INNER

DEMONS

STEPHEN BYRD



Published by Dreamscape Books, Columbia, Tennessee.

This novel is a work of fiction. Names, characters, incidents and places are products of the author’s imagination. Any resemblance to actual persons, living or dead, events or places is entirely coincidental.

Copyright (C) 2023 by Dreamscape Books. All rights reserved. No part of this book may be transmitted or reproduced in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage or retrieval system, without the written permission of the publisher, except where permitted by law.

ISBN: 978-1-329-05637-4

Printed in the United States of America

February, 2023

10 9 8 7 6 5 4 3 2 1

CONTENT WARNING

Contains graphic depictions of violence, including themes of self-harm. May not be suitable for all readers.

CHAPTER ONE

Alex sat up in the bed. He was drenched with sweat, his short, brown hair sticking even more to his scalp than usual, and it felt like something was stuck in his throat. Another nightmare. This time, it was a victim of a car accident. He had seen his mother's face on the broken and mangled remains of some poor soul who had lost their life to a drunk driver.

He remembered the accident well. He'd been the first medic on scene, and the twisted, bloodied body of the woman who had been killed was burned into his memory. He couldn't see her face, though. He could never see their true faces. It was always the face of someone he loved.

Laying his head back on the pillow, Alex drew a deep, ragged breath. It was only a nightmare, he thought. He still felt an intense loss, and he hurt as though it had been real. He hugged the pillow beside him, burying his face in it as he started to cry. For a split moment, Alex was thankful that he lived alone and there was nobody to see him crying over a nightmare, like a child afraid of the dark.

But he did cry, deep and sobbing, tears falling like rain onto the pillow. His heart hurt and ached, and he felt an intense loss, as if his mother had really died. He was afraid for her and wanted to call her to make sure she was, in fact, okay. But it was three o'clock in the morning, and surely, she would be sleeping. He didn't want to disturb her at this hour. A phone call now would certainly require an explanation. The embarrassment was too much for him, explaining that he was waking her up to check on her because he had a nightmare.

No, he was a man, and he would get through this. Nobody else needed to know that he was frightened of his own memories. He hugged the pillow tighter and the tears began to slow. He wasn't sure when, but at some point, he fell asleep again.

The next time he woke was with his alarm clock. He still felt rattled by the nightmare, and he couldn't get the horrific image out of his head. He showered and dressed for work, the entire time replaying the incident of the accident in his mind. He thought about what he'd done, things he should have done, and ways he could have performed better. Ultimately, the woman was dead, and nothing he did would have brought her back, but that didn't stop him from doubting himself.

Alex pulled on his work boots and sat on the edge of his bed. He didn't want to go to work today. No doubt there would be more dead bodies. At least the dead didn't whine, he thought. One of his pet peeves was the whiny people who thought they needed an ambulance because they had a toothache or a stubbed toe. There would be no shortage of those today, either.

Arriving at work, Alex met his partner, Zach, in the ambulance bay. The sight of Zach’s messy, black hair and crooked smile shifted Alex into a different mode, one where he could be himself for the most part, but he had to hide the fear and doubt that he felt. Zach was probably the closest friend Alex had, and being around Zach made it easy for him to push his nightmares aside and forget about them for a while.

Their first call came in before they had a chance to do their morning truck inspection. Loud tones sounded through the overhead speakers.

"Medic Three, respond. 107 Meyer Road. Meyer Road Cleaners. 48-year-old male, CPR in progress." The dispatcher's voice was calm and professional.

Alex's heart sank. He dreaded working codes the most. There was so much to do, and such a short time to do it in. He almost always came away feeling inadequate, like he should have done more, should have worked harder or longer. He never had a perfect code, where all the drugs were given at just the right time, the airway was secured and stayed secured, compressions were done perfectly, and the patient survived. He never got those codes. His were always train wrecks.

He and Zach jumped in their truck and responded to the call. When they got to the cleaning business, a woman met them in the parking lot and directed them to a side door entrance. Just inside the door, Alex found the man lying on the floor. Two other people were performing CPR. They jumped back as Alex approached with his cardiac monitor and trauma bag.

Zach was right behind him with the AutoPulse. The two worked fervently to get the AutoPulse running, so that it could do mechanical chest compressions for them. Alex attached the cardiac monitor, which showed a straight, flat line when he paused the AutoPulse. When he switched it on again, the monitor showed a rhythmic waveform. Zach was drilling an intraosseous needle into the leg, while Alex inserted an endotracheal tube into the airway. He taped the tube down carefully and attached a ventilation bag. He squeezed slowly, watching the chest rise and fall with each ventilation.

When Zach finished with the drill, they switched places. Zach ventilated, while Alex pushed epinephrine through the intraosseous line. He paused the compressions to check the rhythm again. Still asystole, no electrical activity within the heart. The AutoPulse began its compressions again, and they prepared to move the patient to the stretcher.

As they lifted, something snagged the endotracheal tube, pulling it out.

"Fuck!" Alex cursed out loud. This kind of mistake was what always happened. Whenever a code was running smoothly, something had to go wrong. Alex grabbed the tube and reinserted it, this time using both a tube holder and twice as much tape as the first time. He noticed a deep purple bruising on the back of the man's neck. Alex knew that this man was not going to survive, despite his best efforts. He continued ventilating as they drove to the hospital, where a doctor pronounced death as soon as they arrived.

As he got back into the ambulance to leave the hospital, Alex realized that out of everything he did, he never looked at the man's face.

#

They returned to the station. Alex was working on typing his report on the laptop, while Zach drove in silence. Finally, Zach asked, "Do you think he ever had a chance?"

"No," Alex replied. "He was dead when he hit the ground." Of course, Alex was lying. He had no idea if the man had a chance or not. He actually knew very little about what happened, only that the guy had been working at the cleaners when he suddenly fell to the floor and wasn't breathing. His coworkers had started CPR immediately, Zach and Alex had done everything they could without delay, but he had died anyway. Alex felt like he should have done more, although he knew that there was nothing more that could have been done, and he shared that thought with Zach. He kept his feelings of inadequacy to himself.

They sat quietly in the cab of the ambulance, Alex focused on his documentation while Zach navigated the narrow city streets full of cars. Occasionally, he would slam on the brakes and curse another driver for making a stupid move in traffic. The silence was broken by the tones sounding again.

"Medic Three, respond. In the area of 2902 Highway 41 South. Motor vehicle collision involving a motorcycle."

Zach reached to the console and flipped on the lights and siren. The diesel engine whined as he pressed harder on the accelerator, and Alex felt the sway of the vehicle as Zach weaved around the stopping cars. As they approached the scene, the flashing blue and red lights of the police and fire vehicles came into view. Zach navigated past the line of emergency vehicles and parked as close to the crowd of emergency responders as he could.

Alex jumped out of the cab, his gloves already on his hands. Firefighters were strapping a patient to a long spine board. He walked up to them and asked, "What have we got?"

One of them looked up and him and said, "Thirty-two-year-old male, on a motorcycle, rear-ended that flatbed truck. His throat hit the bed of the truck."

"Any airway issues?"

"Not yet. Helicopter is five minutes out."

Zach arrived with the stretcher, and the firefighters all lifted the spine board, laying it carefully on the stretcher. Alex started checking the patient for injuries. There was no bleeding, but a deep purple bruise was forming in a horizontal line across his neck. After being laid flat on the stretcher, the man began coughing. Blood sprayed from his mouth when he did so. Alex, suspicious that blood was beginning to fill the lungs, grabbed his stethoscope. His breath sounds were diminished on both sides. He had a feeling of dread, and he knew that this patient was about go south quickly.

Sure enough, the man started wheezing, "Can't breathe."

Alex heard the faint sound of rotors whipping in the wind. He knew that help was on the way, but he didn't know if they would be there in time. The man needed to be intubated, but Alex couldn't do it while he was still awake. But if he waited for the patient to lose consciousness, it could be too late. It was a conundrum, and Alex hated those.

The sound of the rotors got louder as the aircraft touched down on the pavement. Police had closed the entire roadway to allow it space to land. A flight crew, consisting of a paramedic and a nurse, entered the ambulance.

"We need a rapid sequence intubation," Alex said to the flight paramedic.

"What's the story?" The nurse asked with condescension in her voice. She looked him up and down, her eyes scanning him and apparently finding him lacking. Maybe she could sense his inner turmoil he constantly battled against.

"Thirty-two-year old male, riding his motorcycle at highway speeds, rear-ended a truck and struck his throat on the bed of the truck. Diminished breath sounds bilaterally and just started coughing up blood. He has a gag reflex, so I can't intubate him."

The flight paramedic began making preparations to sedate the patient, so that the intubation could be performed. The whole procedure was over in a couple of minutes. Alex watched as the flight crew worked with precision and finely-honed skill. The patient was unconscious and paralyzed, the tube was in place, and the flight paramedic was ventilating the patient with a ventilation bag.

As they moved the patient to the flight stretcher, Alex felt a sense of relief. The patient would survive, at least long enough to get out of his ambulance. Someone else would be responsible for him after that.

Alex watched as the flight crew loaded the patient into the helicopter, and the wind kicked up as the rotors turned faster. They made a chopping sound as they sliced through the air, dust and debris blowing into Alex's face. He turned away as the aircraft lifted off, turned in mid-air, and flew away in the direction of a trauma center.

The back of the ambulance was a mess. There were empty packages of medical supplies, used IV lines, medication vials, and boxes littering the floor, which was spattered with blood. Zach was already picking up the trash and putting it into a red biohazard waste bag. Alex climbed on board to help him.

They worked in silence. No words were needed, as each knew what the other was thinking. It had been a close call, and the patient still might not survive. Alex took a bottle of spray disinfectant and sprayed down the floor, wiping up the blood with a towel.

A few short minutes later, the stretcher was cleaned, with fresh linen put on and the trash bagged neatly and put away. The ambulance was ready for the next patient, who would have no idea what kind of horror show had been there previously.

Alex shuddered as pulled out the laptop computer and began his documentation of the incident. Word by word, he relived the call as he wrote down happened. Zach began driving back toward the station, and Alex balanced the computer on his lap as he worked. For some reason that he couldn't quite put his finger on, Alex knew that this call was going to stay with him for a while.

#

Alex and Zach returned to their station. Zach parked the ambulance in the bay and went into the bedroom. Alex sat in a recliner and tried to decompress from the morning he'd had. He was tense, and his nerves were on edge; he couldn't fully relax, no matter how hard he tried.

He felt like crying. Tears sprang into the corners of his eyes, but he stifled them. An emotional reaction in front of his coworkers was the last thing he needed. He had to remain stable and steady.

In his heart he knew that he wasn't responsible for the tragedies that people experienced. He knew that he wasn't to blame and that he rarely influenced the outcome of their situations. But in his mind, he was a failure, and he blamed himself for not acting faster or doing something differently. He took it personally when someone died, as if he should have been able to intervene and prevent death in each and every situation.

As the tones sounded overhead, Alex felt his mouth go dry. His heart began to race, and he felt the urge to pee. He only calmed down slightly when the dispatcher assigned a call to Medic One. He got up and went to the bathroom. He leaned forward over the urinal, resting his head against the wall. He still felt like crying. All of the emotion that was bottled up inside him was pressurized, like it was about to burst out of him all at once.

He was startled by the sound of the tones going off again. This time, it was Medic Two receiving a call. He was up for the next one. Alex washed his hands and went back to his recliner. He sat down but did not relax. Waiting for the sound to indicate that he would be responding to another emergency, he wondered what the next call would bring.

An hour passed, with Alex waiting anxiously for the call that he knew would be coming in any minute. The tension was almost unbearable. He almost wished for a call to come in, just to get it over with. Alex thought he would be relieved when the tones did finally sound. He felt tortured by this hypervigilant state.

The feeling of relief did not come, though. The tones sounded, and Alex sprang from the chair, startled despite his best efforts and knowing that the sound would come. "Medic Three, respond. 301 Valley View Drive for a 72-year-old male, psych issue."

He finally breathed a sigh of relief. It wasn't a life-or-death emergency, just an old man with dementia. Alex was conflicted because on the one hand, he was thankful that it would be a simple call, but on the other hand, he was annoyed to be called out for a psychiatric issue, which was supposed to be handled by the sheriff's department.

As they drove to the call, Alex thought about retirement. He was only forty, but he had been in EMS since graduating high school. The years had taken a hard toll on him, mentally and physically. He wanted to retire, to be done with the life-and-death decisions, the responsibilities that weighed on him and the ghosts who haunted him. But he didn't have a plan for retirement, and he didn't know how to do anything else to be able to change careers at this point in his life.

When they arrived at the house they had been called to, a woman met them in the driveway. "It's my dad," she said. "He's been talking to himself, talking out of his head. I'm worried because I don't know what he is capable of. There are guns in the house, and I'm afraid he's going to hurt somebody."

Alex nodded and walked into the house, though his irritation still lurked in his gut. The smell of cigarette smoke and urine that greeted him was strong enough to make his eyes sting. A small dog yapped from the couch and ran to hide. Alex found his patient sitting in his recliner in the cluttered living room. "Good afternoon," Alex called out to the man. "How are you doing today?"

The man glared at him. "I'm not going anywhere. I'm going to stay right here."

"Okay. Tell me what's going on today."

"My dog is the only one I trust, and he tells me who I can and can't put faith in. He's telling me I can trust you."

"Okay, that's good. I trust you, too. Does your dog talk to you often?"

"All the time. He's my buddy."

"I'm going to ask you a few questions, okay? Do you know what day today is?"

"It's Wednesday."

"Not quite. Today is Friday. Do you know where you're at right now?"

"Yeah, I'm at home."

Alex proceeded through his line of questioning, and he determined that the man was confused, although he didn't seem violent. The family was worried about him, and the man was just confused enough that he couldn't make his own decisions. Alex stepped into an adjacent room out on the man’s sight and decided to call medical control and let a physician decide what to do.

The physician ordered Alex to bring the patient in, using a mild sedative to keep him from becoming violent or combative. Alex drew up the dose and hid the syringe in his sleeve as he walked back into the room. He walked right up to the man, while Zach distracted him with some more questions, and Alex injected the sedative. He was finished before the patient even noticed.

Alex and Zach picked the man up by his arms and legs and carefully placed him on the stretcher. Zack strapped him down while Alex attached the cardiac monitor and obtained a set of vital signs. Everything was going smoothly. Simple psychiatric call, Alex thought.

On the way to the hospital, Alex sat down to work on his documentation while he watched the monitor. Suddenly, without warning, the steady, organized rhythm on the monitor changed. Alex jumped up, checking for a pulse. There was none. He quickly applied the defibrillation pads to the man's chest and delivered a shock. He started CPR and yelled for Zach to speed it up. Panic filled his mind.

When he felt for a pulse again, it was strong and regular. Alex stopped CPR and saw a steady rhythm on the monitor again. He sat down, breathing heavily and shakily. His hands were trembling as he called the hospital to let them know what had happened.

CHAPTER TWO

Alex did not sleep that night. He felt tired, exhausted even, but his mind was racing. He tried to sleep, but it was futile. Zach was asleep in the next bed, snoring gently. Alex rolled over on the twin mattress to face the other direction. In the bed to his left was Nick Dawson, the paramedic on Medic Two. He also was sleeping soundly. Alex sat up quietly and put his boots on. He left the bedroom, trying to be as silent as he could so as to not disturb the others. He went into the office and sat down at the noticeably damaged desk. He put his hands on the sides of his head and rested his elbows on the slightly warped wooden surface.

The shock of the psychiatric patient coding on him was what was keeping him awake. He was still in disbelief that it even happened. He wondered if the family would sue. Most certainly the physician was going to rip him a new asshole.

He sat there at the desk, going over the events of the call in his mind. The more he thought about it, the more anxious he became. He wondered if there would be a disciplinary hearing. He hadn't done anything wrong, but that rarely mattered. He wondered if the patient had coded again or if something else had happened in the hospital. The worst part was that he just had to wonder. There would be no answers to his questions, unless there was a disciplinary hearing, and by then, it would be too late.

A dark cloud of depression came over him. Alex told himself that things had worked out fine, the patient coded in an ambulance with a trained paramedic watching over him, and he had been saved. The patient was alive when he was dropped off at the hospital. But it was like spitting into a gale force wind, with the wind being the depression that was creeping into his mind.

Alex thought that he was useless, that he had nearly been the cause of a man's death. And surely not for the first time. How many others were worse off because of him? He was called upon for help, but was he truly any help to the people he was supposed to serve? Probably not. Most of them didn't need his help, they just needed a ride. That's all he was good for, anyway, a babysitter for the expensive taxi ride.

