text: People like me are more likely to die from suicide than in the line of duty. With Stella moving out things have gotten insufferable. The more friends and colleagues who “Exit Stage Left,” the more it seems like an option. It seems odd that those of us who answer the call to save lives at all costs, somehow can’t find a reason big enough to save our own. The emergency tones had beeped loudly from a dozen places in my apartment, startling me out of a whiskey-induced coma. Just after ten in the morning, on my day off, no less. “THIS IS A NATIONAL EMERGENCY. IF YOU ARE HEARING THIS...” Then the message broke off. Our cell phones went silent. The TV died. It all happened without any warning. Much like Stella deciding to leave without saying a word of goodbye. When Stella left, I could have started exercising, got fit, started going back to church gatherings, engrossed myself in my Ambo duties and angled for a promotion, or tried coping in any one of the dozens of other ways they urged at HERO--my First Responders Support Group. The ways I had after my past breakups. Not this time. I hunkered down with my Johnnie Walker Red, ate greasy takeout, stopped showering, and degenerated like a putrid limb cut off from circulation by a tourniquet after a gunshot wound. The real death knell for all of us is being disconnected. In times of crisis, isolation is death. Was it an EMP? A solar storm? A result of the megaquake on the West Coast? Collateral damage from the Gulf of Mexico being poured over Galveston like a mother pouring a bowl full of soapy bathwater over a child’s head? Causing the child to furiously wipe his eyes off with his knuckles as if soap water in the eye could kill you. I couldn’t tell you what it was. There was a blinding light. I wasn’t looking at it, but I could feel it on my face through the window, as it woke me. It felt like being by a campfire with the heat on your skin on just the side closest to the flame. Curls of dark smoke from various places dispersed and muddied the sky over Galveston. That bright Texas sun took a knee. And the world seemed just a little colder and darker. Maybe it was the shock of it all. Whatever it was, the lines are all dead. The towers too. No electric. No cell phones. No landlines. No radio transmission. The grid is down. I turn the tuner on my radio and get the consistent tone of static on every channel, even the satellite stations. The hurt and helpless are crying out all around Galveston. But I can’t find them. My Ford F-350 Super Duty Ambulance hurtles down I-45 scouting for areas where people may be in distress, pulling off of one exit after another onto flooded local roads, littered with stranded sedans and crossovers without sufficient ground clearance. The thought of wishing for a catastrophe that takes me out of the game persists. I can’t shake it from my mind. A part of me wants a way out. That part is loud. Ever present. Goading me. Reminding me of the numbness that has become my world. Reminding me of the wall I’ve put it up which makes it impossible to take one more injury. Leaves me with floosies and drifters like Stella, until they pass along, like shadows. Those shadows are evidence of a personal connection. But the evidence disappears instantly when the darkness descends and the shadow diffuses and merges with all the other lost things that cannot be seen, but which you can bump into in the dark times. At least I don’t have to grieve the relationship. The relationship was never for real to start with. Like showing up for AA meetings when you have no intention of getting clean. The disease laughs at the subterfuge. It isn’t going anywhere. The dulling of the pain outlasts the pain and replaces it. A companion that sucks all the air out of the room. It is there in the way we talk about our patients, referring to them by their ailments. “Broke my heart telling the family of that ‘A&E’ that he was DOA... that ‘bag and collar’ was going for an Emmy... my last call was a 'frequent flyer' Deb, I wish I could’ve just thrown that one back.” Our ability to feel human emotions is drowned out by the constant motion. At the end of the day, you show up. It doesn’t matter how you feel. If you feel anything. It’s their emergency. I’ve got to act now. Stay in it. Before the time is up to do some good. The freeway lights are all out and it is going to be hard to see anything on the island after dark. The window is closing. This is my chance to save a few souls. I pull down the visor and look at the notches I’ve made with my straight edge over the last two years since I’ve been doing this job. Seventy-eight. Twenty-five tallies of five. Three lonely straight-line stragglers. These are the souls saved that I’ve got to my credit so far. But what about all the ones I didn’t get to? The ones I failed to save? How do you account for those? A frequent anecdote at HERO is the Drunk Superman Syndrome. Jesus in Gethsemane weeping blood is another one. Who is there to save the savior? Where does the comforter find comfort? It is kind of like that bar scene in Superman II, where the beleaguered drunk superhero, swilling Johnnie Walker Red for good measure, descends into petty bullying and self-loathing, breaking liquor bottles, before touching down in a scrap yard a few miles away and having a full-on meltdown. Or the