.

Kane met Mitchell when another educator told him the student was having difficulties. By their second conversation, Mitchell opened up about fatherhood, food insecurity and housing instability.

Kane worked to build a campus family around Mitchell, including secretarial staff, a support specialist and the security staff. The team “was able to help just make sure that his basic needs were being met because when you’re doing this type of work, the last thing you’re thinking about is yourself,” said Kane. “The people who show up first to serve are always the ones that are last to get their own help.”

Remembering details of 72 drugs? Not an issue for Mitchell. Mastering digital endotracheal intubation? “Like 1,000 or 2,000 times on a mannequin, you get pretty used to it,” said Mitchell, while demonstrating the process. “You feel for the epiglottis, you use your fingers to maneuver the ET tube inside of the trachea …”

Dealing with a person he felt was being dishonest, though, threw Mitchell into confusion. He turned to Kane. “I was in his office almost crying,” he said, “but I don’t give up.”

Instead he refocuses on the work. “Sometimes I do EMS just to get away from my personal life. When you focus on other people’s problems, sometimes yours seem just quite small.” Compared to the person you’re serving, who is in a life-or-death situation, “What is a little bit of an emotional problem?”

As December waned, Mitchell was waiting to take the National Registry of Emergency Medical Technicians test, which would officially make him a paramedic. He was running through hundreds of practice questions on protocols and pharmacological facts.

He was also looking at job openings. He said he knows it’s a tough labor market, but his training gives him a shot. “As long as people get sick or there’s house fires, I’ll have a job.”

He’d prefer to stay local, but also has eyes on openings a few states away, as long as it’s not so far that he can’t get back in a day if his daughter needs him. Mitchell called his ex “a wonderful mother to our daughter.”

“Once I finish raising my daughter, I plan on actually going back to med school,” he said. Being a paramedic would prepare him well for an emergency room residency, he added.

Is he as self-assured as he seems? “No, I’m worried about the future every day.”

Paramedicine is stressful work. A high percentage of medics suffer post-traumatic stress disorder.

Mitchell said he’s gotten accustomed to the stress. He’s seen patients rapidly deteriorate before his eyes and become unresponsive. He’s been out on scenes in which the patient is in cardiac arrest — and doesn’t make it. He has had to tell people that a loved one is gone.

He’s been there when he knew, and the patient knew, that the end had come “but they don’t want to die alone. You have to be that person who is just not going to leave.”

His aspirations would put him in a field in which people with disabilities are dramatically underrepresented. While 1 in 4 U.S. adults has a disability of some kind, only around 1 in 32 physicians identifies in that way.

There’s no reason someone on the autism spectrum can’t have great bedside manner, Mitchell argues.

“Just because it’s hard for you to understand how people are feeling doesn’t mean that you can’t be a good healthcare provider,” he said. “Just because it’s hard to understand people’s feelings doesn’t mean you can’t have great empathy for others.”

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This story was originally published by Pittsburgh’s Public Source and distributed through a partnership with The Associated Press.