He had wanted to get the psychiatric patient out of his head, and his wish was now being granted. But instead of a clear mind that would allow him to sleep, the psychiatric patient was being replaced by the ghosts of his past. They replayed in his mind, scene after scene, like a horror film that just wouldn't stop.

Alex started to cry. At first, it was a slow trickle of tears that he couldn't control. He looked around at the deserted station. All of his coworkers were in bed, sleeping. He was all alone.

That was the story of his life, all alone with no one to talk to. He started sobbing, feeling the solitude and weight of his mental illness pressing down on him. Maybe he wasn't fit to be a paramedic anymore. Maybe he never was to begin with.

#

As he cried, Alex remembered the baby. It had only been a couple of weeks, and he still recalled the event as vividly as if it had been only moments ago. Of all his memories, and all of his demons, the baby was the worst.

He'd been asleep when the call came in. It must have been a sound sleep, because he wasn't sure he heard the dispatcher correctly. It sounded like they said, "One-month-old, CPR in progress." Surely, he had heard it wrong.

When he arrived at the address and went inside the house, he had noticed a lot of details, things that didn't even register at the time. The house was dimly lit and heated by a wood-burning stove. The smell of burning wood permeated the tiny living room, and the air was hazy. A frantic mother and father stood in the corner, watching and crying, with the man trying to console her as best he could in his own grief.

In the dim light, Alex could see a firefighter standing in front of the couch, holding a small baby in his left arm and doing chest compressions with the right hand. The baby was small, even for only being a month old. The firefighter’s hand covered most of the chest and belly, and he was compressing the chest with only two fingers. Lividity was visible, even from across the room. The baby's arms and legs were frozen in place and did not move. Rigor mortis. This baby was dead and had been for a while.

The firefighter, spotting Alex by the door, thrust the baby into Alex's arms. He took over CPR and continued compressions, running out the door to the ambulance. In the brightly lit box, Alex confirmed his suspicions. The cardiac monitor showed no electrical activity, and Alex called the hospital, where a doctor said to stop CPR and pronounce death.

He could hear the mother wailing from inside the house as the firefighters broke the news to her. That scream haunted his memory and probably always would. The sound sent chills down his spine.

They had waited on scene for the coroner to arrive and begin the investigation. The coroner found out that the baby had been sleeping in the bed with the parents, and one of them most likely had rolled over during the night, smothering the baby. They found her when they woke in the morning, not breathing.

Once the coroner had finished the investigation, Alex and Zach had taken the baby to the morgue. After finishing all the official documentation, Alex's part of the call was over. But it stayed with him. It was his last call of the shift, and for the first time ever, he cried on his way home from work. Since that call, crying came easy. He'd been doing it off and on for two weeks.

The combination of depression and post-traumatic stress was more than Alex could bear. The weight of his emotions made him feel as though it was hard to breathe. And once he started crying, it made his breathing worse. More than once, he had cried so hard that he gagged.

Alex pulled himself together when he heard the office door open and close. Someone was awake. He wiped his eyes and took a deep breath, just as Zach stuck his head in the room.

"Are you okay, buddy?" Zach asked.

"Yeah, I'm fine. Just taking some time to think about things."

"You sure you're okay?"

"Yes. I'm sure." Alex hated lying, but he didn't feel like having a conversation about his feelings, especially not with Zach. He didn't want to show any signs of weakness, because he had to work beside Zach, and Zach needed to know that he could trust Alex and depend on him.

"Alright. I'm going back to bed. Let me know if you need anything."

"Will do. Get some sleep." Alex was lying again. There was no way that he would ask Zach for help with his feelings.

Alex watched as Zach walked back down the hall to the bedroom and disappeared inside. He sat there, letting his emotions boil, feeling like he was in crisis. He wanted to go home, to lay down in his own bed, his safe space, and let all of the problems of the world go away. He would be fine if he could just get to his own bed. At least, that’s what he told himself.

As the hours passed, he sat and stared at the wall. Seven o'clock finally rolled around, and the crew for the next shift arrived for work. Alex said nothing to them, just packed up his belongings and left for home.

When he got home, he was hungry. He fixed himself a quick breakfast of leftover pizza and ate it just as quickly. Eating fast was a bad habit he had as a child. His father used to scold him, saying, "Slow down. Nobody's going to take it away from you." As an adult, it became a necessity since there were times that he had to eat fast or not at all.

He barely tasted the food as he chewed and swallowed it. He didn't care that he didn't taste it, he was only eating to satisfy the hunger he felt. He didn't get any enjoyment from food; it was just a necessary action that had to be taken.

After finishing his leftover pizza, Alex put his dirty dishes in the sink with the other dirty dishes left over from two days ago. He knew he needed to wash them and put them away, but he didn't feel like it. No, the dishes would just have to wait. He went into the living room and sat down in his recliner. He turned on the TV and looked for a movie to watch. He was exhausted, and he hadn't slept all night, but his mind was still too active to sleep now. Maybe a movie would help occupy his mind and settle him down so that he could sleep. He was going to at least give it a try.

#

After the movie ended, Alex was more tired than ever. He went into the bedroom and stripped off the uniform he was still wearing. He lay down in the bed and was able to drift off to sleep. But he did not sleep well. His dreams turned to nightmares as the cold, dead face of the baby entered his mind. The face was purple and bloated, starting to decay. Suddenly, it changed and was no longer the face of the baby, but of Zach, and he was lying in a ditch with a motorcycle on top of him. He felt the heartache and loss as though it was real. He frantically performed CPR, feeling the cold, dead skin beneath his fingers and knowing that nothing would bring his friend back. He cried, wailing in sorrow and pain. He woke suddenly, still crying.

Alex felt as though he were choking. He coughed, his chest burning. He had aspirated vomit in his sleep. His lungs were on fire as he coughed, and the acid came back up into his mouth. He started spitting and sputtering, trying to get it out. He ran into the bathroom and vomited into the toilet. He hovered there above the bowl, coughing and trying to force out the vomit that had been sucked back into his lungs. He felt dizzy from coughing so hard, so much that he thought he would pass out.

He collapsed onto the bathroom floor, gasping for air. As his breathing returned to normal, he contemplated how close he had come to death. If he had aspirated more vomit, or vomited again while he was trying to breathe, he could easily have choked to death.

The thought occurred to him that if he had died at home, he wouldn’t even be noticed missing until he didn't show back up for work in two days. Nobody would even think to look for him before then, and when they did, it would only be because he didn't show up for his shift. He thought about how pathetic of an existence that was, that there was nobody that would even personally miss him. His body wouldn't be discovered until they came looking for him and broke into his house. That could possibly even take several more days, depending on how suspicious his absence was considered.

He cleaned his face and returned to the bedroom. He sat on the edge of the bed, not quite trusting himself to lie back down just yet. He was still shaken from the close call he'd just had and wouldn't be able to go back to sleep just yet, anyway. He clicked the TV on for background noise and picked up his phone. Over four hundred friends on social media, and not a single one of them would even notice him missing if he were to die.

#

Alex became aware of his heart pounding in his chest. This sensation was relatively new and happened only when he had nightmares about the baby. It started shortly after the nightmares did and would go away after a few minutes. He knew that it was just an adrenaline response to the nightmares.

Furthermore, he was acutely aware of his depression and PTSD. He'd never been formally diagnosed by a physician, but he knew the diagnostic criteria, and he knew that he met it. The depression had been diagnosed when he was a teenager, but he'd never been on medication for it.

Dealing with PTSD was something that Alex had been doing for years. He usually just suffered through it and found something to occupy his mind. Keeping himself busy was his way of coping. Usually, he would read a book or work on some craft project. Staying busy helped with the depression also. It was self-medicating, of sorts.

Lately, however, he had no interest in reading or crafts. He knew that he needed a hobby, something to keep his mind occupied, but he had no interest in anything. Since the baby, he'd been like a zombie. All he did was work, come home, and lay around the house until the sun went down, and then, he would go to bed. When he would wake up the next day, he would be just as lethargic until time to get ready for work the following morning.

He lay back down in the bed, but he wasn't able to go back to sleep just yet. His mind returned to the thought about him dying at home, alone. He realized just how lonely he was. He stopped dating, or trying to date, because there were so few people interested in meeting him. He had dating apps on his phone, but he never looked at them anymore, in part because he didn't want to face the rejection that would surely come from attempting to strike up a conversation with a stranger.

No, Alex had built his walls, and now, he had to live behind them, and that meant being alone. Nobody loved him, nobody could love ever him, and he would just have to learn to deal with that. Zach was the only friend he had in the world, and even he wasn't as close as Alex needed.

He had considered therapy and even tried to see a therapist once. That didn't end well for Alex because he didn't like the condescending and patronizing attitude that the therapist had toward him. Alex had gone for one session and never went back. He wondered if he should try therapy again, to see if another kinder, more empathetic therapist would have any impact.

The thought was quickly dismissed. Therapy wouldn't work for him. He was too far gone. He was burned out, and there was no way back for him. His only option was to cope the same way he had been coping. Just deal with it, he thought.

His mind turned back to the psychiatric patient. He got up from the bed and went to his computer. He checked to make sure he had paid his malpractice premiums and to see what his personal liability limit was. He was covered for a million dollars. Surely, even if they sued, it wouldn't be more than that. He worried about the disciplinary hearing and whether there would be one. He shouldn't be at-fault because he did nothing wrong, but that nagging feeling would not go away. What would happen to him? A letter of reprimand? Suspension of his license?

He lay back down in the bed. The exhaustion was too much for him this time, and it finally won over the anxiety and depression. Alex faded off to sleep.

When he woke up, it was dark outside. He'd slept all day. In the past, he would have been upset that he'd wasted an entire day sleeping, but now, he just didn't care. He got up and stretched, then went into the kitchen. He wasn't hungry, but he knew he would be soon if he didn't eat.

He took out a couple of slices of bread, some cheese, and turkey and made himself a sandwich. He inhaled it without even thinking about the choking incident that had woken him earlier in the day. After the sandwich was gone, he went to the TV and turned it on. He sat down in his recliner and started flipping through channels until he settled on a cooking show. He didn't really care what he watched. It was just for the noise.

Alex curled up in the recliner and pulled a blanket over him. He still felt tired, even though he had slept the day away. He thought about how he must look, after working a twenty-four-hour shift, then sleeping all day and now curled up in a recliner. No wonder he was still single. Why would anybody ever want to be with him?

He sighed in desperation. He was getting older, passing the prime of his life, and he was doing it alone. It had been three years since he had been on a date, since there was anybody dumb or desperate enough to go out with him. He felt that there was somebody out there for him, but his mind kept telling him that he was just thinking wishfully.

He watched absently as the TV showed how to prepare some recipe. Watching the show made him feel hungry, as if the sandwich was not enough. He got up and fixed a bowl of popcorn, knowing that wouldn't satisfy him either. Dirty dishes were piling up in the sink, but Alex didn't care. They weren't his problem at the moment.

CHAPTER THREE

The next morning, Alex woke up still in his recliner. He'd spent the entire night in the chair. He didn't know at what point he fell asleep. He wasn't sure what time it was, either. He was pretty sure he had been awakened by his phone alert. He checked the screen and saw a calendar pop-up. There was a debriefing session today about the call with the baby. He would be expected to be there, and it started in fifteen minutes.

He jumped out of the recliner, threw on a clean shirt and some pants, and sprayed himself with cologne. He put on his shoes and ran out the door. The idea behind the debriefing session was simple. Everyone who responded to the call would sit down with a counselor, and they would all talk about the call. It was an opportunity to talk about what happened with the people who experienced it with you. It also served as a chance for you to find out some of the information that you might have missed at the time.

He drove faster than normal to get to the meeting. When he arrived, everyone else was sitting around a large table. Some looked bored, others nervous, and more than a few appeared sad. Alex didn’t know where on the emotional spectrum he belonged. He took his seat, and the debriefing session began. The counselor started by reviewing the events of the call. Once she finished that, she asked if anyone wanted to share anything about the call or how they were feeling.

Alex hated these things. He never knew what to say. He knew that he should say something, if nothing else just to let everyone know that there was nothing more that could have been done. But he couldn't find the words.

One of the firefighters spoke up. Alex recognized him as the one who had been doing CPR on the baby when he arrived. The firefighter cleared his throat, and then said, "I think we should have tried harder, done CPR longer, and transported him to the hospital." He made eye contact with Alex, glaring at him.

Alex shook his head. "It wouldn't have made a dif-"

"You don't know that!" The firefighter screamed at him, his angular face turning red in his rage, his blue eyes staring daggers at anyone who dared looked like they were about to intervene. "You don't know that it wouldn't have made a difference. You just didn't want to work it. If you had, maybe that baby would still be alive. I've got kids at home, and if something happened to one of them and you didn't even try, I would kick your ass. That's what you deserve."

Alex sat silently as the firefighter ranted. The others around the table looked uncomfortable, as if they agreed with him but were too afraid to say anything or too afraid to speak against him. Finally, the counselor intervened.

"This is a forum for you to get things off your chest, but it's not a place to blame someone else for what happened."

The fireman slumped back in his chair. Alex gave no reaction at all, at least not physically. They all blamed him, and what was funny about it was that none of them knew what he had been going through since this call happened. And he wasn't about to tell them.

#

After the debriefing session was over, Alex felt worse than he had before it started. Now he knew that not only did he have to deal with the death of an infant, but some —if not all— of his co-workers blamed him for that death. His self-doubt was now compounded by the doubts of others.

He wished Zach had been at the debriefing. Zach would never have let that firefighter go that far. He would have shut it down before it came close to the spectacle that had unfolded. Alex was surprised, and disappointed, that the counselor didn't intervene sooner.

On his way home, he passed a sign for a liquor store. He considered stopping for a moment, then did a U-turn and pulled into the parking lot. He didn't know what he wanted, only that he was going to buy a lot of it.

He browsed through the large selection of beers, whiskeys, vodkas, and wines before he decided on bourbon. He bought three large bottles and spent one hundred and fifty dollars. He nodded as the clerk told him to have a nice day and left the store.

When he got home, he opened the first bottle of bourbon without hesitation. He poured a glass and drank the whole thing in one gulp. He felt the burning sensation in his throat, and he nearly gagged. He was a lightweight when it came to alcohol, as he didn't drink much or often. He'd only been drunk one time in his whole life, and that had been his twenty-first birthday party.

He rinsed his mouth out with a soda, then poured another glass of bourbon. He sipped more slowly this time, but he still finished the glass quickly.

Alex poured another and stripped off his clothes. He put on sweatpants and a t-shirt and sat in his recliner. He had the glass and the bottle on the table beside him.

After a few more glasses, the bourbon didn't burn as much. It instead started to leave a semi-pleasant tingle in his chest. He felt dizzy, so he slowed down some, but he kept drinking. His goal was to drink until he just didn't care anymore.

How could they blame him? He had only been doing his job. He knew at first glance that the baby was dead, there were signs of obvious death, and he even confirmed it with the cardiac monitor and consulted with a physician. He'd done his job.

He started to cry again. He felt hopeless and worthless. The alcohol, which was supposed to ease his pain, only intensified the feelings he had. Alex cried while he drank, and he finished the first bottle in the afternoon. He felt sleepy, and the room was starting to spin, so he settled down into his recliner to take a nap.

Alex awoke a short time later with severe nausea. He could tell he was going to vomit. He rushed to the bathroom and hugged the toilet as the bourbon came back up. The muscles in his abdomen squeezed and strained to rid his body of the alcohol in his stomach.

He sat on the bathroom floor, heaving and sobbing. Part of it was emotional pain from the debriefing session, the other part was physical pain from vomiting. He vomited again, this time missing the toilet, and it went all over him and the bathroom floor.

Instead of getting ready for work, like he usually did, Alex decided to save it for the morning. He rinsed his mouth out and took off his shirt. He went to bed, leaving the vomit and his dirty clothes on the bathroom floor.

There were no nightmares that night. Or, if there were, Alex didn't remember them the next morning, and they didn't wake him up during the night. It was the best night's sleep he'd had in a while.

Alex woke up late the next morning. He looked at the time on his watch. He had to be at work at seven o'clock, which meant he had exactly fifteen minutes to get dressed and drive across town. He leapt out of bed and rinsed himself off in the shower. He located a clean pair of pants and a clean shirt. He would have to do laundry when he got home because he was down to his last clean uniform.

He picked up the half-empty glass of bourbon from the bedside table and carried it to the kitchen. In his haste, he dropped the glass, spilling bourbon all over his shirt. "Shit!" He yelled as he jumped backwards, as if that would stop the liquid from spilling all over him.

