Hell calls hell.
I’m not a good man. As I near the 30 year mark in my life, I’ve come to this realization. Honestly, it’s not a particularly startling one. I am a dark, violent, and brutal personality in a dark, abysmal world. Many years ago I came to realize that I am comfortable with violence, with death, with hardship and loss. I am built this way, wired this way. Things that I see on a regular basis that should phase me and leave indelible marks do not. I know they should, but they don’t. I’ve always had a box that I have been able to shove those things in and push away, leaving them unopened and unexamined. I thought that I could do that and it would not affect me. The reality is that it has, however.
I am prone to episodes of inexplicable and disproportionately violent rages. Often times people will say that they can’t believe that about me. “You’re way too nice and well balanced. There’s no way!” “He’s the angriest person I have ever met in my life,” my partner is always quick to chime in. “Actually,” he usually continues, “it’s one of the things I love about him. When shit hits the fan, I know that if someone tries to take us down he’s bringing souls with him to hell.” Ever since I started the anti-depressants and have learned to at least temper that anger, keeping it simmering for longer before I finally lose the desire to control it, he often likes to tell people that “he misses the old [me].” “I miss the angry you,” he’ll tell me from time to time. “You know, I’m glad you’re getting better and all, but fuck man, watching you go Hulk is a sight to behold.” To be honest, it was one of the reasons I avoided the antidepressants for as long as I did. I liked my anger. I liked my rage. In some deluded, sick way I saw it as something integral to me. Something primal and pure. It appealed to the primitive parts of my brain that embrace the harsh realities of a world that, for as long as man has walked it, has been filled with violence. Lt. Col. Dave Grossman, in his book On Combat (a masterwork on the psychology of conflict and the companion to his other masterwork On Killing) calls it the “gift of aggression.” Rather than something to shun, it is something to embrace and harness, to use when needed. To be honest, I only got on the meds because I love my wife, and while I loved my anger, I loved her more. Given the choice of righteous anger or our marriage, I chose the marriage. I’ve come to realize the anger is still there, available in times of need. The meds just help me push it down and control it better than I did before, allowing me to focus it not on her, but on things where it is useful.
Still, I won’t lie. I know what my partner means. As wrong as it is, there were times I relished at the fear in the eyes of some cracked-out asshole who pushed me over the edge. When they realized that under this unimposing, average sized, blue eyed exterior lay the propensity for violence the likes of which they had never seen, there was a sudden flash of their eyes as the primitive parts of their brain realized they had crossed a predator who was more than happy to give them all the fight they could ask for. Not the flashy, for show street fighting they liked to roll with in our district, the kind where they would swing and slap without ever actually doing any damage, but instead the bloodthirsty rage of a fucking savage. I lived for that. I loved knowing that with a flick of a switch I could intimidate the fuck out of someone, and generally had the sheer, force of will and rage to back it up, not out of skill but out of sheer anger and survival instinct. This isn’t to sound like I’m bragging, or that I think I’m the baddest motherfucker to walk around. Far from it. I realize exactly where I sit in the food chain – a little higher than most, but nowhere near the top. It’s just an example of the mindset of rage and aggression I had adopted for so long that it was hard to let it go. Something is wrong with me, I’m sure.
I think I’m broken.
I worked a major wreck the other morning. The call came in at just before 0600. By some miracle, despite being horribly understaffed, we had managed to sleep most of the night uninterrupted, a luxury I’ve long since become accustomed to going without.
“Reported two vehicle MVA on the freeway, with entrapment. Both vehicles fully involved. Multiple calls.”
Shit. That means it’s fucking legit.
I quickly pulled up the police department call notes on the mobile dispatch computer (or MCT). A quick read reveals that PD had been in pursuit of a vehicle that had ultimately struck another head-on at highway speed. Officers on scene report both vehicles on fire.
Now, the average person would most likely begin to feel a sense of dread, or at least apprehension. Sadly, that’s not what was going through mine. No, what I was thinking was how I hoped they were single occupant vehicles and that the occupants were deceased. Deceased meant less paperwork. Less hassle.
I know objectively that this is a horribly inappropriate attitude. Yet I believe you would find it a common one in the emergency fields. A popular axiom, slightly modified for EMS says that Life is pleasant, but death is less paperwork.
