Survival of the Fittest

I listened to Survival of the Fittest while reading A Thousand Naked Strangers.

Earlier that afternoon, I left home and watched the clouds descend over the hillside, wisps of cotton at first, then something more alive, like an ancient beast clawing its way downward to claim the trees and sagebrush.

I leave for Italy in a week. A small break from the chaos. I wondered how it might change me. Lately, I’ve been consumed by work, the endless motion, the calls, the quiet moments between. People die around the city as I look on from my rig, radio humming in the background. I wait for word from the job I interviewed for, more medicine, more miles, more pines. Back to where I was born.

Is there a story here? Maybe it starts with this: paramedics are human first.

To understand what it’s like to be one, I share how I try to stay that way.

Not every day is life or death. So far, we’re four hours in. A little old lady in A-fib RVR, nothing to call home about, heart running 140 but pressure’s solid, mind sharp. She jokes about her Chicago days, we reminisce about the arboretum. I start an IV and hang a bag of what some like to call “isotonic crystalloid.” I hate that term. Just call it saline. Or NS. We’re blue collar, man.

Outside, the clouds finally give in and spit on the high desert. Rain. Rare here. The air cools. The day moves on…

She screamed at me over the top of her husband’s body. Fresh. Freshly dead, freshly placed on hospice. No DNR.
“Don’t look at me like that!” she yelled.

Well, what look was I supposed to have? You just handed me a terrible situation. I don’t want to do CPR. You don’t want me to do CPR. Even the ghost of your husband doesn’t want me to do CPR.

I can’t remember exactly what I thought, just that her tone hit me like a slap. All her frustration, her anger, her grief, they landed on me. For a moment, I was everything wrong in her world.

Fuck you.

I was trying to preserve this man’s dignity. Maybe I hesitated, maybe I stared half a second too long, trying to weigh my responsibility and the next step. And this was the reaction. Her pain erupting into mine. Have your grief. Have your trauma. Have your life. But why did you have to throw it all at me? I just showed up because you called…

You ever been so focused you want to cry? So in tune with yourself that you finally start to think? EMS makes that kind of reflection hard. If I focus inward too long, I start to feel the weight of it all. If I don’t, if I just drift through shifts without that internal mirror, life feels manageable, at least for a while.

But how do you choose the long term when the present is pain?

I have pain I ignore, deny, and fear.

He asked me once, “How do you do it? How do you keep showing up?”

This was after his first arrest. He’d gotten the IO, done compressions, achieved ROSC. We used the CareVent and prepped a presser to keep the demons at bay.

Pressors constrict the veins, think of a garden hose as a kid. It dribbles at first, but press your thumb over the spout and it becomes a weapon, something powerful, something desperate…

I crave the sirens.

This could be my last week on the ambulance for a while. The past year and my change as a medic, a human, is closing out. So is my time on the West Coast.

Love, dates, Cass, walks to Idlewild. The dog, Boonie Guy, or as I call him, Mister Brown. Happiness, connection, self-discovery.

And fear. Especially the fear of confrontation.

The radio crackles.
Call comes in.
Lost the thought.
Lift assist…

Code 50. Sixteenth floor of the casino.

She died in bed. The room was tidy, just a med or two on the nightstand. From the window, we could see the pool below, the shimmer of summer. Swimmers laughing, floating, alive. David and I watched for a moment before remembering why we were there.

It was a welfare check. Big room. I learned that these suites are usually reserved for the high rollers, people who win just enough to forget what losing feels like.

Then, maybe her daughter called. Or a friend. Hard to say now.

Anyway.

King-sized bed. Her body rotting quietly under the covers. We’d already called time of death. The scene was calm, almost peaceful.

Then her phone started ringing.

And it didn’t stop.

Endless ringing.

It sat there on the bedside table, buzzing with a steady pulse that felt wrong. I thought about answering it. Talked to security, my supervisor. We all agreed to wait for verification.

So we stood there, friends in a suite overlooking the pool, studying the marble bathroom, the clean sheets, the view. The phone kept ringing. Someone on the other end knowing, but not knowing.

We were cradled in death, and all they wanted was to hear her voice.

How do you capture the essence of EMS, of paramedicine? When it lives in moments no one sees? In the silence after a call. In the ringing phone beside the dead. In the laughter between runs, the rain on the windshield, the ache that follows you home.

The human parts we carry, and the ones we leave behind.