He had no choice. He would have to go to work anyway and just hope that nobody noticed until it dried. He stood there, holding the nearly empty glass. "Fuck it," he decided. He drank the remaining bourbon from the glass.

In his rush to get out the door, he forgot to lock it behind him. He checked his watch. 6:52. He didn't have time to go back. He had to get to work. He drove across town, driving faster than normal. Traffic was already starting to pick up, and he was stopped at every red light between home and work.

When he finally made it to work, Nick Dawson stopped him in the parking lot. "Hey, Alex!" he called out.

"Yeah, Nick?"

"I heard about what happened at the debriefing yesterday. I just wanted to tell you that I'm sorry that happened to you."

"Yeah, thanks, Nick." Alex hoped that Nick wouldn't come any closer, because he could still smell the alcohol on his shirt.

Fortunately, Nick turned around and went back inside. Alex followed, at a safe distance, and clocked in. This is it, he thought, the beginning of another shift. The calls were about to start, the bullshit errands and the "oh shit" calls. He wasn't ready. He wished he had just called off and stayed at home. It was going to be an unbearable day, he could already tell. Alex just wanted to hide somewhere, away from the world, and lick his wounds. But it was time to man up and face the new ones.

#

Alex climbed in the back of his ambulance and began his morning inspection. He still hadn't seen Zach yet, but that wasn't unusual. He would be there in a few minutes. Alex cast his thoughts about his partner aside since it was all he could do to open the cabinets. He was in the midst of counting bandages when he heard Zach calling his name.

"Alex! Are you out here?" The sound of Zach's voice caused a pounding headache to bloom in Alex’s temples.

"Yes! I'm in the truck!" Alex called out, trying not to exacerbate the pain in his head.

"Greg wants to see you in his office!"

"On my way!" Greg Morris was their supervisor and the ambulance service director. He was also the county's assistant medical examiner. He had been at the debriefing the day before, but he had remained silent, sitting in a corner away from the table. Most of the others probably hadn't even noticed his presence, but Alex did.

Alex trudged into the office. Greg sat behind the desk, a short, balding man of about fifty. "Come closer," Greg said. As Alex approached the desk, Greg sniffed hard.

"You reek of alcohol and body odor, and you look like you haven't shaved in a week. Did you shower this morning?"

"I did."

"You should try using soap next time. I can't let you work smelling like that. Sit down."

Alex took a seat in a chair opposite Greg.

Greg continued, "I saw what happened at the debriefing yesterday. He was out of line. I reviewed your documentation. You did the right thing. Some people just can't handle it when there's a baby involved."

"I know I did the right thing. It doesn't make it any easier."

"True, but alcohol is not the answer. At least, you can't show up to work smelling of alcohol or hung over. I'm going to need you to go home and get cleaned up, and you can come back next shift."

Alex breathed a sigh of relief. He wanted to go home. There were no dead bodies at home, no impending calls, only a few ghosts. Those he had found a way to handle. Without another word, not even a thanks, he stood and left the office, clocked out and gathered his personal belongings. He almost wished he'd been fired. At least then he wouldn't have to come back next shift.

He didn't see Zach on the way out the door and didn’t care to. Alex got in his car and left the parking lot. He was thankful that Greg hadn't checked his breath, because if he still smelled alcohol, he wouldn't let Alex drive home.

When he arrived back at the house, Alex stripped off his uniform and threw it in the washer. He collected his laundry and began washing it. He would need clean clothes for his next shift. He saw the empty bottle on top of the trash in the trash can. "At least I'm functioning," he said to himself. One night of drinking didn't make him an alcoholic. It only meant that he had a bad day and needed some help getting through it.

#

While he waited for his clothes to dry, Alex sat in his chair staring at the blank television screen. From the corner of his eye, he saw the two unopened bottles of bourbon on the kitchen table. He decided that since he had nowhere to go, and nobody to see, that he would have some more.

"What my mind can't handle, my liver can," he said. His train of thought shifted after the word "liver." He remembered a call he had run a couple of years before. It was a fifty-year-old female who had overdosed.

Alex had a different partner that day. He didn't remember who it was, because it was during a time that he didn't have a regular partner. He just worked with whoever showed up for work on a particular day. On this day, he and whomever he was working with had been dispatched to a residence for an overdose.

When they arrived, they found the woman standing in her living room, wearing a bathrobe. She was crying, and her family was distraught. The husband handed Alex an empty bottle of acetaminophen and said that she had taken over half a bottle.

She had admitted to Alex that she was trying to hurt herself. She said that her life was bad and she just wanted to die. Alex's instinct told him that this was a cry for help, not a genuine suicide attempt. She had willingly sat down on his stretcher and allowed him to buckle the straps across her. She put up no resistance to being transported to the hospital. She wanted help.

The problem was that she had been stupid. The amount of acetaminophen she took was toxic to her liver. It was going to kill her, and it would just take several days to do it. People think that just because a medication was available over-the-counter that it was safe, but that was only true for proper doses. An over-the-counter medication could be just as deadly as a prescription medication if you overdosed on it. Alex kept his mouth shut, even though he wanted to tell the woman that she was dying.

The husband was a different story. He pulled Alex to the side and asked, "She's going to be okay, isn't she? I mean, you can reverse an overdose, right?"

Alex looked at him somberly and said, "The options for this kind of overdose are limited. Right now, all of her vital signs are okay, but don't get your hopes up. There is a chance she could still die from this."

And she had died. It was a terrible, agonizing death. Her liver failed, her kidneys failed, and she spent three agonizing days in intensive care, unable to receive pain medication because her body couldn't metabolize it anymore. Finally, mercifully, on the third day, her heart failed.

Alex looked down. He had been drinking while he remembered that call. Nearly half of the second bottle of bourbon was gone. He was briefly concerned because he didn't realize that he had drank so much so quickly. "Fuck it," he thought and poured himself another glass.

CHAPTER FOUR

Alex was angry. He didn't want to go to work. It had been three days since he was sent home, and he had consumed four bottles of bourbon in that time. He stayed drunk, and he preferred it that way. When he was drunk, the memories still came, but they didn't hurt as bad. It was as if they had lost their power to hurt him.

He dragged himself into work. He really didn't want to be there, but sitting at home didn't pay the bills. It was only for one day, and then, he could go back home and drink himself into oblivion again. He clocked in and then ran through his morning inspection.

The first call came in around nine o'clock. Alex was sitting in the kitchen, wishing that he had stayed home. The tones sounded overhead, followed by "Medic Three, respond. 1619 West Fourteenth Street. Fall."

Great. 1619 West Fourteenth was one of their regulars. It was always the same thing with her. She would get drunk and fall out of her wheelchair, and her mentally handicapped son wouldn't be able to help her back up. He'd call 911, not knowing what else to do. She was a mean drunk, too. She would berate her helpless son for not picking her up and for calling 911. He would usually just stand there and cry while she heaped verbal abuse on him.

Zach and Alex drove to the call in silence. Alex wondered if Zach knew why he was sent home last shift. He decided that it was likely since word got around in a small workplace. There was no privacy. He didn't care. He decided to own it and get past it. Hell, it was nobody else's business, not even the one person he thought of as a friend.

When they pulled up in front of the address, Alex gave a deep sigh. He was aggravated that they were being called out here again, especially for something so trivial. He put on his gloves and walked into the house.

Just as he expected, the mother was on the floor. She had slid out of her wheelchair and couldn't get back in it. She was crying, angry and yelling, while her son stood by, crying because he was the one who she was yelling at.

Alex couldn't take it. "Enough!" he roared. They both stopped and looked at him. "That's enough. Both of you, stop it right now." He was vaguely aware of Zach's presence behind him. "You," he said, looking at the son, "get out of here. Go to your room." The son left. "And you," he said, turning to the mother, "if you're going to drink yourself to death, at least have the courtesy to keep your sorry ass in that wheelchair. If you fall out, it's your own problem and your own fault. I ought to leave you sitting there on the floor, you hateful, old bitch!"

Zach stepped up and helped the woman from the floor to her wheelchair. Then, he stood in front of Alex and said, "Okay, it's time for us to go." Alex turned and walked out the door. He didn't regret a single word he said.

#

Alex recognized his irritability. He knew it was a sign that he needed to get help. He wondered once more about trying counseling again. He was open to the idea, but he didn't know where to start. He knew he couldn't afford it, but he wasn't sure if his insurance would cover it.

The financial burden wasn't what stopped him. Seeking help meant that you were weak. It meant you weren't capable of handling the stress of the job, that you weren't fit for the job. Alex would never admit weakness or let anyone think that he wasn't able to perform his duties. Counseling might be a good thing for him, but it would have to be secret. He would have to make sure that there was no way for anyone at work to find out about it.

Tones sounded again. Alex wasn't expecting it, and they took him by surprise. He jumped, his heart rate went up, and he had a metallic taste in his mouth. "Medic Three, respond. 749 Teal Way. CPR in progress."

He wasn't familiar with Teal Way. He looked it up and saw that it was out in the country. It would take them at least ten minutes to get there.

As they drove, Alex pushed the thoughts of his mental problems from his mind. He instead focused on the call that they were going on. When they arrived, he found an older woman lying on the couch, unresponsive, with an older man pushing on her chest. Instead of compressing the heart, he was just pushing her body down into the couch cushions. But he was trying for all he was worth, following the directions the 911 dispatcher gave him.

Alex instantly felt sorry for the man, knowing that there was nothing he could do to ease his torment. Alex dragged the woman off the couch and onto the floor. Her skin was cold. Zach came in with the AutoPulse, and they quickly deployed it. The cardiac monitor showed no electrical activity. Zach drilled an intraosseous line into her leg, while Alex inserted an endotracheal tube. They switched places, with Zach ventilating and Alex pushing medications. They worked for another ten or fifteen minutes before Alex pulled out his phone and called the hospital.

Alex switched off the AutoPulse. The cardiac monitor still showed a flat line. He wrote down the time on his glove. He turned to the old man and said, "I'm sorry. She's gone." The man sat down on the couch where his wife's body had been laying and started to cry.

Zach retrieved a body bag from the ambulance, and they carefully placed the woman in it, then moved her to the stretcher. They cleaned up the mess they had made with their supplies and equipment, and again, they each told the old man how sorry they were for his loss. Alex's sympathy was genuine. It tore at his heart to see the old man, broken and helpless, crying on the couch. As they transported the woman to the morgue, Alex felt the tears begin to sting his own eyes.

#

Greg was waiting in the office when Alex and Zach returned to the station.

"Alex Jackson! Come in here for a minute," Greg called out.

Alex walked into the office and closed the door. He figured he was about to get chewed out for the way he talked to the drunk lady. He was partially right.

"We need to talk. What's going on with you?" Greg sounded gruffer than usual, like he was struggling to contain his emotions.

"I don't know what you're talking about."

"Did you yell at a patient and call her a bitch?"

"She was acting like one."

"That doesn't give you an excuse. You know better. First, you come to work smelling of alcohol, and now, you're yelling at patients? You need to talk to somebody."

"I am talking to somebody. I'm talking to you."

"Don't be a smart ass. I mean a professional. Like a counselor."

"I don't need counseling."

Greg leaned across the desk and passed Alex a business card. "That's a counselor for our employee assistance program. Make an appointment, get this shit out of your system."

Alex took the card and studied it. He resented being told that he needed to get help, even though he already knew it. He put the card in his pocket.

"I'm not kidding. You need to see somebody. Make an appointment." Greg was being stern now. His eyes were squinted, and his mouth formed a severe frown. While the sight might have intimated the others, Alex found that it had little impact on him.

With Greg not making a move to stop him, Alex stood and left. He walked out of the office and went to the bedroom. Zach was lying in bed, reading a book. He looked up as Alex walked in but went back to reading without saying anything. Alex walked to the middle bed and starting putting on his sheets and blankets. Once the bed was made, he kicked off his boots and laid across it.

He thought about the employee assistance program. It was mainly for substance abuse, but they covered mental health issues as well. He would be able to see a counselor or therapist, and it wouldn't cost him anything. So much for nobody at work knowing, though.

The idea of seeing a therapist gave him a glimmer of hope. Maybe there was a way out of this dark hole after all. Of course, it would involve talking about his feelings, and Alex didn't like that idea, but he was willing to give it a try if it would help. Maybe he could, like Greg suggested, get this shit out his system.

Alex closed his eyes. He felt better right then than he had in a long time. The room was silent, except for Zach occasionally turning a page in his book. There were no voices, no footsteps, no radios blaring. He thought that he might actually be able to take a nap. He had a solution in his mind, and he was eager to implement it. He did feel a little sorry for whatever therapist he saw, however. They would likely be unprepared for the train wreck of emotions he would be bringing in.

#

Alex fell asleep there in his bed. His dreams started off benign, then slowly changed to become darker. He was reliving another call, this one in the late evening. He and Zach had been watching a movie when the call came in. Zach paused the movie when the tones went off, and the dispatcher said, "Medic Three, respond. 708 Hayes Lane. 61-year-old male, possible DOA."

Possibly dead also meant that he was possibly alive. It was undetermined. They had raced to the scene, only to find the man sitting in his recliner, obviously dead from a gunshot wound to the head.

He had been watching the evening news with his wife. She said that there was nothing out of the ordinary, nothing that she knew was wrong and nothing she noticed that was different about him. During a commercial break, she got up to go to the bathroom, and that's when she heard the gunshot.

Alex was surprised by the lack of blood. There was no bleeding from the exit wound in his head. The man was still in a sitting position, and Alex had trouble finding an entry wound. He assumed the entry wound must have been inside the mouth.

Greg arrived and conducted the death scene investigation. They took photos of the body and the scene, and then got some pertinent information from the wife. Finally, when all was said and done, it was time to move the body. The wife went outside, as she didn't want to watch. It was probably for the best.

Greg helped Alex and Zach drag the man out of his chair and into the body bag spread out on the floor. Once he was in a horizontal position, blood came pouring out of his nose, mouth, eyes, and ears. It was everywhere. Alex did his best to keep it all in the body bag, but some still got on the floor and the chair.

They carried his body to the ambulance. His wife was standing in the driveway, sobbing. When she thanked them, Alex realized that she wasn't aware that he was dead. She thought they were still helping him. Maybe it had been shock, or denial, but she believed that her husband was still alive.

Alex broke the news as gently as he could. It took a few seconds for his words to sink in. When they did, she let out an inhuman wail. Alex caught her as she started to fall to the ground. He eased her down gently and stood there as she cried. As he waited patiently for her, he wondered how she had not come to the realization that her husband was dead.

There had been police investigators, Greg, and other police officers inside the house, gathering information, taking pictures and asking questions, but no medical treatment had been started. He felt sympathy for her but wondered how she didn't already know.

A police investigator came to her with more questions. Alex left her with the investigator, and he and Zach transported the body to the morgue.

#

The remainder of the shift was uneventful. Alex had woken from his nap in the late afternoon, watched some TV, went out for a fast-food dinner with Zach, and then returned to watch more TV. He missed the old days when he and Zach would hang out while on shift, watching movies together, talking and planning vacations. They shared a lot of the same interests, and when they had first been assigned to each other, they became friends quickly.

But now, things were different. Zach was more distant, staying in the bunk room, reading a book or scrolling through his phone. He wasn't as social, at least not toward Alex. Nobody really was. Everyone was polite, and they would speak when they passed him in the hall, but he couldn't really call any of his co-workers friends. Zach had been the only one, his only friend in the world, and now, he wasn't so sure about that anymore.

That night, as Alex slept, the nightmares returned. He dreamed that he and Zach got into a fight, and then, Zach was killed in a car accident. Alex was the paramedic who worked the accident, and he had to pull his only friend's lifeless body out of a mangled machine that used to be his car. When he woke the next morning, Alex hugged his pillow, burying his face in it so no one would hear him sniffling or see his tears.

On his way home, Alex considered the EAP business card in his pocket. He began to have doubts that even a therapist could help him. He would likely need to be heavily medicated in order to cope with all the trauma he had accumulated over the years. He was afraid of being medicated. He didn't want to lose his identity or his personality to a drug that might turn him into some sort of zombie.

When he arrived at home, Alex stripped off his uniform and emptied his pockets. He held the business card in his hand. It was just after seven in the morning, and they wouldn't open until nine. He put the card beside his phone and decided to call and make the appointment. It couldn't hurt to just talk to them and see what happened.

A half-empty bottle of bourbon sitting on the table caught his eye. He thought, what could one drink hurt? He poured himself a glass and drank it faster than he meant to. He poured another and sat down in his recliner. Before he knew it, the bottle was empty, and he was feeling tipsy. He opened another bottle, and as he drank straight from it, he wondered how much money he had spent on alcohol in the past week.

