Any other time, and I’d have laughed at the joke. I recognize it for what it was; good-natured ribbing, just the easy camaraderie between professionals that know and respect one another. That’s why we’d rather bring patients to your ED, frankly. Yours is the only ED in the city where paramedics and nurses aren’t in an adversarial relationship. And most times, it’s us dishing out the gentle jibes, and you take it all in stride.

Besides, I know I’m an easy mark. I’m a big guy, and I sport quite an impressive crumb catcher. I eat most of my meals in the ambulance, too, and a good many of them are finished hurriedly en route to a call. Occasionally, some of those meals find their way onto my uniform shirt. Just like you said, you can indeed tell how my shift has gone by looking at my uniform shirt.

And any other night than this one, that would be true.

But you took my silence for offense, and hurriedly stammered an apology. It wasn’t necessary. I’m grateful both for the banter, and for the apology when you thought you’d gone too far.

But honestly, rather than your apology, I’d rather have your understanding. We shield you from a lot, you know. I realize you work in an Emergency Department. You deal in misery and human suffering every day. But you rarely get to experience it in the raw, like we do. If you knew from whence these stains came, you might know me better. You’d know why, right now, at 6:45 in the morning, I can’t muster a smile. And you’d know why sometimes, even when I can, the smile always looks tired, and never quite reaches my eyes.


There were seven cars in the accident, eleven victims in all. You probably saw it on the news before your shift started; a horse loose on the highway north of town, out there where the traffic starts to open up on the four lane.

The first car hit it at seventy miles an hour.  Six more followed in rapid succession.

It was a freak accident, really. No one knows how the horse got out. A limb down across a fence, or perhaps a strand of barbed wire that finally succumbed to the demands of time, tension and rust. Or it could simply have been a careless hand that forgot to latch the cattle gap securely after driving through. Any country boy will tell you that the real cowboy sits in the middle seat of the pickup, so that he neither has to drive, or get out to open the cattle gaps. So maybe it was just an inexperienced hand that forgot to securely hook that twisted wire loop over the post…

… but regardless of how it happened, on that long, straight stretch of highway north of here, a horse was in the roadway when it shouldn’t have been. In that no man’s land between suburbs and farmland, where the glow of city lights have faded into a starlit country sky, a roan horse is just a vague shadow until those dark legs loom in your headlights, too close to avoid. Just a moment of blind panic, and then the crunch of metal and bone, accompanied by the near simultaneous bang of deploying airbags. It’s disorienting, really.

And then you regain your senses, and turn to your right to check on your wife, only to discover she’s gone, parts of her carried out of the back window along with the carcass of the horse. And just like that, your life as you knew it, and the future you had planned, is gone, too.

As MCI’s go, it wasn’t too bad. Only one critical patient, and nine walking wounded. Half of those signed refusals.

Triage for you is a relatively simple matter of deciding who gets a room first. “Worst come, first served,” as the saying goes. When you run those drills once a year, we bring you simulated patients with triage tags neatly filled out already.

In my world, it’s uglier.

When it’s eleven patients and one medic, and the second-in unit is still five minutes away, you have to decide who can most benefit from your care. Reds are immediate, yellows are delayed, greens have minor injuries and a few of those will even sign refusals. Some of the sickest reds will be blacks by the time you get back to them.

And the blacks… well, the blacks are just inanimate meat between you and your viable patients. They just tie up resources, with little chance of survival. They get a quick check for breathing, repositioning of the airway, and checked again before you move on to someone you can help. And if necessary, you ignore her husband standing next to her, begging you to stay, begging you to check her again, begging you to do something.

And you wonder afterward how much of your humanity you’ve sacrificed to be able to make that decision so easily.

Later, when we pulled her shattered body from the car, her head lolled back on her broken neck, wiping her blood-smeared hair down the front of my shirt. The stain came out easily enough; a little peroxide and some scrubbing, and all that remained was a wet spot on the front of my shirt.

It was the stain of deciding her fate fifteen minutes earlier that made the shirt unwearable. At least the spare I kept in my truck didn’t have a visible reminder of her.


We bring you the wreck victims neatly packaged, and with as many injuries treated as time and priority will allow. And yes, sometimes not so neatly packaged, but packaged nonetheless.

But you only see the victims we bring you. You’ve never knelt in the remains of a back seat, huddled under a heavy blanket while metal and glass groan and pop around you, whispering words of encouragement and reassurance.

“Just a few more minutes, and we’ll have you out. Stay with me now, only a couple minutes more…”

And you’ve never had to dodge the desperate questions about the guy in the passenger seat, sitting less than a foot away. His fraternity brother and classmate. His best friend, inseparable since middle school, now sitting outside that blanket, fully exposed to the sharp edges of tortured metal and flying glass, because the dead need no such protection.

I picked up a stain in that wreck, probably grease from the rescue blanket, or hydraulic fluid from one of the extrication tools. Maybe by pre-treating with Dawn and Oxy Clean, I can scrub that one out, or fade it enough that it’s relatively unnoticeable.

But it won’t set in nearly as stubbornly as the name of the dead kid in the passenger seat, the one I couldn’t help, the one his best friend told me all about in those interminable twenty minutes while we tried to free his mangled legs from the wreckage.


There’s an ink stain on the front placket of my shirt, right where I habitually clip my pen, courtesy of a psych patient we were trying to restrain. Rookie partners… sometimes they forget their limb assignments when we take someone down, and the patient gets a leg loose. Kicked me right in the chest, the bastard, breaking my brand-new gel tip pen.

The stain will lift right out with a little hairspray. What is harder to remove is the guilt I feel whenever a psychiatric or intoxicated person call pops up on our computer, and I feel a flash of hate for a person I haven’t even met.


In an apartment just south of here, the police and coroner are probably just finishing their investigations. Reports will be written in dry legalese and sterile clinical prose, attempting to explain the unexplainable, as if an explanation were any substitute for an answer.

There will be an autopsy, of course. Such things are mandated by law when the victim is less than a year old. And a family’s grief will swell and linger interminably, hoping that the horror of a pathologist cutting their son open, weighing and dissecting his organs will provide the answer they seek.

And likely as not, it won’t. An explanation, maybe, but not an answer.

All I know is, at 0430 this morning, I had neither explanation nor answer they could fathom, and my faith ran away from me like a thief in the night, leaving me without even the solace that perhaps God had a purpose in mind.

For after all, what loving God takes a healthy infant away from his parents, without so much as a hint of sickness as a warning? Without so much as a reason anyone can discern? And what purpose is there in wrecking a mother, leaving her sobbing in the grass as we hustle her son’s lifeless body into the rig, doing futile measures along the way?

And why get me involved? If there is purpose in his death, then at least put me in a position to do something. Let me at least fight against it, using the talents I’ve always credited God for granting me. Why deny me my purpose?

And so I had no answers for her. All I could do was explain to her that her son was dead, and had been for so long that there was no point in even trying. Indeed, CPR at that point would have been a sin.

And so I just stood there mutely as she sobbed into my chest, her fingers digging into my arms, tears soaking through the fabric of my shirt, searing my soul like drops of acid. And there was not one Goddamned thing I could do to make it easier for her.

So yeah, that’s why I was in your Emergency Department at 0645 this morning with a big mascara stain on my shirt. I’m sorry I didn’t smile at your joke, and I promise the next time you see me, I’ll be wearing a clean uniform.

But the stains will linger still.

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