Chapter 1

The oilfield wasn’t my first job. I’d been an EMT for a couple years after high school. That had its own scares, especially at the beginning. When you’re new it feels like you’re never going to catch up. But then you settle into a rhythm. The sky isn’t always falling, just most of the time. The easy times remind you that the hard times pass.

And there are laughs. Most of the calls we got were for something totally useless. One of my favorites was this mid-forties loser. Real boy who cried wolf situation. The guy loved football, watched every Sunday, all day long. Probably he was addicted to sportsbetting or something. I don’t know for sure about that part, but it seems right for a loser such as himself. Anyway, every Sunday this guy would crush a six pack of beer, maybe more. Then, when the indigestion set in, he would tell his wife he was having a heart attack. We got called to that house four or five times at least while I was on the job. The guy’s wife was actually really nice. I guess when all you’ve got is the loser, you’re still going to worry about him.

I couldn’t laugh off every call, though. Probably once a week (once a shift around the holidays) there would be someone really dead or really dying. It’s not an easy thing to see, especially the first few times. It’s actually a lot better when you get there and the body’s already a body. As opposed to, you know, a living breathing human being who becomes a body on your watch. When they’re already dead, there’s no “oh, maybe I should’ve done something differently.” Doesn’t feel like it’s your fault.

From time to time, we’d get called to this one particular nursing home on the west side of town. A real shithole – you walk in and everything’s yellow. The floors, the walls, the lights. All yellow. You could tell it all used to be white, but that’s the way things go with age. Maybe I’m exaggerating the whole general vibe, too. Like I have a scary-movie image of the place in my mind because of what happened there. But like I said, real shithole.

Most nursing home deaths are expected, or at least not-too-unexpected, and they just call a hearse instead of a whole ambulance. But every once in a while, there’s some poor bastard whose kids weren’t ready to let go. If you ask me, it’s something wrong with the relationship. “Daddy issues” or whatever you want to call it. Can’t make daddy DNR, cause what if he dies? How am I going to fix things with him then? Anyway, they never fix things and then dad dies and now it’s my problem.

I’m complaining a lot, but CPR isn’t pretty. You don’t really get it in the training, with the rubber dummy who has no limbs and an open mouth. You really learn the first time you do it. And someone yells at you that those aren’t good compressions. Then, you lock your elbows and really start pushing, and you hear the bones cracking. Feel them cracking, too.

So one of the first times we get called to the place, it’s for this old fella. Real old, late nineties. His nurse had called 9-1-1 thinking he was having a stroke. Face wasn’t droopy or anything like that, but she told the operator he had an “altered mental status.” At his age, that was enough. We made decent time, twelve minutes between the call and arriving on the scene.

When we roll into the guy’s room, the nurse is panicking. Telling us how he’s normally super sharp, but today’s different. I remember thinking she must’ve been new. Normally, the staff at these places are pretty level-headed. “Desensitized” and all. A confused old man shouldn’t be all that shocking. But she was pretty young. Same age as me or a couple years older maybe. Nice looking girl, too.

Anyway, we walk in the room and she’s crying and talking real fast. I walk over to take a look at the guy while she’s giving us the details. She came to check on him a half hour ago and he wasn’t himself. Slurred speech. Confused. Kept saying he was sorry. “He didn’t mean to.” By the time I get to bedside he’s not talking at all. Eyes closed. I ask him, “sir, can you open your eyes for me?”

Nothing. I think maybe he’s hard of hearing, so I say it a little louder, wave a hand over his face. “Sir, can you open your eyes for me?”

He’s not moving. The hair starts to stand up on the back of my neck. As I reach toward his neck with my first and second fingers, I interrupt the nurse, “what’s his code status?”

She stops talking for a second, sniffs, still crying. Asks, “what?” I don’t think she realized yet what was happening, or how much worse it was going to get.

“What is his code status?”

That’s when she figures it out. She stops crying, goes real serious. Straightens her back and all. “He’s full code. We’ve talked to the family about it but . . .”

I’m not listening. My fingers are on his carotid artery. Nothing. In your average near-centenarian, this wouldn’t be a big deal. A 90-something in a nursing home. He should be DNR/DNI. Do not resuscitate, do not intubate. But like I said, some kids are never ready. Now we have an obligation to do everything we can.

This was the worst part of the job. Sometimes, when I’m in a mood to complain, I’ll say otherwise. It was “abuse of the system” or something like that. Maybe it was the ODs. Those were pretty bleak. But no, nothing could hold a fucking candle to the real worst part of the job: torturing some old bastard in his final moments because his kids weren’t ready to let go.

I could tell this was going to be a bad one. The old man’s skin was paper thin, translucent. I set my hands on his chest, fighting against my hesitation. My instinct to be delicate with my movements. Like he was a baby bird I was holding in my two hands.

His chest collapsed with the first compression. No resistance at all as my hands sank down, down, like his ribs were going to touch his spine. I couldn’t fathom how his heart and lungs were still intact. Surely they’d been reduced to jelly under my hands and his collapsed sternum.