He pushed the thought from his mind and turned up the bottle again. With each swig, he felt more and more numb. That's what it was supposed to do, numb the pain and make it go away. Self-medication, he thought, it's the best medicine there was.

CHAPTER FIVE

The first call of the next shift was a fall. As Alex and Zach responded, dispatch updated them with more information. "Medic Three, your patient fell from the roof of a four-story building."

The call was in a very rural part of the county. Alex searched his recollection, trying to think where in that area had a four-story building. He couldn't think of anything. He asked dispatch to put a helicopter on standby.

Zach turned off the main highway onto Silverwood Road. The ambulance bounced and jarred as it traveled across the poorly maintained road, hitting ruts and holes in the dirt and gravel surface. Alex felt his teeth rattle a couple of times when they hit a particularly large hole.

The address turned out to be a new-construction lodge, in the middle of nowhere. It was, as described, four stories tall. The construction foreman met Alex and Zach at the end of the driveway and flagged them down.

"He's around back, behind the building. He was on the roof, trying to take a selfie and stepped off the edge."

Zach drove around behind the building, where a sheriff's deputy was already parked. The deputy approached Alex as he exited the ambulance.

"I cancelled the helicopter. He's not gonna need it," the deputy said.

Alex saw what the deputy meant when he found the patient. He was so twisted and mangled that Alex couldn't even determine where to press to do chest compressions. This man was obviously dead. His neck and both legs were bent at unnatural angles, and his torso was twisted with one leg behind his back and the other beside his ear.

The death scene investigation was quick, as it was obvious what happened. Once the photos were taken and information was gathered, Alex and Zach set about the task of moving the man into a body bag.

They spread the bag on the ground beside him and carefully pulled his extremities back into their natural positions. Alex heard and felt the grinding noise as bone rubbed against bone. Once his arms and legs were back in a normal position, Alex rolled the man onto his left side while Zach pushed the body bag underneath him. They rolled him onto his right side, and Alex pulled the bag taut. When they rolled him on his back, he was laying perfectly within the bag.

Alex zipped up the bag, and Zach helped him lift it onto the stretcher. They drove the body to the morgue, the ambulance bouncing and rattling down the bumpy road. Zach had to drive slowly, to avoid damaging the vehicle or jarring the body off of the stretcher.

When they arrived at the morgue, they slid the body bag off of the stretcher onto a cold, stainless steel tray. Zach pushed the tray into the cooler and closed the door. Alex signed the paperwork, and they went back to their ambulance to get ready for the next call. Alex realized that, once again, he never looked at the man's face.

#

Alex watched the storm clouds roll in. The sky darkened and a light rain began to fall. He stood at the station window and stared into the darkening sky, his mood changing with the weather. Droplets of water appeared on the window panes and slowly trickled downward. He felt the weight of loneliness crushing him. He put on his headset and connected it to his phone. He started the streaming music app, which started playing an old country song. It didn't help his mood; if anything, it deepened it.

He stood there, watching the wind, rain, and lightning. He had a thought that he probably shouldn't stand in a window during a thunderstorm, but he didn't care if he was struck by lightning. The odds of it happening were pretty slim, anyway.

The tones sounded overhead, blaring louder than the music in his ears. He took one side of his headset off to listen to the dispatch information. Medic Two was getting a call for a motor vehicle collision. Medic One must already be on a call. That meant he was up next.

The melancholy music calmed his anxiety but worsened his depression. Alex thought about how lonely he was in life, how he had no family of his own, no close relationships, and only one person he talked to on a semi-regular basis. Zach probably didn't even think of Alex as that close of a friend. To Zach, he was probably just a co-worker. Zach was a good guy and treated everyone with respect and a polite disposition. Maybe that was all he was doing with Alex. Maybe he was just being a nice guy.

The tones sounded again. Alex took off his headset. "Medic Three, respond. 1201 Laurence Road. CPR in progress." Dammit. Fucking dammit. Another code. He wondered why he was the only one who kept getting codes. Why didn't either of the other trucks get codes? And so far out in the county? This guy didn't stand a chance. It would take them well over ten minutes to get there.

Zach passed him in the hall, and Alex hurried to keep up. It was still raining when they pulled out of the bay, the slapping tempo of the windshield wipers just audible over the siren.

When they arrived on scene, they found the man just inside the back door of the house. He was laying on the kitchen floor, a woman doing CPR on him. She identified herself as a volunteer firefighter. Another woman was watching curiously. She didn't identify herself at all, and Alex didn’t care enough to ask. Zach took over chest compressions while the volunteer firefighter helped Alex deploy the AutoPulse.

Alex intubated while Zach drilled an intraosseous line. They switched places. They worked for several minutes, and Alex decided that since the code was witnessed, and he'd had immediate CPR, that he would continue to work it on the way to the hospital. They lifted the AutoPulse and moved the man to the stretcher.

The rain was still pouring and had soaked the sheets on the stretcher. Alex was drenched and cold, but he kept working. When they arrived at the hospital, the physician's first question was "How long has he been down?"

Alex estimated that it had been about thirty-five minutes. The physician pronounced him dead and ordered all efforts of CPR to be stopped.

#

Losing another patient did not do well for Alex's mood. He became hyper-vigilant again. He was anxious and depressed at the same time. He hated feeling this way, and it seemed hopeless because he didn't know how to stop it.

He thought about the EAP card in his wallet. He'd been carrying it around with him for days, thinking that he would call the next time he was off, but he never had. He heard a slamming sound followed by a loud voice saying "Hi, Byrd!" He jumped and turned to look. One of the EMTs had jumped out of the shadows and slapped the side of the ambulance to scare a paramedic sitting in an ambulance from another county.

Alex realized that his heart was racing. He took several deep breaths to try to calm himself down. He closed his door, and Zach put the ambulance in gear.

When they arrived back at the station, Alex was convinced that he could not continue living this way. Something had to give, or something was going to break. He pulled the card out of his wallet. He stared at it for several minutes before dialing the number on the card.

A pleasant-sounding voice on the other end of the phone answered. "Employee Assistance Program, my name is Cheryl, how can I help you today?"

"Umm. Yes, ma'am. I need to make an appointment to see a therapist."

"Okay. I can help you with that. What's your name?"

"Alex Jackson."

"Okay, Alex. Are you coming in for alcohol or substance abuse?"

"Umm. Post-traumatic stress."

"Okay. The first appointment I have is on the eighteenth of next month."

"That's the earliest you have available? I mean, I expected it would be a day or two, not a whole month."

"I'm sorry. That's the first thing I have."

Alex went ahead and made the appointment. He didn't know how he was going to make it another month before he could get some help. As he hung up the phone, he gave serious consideration to going to the emergency room and telling them he was in crisis. But he'd seen what happened to people who did that. They were put in paper scrubs, their phones and personal belongings taken away, and they were locked in safe rooms with furniture that was bolted down. He didn't want to be treated that way. It was dehumanizing and, in his opinion, cruel.

He understood the reason; it was to keep people from using things as weapons to hurt themselves or others. But still, he didn't want to subject himself to that type of treatment. He didn't think he could handle the embarrassment, especially since he knew almost everybody who worked at the ER.

One whole month. Alex sighed. It would be a difficult time, but he would get through it and go to this appointment. He didn't have any choice. At least having the appointment would give him something to look forward to. That's the best he could do, and it would have to be good enough for now.

#

Late that evening, Alex was getting ready for bed. The tones sounded again. "Medic Three, respond. 1710 Collins Road. 48-year-old male, chest pain."

"Dammit," Alex swore as he put his boots back on. He trudged out to the bay and climbed in the ambulance. This call was another one that was far out in a rural part of the county. Zach drove, the only sound was the siren wailing. Before the baby, Alex and Zach always maintained conversations, even if it was just mundane small talk, on the way to calls. Now, neither one them cared to put forth the effort. The rain had stopped, and the ground was still very wet. It was still dark, although now it was because the sun had gone down.

When they arrived at the address, Alex went inside the open front door of the house. He found the patient laying in the hallway. The man was pale and sweating profusely. "Help me," he struggled to say.

Alex knelt and felt of the man's pulse. He didn't feel one. He yelled to Zach, "We gotta go, NOW!"

Zach arrived with the stretcher, and Alex began dragging the man to it. Zach helped him lift the patient, and they raced back to the ambulance. The cardiac monitor showed a regular rhythm, just a little fast. But the man had no blood pressure at all. Zach started looking for a vein to start an IV. Alex asked him what had happened.

"I started having chest pain. I was sitting on the couch watching the game. I took my nitro, took three of them. It didn't help, so I called 911. The dispatcher told me to take the nitro like my doctor prescribed it, so I took three more."

"So, you've had a total of six nitro?"

"Yes."

Alex felt his own heart race faster. The excess nitroglycerin was why there was no blood pressure. Alex looked at Zach. Zach looked back at Alex and shook his head. There were no accessible veins to start an IV. Alex said, "Let's go." Zach got out of the ambulance and went to the driver's seat.

Alex didn't have a protocol for an intraosseous line on a conscious patient, and there was no access for an IV. He didn't have a good enough phone signal this far out of town to get permission to do the intraosseous line. He considered sticking an IV catheter in the jugular vein, but he'd never done it before. Too much could go wrong. He decided against it.

The siren came on as Zach raced back toward town. The patient said, "I'm going to die. I know it. I'm gonna die."

Alex said, "No, you're not. Not now." He started pulling medications and the intraosseous kit out of the cabinets. He was preparing for the impending cardiac arrest.

They arrived at the hospital while the man was still conscious. They rushed him inside the ER and were directed immediately to a trauma bed. As soon as they moved the man over, his heart stopped. Alex started CPR as a nurse called a code. Zach drilled the intraosseous line and began administering fluids. They worked for about fifteen minutes before the doctor pronounced him dead.

Alex left the room. He went into a supply closet and tried to compose himself. He was about to cry, and he was frustrated and angry. He knew this death was his fault. If he'd done the jugular IV, he could have administered fluids sooner and prevented this tragedy. If he'd ignored protocol and drilled the intraosseous line, he could have prevented it. Any way he looked at it, the patient was dead, and it was his fault.

#

Alex put off going to bed by sitting for a while in the office and staring at the wall. He was afraid to sleep, because he knew the nightmares would come again. Finally, he was so tired he had to go to bed. He tried to lay there awake, but eventually, he fell asleep.

He dreamed of a beautiful mountain landscape. He and Zach were on vacation together. They were driving through the mountains and enjoying the scenery on their way to the beach. Zach drove, and he skillfully navigated the treacherous mountain roads. Alex took pictures from the passenger seat.

They passed a sign that said, "Scenic Trail 1 Mile." Zach turned to Alex, smiling as he asked, “You want to stop?” Alex nodded absently as he took a picture of a snow-capped mountain peak. When they reached the trail, Zach pulled off the road and parked the car.

They embarked on the trail, which wound its way up the side of a mountain. There were steep cliffs and no guardrails. Alex felt trepidation about the safety of the trail, but Zach was enthusiastic. “Come on, we’re almost there,” Zach encouraged him to keep going. The scenery at the top was well worth the climb.

It was a magnificent view of the mountains and the valleys below. Alex stood there, high above the trees, roads and streams looking down at the world below him. They both stood there, admiring the view that few people were ever privileged to see. Alex took a photo from atop the mountain.

As they turned to go back down, Zach decided to race back to the car. He was in the lead, with Alex trailing behind. Suddenly, Zach missed a step and fell off the side of a cliff. He disappeared from view so quickly that it took a moment to register in Alex's mind what had happened.

Alex rushed to the edge and peered over the cliff. Zach lay on the rocks below, unmoving, blood gushing from his head. Alex tried to call 911, but he didn't have a signal on his phone. He knew there was no way that he could reach Zach alone, so he ran back to the car. There, he had a signal and called 911.

When help arrived, Alex showed them where Zach had gone over the edge. Rescue crews went down to retrieve Zach, but when they brought him back up to the trail, he was dead.

Alex woke up in a cold sweat. It had only been another nightmare, but Alex felt like it had been real. It was so vivid. He felt the tightness in his chest, panic rising and tears springing to his eyes. He couldn't control how he felt about these stupid nightmares, or his reactions to them. He felt helpless and out of control.

He thought about the EAP card in his wallet. He only had to get through another month and he would be able to talk to somebody. Just one more month and he would get the help he needed.

CHAPTER SIX

Alex spent the next two days in a drunken stupor. He knew, like he always did, that he shouldn't drink to deal with his mental health issues, but it was the only thing that kept the nightmares away. It made him feel numb, like nothing could hurt him.

He was more careful now. He quit drinking at least eight hours before his shift and didn't handle the alcohol near his uniforms. He didn't need another incident where he would be sent home from work. He couldn't afford to miss any more time.

When he arrived back at work for his next shift, Zach was late. He had called to say that he overslept and would be a couple of hours late to work. The EMT from the previous shift, Christine, would be staying over to cover for him until he got there. Alex didn't know Christine well since he'd only met her once before. He saw her each morning as she was leaving work and he was coming in, but he never talked with her. Christine was new, a brand-new EMT Basic. Alex was not comfortable working with her, and he hoped they didn't get any calls before Zach arrived.

Luck was not with him, though, as it never was. The tones sounded early in the shift, with the dispatcher saying, "Medic Three, respond. 101 Oak Lane, possible DOA." Alex groaned. Why did it have to be another dead body?

Christine chatted the whole way to the call. Alex was annoyed. He was used to working with Zach, and the two of them would almost always drive in silence nowadays. Alex liked the silence. Zach knew instinctively what to do, and the two of them usually worked together well without ever speaking. Christine was not the silent type.

When they arrived on scene, Christine parked in the gravel driveway. Zach carried in his monitor and trauma bag, expecting that, like Zach, Christine would follow with the AutoPulse and position the stretcher at the bottom of the steps. She did not. Christine trailed behind him, carrying no equipment at all.

Stepping into the house, Alex immediately saw the patient laying on the couch. He was already in rigor mortis, and there was no need for CPR. He called for Greg to come out to do a death scene investigation. While they waited, Alex decided to speak to the wife. “I’m sorry for your loss, but is it okay I ask a couple of questions?” He offered his condolences to the wife and waited for her to nod before he started gathering information that he knew Greg would need.

Christine was still chatting, and now, she was playing detective, trying to determine the cause of death. She looked at the surrounding furniture, the patient’s clothes, and anything that else that caught her eye in case she found any clues—which she did not. Alex was embarrassed and irritated that she was behaving in such a flippant manner in front of the family, so he pulled her aside. “Go outside and back the ambulance up in front of the house, take out the stretcher, and bring in a body bag,” he ordered. She opened her mouth to argue, but after one look from Alex, did as she was told.

A minute or two later, Alex heard the beeping sound of the ambulance backing up, followed by a woman's voice screaming "HEY!" He looked out the front door. The ambulance had crashed through a knee-high fence around a flower bed. The patient's daughter was standing outside and was almost ran over by the backing ambulance. Alex shook his head. He walked outside and stood behind the ambulance, where Christine could see him in the driver's side mirror. He guided her back until the ambulance was in position. He then took the stretcher out himself and placed it at the bottom of the steps and retrieved the body bag.

Greg had arrived in time to witness the debacle. He said nothing but completed his investigation quickly and helped Alex carry the body out to the stretcher.

When they were ready to leave, Christine drove out of the driveway and made a right-hand turn, driving away from the morgue. Alex let her drive a couple of blocks, then asked her where she was going.

"Umm. I don't know. Where is the morgue?" she asked.

#

Alex sat at the station waiting for the tones to go off again. Zach arrived, and Christine went home. Alex was not sad to see her leave. The tones did not sound again, and it started to look like it was going to be a good day. But Alex had so few of those, and he was on alert waiting for the next call and could not enjoy the quiet while it lasted.

Greg, however, took full advantage of the lull in call volume. He called Alex into the office and chewed him out for using so many intraosseous needles on patients who did not have insurance. He then went into a tirade about how many codes Alex worked, where he should have just stopped and treated them as dead-on-arrival.

He was too weary and stressed to defend himself. He just let Greg rant and tire himself out. When he was finished, Greg asked, "Did you ever make an appointment with that EAP therapist?"

"Yes. I have an appointment on the eighteenth."

"Is that the soonest they could see you?"

"Yep. First appointment they had available."

"Fine. Make sure you're there."

Alex stood and left the office. He was surprised the tones had not gone off yet. He had been hoping for a call to come in and rescue him from the ass chewing he was taking from Greg, but no such luck.