tantrum in Man of Steel where Supes skewers the 18-wheeler the rude grab-ass trucker from the bar owns. I mean, I get it, I do, the dude--literally--has the weight of the world on his shoulders. We have that in common. The only difference is that I wouldn’t be caught dead in those tights. Margot, the support group leader, calls it the “Martyr Complex.” Whenever someone starts going on about their first responder burden like it is a form of slavery rather than a privilege, she plays the martyr violin over her shoulder. Margot is a real pisser. In the natural world, there’s no one coming to save you. They are probably coming to eat you. The first line of defense for humans is that we can call for help. We’ve got that going for us. That there are helpers on the other end of the line. That somehow two-legged meat popsicles see each other as more than a meal. But what happens when the line goes dead? I guess there’s nothing to do but go on patrol. * * * Carl Belafore is doggone lucky. I am just passing the boat rental on the 342 huffing down a Marlboro Red cigarette before the fun starts and I see a crowd out in the Hooters parking lot. I flick the stogie and go to work. I swallow hard and brace myself. This is going to be a bad shift. Without my day partner, Debbie, riding with me, I’m all alone out here, doing a two-man job. Even if Deb is a real shit magnet--she’s my shit magnet. Drunks, vomiters, and urine patients. Bar fights. And 300-pound men that you have to carry down 7 flights of stairs. Those are Deb’s specialties. I pull up and jump out, carrying my Defibtech Lifeline Auto AED, battery-operated, out to the patient. Carl’s wife Angel is there screaming. Saying Carl just had heart surgery on Tuesday, three days earlier, and he went down in the parking lot after a healthy helping of onion rings and a few pitchers of Bud. Don’t get me started on Carl’s bad life choices. But who am I to preach that the body is a temple? Angel’s jawboning is jarring and shrill. She is just talking out her nerves like a kid filibustering a parent the kid thinks is mad at him. I tune it out like I have on imaginary earmuffs and focus all my attention on Carl. I check his breathing, skin tone, blood pressure, eye alertness, and skin. His skin is cold. Carl is down on the hot Texas pavement gasping for air and looking up at the clear blue skies, through a haze of ashen fog, as his whole body ironically starves. The layers of fat clogging his arteries prevent all those nutrients and all that oxygen from getting where it needs to go. Alright, Carl. You aren’t checking out tonight. Not on my shift. My two-way to the emergency room is the only means of communication. But I thank God it is still operational. “UTMB Emergency. This is Ben in ALS Ambulance 33. On the scene with a Code Blue. Please have a bed ready. Forty-eight-year-old male, conscious, disoriented. Skin pale and cold. Recent heart surgery. Administering CPR. Will defibrillate if he codes. I will bag and bed and head to you. I’m on my own. I’ve got no one in the cab.” “Oh my God,” Angel screams. She acts like this is her first rodeo with an ALS event and like she’s not an enabler. I want to strangle her for running up his blood pressure with beer, salt, and grease, when he’s not even a week out from discharge. I’d ask her if he took his prescribed meds, but I already know he hasn’t. As I perform some light chest compressions, I look up at Angel and say, “I can feel a pulse. There it is. Very weak. We are going to get him up on the bed and take a closer look at his vitals before we scoot.” Some blood starts making a triangle on Carl’s camo Bass Pro Shops T-shirt. The damn steri-strips are getting ripped open from the wound. I’m not going to be able to do compressions without hurting him. I place him on the stretcher, elevate it, and wheel him into the cab, breaking down the stretcher as I lift it inside the metal tomb. Angel comes in with me, crying distractedly as I continue to care for Carl. I want to throw something at her, but I just meet her gaze and say, “Maam. It’s okay. Carl’s going to be alright. We’ve got him now.” Once I have Carl in the cabin, I cut his shirt off and start placing the 12-lead ECG. First, I get the precordial leads in place, measuring the intercostal spaces to get the right orientation, and then attaching the other leads to his limbs. And we wait about thirty seconds for the monitor to pick up the signal, during which time I bag and intubate Carl, getting him some oxygen. The blips start running down the monitor and we are getting tombstones. A ton of them. Those patterns show the heart stalling like the motor of a car that won’t turn over properly. A sure sign of a heart attack. Angel is hyperventilating. She is heaving out small wet sobs. Her cinnamon-colored hair is matted on her forehead and her mascara is running off her long press-on lashes down the sides of her eyes. To be honest, her reaction is evidence that Carl has something worth living for. This devotion is touching. Lower-case t. “Is he going to make it,” she says. “Sir, please, please take care of my Carl. He’s all I have.” “I’ve got to drive,” I say. “Stay put and let me know if he flatlines.” * * * Margot is in the Emergency Bay, chain-smoking Marlboro Reds like it’s her job. As the rigs pull in and out, she barks orders and