We pulled up and found exactly what was described. Two vehicles. Massive damage. An entire engine block thrown completely from a vehicle down the road. One car is totally engulfed. That’s a DOS, I thought to myself. FD hadn’t even started to combat that blaze, so anyone in there was a lost cause. The other vehicle, while burning, was not near as bad.
Fire extinguished, door popped. The occupant, unrestrained. Apneic. Pulseless.
Massive blunt trauma. No way in hell. DOS.
As I reached for the radio to call it, the occupant takes one last agonal respiration. A guppy breath, as we often call it. FD immediately begins scrambling.
“Hey! We got a live one! We need to get them out and work it!”
Fuck. This is going to be a fucking nightmare. I reach for the radio and call the trauma alert. As I do this, FD rolls back the rest of the door. I stop, mid-sentence. Hidden behind the shambles of the door was the mangled mass of leg tissue of the driver. One leg completely amputated, the other trapped under a tangled knot of metal and plastic. No other way into the vehicle.
“Call it man, we can’t work ’em like that. Too late anyway,” my partner opines. He’s right, and I cancel the trauma alert. Our supervisor arrives, and concurs. No sense wasting resources on a lost cause.
And so begins the long, slow process of body recovery. While one engine company struggled to knock out the fuel fire of the other vehicle, another crew works to begin extricating the body of the driver we’d just pronounced.
This is a tedious and laborious process. Because life and limb are no longer threatened, and this is in effect a crime scene, FD takes their time, ensuring their own safety around the jagged steel. My partner wanders off to PD to see if they’ve had any luck finding the driver’s information for our report.
I wander over to the other vehicle, where the flames have begun to die down.
Fuck, that was hot.
Plastic burns at an incredibly high temperature, particularly when exposed to gasoline. Inside the crumpled ball of steel is the barely-distinguishable-as-human body of what appears to be an adult male, though most of the fatty tissue had melted away, making determination of sex difficult. I walk around the vehicle, sizing it up for more occupants or, God forbid, a car seat. The roof of the small car had caved in during the collision.
I rounded the far side of the vehicle. Right under the roof was something I couldn’t identify. It was bright white and glistening, and strangely shaped.
Holy fuck. That’s a brain. That is a fucking, cooked, brain.
When the roof caved in, it had partially decapitated the driver, exposing his cranial vault to the high temperatures of car fire and steam of fire suppression.
I took this in in the space of a couple heartbeats. And then I moved on. We finished the paperwork, and cleared the call. I took this tragedy of others and put it in the box and put it away. Then I went on about my day.
Days later, as I was talking to my wife, I had an epiphany of sorts.
I’ve long been accustomed to death, and gore, and the physical and mental wreckage that surround them. As a survival mechanism, I’ve learned to compartmentalize that for my own sanity.
My epiphany, though, was that when I stood there, staring at something that no human being should have to see, I was completely and utterly fine with it. It was then I realized how far down the rabbit hole I had gone. Years and years of pushing down traumatic experience had become so natural to me that I could do it without ever thinking about it.
What does that say about me?
In part, I bury those things because I also realize a simple truth. How do you tell someone that story? How do you go home and tell your wife over dinner that you saw your first cooked human brain and how fascinating it was?
And there in part, I think, lies part of my dilemma. I can’t share these things with her. She’s not wired for that. I realize that. She is far too sweet, too empathetic and too tender for such horrific detail. And to be honest, it’s somewhat ironic, because the empathy you would expect would make someone an ideal caregiver is often the thing that tears them apart, drives them out of the field or into a bottle, a divorce, or other dark and winding roads.
It’s hard to talk about these things with coworkers. All that comes of such things is an inevitable contest of one-upmanship and war stories.
So, I bottle it up, and I bury it deep.
But here’s the thing.
I fucking live for this shit.
Hell calls hell. Remember how I said I’m not a good person?
I don’t do this job because I want to help people. I don’t do this job out of a sense of public service.
I do this job because it is utterly and terribly fucked up. I do this job because I CAN do it, and others can’t. I take pride in that. I take this darkness, the trauma, and I wrap it around me like a conquering hero would have worn ceremonial robes. I live for my own misery and my own hardship and my own suffering. I do it because I CAN. I take a sick, twisted pride in that fact.