All that afternoon and late into the evening, he waited for the next call to come in. Finally, he decided to go to bed. He felt sure that the tones would sound just as soon as he was comfortable. They did not. He fell asleep, but it was a very light sleep. He was still anxious and waiting for a call. There were no nightmares because he was barely asleep at all.

Around five in the morning, the call he had been waiting for came in. The tones sounded, and the lights flickered on. "Medic Three, respond. 1881 South Main Street, apartment 602. 47-year-old female, chest pain."

He leapt out of bed and started pulling on his boots. Zach groaned and sat up in his bed. "Is that us?" he asked Alex.

"Yes, that's us."

"Dammit. Why does she have to have chest pain at five o'clock in the morning?" Zach rolled over like he was going to go back to sleep, but then he sighed and got up.

"Keep it down over there." Nick sounded irritated, the noise having woken him up as well.

As they left the bunk room, Zach hit the switch to turn the lights back off so Nick could go back to sleep. Alex felt a twinge of jealousy that Nick was able to sleep all night, save for this small interruption.

When they arrived at the address, Alex entered the apartment with his cardiac monitor and trauma bag. He was surprised to see Angela Mitchell, the paramedic who worked the shift before him, sitting at the kitchen table, clutching her chest.

"Angela, what's wrong?" Alex asked.

" I'm having chest pain. It woke me from sleeping about ten minutes ago. Nothing makes it better or worse, it's a sharp pain radiating to my jaw, and it's about a seven out of ten." Angela was answering questions before Alex could ask them. She continued, "I don't have any medical history, no allergies, and I don't take any medications."

As Alex unrolled the cable from the cardiac monitor, Angela lifted her shirt, exposing her chest. Alex applied the electrodes and ran the ECG. It showed she was having a heart attack. Zach entered the room and was startled when he recognized Angela. "STEMI protocol!" Alex said, louder than necessary. He and Zach helped Angela to the stretcher, then started an IV, gave her aspirin and nitroglycerin.

After three nitroglycerin, Angela was still having severe chest pain, so Alex gave her pain medication. They rushed her to the hospital, calling ahead to activate the Cath lab. Alex's adrenaline was pumping, as he'd never had a serious medical emergency involving a co-worker before. He was concerned for Angela's well-being, and knew all too well how these things could go south quickly.

When they got to the ER, they moved Angela to an ER bed, where the staff took over and rushed her right into the Cath lab. Alex and Zach stood there in the ER, still in disbelief that one of their own had suffered a heart attack.

#

They only had forty-five minutes until the end of their shift. Nick was not in the bunk room when Alex returned to his bed. He sat there, pondering what to do. There wasn't much sense in trying to go back to sleep for only forty-five minutes, but at the same time, he felt tired.

The overhead tones made the decision for him. "Medic Three, respond. 128 Silverwood Road. One-month-old, CPR in progress." Alex ran back to the truck. Zach was already inside waiting. As they made the long drive to Silverwood Road, Alex's stomach was in knots. Every minute counted, and the call was so far away.

Zach drove faster than he normally did. Alex could tell he was tense as well. As they made the turn onto Silverwood Road, the back tires of the ambulance lost traction, and they turned sideways. The ambulance hit the stop sign and knocked it down. Zach came to a complete stop. The only damage was to the stop sign. Zach hit the accelerator and drove away, continuing to the call. He laughed nervously and said, "Well, shit."

Alex didn’t respond.

When they arrived, the house was already crawling with volunteer firefighters. They were doing CPR on the baby, and Alex took charge, assigning tasks to each of them. Zach questioned the mother about what had happened. She said that she had just fed the baby and put him in his swing when she heard him choking, then he stopped breathing completely. She had done back blows and chest thrusts, but nothing had helped.

The baby was very pale. Alex had everything done and ready to transport by the time Zach had gotten information from the mother. He took the baby from a firefighter and continued chest compressions as he ran to the ambulance. Zach followed, and Alex said, "Let's go!" Zach ran around to the driver's seat.

Alex brought two firefighters with him to help with CPR. He was thankful that there were enough volunteers available; in this part of the county, they rarely got this much help. Zach raced to the hospital, while the team in the back worked frantically to restart the baby's heart.

"Medic Three to General ER," Alex called on the radio.

"General ER, go ahead Medic Three."

"Coming in with a one-month-old male, CPR in progress. We'll be there in about five minutes." Alex replaced the radio microphone and stopped chest compressions to check the cardiac monitor. Still asystole. He started chest compressions again, with a nagging feeling that CPR wasn't going to do any good. This baby was not responding to anything they were doing.

As soon as Zach stopped the ambulance, Alex swung open the side door and sprinted into the ER, the baby in his arms, still doing chest compressions. A team of nurses were gathered around the room, waiting for him. As he ran in, they sprang into action. They took over CPR, a respiratory therapist took over ventilation, one changed out the cardiac monitors, and another was pushing medications. Alex watched as they worked until the doctor decided they had tried everything. His heart sank as he heard the words he had known were coming.

"Let's call it," The doctor said.

Silence was the only response.

#

On the drive home, Alex was confused about his emotions. He felt everything, and yet nothing, all at the same time. He was numb, but he could feel sadness, emptiness, and helplessness. He thought he should cry, but he couldn't. Not yet, anyway. The tears just wouldn't come.

He'd been pretty stoic when he got back to the station. Everyone had heard by then what the call was, and he had plenty of co-workers offering their sympathy. He'd told them all that he was okay, he even showed concern for Zach and made sure that Zach was handling it well. He buried his own emotions, putting on a steady and stable front for everyone to see.

Now that he was alone, he knew that he could drop the false steadiness. He was free to fall apart and grieve. He knew that it was okay now that no one else was around, but try as he might, he just couldn't do it. He was too numb.

When he got home, he was struck by the mess. Dirty dishes piled up in the sink, laundry amassed in front of the washer and laid strewn across his bedroom floor, trash overflowed from the trash can and cluttered the countertop. It was his mess, but he'd been too drunk to clean the house for over a week now. The stench of the trash can made him gag, and the smell emanating from the sink wasn't much better.

He absently started cleaning, not really paying attention to what he was doing, just working on autopilot. He bagged the trash and took it out, using the garden hose to spray out the trash can. Then, he started a load of laundry and washed the dishes.

As he worked, the depression started creeping in again. The numbness was replaced by emptiness, and he felt cold and alone. He was useless at his job, he thought. He never really saved anybody, he never made anybody's life better, he was just an expensive taxi attendant. When he did intervene in a medical emergency, people were usually worse off than they were before. He figured the only reason he hadn't been fired was because the ambulance service was desperate for people to work and fill slots on the schedule.

As he finished cleaning the kitchen, he came across a half-empty bottle of bourbon. He poured himself a glass and then another. He looked into the living room. Empty pizza boxes surrounded his recliner. He knew he needed to clean in there as well, but he didn't have the energy anymore. He went to his bedroom. More laundry was strewn across the floor, but he didn't have the energy to clean that up either. He stripped off his uniform and added it to the dirty laundry cluttering his floor.

He felt disoriented, dizzy. He sat down on the bed to think, but the thoughts of how useless of a person he was plagued his mind. He couldn't control them or steer his thoughts to a positive direction. He lay back on the bed, letting the exhaustion wash over him, and he fell asleep once more.

#

Alex texted his mother. He hadn't heard from her in days. Talking to her always made him feel a little better. She had no idea that he was depressed, and she rarely knew what was going on in his life. He didn't share much with her, but he would listen to her talk, and it would make him feel a little better.

She didn't respond to his texts. He got up and started drinking again. It was still morning, but he didn't care. That didn't matter to him anymore. He sat down in front of the TV. After about an hour, he noticed that his mother still had not texted him back. He called her and got no answer. That was unusual for her not to answer his calls or texts. She lived about an hour away, so Alex changed his clothes and got in the car.

The drive seemed shorter than usual. Alex felt a sense of urgency to get there and check on her. He told himself that he was just being paranoid and everything would be fine. When he arrived at her apartment, everything was locked up tight. Her car was in the parking lot, but there was no sign that anyone was at home. Alex had a sinking feeling in the pit of his stomach.

He called the apartment manager to let him in the door. As the door opened, the smell was the first thing Alex noticed. He knew that smell. He pushed his way into the small apartment, looking around for signs that something was out of place. Everything appeared normal until he entered the bedroom.

The smell was stronger as he pushed open the bedroom door. Sunlight was streaming through the partially open blinds, and it was the only light in the room. He saw her immediately. She was laying in the bed, obviously dead, bloated and purple. He fell to his knees, screaming in pain at the death of his mother. He began hyperventilating.

Alex woke suddenly. He was soaked in sweat again. He sat upright in the bed. It had only been a nightmare, but it was so vivid that he could even smell the putrefaction of her decaying body. He hated that his dreams were so realistic.

He finally was able to cry again, and he cried hard. It wasn't just the nightmare; he was able to cry for the baby, too. It all hit him at the same time, and the emotions overflowed. He sat there in the bed, rocking himself back and forth, hugging his pillow and crying.

"Men don't cry like this," he told himself. "You need to pull it together." But no matter how he tried, the outpouring of emotion would not be stopped. He continued to cry until he choked and gagged from crying so hard. When the tears finally subsided, he stared at himself in the mirror, hating himself for being so weak. He felt like all the things he told himself about being weak and useless were all true, and this breakdown was just more evidence of it.

CHAPTER SEVEN

The next shift started off slow. Alex and Zach checked off their truck and went to breakfast, where they only time they spoke was to place their orders. When they returned from breakfast, they sat around the station for about an hour before they got their first call. It was a motor vehicle collision on the highway.

When they arrived on scene, Alex saw that a car had been struck in the driver's side by a pickup truck. The first patient, the driver of the car, was still entrapped but did not seem to have any serious injuries visible. A small child was strapped into a car seat in the back, also with no visible injuries. The passenger of the car was dead, although again, there did not appear to be any external injuries.

Alex called for helicopters to transport the two living patients. The first helicopter to land took the child, and when the driver was freed, Alex and Zach moved her to their ambulance to wait for the second helicopter. Her vital signs were normal, and Alex couldn't find any injuries. He was still concerned because the impact had been on the driver's side, and yet, the passenger had been the one who died. He kept a close eye on the woman's vital signs until a flight crew arrived and took over.

It seemed like only minutes before both living patients had been flown from the scene. Alex breathed a sigh of relief, believing that they would both be fine. They would be flown to a trauma center, where they would be thoroughly examined by trauma specialists before being cleared.

Alex checked the driver of the truck and had him sign a refusal for care, even though he wasn't injured. The accident investigation was underway, and Zach waited with Alex in the ambulance while the investigators did their jobs. Finally, after about an hour of waiting, an officer signaled to Alex and Zach that they were clear to move the body.

Zach positioned the stretcher by the passenger side door, while Alex spread a body bag across the stretcher. They pulled the woman out of the car and lay her on the stretcher. Even though Alex could see her better now, he still did not see any signs of injury. He zipped up the body bag and buckled her onto the stretcher.

She was only thirty-two years old. Alex got her name, date of birth, and age from her driver's license, handed to him by one of the investigators. She was younger than he was. Alex thought about how sad it was that someone so young would never get the chance to grow old.

He felt sorry for the woman. There were so many things she would never get to do. Her life was over. He contemplated what happened after death, whether you just cease to exist or if there was an afterlife.

Alex wasn't sure what he believed. On the one hand, there was the possibility that this life was all there was. Once you died, you just ceased to exist. There was no spirit, no ghost, no consciousness that transcended this world, and you just ceased to be. He felt like this explanation was the most plausible one.

On the other hand, there was the possibility that there was life after death. Paranormal investigators everywhere had collected evidence that suggested the existence of spirits, which would lead one to believe that there was some kind of spiritual world, and it would make sense that there could be life after death in that spiritual world. And if such a world existed, then it was possible that there was a God, and if there was a God, then there must have also been a counterbalance, which would mean that there was a Devil.

His attempt to rationalize the theology of life and death left him with a headache. There were so many questions, and so few answers. The only way to definitively find out if there was life after death was to die, and if you were wrong, you'd never get the chance to tell anyone.

The question weighed heavily on his mind. He wondered if his patient had moved onto another plane of existence, another realm of consciousness, or if she had just ceased to exist. It bothered him, not knowing, not being able to know.

Zach drove them to the morgue, where they silently unloaded the stretcher and then returned to the station. Zach went to the bunk room to read his book, Nick was playing video games, and his partner Kelly was outside smoking, talking on the phone. Alex stood there alone with his questions and confusion. There was no one to talk to, no one to ask questions of, nobody to help him understand.

Alex had been raised in church, but as a teenager, he began to question some of the church's teachings, which in turn led him to question them all. He found no solace in the answers provided by the church, and in time, he had come to regard the clergy the same as snake-oil salesmen. Their answer to everything was to "have faith." Alex didn't have any faith and didn't know where to find it.

He thought about his own mortality and how someday he would find the answers he sought. Or maybe not, if he was correct in thinking that his consciousness would cease at the moment of death. Logically, that made sense to him. It was reasonable that death was the end of life. But he still had that nagging question, that shred of doubt that an afterlife was possible.

Since there was no one available to talk to, Alex laid down on his bed and pondered the existence of God, his thoughts taking him deep down that rabbit hole. The questions without answers left him frustrated, angry and depressed all at the same time. He wished he had someone to talk to, and at this point, even a priest or pastor would have been welcomed. But no one was there, no one was available. He was all alone.

#

Alex was waiting for the tones when they sounded. He already had his boots on, ready to go. "Medic Three, respond. General ER for an inter-facility transfer for higher level of care."

Zach sat up in his bed and put his boots back on. He carefully marked the page on the book he was reading. Alex waited until Zach was ready, and they walked out to the bay together. "I wish they'd tell us what's wrong with the patient," Alex said. "This 'inter-facility transfer' bullshit does not prepare us for what we are walking into."

Zach nodded but offered no verbal response. The drive to General Hospital was silent, as per their usual. Zach turned on the radio and they listened to his music streaming app. He had chosen a techno station, and the upbeat music was helping Alex's mood.

When they arrived, Alex went to the nurse's station to get the paperwork and a quick report on the patient. The nurse wouldn't make eye contact with him. Alex took that as a bad sign.

"So, what's going on with this patient?" he asked.

"Broken toe," she replied.

"Excuse me?"

"She fell in the bathtub and broke her toe. She had a kidney transplant ten years ago, so she's going to see a trauma surgeon."

"For a broken toe?"

"Yes."

"Are there any other injuries?"

"No."

"Are you kidding me?"

"I wish I was."

The trauma center was an hour and fifteen minutes away. Alex got pissed off. He had to take a couple of minutes to cool down before he went into the room to meet the patient.

When he walked into the room, the patient smiled and stood up from the bed, taking care to avoid putting weight on her injured foot. She walked to the stretcher and sat down. "I'm ready to go," she said.

Alex said, "Okay," and buckled her in. He bit his tongue before he made the same mistake he committed with the drunken mother. He and Zach wheeled the stretcher outside to the ambulance. The ride was uneventful since the patient did not talk, and neither did Alex. He checked her vital signs every fifteen minutes, but other than that, he let her rest. He worked on his documentation on the way there.

When they arrived at the trauma center, they were directed to a room. A nurse came in to get report, and while Alex was talking to her, the physician came in, obviously in a bad mood.

"What minor medical problem was General Hospital too incompetent to handle today?" he asked.

Without blinking, Alex responded, "Broken toe."

Turning to the patient, the doctor said, "Not to worry, ma'am. You're in good hands now, and you'll actually get decent medical care here."

Alex asked the nurse if she needed anything further, and she said, "No, I think I have everything." He turned to leave the room.

The physician called after him, "Hey! A little less attitude next time."

Alex turned around without missing a beat and said, "That road goes both ways, doc." He turned back around and walked out into the hallway.

The doctor chased after him. "Hey! You don't speak to me that way. I'm the medical director for the fire department and the chief of emergency medicine here."

"That's great for you. I don't work for either of these places, so you're not MY medical director!" Alex snapped back.

The two of them yelled at each other, gradually getting louder and louder until they had attracted the attention of hospital security, who were getting ready to break them up. The doctor noticed security gathering around them and softened his tone.

"Look, all I'm trying to say is that your physicians there at General transfer these bullshit complaints to us, and they're taking up beds that we need for real trauma patients. Your physicians are incompetent hacks!"

"Tell me something I don't already know!" Alex was not backing down. "I know it's stupid to bring a broken toe to a trauma center. But what can I do? Refuse? That gets me fired, and another ambulance brings her anyway. So, what good does that do?"

The doctor softened his tone even further. "Okay, you're right. I'm sorry. I shouldn't have snapped at you like that."

"Damn right, you shouldn't have. I'm just trying to do my job."

