The first call, on the first day, in the first hours of a cool summer morning began in death and ended in death.
The first man walked away from the hospital, barefoot but for the hospital socks with their non-slip chevrons across a city that never sleeps. His friend didn’t know where he’d come from, but it was clearly a hospital. The night before, he’d made a quiet knock-and-entry at his friend’s apartment. He was given a blanket to sleep on the floor. Wrapped in fleece and catecholamine release.
We call it an AMA: Against Medical Advice. It’s almost always against medical advice to leave a hospital when your heart history is written in ischemic tissue. We got his name off the wristband, peeled back his rigored hand, and cut off the plastic printed with his demographics.
I watched in silence as my partner consoled the man’s acquaintance. I still don’t have my first cup of coffee. Death already in the air. I’ll never know how he died, but I keep wondering why it’s always us who respond.
Earlier that morning, we’d entered the garage, our supply room, our staging area. Air thick with gasoline. Unit 19. I was born on the 19th. My mother broke her finger on the 19th. My little brother almost died on the 19th and recovered in the trauma ICU, room 19. Today, I’m assigned Unit 19.
I don’t usually place importance on symbols, but I’m human, and these connections make life more vivid. We check the rig: the airway bag, the BVM, the oxygen tanks, the meds. I pull my narcs and place them in a Plano fly-fishing tackle box that sits permanently in my right ankle pocket. One sticker marks it, a design from Hailey’s company. YEE Hotdog: a sentient hot dog with a lasso against a desert sunset of reds and purples. It’s my last reminder before I push narcs, screaming that I too am ready.
We check the CAD, computer-aided dispatch, but the Wi-Fi won’t connect. An Ethernet cable juts from the tablet like an IV line, its clip broken like most things on the meat wagons. If I press it up and tape it just right, it connects for half a second. That’s still a victory.
We switch to Rig 47. The first call, the first day, the first hours of a warm summer morning.
The second call of the first day takes us to the edge of the county. A breather not breathing well, but breathing all the same. We light up the sirens and take the highway. My preceptor in the back asks to turn them off, the Doppler scream rattles the cabin and out to the void. I keep playing. The siren dial has three tones. On the hands-free mode, I tap out “Jingle Bells” as we speed toward someone else’s emergency. She rolls her eyes. I’m sure she enjoys it anyway.
A large fire engine waits in the lot, and as always, a bystander waves us over as if we might not see the flashing lights.
On this second call, of the first day, in the first hours of summer, I’m met with my second dead body, but this one still has a chance. We step out, never run, and walk our gear to the fire crew performing CPR.
I take command. We start our work.
Quick spoiler: he dies too. Most of them do.
Does it matter? We get ROSC. Lose it. Get it again. I can still see his eyes, bloodshot deeper each time we drag him back. He bites the tube, still neurologically intact, to some degree. We load him, drive just fast enough. We start to pace him. Little sparks telling his heart not to quit. We say his name. He dies. He comes back. Dies again. Returns.
The pacing works. He has a pulse. The end-tidal is high. We start a pressor. We have him back. We roll through the ER doors. Before we break that threshold into his tomb, we lose him again. I do compressions while handing off report. You already know how this ends.
The first day. The second call. The warm summer morning beginning again.
The last call is in Room 119. He’s been dead for weeks. We know it not by sight, but by smell. Thick, sweet, unmistakable. You’d be surprised how common it is for neighbors to ignore that smell, living their normal lives while someone decomposes a wall away.
We know the smell. We know the fear when breaching a locked door. The fire department forces it open. We double our masks, smear Vicks between layers, hoping to blunt the stench. It never does.
Inside, he’s supine, surrounded by empty bottles like grave offerings, pizza boxes stacked in this pyramid . His skin is yellowed, blackened, mottled. His eyes are white, and from them black tar streaks like tears.
There’s more I could say, more thoughts, more small rituals, more ways of moving on. But these are my death maps. And my death maps are my own.
Death Maps 