In Neil Gaiman’s great novel American Gods, Mad Sweeney, a leprechaun, is talking to the main character about the joy he finds in fighting. As he puts it, the “sheer, unholy fucking delight of it.”
I get that.
I know that in a lot of ways, that has ruined me. It’s ruined a lot of the best parts of my life. I love my wife, but I have hurt her in so many ways through the years, because I am fucked up, and I revel in that.
I’m working on changing that. I’m tired of pushing her away because of the darkness I have consumed. I can try and put a positive spin on it, pretend I’m a sin eater swallowing up the darkness of the world in order to serve and make the world a better place. But that would be a lie. “To thine own self, be true.” Cheesy, cliched. But true.
I love Latin. I love its simple complexities. I love the history, the connection to the past. To a darker time where I think that maybe, I would have understood and would have thrived in, in my own way.
There are so many great phrases in Latin that evoke this sense of connection to the darker side of human nature.
Mors ultima ratio – death is the final accounting.
Non mortem timemus, sed cogitationem mortis – We do not fear death, but the thought of death.
Tanta stultitia mortalium est – such is the foolishness of mortals.
There is one, however, that is my favorite. I feel a deep connection to it.
I’m not a good man. I’m a dark, violent, and brutal. I am comfortable with violence, with death. Death comes to us all. I understand that not everyone can embrace that so freely, yet it is something that I understand at a basic, primal level I can’t explain.
Timor mortis conturbat me.
The fear of death confounds me.
Contrary to what people think, death is never senseless. To some extent, it really is quite the opposite. Death comes for us all, and I’m fine with that.
How fucked am I?
I am, first and foremost, a firefighter. That is the career I have chosen.
But I am also an EMT with advanced training, working on finishing my EMT-Paramedic.
My department required me to have a Basic certification to be eligible for hire. But that is all.
No one forced me to advance my medical certifications. I have done that of my own accord and mostly at my own expense.
That being said, I could care less whether fire runs EMS or EMS is a third agency. That’s above my paygrade and beyond my scope. The people I work with in EMS are fine, dedicated people. I am proud to work alongside them, regardless of whose name is painted on the outside of the ambulance.
But what irritates me is when people say that Fire-EMS is just the Fire Department trying to justify their existence by trying to do someone else’s job.
That’s like saying that the 343 firefighters who sacrificed everything on 9-11 were only justified because FDNY also runs medicals.
I know it’s more complicated than that (I think FDNY took over EMS in 2005, but that’s not the point), but yet it is also that simple.
“I can think of no more stirring symbol of man’s humanity to man than a fire engine.”
Kurt Vonnegut was a firefighter. He is also a fire survivor rescued by firemen. At a tribute for our fallen brothers and sisters, he recited the names of all of the firefighters who were killed from the station he was saved by.
Firefighters are not heroes by default, and fire calls are down. I will give you that.
But go home. Look around. Look at the things and the people you love.
Now imagine that all burning to the ground.
I have worked in a burn center. I have seen what flame can do and I have felt its heat kiss my flesh.
George Orwell is attributed (perhaps incorrectly) with saying “People sleep peaceably in their beds at night only because rough men stand ready to do violence on their behalf.”
Maybe we can sleep peacefully because someone stands ready to rush into harms way, regardless of their career (Fire, EMS, law enforcement, military, etc) and who needs their help.
They hear the call, and they answer.
That, to me, is justification.
It was a saying he seemed to like, though he couldn’t resist modifying it.
“Write.” – “For whom?” – “Write for the dead, for those in the past whom you love.” – “Will they read me?” – “Yes, for they come back as posterity.”
I’m not a Kirkegaard expert, so there won’t be any brilliant literary analysis or some moment of existential clarity. If you want that, you’d have to talk my wife, Dr. KindofAFireWife. She’s the English expert. I just love the quote.
It makes me think of Bringing Out the Dead by Joe Connelly. In his book (and in the film adaptation), a burned out paramedic in New York reflects on his role as a provider. He has stopped seeing himself as anything beyond an intruder on the end of the people he is sent to help. Indeed, as he performs CPR on an elderly man surrounded by his family, the medic decides that his purpose is now solely to bear witness to the lives of those he responds to.