"You're right. I'm sorry." With the doctor's second apology, the security officers relaxed a little. Alex did, too. The physician turned and went back into the patient's room, and Alex walked toward the ambulance entrance. Zach was standing by the door, facing Alex with his mouth open in surprise. He began slow-clapping as Alex approached.

"You really put him in his place," Zach said, laughing.

Alex kept walking until he was outside of the hospital. Once he was far enough away from the door that he was certain no one could hear him, he started to laugh nervously. He hadn't meant to get so loud, or confrontational, but he had been pushed and wasn't going to back down.

Zach was laughing the whole way back to town, still in amazement that Alex had fought with the doctor, the chief of emergency medicine at that, and gotten an apology from him. Alex was a little embarrassed by what he had done. He was afraid that he would be in trouble as soon as Greg found out, which he most certainly would as soon as the physician called and complained.

He decided it would be best to tell on himself, that way he could be sure his side of the story was heard. On the ride back, he took out his phone and composed an email to Greg, detailing the encounter and the potential complaint that would follow. He hesitated before pressing "Send." He thought about the repercussions but decided that it was worth the risk. Again, he wanted to make sure that his side of the story was told. He pressed the button and heard the "whoosh" sound from his phone, indicating that his email had been sent.

It was in Greg's hands now. Alex rode back to town silently, listening to Zach giggling about the incident, worried that he would be reprimanded upon his return.

#

Greg had already gone home for the day by the time they got back to town. Alex had no idea if he'd gotten his email or not before he went home. The other two trucks had both run calls while they were gone, so they were back up again for the next call.

They returned to the station and began preparing for bed. Alex was exhausted, some of it from exertion and being up all day, some of it was emotional from the depression. He suspected that the emotional aspect was the biggest part of it, although the confrontation with the doctor didn't help any.

Alex fixed a quick dinner in the kitchen, and he and Zach ate. They were both famished. Zach did the dishes, while Alex made his bed. He was sitting on the bed, taking off his boots when Zach walked in the room. Zach regaled Nick with the tale of Alex taking on a doctor at the trauma center, while Alex sat there quietly, letting Zach tell his story. Alex felt embarrassed by the attention, but it boosted his confidence when Nick agreed with Zach that it had been deserved and warranted.

Alex lay down on the bed. His feet ached, his legs hurt, and his whole body felt tired. He remembered that tomorrow was his appointment with the EAP therapist. He was anxious for the appointment and eager to finally get a solution to the problems he was having. It made him happy to think that he could finally be cured of the depression and his PTSD. He made himself comfortable in the bed and drifted off to sleep.

Around two o'clock in the morning, the tones sounded again. "Medic Three, respond. 801 North Main Street, apartment B-24. Domestic assault." Alex heard Zach groan loudly. This kind of incident was supposed to be the police department's job. No doubt somebody involved in the fight complained of an Ouchy and police were calling for EMS to check it out.

When they arrived on scene, Alex walked toward one of several police officers flagging them down. Zach followed close behind.

"We've got a twenty-four-year-old female involved in a domestic assault. She's complaining that she hurt her finger and wants to get it looked at," the officer said.

"Excuse me, did you say a hurt finger?" Alex's anger boiled over.

"Yes."

"You mean to tell me you dragged us out here at two o'clock in the morning for a hurt FINGER?"

"Well, she wanted to get checked out."

The young woman was now within earshot and heard the officer's response. She replied, "No, I didn't. You were the one who said I should get it checked. I didn't ask for them, and I don't want them."

Alex stared holes in the officer, glaring at him, daring him to speak again.

The officer sputtered, "I... but... well... I..."

Alex turned and walked away. He climbed back into the ambulance. Zach was laughing again, so much so that his whole body shook and tears leaked out of the corner of his eyes. "You're on a roll today," he said when he finally regained control of himself.

Zach's comment made him stop and think. Greg was definitely going to be angry now.

#

Alex waited patiently in the therapist's office. His therapist was a large, dumpy looking, round man with a bald head and tiny legs. Alex thought they looked like a chicken's legs. He looked like a cartoon drawing of Humpty Dumpty brought to life. Alex tried not to snicker at the thought.

The therapist spent several minutes typing on his computer. Alex assumed he was charting on the previous patient he'd seen before Alex. Finally, after about fifteen minutes, Alex was getting uncomfortable. The therapist had not spoken to him since he came into the office. He must have sensed Alex's discomfort, because he said, "I'll only be another minute."

Alex waited as the therapist finished up what he was typing. He turned to Alex, giving him his full attention and said, "So, what brings you in today?"

"Well, see, I'm a paramedic. And I see a lot of trauma, a lot of bad things. I've been having a really tough time lately. I know I have PTSD, and I've been really depressed also."

"Okay. Have you been diagnosed with PTSD or depression? By a doctor?"

"No, I haven't."

"That's going to be our first step. We need to get you an official diagnosis. Tell me what makes you think that you have PTSD."

Alex's mind went blank. Suddenly, he couldn't remember a single one of his symptoms. Thoughts swirled in his mind, but he couldn't form them into words. He felt his face getting red with embarrassment.

"That's okay," the therapist said. "What about depression? Everyone gets a little sad every now and again. It doesn't mean that you are clinically depressed. You have a stressful job, but it's a good job, and I'd hate to see you jeopardize that with a diagnosis of PTSD or depression, especially if you don't really have those disorders. Here's what I recommend. I think you should go home and pray about it. Ask God for peace and calmness in your life. Do that, and you'll be just fine."

The therapist turned back to his computer and started typing again. Alex took that to mean that he was dismissed, so he stood to leave. He hesitated to give the therapist a chance to say more, but the other man didn't speak. Alex left the office, confused and angry.

Pray about it? What kind of advice was that? He'd been hoping to get some actual help to make it through the hell that was his life and the best advice he could get was to pray about it? One thing was for certain. He would never be back to see Humpty Dumpty again.

Alex drove home, furious and hurt. He had really expected to have some sort of breakthrough with therapy, and it turned out to be just a meeting where he was completely dismissed and ignored. He gave up on therapy right then and there. He wasn't going to waste his time listening to advice that he could get from his mother for free.

He stopped by the liquor store on the way home and bought another couple of bottles of bourbon. That was the only therapy he was going to get.

CHAPTER EIGHT

Alex stayed drunk both days he was off work. When he returned, he was hung over. His head hurt, and he felt sick. He considered calling off but decided that he needed the money. He would just deal with the hangover.

When the tones went off for Medic One's first call of the day, Alex thought his head would split open. His ears were ringing, even after the tones stopped. He felt dizzy and lightheaded. He went through the motions of checking off his ambulance. Zach noticed his condition and was trying to work quietly.

He felt miserable. As soon as the truck check off was complete, Alex went into the bunk room and made his bed. He laid down, hoping to get a nap before their first call. Zach and Nick came into the room, each of them making their own beds, conversing among themselves. The sound of their voices grated on Alex's nerves. He wished they would shut up and stop making so much noise. It was hurting his head.

The tones went off again as Medic Two was dispatched on a call. Nick sighed and left the bunk room, cursing under his breath. Alex closed his eyes and tried to fall asleep. He didn't get a chance before the tones went off again.

"Medic Three, respond. 414 Waverly Place. 28-year-old male, shooting. Stage for police."

Alex rolled out of the bed. He hadn't even taken his boots off when he laid down. He was dressed and ready to go, physically at least. Mentally and emotionally, he did not want to go on the call. He got in the ambulance, anyway. Zach already had the engine running and the ambulance in gear.

They pulled over about a mile away from the address to wait for police to clear the scene and secure any weapons. After waiting for about five minutes, they got the all clear to enter the scene. The first thing Alex noticed was that there were no bystanders. No family members were milling about, just police. He walked up to one of the officers, who said, "He's dead. It's a suicide."

The officer pointed Alex toward the bathroom in the back of the house. He entered the bathroom timidly, because there were police officers everywhere, and he didn't want to hit anyone with the door. Nobody was in the bathroom except the body. He was sitting on the toilet, the barrel of a gun still in his mouth. The walls and ceiling were splattered with blood, brain matter, and bone fragments.

Alex watched and listened as the police conducted the death scene investigation. The man had been in an argument with his girlfriend, grabbed his gun, and locked himself in the bathroom. She heard the gunshot and ran next door to call 911. The first officers to respond were the ones who found his body.

They waited for the police to conclude their investigation, then they spread a body bag onto the floor. They moved the body from the toilet to the floor, taking care with his head, which was open on the top like a bowl. Alex zipped up the bag, and they carried it to the stretcher. He noticed a woman watching from the front door of the neighbor's house. He assumed she was the girlfriend.

They transported the body to the morgue, then returned to the station. Alex had completed his documentation before they got back, and he tried to sneak back to the bunk room without running into Greg. He was successful, and he lay back down in his bed to try to sleep again.

#

Alex woke in the late afternoon. Greg was already gone for the day, so he didn't have to worry about avoiding him anymore. He looked around the station to see what everyone was doing. He felt lonely and was looking for someone to talk to and hang out with.

Zach was laying on his bed, reading his book. Alex didn't want to disturb him. Nick was taking a nap. He walked outside to the smoker's area. Nobody was there. He saw Kelly in the parking lot, talking to someone. As he got closer, Alex saw that it was her boyfriend. They were in a very intense conversation, and neither of them noticed Alex looking at them. Kelly's boyfriend was holding her close with his arms around her as they talked. Alex felt lonelier than ever.

He went back inside the building. Everyone he knew was either married or in a serious relationship. Out of everyone in his life, Alex was the only one who was still single. He thought he deserved to be alone, though. He wasn't the kind of person who someone could love. He had a lot of issues and came with a lot of baggage. Nobody wanted that.

He went into the TV room and sat in a recliner. There was nobody else in the building, except for Zach and Nick, and Alex knew where they both were. The crew of Medic One was not in the building, their truck gone. They usually didn't hang around the station when they were on shift. In fact, it seemed like most days they came in, picked up the ambulance, and only returned when it was time to go home.

Alex turned on the TV and absently flipped through the channels. A cooking show briefly caught his attention, and he stopped to watch for a moment, before his private thoughts recaptured his focus. He wondered what he had done in his life to make him such an unlovable person. What was it that he did that made people avoid him, despise him, and hate him? How was it that he could devote his life to the service of others, and yet, not one single person on this earth could love him?

His heart was hurting, and he felt a tightness in his chest. The sadness and loneliness enveloped him and completely took him over. He hoped for a call to come in to take his mind off of the overwhelming sadness that permeated his soul. He wanted a drink, just to numb the feelings he had, but he knew he couldn't have one while he was on duty.

After a couple of hours of wallowing in misery, a call came in. "Medic Three, respond. Highway 212 at Two Rivers. Motor vehicle collision."

Alex was grateful for the call. And it shouldn't be too bad, because that area was a thirty-mile-per-hour speed zone. Maybe it would even be a refusal. Either way, it was something to do and likely would not involve a dead body.

As per usual, Zach seemed annoyed about having to put his book down and go on a call. As they responded, Zach complained loudly about the irresponsible driver that couldn't maintain control of their vehicle. “I mean, really, who gets into an accident on a road with thirty-mile-per-hour speed limit? Besides alcoholics and senile grandparents, that is,” Zach said. Alex started to bring up the stop sign at the end of Silverwood Road but decided against it.

When they arrived on scene, the car was well off the roadway, in the tree line. Firefighters had already gotten the driver out of the car, put a cervical collar on him, and were walking him across the field to the ambulance. Alex prepared the stretcher and waited beside it. The driver was a young man, in his late teens or early twenties. He was obviously drunk and very flamboyant.

At the direction of one of the firefighters, the patient sat down hard on the stretcher. He complained of neck pain, and firefighters reported that the airbags had struck him in the face. Alex and Zach loaded the stretcher into the ambulance and climbed inside. Zach set to work starting an IV, while Alex checked vital signs. The patient's blood pressure was just lower than the normal limits, and Alex decided to give him some fluids. He spiked a bag of saline and prepared the IV tubing.

As he was flushing the IV line, it slipped out of his hand. The end flopped toward the patient, dripping saline all over his face. The patient licked his lips, tasting the salty liquid that was on his face, he said, "It came all over me!"

An uncomfortable silence fell over the ambulance. One of the firefighters had to leave the ambulance because he was so uncomfortable. The others began to chuckle, while Alex and Zach laughed out loud. Nobody knew what to say to the patient, because he had left them all speechless.

Alex attached the IV line and said to Zach, "I'm ready to go when you are."

Zach started to drive them to the hospital after the firefighters filed out of the ambulance once they checked with Alex to make sure he didn't need anything else. The ride was uneventful, and they dropped the patient off at the hospital.

When they returned to service, Alex felt the return of the feelings he'd had prior to the call. He'd been hoping for a call, and he got one, but it was only a temporary reprieve from the depression and loneliness he felt.

Back at the station, Zach's girlfriend was waiting for them in the parking lot. She'd made him dinner and brought it to him at work. Alex said hello, then left the two of them alone to eat their meal while he went back to the TV room. He was hungry, but he didn't know what he wanted to eat, and he wanted to stay out of the kitchen to give them some privacy. They looked so happy together. Alex longed for that kind of happiness. He felt a pang of jealousy before he reminded himself that he didn't deserve to be happy.

#

Alex slept that night, but the nightmares were back. He dreamed of dead babies, grotesque corpses, and violent deaths. The nightmares were interrupted by the tones twice as Medic One, and then Medic Two, went out on calls. After Medic Two went out, Alex did not sleep as well. He was waiting for the next tones to send him out the door.

The call that he knew was coming finally came in around five o'clock in the morning. It was in the parking lot of a convenience store near the station for chest pain.

It was only a two-minute drive to the location. As they pulled up, Alex saw a middle-aged man sitting on the curb, clutching his chest. Zach pulled right up to the man, and Alex jumped out of the ambulance.

"Hi, I'm Alex. What's your name?"

"Mike Ray." He continued clutching his chest, breathing through the pain.

"Okay, Mike. They said you're having some chest pain. When did that start?"

"It started about ten minutes ago."

"Does anything make it better or worse?"

"No."

"Can you describe it for me?"

"It feels like an elephant sitting on my chest."

"Does it move anywhere?"

"No."

Alex continued with the questions, while Zach attached the cardiac monitor. The hair on his chest prevented the electrodes from sticking, so Alex used a surgical razor to shave the chest. The ECG showed that Mike was having a heart attack. Zach prepared the stretcher, while Alex assisted Mike to stand from the curb and sit on the stretcher. They quickly loaded him into the ambulance, and Zach immediately started working on an IV. Alex counted out four baby aspirin and gave them to Mike. Once the IV was in place, Alex gave him some nitroglycerin and a dose of fentanyl for the pain. He faxed the ECG to the hospital and called ahead to activate the Cath lab.

Zach finished taping down the IV and went to drive them to the hospital. Alex heard the siren come on as they left the parking lot. They had only been on scene for six minutes. During the ride to the hospital, Alex helped Mike take his shirt off, and he used a razor to shave Mike's arms at the wrists.

When they arrived at the hospital, Alex grabbed some blood tubes and began pulling samples from the IV line. He dropped them into a lab bag and handed them to the nurse. The cardiologist was standing at the nurse's desk, reading the ECG that Alex had faxed in. He ordered Alex and Zach to take Mike directly to the Cath lab.

As they wheeled the stretcher into the room, a team of nurses swarmed into action. One of them, an older woman with a gruff attitude, yelled at Alex.

"Couldn't you have taken his boots off before you got here? Seriously, you guys are delaying patient care. If you could at least do that much for us, it would make things go much, much faster, and we wouldn't be wasting time prepping for procedures. You could at least do that much for us before you get here."

Alex was stunned and pissed off at the same time. Twenty-six minutes after the chest pain started, the patient was in the Cath lab. He'd had an ECG, an IV, he was shaved, shirt off, blood had been drawn, he had aspirin, nitroglycerin, and fentanyl. But they were complaining that Alex hadn't taken Mike's boots off?

Deciding not to engage, because he knew he would yell if he did, he stood there with his computer, waiting for someone to become available to sign for the patient. The Cath lab team continued their work, ignoring Alex. As they started the procedure, Alex left the lab and went into the control room, where staff were monitoring and recording the procedure.

After noticing Alex standing in the control room, one of the nurse practitioners asked, "Do you need something?"

Alex said, "Yes, I need someone to sign for the patient."

The nurse practitioner was about to sign the touchscreen computer when the cardiologist spoke up and said, "Make sure you know what you're signing."