runs triage. She is in mass-casualty mode. “Get out of my emergency room,” she yells at a newbie EMS lingering in the triage area with a CTD (circling the drain) patient while the poor bastard goes downhill. The internists gather like fleas--the last to jump off a dying dog. “What’s the story with this hit?” Margot asks as I jump off the rig. And I give her the rundown. “So, what is the deal with this blackout?” I ask her. “Couldn’t tell you. Doesn’t matter. We’ve got a Hazard Response Team down at Pleasure Pier, pulling dead bodies out from under the rides. The Tilt-a-Whirl and the Ferris Wheel are in the chop. Roller coasters too. The seawall didn’t cut it. We are about to get slammed.” “Jesus. I guess it’s going to be a long night.” “You aren’t kidding. Hey. How are you holding up since Stella left?” “Par for the course,” I say, with a shrug, like it’s no big deal. “You better get back out there," Margot says. "Head down by Pleasure Pier.” “Roger that,” I say, and jump back in the rig. “Radio me about Carl, let me know if he is out of the woods, so I can mark it down.” I look at my straight edge sitting in the dash organizer. What the hell. I believe in you, Carl. I cut a hash mark into the visor. We’re going to count it. I have faith. * * * The rig pulls out. I take Seawell Boulevard toward the pier. As I drive down by the churning sea, looking over at the yellowed dust sailing across the horizon, I can’t help thinking that it is just another day at the office. Margot always says at the support group that every day counts. Every patient counts. And most importantly, you count. The Hazard Response Team are all wearing yellow jackets. They buzz back and forth like foraging bees. There are body bags lined up on the pier. Everything is black and yellow. Rigs are pulling out with patients on stretchers. There must be three dozen dead lined up so far. They will rot in the Texas heat until all of the injured are taken. Then the dead will be hauled back to the Medical Examiner for processing. Under normal circumstances, the family would be alerted in a couple of days. But now? Who knows. I watch the emergency workers carrying more bodies out from under the rubble. A black man with a proper beard is standing at the boardwalk staging the patients. Two men on the team are coming up the staircase onto the pier with a blonde-haired woman, late twenties, totally unconscious, a gash in her torso, and her jeans stained with red blood. It is Stella. I’d recognize her anywhere. I know right away that she is dead. I walk over to the guy and ask, “You have anyone that needs transport.” “Not yet, pal. All DOA so far.” “Gotcha. Let me know.” I pull out a Marlboro Red and stand on the pier looking out over the rubble while I smoke. I feel nothing. Even the heaviness of the smoke in my chest. My heart beating faster. It is academic. Action, reaction. What was Stella doing down here? I wonder what she was doing when she lost her life. What were her last thoughts? Was she happy? It is so unfair. Every day is a trauma exercise. The only unknown is the degree. Every day it is the same thing. Will today’s victim be experiencing the merely life-threatening, the real-life horror episode, or the apocalyptic nightmare? We never know when we clock in. Routine calls. The severity ranges from life-altering to society-ending. But they all matter. It could be a lone gunman. A theater shooting. Another Sandy Hook or Columbine. A fire with people’s skin peeling off like overcooked hotdogs that bulge, fry, and crinkle, with that screaming steam of nitrates flowing out from the spoiling flesh. Or it could be toppling buildings. A chemical plant explosion. Mad cow hysteria. Garden-variety flooding due to climate change. A gang of marauding cartel enforcers recklessly searching for a lost score. Today it is this. Pleasure Pier caving in. It is as if there is a divine agent with a thirst for vengeance and an infinite imagination for hatred and bloodshed--constantly inventing new implements for human torture. And today, Stella punched her ticket. But I got a free pass. I sit back in the rig and wait, pulling out the hip flask from the glove compartment. I have a long nip of whiskey. My chest burns and my eyes itch. Something tells me there are no survivors. There never are in things like this. Through the yellow haze along the horizon, I see the sun setting. Ribbons of pink blaze out from the sun’s vicious gaze. And a splinter of feeling pierces my heart. I know for a fact that this job is going to kill me. Suddenly, I feel an overwhelming instinct to get away. To get away from danger. To get away from the poison that is polluting my soul. You can’t save anyone else if you don’t keep yourself safe. There’s no one to call. The lines are all dead. It is up to me. Maybe Margot will visit once I get situated. Maybe I’ll start my own group out in Colorado, in the mountains, in the cool mornings, with that dark roast. I pull down the visor and reach for my knife. I draw the diagonal and complete the tally. Ben is marked safe. Eighty lives. That’s enough. Enough is enough. I rev the engine, pull out on I-45, and head west. Tears roll down both cheeks. And I begin to grieve. Margot’s voice comes over the two-way. “Benji. Good news. Carl Belafore is gonna make it.” Doggone lucky, that guy. Maybe we all are.