It’s a great book that shows the dark side of EMS through powerful satire. And let’s be honest: there is a dark side to this job. There has to be. We witness terrible things in dark places. We often share in the worst moments of the lives of those we help. Anyone who says otherwise is either ignorant or lying.
Maybe that’s the real reason I’m typing this. Maybe I want someone to know I was here. Maybe I want to let out the darkness so that it doesn’t follow me wherever I go. Maybe this is my 911 call.
Maybe I just want someone to bear witness to me.
Kirkegaard wasn’t satisfied with the saying the way it was.
“Write.” – “For whom?” – “Write for the dead, for those in the past whom you love.” – “Will they read me?” – “No!”
That’s a bit more damning.
Hell, maybe I’m a little damned, too.
It may be just a legend. No one is really sure.
Picture this: The streets are full today. Plebeians and senators, soldiers and scholars; all are there. The delineations between classes are not as apparent today as they usually are.
Over the roar of the crowd, you catch the slightest echo of something. You strain harder to hear it, and there it is again, only louder. Horns. The deep, throaty rumble of horns. The clap of iron sandals on stone. The harsh crack of drums. As the noise grows, the shouts and yells of the crowd slowly meld together into a colossal cheer.
Then you see him.
He rides in a chariot pulled by white horses. His armor is draped with the skins of leopards and the deep purple of royal robes. On his brow sits a laurel crown, the gold leaf glinting in the sun. Behold, the victorious general, returned to Rome and honored for the glory he has brought it.
But it is not the general who catches your eye. It is the lowly slave behind him, the one who almost seems to disappear in the general’s splendor. You can see him whisper into the victor’s ear, but you can not hear over the cheer of the crowd.
“Respice post te! Hominem te esse memento! Memento mori!”
“Look behind you! Remember that you are but a man! Remember that you shall die!”
Maybe it’s true. Who knows. The Romans didn’t always keep the most accurate histories. It’s been argued that the story of the servant is more a moral reminder than a literal history. Perhaps it was meant to serve as a warning to the rivals of Caesar – remember that while you are the victor today, you may fall tomorrow, especially if Caesar wills it.
Remember, thou art mortal.
I’m rambling again. It’s what I do. But this is the story that came to mind this morning as I sat at work. While I was roved out to another station, my regular engine crew ran a cardiac arrest today. I honestly don’t know the specifics, but it wouldn’t matter if I did. They rarely differ. This one did slightly, as resuscitation was ceased on scene. We often ride in, still performing compressions. Not today. No need.
In a recent med refresher course in which they stressed the importance of quality compressions and minimized interruptions (because we didn’t know that already, apparently), they pointed out an interesting fact. I don’t recall the doctor’s name, or what his title was, but I do recall that he was a major player in resuscitation research. One of his key points is that the success of a cardiac arrest resuscitation is almost always determined on scene. If they don’t regain pulses before we put them in the ambulance, they probably won’t get them back at all.
When I first got into EMS, I had to take my CPR class just like everyone else. I was lucky. I had a burned out, retired medic as my instructor, and there were only two of us in the class.
She didn’t sugarcoat it. She told us the things they don’t typically tell you about CPR.
She told us that we would save less than 8% of our cardiac arrest patients. She told us that we would break ribs. She told us we would stare into open, empty eyes while families screamed at us, and that we would begin to feel remorse for working most. I’m glad she prepared me for that.
That’s not to say that I’ve lost my compassion. Far from it. If anything, the calls that haunt me the most aren’t the bloody traumas or massive AMI’s. No, for me, it’s the wife hugging her son in the corner, crying into his shoulder as we pump on the cracking chest of her husband of 50 years. It’s the tears in the crystal blue eyes of a 50 year old man as we tell him not to be scared while we hand squeeze saline bags to try and force fluid into him and to force his pressure above 70. It’s his quiet whisper of “I’m not scared,” while the monitor shows a massive heart attack that has pushed him into cardiogenic shock, and that will ultimately take his life in the next two hours.
What we do is important. CPR is important, and it saves lives. But the ones we don’t save slip in line behind us as make our triumphal entry through the sliding ambulance bay doors with the patient we just snatched from the jaws of death, whispering in our ears:
“Respice post te! Hominem te esse memento! Memento mori!”