The nurse practitioner paused and looked at Alex. He was very annoyed by the cardiologist's comment. He said, "It's a transfer of care." The nurse practitioner signed her name. Alex didn’t bother to thank her, which caused the cardiologist to huff and roll his eyes.

He left the control room and went back to the ER, where Zach had already cleaned the stretcher and prepared it for the next call. They restocked the ambulance together, and Alex submitted his documentation of the call.

He checked the clock. Thirty-eight minutes had elapsed since Mike had first started having chest pain, and he was in the hospital on a Cath lab table, with the procedure well underway. Alex was very proud of himself and Zach for working with such speed and efficiency, despite the complaints of the Cath lab staff.

#

When they got back to the station, Greg's truck was in the parking lot. Alex wondered what he was doing there so early. Zach backed the ambulance into the bay. It was only a couple of minutes before seven o'clock, so Alex started cleaning the ambulance and getting ready to go home.

The oncoming crew arrived and started checking off the ambulance before Alex was finished cleaning it. They told him to not worry about cleaning it, that they would take care of it. He went into the bunk room and packed up his bedding and personal belongings. He was in the hallway, on his way out the door when he heard Greg's voice.

"Jackson! In my office. Now!"

Alex froze. He gave a deep sigh, and then turned around and walked into Greg's office. He wondered what infraction he would be chewed out for today. He'd been avoiding Greg all day yesterday, but now, he was caught.

He sat his bag outside the door and stepped into the office, closing the door behind him. Greg motioned for him to take a seat.

"I thought I told you to see that EAP therapist."

"I did."

"Well, obviously it didn't take. You've been in confrontations with the police, the fire department, and the chief of emergency medicine at the trauma center. I've gotten complaints from the Cath lab, you didn't clean your ambulance this morning, you came to work hung over yesterday. What in the hell is wrong with you?"

"I'm sorry. Those weren't all my fault."

"Of course not. It was all somebody else's fault. Look, I understand that you're having a tough time right now. But if you can't handle the stress of this job, you let me know, and I'll find somebody who can. I can't have paramedics who come in hung over, yell at doctors, do shoddy work with critical patients, and don't clean their ambulances at the end of their shift. Maybe there is a place you can work where that's okay, but this isn't it. I'm sorry, but you're suspended for the next three shifts until you can get your shit together and do your job. If we have to have this conversation again, it will be the end of your job here."

Alex sat back in the chair, stunned. He couldn't believe that he was in this much trouble. He nodded his head slowly, acknowledging that he had heard and understood Greg's message. Greg didn't speak further, so Alex stood and left the room. Three shifts. That was twelve days in a row that he would be off work, which wasn't so bad. The seventy-two hours without pay would be the hard part. That was his real punishment.

Alex left the station and drove home. He felt the unfairness of the situation, and he felt like crying again. He told himself to man up. His emotions getting the better of him was what landed him in trouble in the first place. He was going to have to do better, and he was going to have to do it on his own. There was no help for him.

CHAPTER NINE

Alex spent all twelve days off at home without leaving. Nobody called or came by. He spent twelve days with no contact or communication with another human being. He never ventured outside his house. His punishment was to remain in solitude, which only served to deepen his depression and loneliness. He didn't think that was possible until it happened.

He spent his days in his own little prison. He didn't shower or shave, didn't clean the house, or do any chores. He just laid around, watching TV or sleeping. He didn't have the energy to do anything else. He knew he should get up and shower, put on clean clothes and start cleaning his house, but he couldn't muster the strength to do it.

By the second week, he couldn't stand the smell any longer. The trash was overflowing, and there was an awful stench coming from his kitchen. His body odor was so bad that he could smell himself, and the smell made him sick. He decided that it was time to get himself together.

He showered first, taking about an hour to scrub his entire body repeatedly. Then, he shaved, brushed his teeth, and put on clean clothes. He started in his bedroom, collecting all of the dirty laundry to be washed. He moved on to the living room, picking up dirty dishes and food wrappers. He saved the kitchen for last, because it was a monumental undertaking.

He put on some upbeat music to help keep him in a positive mood. He opened the windows to let fresh air into the house, as well as some sunlight. He sang along with the radio as he worked. He took out the trash, then started on the dishes.

Mid-way through washing the dishes he started feeling bad again. The music was no longer helping his mood; in fact, it was becoming annoying. He turned off the radio and forced himself to finish the dishes. He put away the last of his pots and pans, then went to the living room and flopped down in his recliner.

Alex once again began contemplating death. He wondered if this life was all there was. He thought about plants and animals, other living beings and whether they had afterlives. If there was a God, and each living creature had a soul, then there must be a lot of animals, insects, and plants in Heaven. But on the other hand, if there wasn't a God, and no soul in any living creature, there wouldn't be anything to look forward to after this life.

He couldn't decide what he believed. He sat there in his recliner, pondering the tough questions. He was more confused than ever. He wished someone could give him a definitive, proven answer that was irrefutable, in one direction or there other. But he knew that answer would never come, at least not while he was still alive.

#

Alex was more than ready to return to work when the day rolled around that he was scheduled to go back. He woke early that morning, showered and dressed and arrived for work fifteen minutes early. He sat in his car in the parking lot, waiting for the time to go inside.

He clocked in, enthusiastic and eager. He was happy to be back at work, and he had not realized just how much of a difference it made to be around people again. He resolved to have a good day, no matter what happened. He accepted the fact that he would run several calls, and some of those might be bad ones. He wasn't going to complain, or whine, or moan about running them. He was going to do his job, and do it to the best of his ability.

The tones sounded overhead, louder than Alex remembered. Medic One was getting a call. He started checking off his ambulance, hoping to get finished before he got a call.

"Hey, buddy! Glad to see you back." Zach climbed in the back of the ambulance and gave Alex a big hug.

"It's good to be back." Alex tried to be enthusiastic but didn’t know if he succeeded. Zach, thankfully, didn’t comment on it either way. He and Zach worked together to complete the truck check off, and just as they did, the tones sounded again, this time for Medic Two.

"Well, we're up next," Zach said.

"We are, but at least we’re expecting it." Alex was really trying to be optimistic and positive. The tones sounded again, before Medic Two had even pulled out of the bay.

"Medic Three, respond. 1881 South Main Street, apartment 602. 47-year-old female, chest pain."

"Isn't that Angela Mitchell's address?" Zach asked. Alex nodded. It sounded right. They rushed to the cab of the ambulance and raced to her address.

Once again, Angela was sitting at her kitchen table, clutching her chest. Alex rushed to put on the cardiac monitor. She looked worse than the last time, and she was short of breath.

"I. Can't. Breathe," she said, only able to speak one word at a time before stopping for breath. Zach applied an oxygen mask.

"Angela, what did they do last time?" Alex asked.

"Stent," she answered.

Alex looked at the ECG and saw that she was having another heart attack. Angela saw the monitor as well, and when she did, her face turned pale.

Zach and Alex helped her to the stretcher and navigated it down the steps while Alex faxed the ECG to the hospital. They gave her aspirin and nitroglycerin again, and Alex gave her some fentanyl for the pain. They rushed her to the hospital, where the ER physician was waiting for them at the door.

"The Cath lab team is twenty minutes out," he said breathlessly. He directed them to an ER room, where they moved Angela to the ER bed. Zach left with the stretcher, while Alex delivered his report to the nurse.

After leaving the ER, Alex looked at his times. It took them twenty-two minutes from the time Angela called 911 to get her to the hospital. He was feeling proud of those times, but he was worried about Angela, since the Cath lab team wasn't there yet.

#

Alex was shaken by the fact that he had transported Angela again for a second heart attack. She didn't look so good this time. She hadn't looked good the first time, but the second was much worse. Zach notified dispatch that they were back in service.

They had arrived back at the station and were about to back into the bay when the tones sounded again. "Medic Three, respond. 2320 South Main Street. Unresponsive female."

Zach did a U-turn in the station driveway and turned on the lights and siren. Alex ran through the possible scenarios in his head. It could be an overdose, a stroke, a head injury. There were multiple possibilities. He wouldn't know how to treat it until he arrived and found the cause.

When they got on scene, they were met at the curb by a younger woman, about thirty years old. She said, "It's my mother. She's not responding to me, and she's just sitting there on the floor."

Alex asked, "Is she breathing?"

The woman said, "Yes. She's breathing, but she's just not responding to me."

Alex grabbed his cardiac monitor and trauma bag and hurried inside the house. He found the woman sitting on the bedroom floor, face down in a plate of food. She had her legs folded and was leaning forward. Alex called out to her with no response. He pushed her shoulder to raise her head forward, and she fell over backward. Her legs, still folded, went up into the air. The woman was in rigor mortis and very obviously dead.

She had bits of food on her face where she had been lying face-down in the plate. Mashed potatoes were stuck to her nostrils and the corners of her mouth. Alex tried not to gag. He had to step outside for fresh air while he called for death scene investigators to come to the house.

He broke the news to the daughter as gently as he could. “I’m so sorry to tell you, but your mother is gone.” He realized as he delivered the harsh words in the softest manner possible that he was terrible at giving bad news. He hoped he would never do it enough to get good at it.

The police investigator and Greg arrived at the scene and conducted the death investigation. Alex waited outside until they were finished. Zach carried in the body bag, and they moved the body to the stretcher.

Alex wasn't as confident as he had been when he arrived at work that morning. He had been in a good mood and ready to have a great day. But after transporting Angela, and now a dead body, he wasn't having the day he had planned on. His mental preparation and readiness were shaken, and he felt the anxiety returning.

After dropping off the woman's body at the morgue, Alex was on high alert, waiting for the tones to sound again. He was not able to relax or calm his nerves. He asked Zach to stop at a convenience store. He bought a pack of cigarettes and a lighter, hoping that maybe nicotine would help his nerves, since he couldn't drink while he was on shift.

#

When they got back to the station, Alex went straight to the smoker's gazebo behind the building. It was there for everybody to use, but the only people who ever did were the smokers. He took a cigarette from the pack, lit it, and inhaled deeply.

He began coughing hard, so hard he felt dizzy. After it passed, he took another puff from the cigarette. He felt his nerves start to calm. Maybe the nicotine was all he needed after all. He finished the cigarette, taking short puffs and coughing several more times.

He walked back inside the station, passing Zach in the hallway. Zach said, "Oh my God, you stink. You smell like an ashtray!" He had not seen Alex buy the cigarettes at the convenience store.

Hurt rushed through Alex at co-worker’s blunt words.. He went in to the bunk room and searched through his bag for a can of body spray, which he applied to his uniform. He popped a breath mint, just to make sure he was covered.

His hurt feelings triggered his depression again. He told himself that he stunk, he was nasty, and nobody liked him. He thought about his dirty house and how bad it had gotten while he had been suspended. "That's how filthy of a person you are," he told himself.

The tones sounded again. "Medic Three, respond. 127 North Elm Street. Lift assist."

Alex let out a breath of relief. A lift assist would be simple. It was as uncomplicated as a call could be. Lift assist meant that someone needed help getting up, they weren't injured, and wouldn't need medical care or transport to the hospital. It would be a nice and easy call.

When they arrived, Alex saw a car parked beside the curb with the passenger side door open. A man sat in a wheelchair on the sidewalk. Family members were standing nearby. Zach parked right behind the car, and Alex got out of the ambulance. One of the family members approached him.

"Hi. We were trying to get him in the car to take him to the hospital, but he can't stand up, and we need some help getting him into the car."

"Okay," Alex said. "What are we going to the hospital for?" He approached the man as he asked. As he got closer, he could see the answer to his question. The man's breathing was labored, and he was struggling to get air into his lungs.

"Maybe we should take him in the ambulance," Alex said. He recognized the signs of respiratory distress and knew that the man would need positive airway pressure to help with his breathing. Zach heard Alex's suggestion and retrieved the stretcher.

The man was morbidly obese, and they weren't able to lift him onto the stretcher. Zach helped the man stand and turn to sit on the stretcher. Alex applied an oxygen mask and the cardiac monitor. As they loaded the stretcher into the ambulance, the alarm sounded on the cardiac monitor.

Alex noticed the rhythm had changed to ventricular fibrillation. The man was no longer breathing at all. Alex charged the defibrillator and shocked the man with no change. He started CPR, while Zach retrieved the AutoPulse. Alex charged the defibrillator again and shocked. This time, the rhythm changed to asystole. Zach applied the AutoPulse and began working on an intraosseous line. Alex performed an intubation quickly and verified that his tube was placed correctly.

Things were running smoothly, as far as codes go. Alex noticed a rhythm on the monitor and stopped the AutoPulse. He felt for a pulse at the carotid artery and felt the strong, bounding heartbeat. Zach went to drive them to the hospital. Alex called ahead to alert the ER staff that they were coming in.

He was excited that the man had a pulse after a cardiac arrest. Perhaps he had saved a life after all. He continued to ventilate the patient, watching the monitor and checking frequently to make sure he still had a pulse.

When they arrived at the hospital, Alex and Zach moved the man quickly to the ER bed. As soon as they did, he arrested again. The ER staff started CPR and worked for several minutes before the physician pronounced him dead.

Alex walked out of the ER, dejected and sad. He had been so thrilled at the prospect of saving a life that when the patient died, it was a huge disappointment. He told himself that he should have known better, that he wasn't going to be saving lives. He wasn't that good of a paramedic. In fact, he was a very bad paramedic. His patients died.

CHAPTER TEN

Back at the station, Alex didn't speak to anyone. He went into the bunk room and laid down in his bed. The self-loathing and depression were hitting him full force after the loss of his most recent patient. And the punches weren't about to stop.

He questioned his abilities, his skills, and his motivation. He got into this profession to help people, but lately, it didn't seem like he was much help. And just when he thought he had finally done some good for someone, they died, anyway. He felt worthless and stupid. If he had been a better paramedic, maybe his patient wouldn't have died. Maybe several of them wouldn't have died.

Alex's phone beeped. He glanced at the screen, hoping that it would be some morsel of good news. It was a text message from Greg to the entire ambulance service. He opened the message. It read: "I'm sorry to inform you all that Angela Mitchell suffered a heart attack this morning and passed away. Please remember her family during this difficult time. Funeral arrangements will be announced at a later date."

He sat there in shock. He knew Angela had looked bad when he dropped her off at the hospital, but he wasn't prepared for her to die. He hadn't expected this. Alex re-read the message, certain that he had misunderstood. Angela couldn't be dead; he had just seen her a couple of hours before.

She was in a hospital, for crying out loud. He felt anger rising. They killed her. She was alive when Alex had dropped her off. She was having a heart attack, but she was alive. It had to have been the Cath lab. They didn't do their jobs, and now, she was dead.

But they did do their jobs. It was his fault, he told himself. It was his fault she was dead. He should have responded faster, should have transported sooner. He shouldn't have wasted precious time asking about what happened the last time, he should have just whisked her away to the hospital. He should have activated the Cath lab sooner. He should have done a lot of things differently. She was dead, and it was his fault.

Angela was a good person, a good paramedic. She didn't deserve to die. It should have been Alex. Nobody would miss him. Angela left behind a husband, two grown children, a grandson, and all her friends, both at work and outside of it. Alex had nobody to miss him. If someone had to die, it should have been him.

He wondered if Angela had gone on to an afterlife. Would she be able to see him for the pathetic mess that he was? Would she even care? The questions of what happened at the moment of death swirled in his mind again. He pushed them aside, wanting to focus his mind on Angela. She deserved to be remembered, and she deserved his full attention. Alex laid across his bed and started to sob.

#

As much as he wanted to just mourn the loss of his co-worker, there were still calls coming in that had to be run. Alex heard both other trucks go out on calls and knew he was next up. Sure enough, the tones sounded followed by, "Medic Three, respond. Dry Creek Road at Sun Valley Lane. Motor vehicle collision."

Dry Creek Road was another thirty-mile-per-hour speed zone, so maybe it would be a non-injury accident. Alex was hoping that there were only minor to no injuries. But then again, it was a rural area and people rarely followed the speed limit there.

When they arrived on scene, Zach parked the ambulance and Alex got out. He saw a younger man lying in the dirt roadway. The vehicle was on its side to the left of the road. The driver, who wasn't hurt, told Alex that they had swerved to avoid an animal in the road and the vehicle rolled over, ejecting the passenger, his patient, through the sunroof. It was believed that the vehicle rolled over the patient, crushing him underneath before rolling off the roadway.

As Alex approached, the young man was awake and complaining loudly of his back hurting. Zach arrived with the stretcher and a long spinal board. They quickly applied the board and a cervical collar and moved the patient to the stretcher. Alex wanted to get out of the road, not just for safety but because there were bystanders watching. They made him nervous.

