The man's ribs cracked methodically, rhythmically, and with a slowly waning sense of purpose and urgency. The worst part was that I could feel his son's eyes on the back of my head.

(Sorry… I'll back up.)

At 21, I was barely a year out of paramedic school, freshly (read: naively) empowered with a bachelor's degree in Emergency Medicine, and working in a depressed part of Pittsburgh, Pennsylvania. Our station was within a town/borough/poorly-defined shitty space in which many of the real-estate benefits include crack houses, prostitutes, gangs, and extremely low education rates.

I arrived at college with a fairly whitewashed view of the world, despite having been an EMT since I was sixteen. Yes, we ran calls, but it was always to the local fitness club for a sprained ankle after too many rounds of squash. Much of that changed in my third year, as I was assigned to mentor with a City of Pittsburgh ambulance in a notoriously bad part of town. I mean, I knew this stuff happened, but I had never treated gun shot wounds, stabbings, heroin overdoses, or bags of bricks hurled at people's heads from two stories above (yes, that actually happened).

The learning curve was nice and steep, thankfully leaving me educated without making me disgruntled and/or "burned out," as they say. Fast forward to a year later, when I'm all certified, registered, etc. to be an honest-to-God lifesaver.

—————

It was two-fifteen in the morning, and we're awakened by the piercing sound of our company's tones coming over an impossibly loud speaker in the bunk room. Shuffling shoes into boots, radios into holsters, and ourselves into the ambulance, we barely caught the dispatch information: "approximately 40-year-old male, son called 911, reports he's not breathing."

Shit. We drove faster.

Our lights reflected off buildings and cars to light our haggard faces as we swerved through the traffic that wasn't there.

The police had already showed up, one of whom breathlessly came pounding through the door and stammered something incoherent. His eyes and the sweat soaking through his uniform told us everything we needed.

"Easy… just grab that bag and follow us up."

Our particular interest in the apartment was lying facedown on the second floor, in nothing but his boxers. A bottle of pills was near his right hand, their contents spilled outwards in a spray of futile effort. We rolled him over and went to work.

I passed the tube into his trachea easily. My partner has the monitor wires stuck to the patient's chest, and the monitor glows with the most simple and recognizable of heart rhythms: none at all.

I turn my head to ask the police officer how long the patient's been lying here, and I catch site of the little boy hiding behind the burly man in blue. My head wants to scream at the cop, bellow and point him out the door, chastising him for not taking the kid outside sooner; he shouldn't have to see this! It kills me that I don't really have time to do any of that… and that now I know the child is present in the room watching everything.

An interesting fact I've found about kids in emergencies: they are undoubtedly the calmest people in a room when something awful is happening to someone else. This particular child heard a thump outside his room that woke him up. Ever curious, he padded out to the hallway and saw Dad facedown. Shaking his shoulder didn't work, so the resourceful little guy went to the phone and stated very clearly that his dad was lying on the ground. When the dispatcher asked if dad was breathing, the child managed to squeak out an "I don't think so. He won't wake up, either."

Quick sidenote: he's eight! My God… I've met fully grown, successful, (supposedly) intelligent adults who can't pull themselves together nearly as much much when their wife/husband/daughter/baby-daddy gets into a fender-bender at seven miles an hour in an Escalade.

Anyways, we continued to work. We inserted an IV, and gave several rounds of various medications designed to flog the heart chemically in the hopes it will start again. It didn't work.

It usually doesn't.

It took a few more minutes to get the stuff up to us that we needed to carry him downstairs. The medication was in, we had a breathing tube attached to a bag that my partner was squeezing, and the only thing left to do was continue CPR—which brings me back to the first line of this story. I switched roles with my partner, buying us a few more minutes of good CPR before we were both winded.

The man's ribs cracked methodically, rhythmically, and with a slowly waning sense of purpose and urgency. I was dreading the next part. The part that I knew was coming.

The question would be directed first at the police officer; he, in turn, would glance desperately over to the EMS crew for an answer. My partner would probably look up first, but instantly recognize what the question was. And I'm the one who always has to answer it. It's one of the shit jobs you get as a paramedic.

"Is my Dad going to be okay? What's wrong with him?"

And in a single instant, I have to come up with an answer.

And in a single instant, I whip out the same ingrained bullshit answer I give everyone.

"We're going to do everything we can to help him." It always feels like so much awful, trite, reusable garbage spilling out of my mouth—but it's the only thing we can say. We don't promise, we don't give false hope, and we certainly don't make guarantees.

Ugh, I hate myself sometimes.

The man's son looked back at me and said the simplest, most child-like thing anybody ever could:

"Okay. Thanks for helping my dad." The police officer (finally!) moved the kid past us and down the stairs to take him to the hospital and try and get ahold of his mother.

In that moment before I picked up the stretcher, before I began to move his father's motionless, breathless, heartbeat-less body, I felt a gratitude that hadn't washed over me in a while. We don't often get thank-yous in this job, and most of them are flippant and full of spite at our perceived incompetence, or inability to fix every problem in the world. But coming from a child, especially one as wide-eyed and calm as he was, this one was one of the few heartfelt thanks I can clearly remember.

We found out later after we delivered the patient to the hospital, after the doctor took a cursory look at the patient and called his time of death as 2:57 a.m., that the dad was a heroin addict. We saw old scars on his arms as we worked him, and even gave him a medication designed to reverse the debilitating effects of narcotics—but he had an existing cardiac condition and his heart just gave out that night. He must have snorted it, smoked it, or injected it somewhere we couldn't easily see, like in between his toes.

I still wonder about that call, almost a year later. I wonder if the boy really knew what was happening to his father that night. I wonder if he'll still remember it when he grows up, or if he ever really knew the truth about his dad's self-destructive ways. Mom was supposed to pick him up the day before (as they shared joint custody of the boy), but she never showed up. I often imagined how the son was probably happy to get one more day with his father before he went back to mom that week.

As a paramedic, I do much of my work with my hands. Lifting, intubating, medicating, comforting, even (sometimes) defending myself. Most of the physical skills we need require coordination and an experienced sense of touch. But what if touch isn't just a physical thing? We say sometimes that we're "touched" by a story, and I hope a few of you might feel the same way about this—but what does it actually mean? Some of the people I work with are so jaded, calloused, and indifferent towards calls that they don't seem touched by anything. Co-workers had warned me when I was younger about getting too personal, too involved with calls; but isn't that what makes us human, after all?

I fear the day that I lose that particular sense of touch.