In the ambulance, the patient started complaining that he was having trouble breathing. Alex listened and heard no breath sounds on the right side of the chest. He used a large needle to puncture the chest wall, to allow trapped air to escape. Instead of air, however, blood poured from the site. Alex hooked up a suction hose to the needle, attempting to remove the accumulating blood and allow the lung to re-expand. Zach was starting an IV, and the patient was complaining that he still couldn't breathe. He began pulling at the cervical collar, trying to loosen it from his neck.

Alex knew that the cervical collar was not the problem, as it was the blood accumulating in the chest cavity, compressing the lung. The suction canister filled quickly, and the patient stopped talking completely. Alex checked him to find that he was unresponsive. He quickly intubated the patient and began positive pressure ventilation.

The patient went into cardiac arrest. Alex started CPR, and Zach went to drive. Blood was coming out of the endotracheal tube, and with each compression, it spurted out of the connection between the tube and the ventilation bag. When Alex squeezed the bag to ventilate the patient, blood sprayed everywhere. He changed out the suction canister and tried to suction through the tube. He got very little blood out of the tube, but again, when he tried to ventilate, blood sprayed everywhere.

He continued CPR as Zach raced to the hospital. When they arrived, the physician in the ER pronounced death immediately, before they had even moved the patient off of their stretcher.

Alex knew the back of the ambulance was a mess, so he went to help Zach clean it. There was blood on the walls, the cabinets, the ceiling, and the floor. Blood covered every surface of the ambulance.

#

Alex didn't know how much more he could take. He was overwhelmed with emotion, and it was starting to spill out again. He was irritable whenever Zach tried to talk to him. He just wanted to get the ambulance cleaned and get his documentation done before the next call came in. He was still in shock about Angela, and he was upset about losing the kid in the collision.

He wasn't really a kid, he had been in his early twenties, but to Alex, that was still a kid. He was young, and only a couple of hours ago, he had his whole life ahead of him. Now, he was laying on a cold metal slab with a paper tag tied around his big toe. The thought crossed Alex's mind that the kid was in the same morgue as Angela. He didn't even know the kid's name. He would just be listed as "John Doe" on Alex's paperwork.

He scrubbed harder, trying to remove stubborn spots of blood from the ceiling of the ambulance. Zach was spraying the floor with the water hose. Greg walked by as they were cleaning and said, "That looks like a mess. What did you guys have?"

Alex kept scrubbing while Zach filled Greg in on the details of the call. Greg looked at Alex and asked, "Are you okay?"

Alex gave a wane smile and said, "Yes, I'm fine." He kept scrubbing. Greg nodded and went back to his office.

After the ambulance was cleaned, Alex sat down to work on his documentation. He relived the call as he wrote down everything that had happened. As he wrote, he heard Medic Two go on another call. He must have been cleaning the ambulance when Medic One went out because he didn't hear it.

He finished his report and sat there in the chair. His emotions were bubbling over, and he didn't know how to handle them. If ever there was a time to need help, this was it. He felt desperate and didn't know where to turn.

The tones sounded again, followed by "Medic Three, respond. 6105 Atkins Court. Shooting."

Alex fought back the tears. Not another dead body. He didn't think he could handle it. But he didn't have a choice. He responded and tried to push down the emotions that were trying to burst out of him.

When they arrived on scene, he found a distraught step-father standing in the driveway, directing them inside the house. The police and fire departments were already there. Alex heard from the step-father as he passed by that the boy was only ten years old. He'd come out as gay, and his mother had been taking him to counseling at their church. The preacher had been pushing some conversion therapy program. The boy and his mother had argued about it that night, and he went into the bathroom and shot himself.

Alex looked into the crowded bathroom. Firefighters and police officers were gathered around the boy, who was still breathing. They helped Alex drag the boy out of the bathroom and put him on the stretcher. Alex called for a helicopter to the trauma center. The gunshot wound was to the head, and Alex could see brain matter around the exit wound. The bullet had gone in one side of the forehead and exited the other.

The boy was unresponsive, and Alex intubated him immediately. He ventilated the boy, and they rushed him to the landing zone to meet the helicopter. Before it could arrive, he went into cardiac arrest. Alex started CPR, determined to not lose this one. They diverted to the hospital, and when they arrived at the ER, Alex continued CPR as the ER physician examined the boy, and then said to stop. Alex didn't, he continued compressions. The ER physician put his hand on Alex's shoulder and said gently, "He's gone."

CHAPTER ELEVEN

Greg sent Alex home. He decided that Alex had seen enough trauma in a single day to last the average person a lifetime. Alex packed up his things and left the ambulance service. He seriously questioned whether or not he would ever be back. He wondered how Zach was able to handle all of this trauma and not be sent home. He decided that it was because Zach had a support system while Alex did not.

Quitting seemed like the smart option. He would be able to stop the trauma and deal with what he had already experienced without adding more to it. The only thing stopping him was that he had bills to pay, the recent suspension hurt him financially, and he didn't know what else he could do to earn enough money to pay all of his bills.

No, he couldn't quit. He would have to tough it out and keep working. As he drove home, he thought about Angela, the kid from the collision, and the kid who committed suicide. He cried over the loss of life, the potential lives that these people would have had. He drove with tears in his eyes and streaming down his face. He was thankful that he had tinted windows and nobody on the road could see him crying.

When he got home, he poured himself a glass of bourbon. He didn't even taste it as he tossed it back, drinking the whole thing in a single gulp. He poured another, then another until the numbness started taking hold.

He stayed drunk for three days. He missed Angela's funeral because he was drunk. He didn't want to go, anyway. He didn't want to face her family or his co-workers because she might have survived if she had gotten Nick, or any other paramedic besides him.

He thought about how busy the funeral home must be, with all the bodies he was sending them. He failed as a paramedic, and as a result, people died.

The nightmares were worse than ever. In one of them, Angela asked him why he let her die. In another, he saw the young boy in the bathroom, putting a gun to his head and pulling the trigger. Alex saw the blood and brain matter spray the walls of the tiny, tiled room. He dreamed of the swollen and bloated body of the man who had coded on the curb in front of his house, and he was still seeing the babies in his dreams as well.

Alex thought about his own death and mortality. He wondered once again if there would be anyone who would truly miss him. He doubted it. He figured that most people would be surprised at first, but then, everyone would be okay with it. It definitely should have been him and not Angela. She had friends and family who needed her. Alex had nobody to miss him. The thought repeated in his head, that he didn't have anyone to love or miss him. It stayed with him, even as he prepared to go back to work.

#

When Alex arrived for work his next shift, he forced a smile onto his face. He hid his feelings and tried to project an image of confidence and professionalism. He smiled as he walked in, giving the off-going crews his best false appearance of enthusiasm to be at work. Zach was already there, and Alex found him checking off the truck. He climbed on board and helped, and they finished the task quickly.

As usual, it wasn't long before the first calls of the day went out. "Medic Three, respond. 802 Arthur Lane. Motor vehicle versus pedestrian." Alex's heart sank. Not another one. He didn't know how much more of this he could take.

They responded to the call, Alex's anxiety worsening with each passing mile. When they arrived on scene, an elderly man lay in the driveway, seriously injured. Alex called for a helicopter.

The man's wife was standing beside the car, distraught. She said that he had Alzheimer's and had wandered out of the house that morning. She went to look for him but didn't see him standing in the driveway and backed over him.

The patient was confused, but Alex wasn't sure what was from a potential head injury and what was from the Alzheimer's. They loaded him up quickly, and Alex checked his vital signs. They seemed stable, but his legs had been crushed by the car. They were turning purple. The helicopter landed nearby, and Zach rushed them over to the empty field to meet it.

The flight crew rapidly removed the patient from the ambulance and carried him to the waiting aircraft. Alex stood outside the ambulance and watched as the helicopter's engines whined louder and the spinning rotors kicked up dust and debris. He felt relief that the patient had survived his injuries and had not died in the ambulance.

Alex sat down in the passenger seat and began writing his report, while Zach cleaned the back of the ambulance. They finished around the same time and drove back to the station. When they got back, Alex had a message waiting from dispatch.

The flight crew had called back to say that the patient had gone into cardiac arrest and died in the air. Alex nodded absently, unable to process the information. He went into the TV room and sat down in a recliner. He wasn't able to relax, but he wasn't tense, either. He was numb, the familiar feeling give him at least some version of peace.

He sat there for over an hour, just staring at the wall. He tried to process the emotions for the loss of a patient, but he couldn't. He just stared. He felt no sorrow, no loss. He wasn't depressed or anxious. He was just there.

After about an hour and a half, he got up from the recliner and made his bed. By that time, feelings were starting to creep back in again, and they weren't pleasant.

#

"Medic Three, respond. 7912 Gorges Spring Road. Eighty-six-year-old female, sick." Alex shuddered as he heard the information. He wondered how this call was going to go wrong.

When they arrived on the scene, they found the old woman sitting in her recliner. She looked like she didn't feel well, and her son provided Alex with the information.

"We took her to the hospital yesterday, and they said she had an infection. They gave her some antibiotics and sent her home. This morning, she went to her doctor, and they lanced a boil and sent her home again. But she's getting worse, and I'm getting worried about her."

Alex promised that they would take great care of her, and he helped the woman stand and sit on the stretcher. Her skin felt hot to the touch, and Alex checked her temperature. It was 106 degrees Fahrenheit. Alex recognized that she was probably septic and initiated the sepsis protocol. But when he put her on the cardiac monitor, he noticed that she had a heart rate of 180 beats per minute. Zach had to stick her multiple times before he finally got the IV started, and Alex was packing her down with ice packs for the fever.

They didn't carry IV acetaminophen, so there was no medication to help break the fever. Alex turned on the air conditioning and started wetting towels with saline to pack around her head, armpits, and groin. Zach started fluids through the IV line and then put an oxygen mask on the patient.

They rushed her to the hospital, which was about thirty minutes away from her house. Zach made the drive in eighteen minutes. Alex called ahead to the hospital. About two minutes away, the patient became unresponsive. Alex immediately intubated her and began ventilations.

He heard the beeping sound and felt the ambulance moving backward as Zach backed in at the hospital. He opened the back doors of the ambulance and climbed outside, pulling the stretcher with him. They rushed inside, and Alex started giving his report to the nurse in the hallway. The nurse looked at the cardiac monitor and asked, "Does she have a pulse?"

Alex looked at the monitor. It showed asystole. He felt for a pulse, hoping that one of the lead wires had come off. There was no pulse.

"No!" He shouted.

"Trauma One," The nurse directed him. Alex and Zach wheeled the stretcher into the room and moved the woman to the bed. They started CPR immediately, and the nurse called a code. The ER staff took over CPR, and Alex walked out the door. He didn't look back, he just walked out to the ambulance and sat down in the passenger seat. He felt tightness in his chest, and he started hyperventilating. Zach walked up and asked, "Are you okay?"

Alex wiped the tears that had started to form in the corners of his eyes and said, "Yes, I'm fine. I'm okay." He gave a wane smile and got out of the ambulance to help clean it up.

CHAPTER TWELVE

They returned to the station. The remainder of the afternoon was uneventful. Alex was grateful for the break, because it meant no more critical patients for him to mess up. No dead bodies to have to transport. No family members to break bad news to.

Alex took a nap and woke in the late evening. He felt bored, but he didn't want to go on another call. The loneliness and emptiness consumed him, and he felt more alone than ever.

The tones sounded overhead. "Medic Three, respond. 1909 West Hembry. Fifty-two-year old male, seizure." Alex groaned. He hoped it was a fake seizure. Whether real or not, he still didn't want to deal with it. He was trying to process the overload of emotions that he felt, and a call for a seizure was just an interruption to that process.

He followed Zach to the bay, and they responded to the call. When they arrived on scene, they found the man lying on the couch. Alex recoiled as he touched the man. His skin was burning hot. He was not responsive. Alex dragged him onto the stretcher, and they rushed him to the ambulance. The cardiac monitor showed a normal rhythm, and Alex packed him in ice packs, just like the last patient, while Zach started an IV.

Alex saw the heart rate dropping from eighty, to sixty, to forty. He worked faster to start the IV fluids, to try and stop the cascade of events that was unfolding. He was not successful. He applied the pacer pads and turned on the pacemaker. Before he could get it set, however, the patient went into cardiac arrest. Zach started CPR because he was closer to the chest. Alex grabbed the AutoPulse and set it up. He intubated the patient and started pushing medications.

Blood spurted back up the endotracheal tube. Alex figured that a rib had probably been broken during CPR and punctured a lung. He suctioned the blood from the tube and continued ventilating. Blood continued to spurt in the tube.

He knew that the man wouldn't make it. He kept trying, because he couldn't give up, but in his heart, he knew that he had lost another patient. Sure enough, when they arrived at the hospital, the doctor pronounced death almost immediately.

Zach and Alex returned to the station. Alex was overcome with emotion and went to hide in the smoker's gazebo. He cried there, sitting on a wooden bench, releasing the pent-up frustration, fear, anger, and sadness inside him. When he felt like he couldn't cry anymore, he wiped his face and slipped back inside the building. He felt exhausted and went into the bunk room. Fortunately, the lights were off because Nick was awake, scrolling through his phone; so was Zach, reading his book by the light of a small reading lamp. Alex took off his boots and lay down across his bed, pulling the covers up over him. He fell asleep, giving free reign to the nightmares once more.

#

It was three o'clock in the morning. Alex got up quietly and folded his bed linens, packing them into his work bag. He gathered up all of his personal belongings and packed them into the bag as well. He crept out of the bunk room, taking care not to wake Nick or Zach. He went out to his car and put his bag in the back seat.

He walked back into the bay and took a body bag from the exterior compartment of his ambulance. He slowly and carefully unbuckled the straps on the stretcher and spread the body bag across it. He sat the cardiac monitor on the bench seat and attached the lead wires to his chest.

He wrote out all of his personal information on a blank chart form, leaving the "time of death" field blank. Then, he swallowed several nitroglycerin tablets. He zipped up the body bag, leaving his face exposed. He buckled the straps and tucked his arms back into the bag.

Zach would be awake in a couple of hours and would find him in the back of the ambulance. He would be dead by then, already packaged in a body bag so nobody would have to move his corpse, except when they got to the morgue. He had already filled out his own paperwork, so there would be no extra burden there, either. His demons had won, and Alex was admitting defeat.

Alex lay there, waiting for the nitroglycerin to kick in. He started to feel sweaty, dizzy, and weak. He figured he would lose consciousness soon. He developed a severe headache, one of the side effects of the nitroglycerin. He could feel himself going into shock as it got harder to breathe. Finally, everything went black as Alex began to lose consciousness, and the cardiac monitor showed a straight, flat line.

THE END

Afterword

Among first responders, studies have shown a 28% rate of feeling as though life was not worth living. An estimated 69% of EMS providers reported not having enough time to rest after traumatic incidents. And 37% of of first responders had contemplated suicide nearly ten times more than the typical American adult.¹

My goal with this book was to shed some light on these stories, and help people to realize that what EMS professionals go through on a daily basis. Many rescue personnel are reluctant to seek help for mental health conditions for various reasons, including the stigma that is associated with mental health problems and fear of disciplinary action. This book did not have a happy ending, as not all situations in life do. I could have chosen a better ending for Alex, the main character. But I felt that by doing so, I would not be accurately portraying the loss and damage done by these horrific conditions.

The beta readers hired to review this book struggled with it. It was a very difficult, very emotional task for them to complete, as I’m sure it was difficult for you, the reader. My goal was not to extinguish your hope, or make you feel that life is pointless, but to open your eyes to others who do feel that way. Coming away from this book, I hope that you can better understand the causes of the trauma that we, as first responders, see and experience and the effect that trauma has on us. I hope that you can understand why we cringe when someone asks us to recount a story of “the worst thing we’ve ever seen?” And I hope that you can understand that if you have a friend or loved one working as a first responder, why that person needs your unconditional love and support, and needs to know that you are there for them.

If you are a first responder, know first and foremost that you are not alone. If you are struggling with depression or thoughts of suicide, please call or text the 9-8-8 Suicide and Crisis Lifeline. There are also a number of resources online, from organizations like the Code Green Campaign and the Firefighter Behavioral Health Alliance.

When it comes to therapy, one thing to keep in mind is that not every patient and every therapist are a good match. Sometimes you might have to keep looking to find a therapist who is a good fit for you. The same goes for medication regimens. It may take some time to find the right one for you. Please don’t give up, and keep trying until you find the right one.

Finally, I want to thank you for taking the time to read this book. I know that it was an emotional toll, but it’s a story that happens too often and needs to be brought to light. I promise that the next book will be a nice, fun mystery/thriller. Thank you for all that you do.

-Stephen