And the sound. My god. A lot of the time, the sound was rough when you were doing compressions on a patient this old. Like you were crushing a bag of chips under the heel of your hand. This was worse. Like a baby bird I was crushing between my two hands. Squish.

Then he groaned.

I looked up from my hands, and his eyes were wide open. Ice-blue and sinking into his skull. He looked at me with something like pleading. To let him die, grant him the peaceful death his children had denied him. But the longer I looked, the more I recognized something else. He wasn’t pleading with me. He was apologizing.

His eyes begging for my forgiveness, the old bastard opened his mouth and spoke to me.

“It’s yours now.”

The old man let out a long, slow breath. Smoke poured out of his mouth. Thick, black smoke that spread like an avalanche down his chest. But when it reached my hands, still one over the other on his sternum, I could feel that it wasn’t smoke. It was something like smoke, hot and fluid, but alive.

Tendrils of it reached up and encircled my wrists, burning me as it traveled up my arms until I couldn’t see my arms anymore. I couldn’t see anything but the thick, black cloud covering me and the old man alike. And then I started to feel its grip. It had settled around my chest and arms, squeezing me like an enormous snake eager to hear my heartbeat slow and stop before it consumed me.

My eyes darted around the room, desperate. I couldn’t tell if the living smoke had covered my eyes or everything else, but I couldn’t see anything. Total darkness. My eyes filled with tears as my ribs struggled against the cloud constricting them. My chin angled upward as my open mouth begged for air.

Suddenly, it let me go. But there was no air to be had. I inhaled deeply, and the living smoke filled my lungs, scalding them. Tears streamed down my face as my gut tightened, my diaphragm fighting for a cough. But there would be no coughing – only more smoke. And when my lungs were full, the smoke continued, cascading into my mouth with a force like it intended to fill my body from head to toe.

Until the smoke was gone. And there I was, my hands still one on top of the other on the old man’s chest, which was worse for wear, potato-chip crunching with each compression, but certainly not caved-in the way it had been a moment ago. The paramedic, holding his arms out and standing across the bed from me, shouted “SWITCH” and started his 200 compressions as I backed away.

I watched the old man’s face the whole time. He didn’t open his eyes. Didn’t speak. Didn’t breathe – in or out. Never got a pulse back. At the end of the paramedic’s 200 compressions, I reached back toward the man’s chest to start my next round, but the paramedic caught my hands in the air, stopping me.

“No, we’re calling it.” The paramedic shook his head. Normally we’d keep going, switching every 200 compressions for a half hour or so. Apparently with a patient that old and frail, you still have to try CPR, but they don’t need the whole dog and pony show. The paramedic left the room to call the Medical Examiner.

Alone in silence with the man’s body, my mind raced. My body was pulsing, hot and dense like I carried something heavy inside of me. Like there was another man the same shape and size as me, coextensive with my own body but made of the living smoke. That sounds fucking crazy, of course, so my first instinct was to keep it to myself. But when the paramedic walked back into the room, I couldn’t help but say something.

“Did you hear what he said?”

The paramedic – John – looked at me. Tilted his head, like he was trying to remember.

“What he said? Do you mean when he was moving around a little during that first set of compressions?”

“Yeah . . . that, I guess.” I didn’t know what to say. “The guy opened his eyes. I felt like he was looking at me, and then he said, it’s yours n-”

John interrupted me with a sharp breath out, shaking his head. “Oh yeah. I don’t think he said anything. It happens sometimes, they open their eyes or take a couple breaths. Maybe say something. It’s called CPR-induced consciousness. It means your compressions are good.” John forced a smile. “You should take it as a compliment,” he said, obviously trying his best to make me, the new kid, feel better about something that’s just part of the job.

Seemingly feeling like he needed to fill the empty space between us with words of encouragement, John continued, “listen, who knows how much time passed between when the guy arrested and when we started compressions? That nurse didn’t seem like she was on top of things. More likely than not, he was long gone by the time we got here. It sucks that the families of these patients don’t understand what they’re asking for.” He rolled his eyes and made air quotes. “Do everything you can. Torture my grandpa while he’s trying to let go.”

Finally, he stopped and looked at me, gauging how much more pep talk it was going to take for me to make it through the rest of our shift.

I did my best impression of someone who hadn’t just gone through a traumatic experience. Shaking my head slowly, I just said, “yeah, it’s wild.” If John claimed not to have heard what the old man said to me, I certainly wouldn’t be bringing up what happened after. Maybe only I got to witness what the old man had given to me.

Seemingly satisfied by my response, John smiled, more convincingly this time. “Well,” he said, “I’m gonna head back to the truck to wait for the M.E.”

He turned and left, heading down the hall to the nursing home’s parking lot and the empty ambulance where he could get a bit of peace and quiet. It would be a while before someone from the Medical Examiner’s office showed up. Normally we wouldn’t wait. The cops generally show up pretty quickly, and we hand off the scene for them to deal with. Something was going on that day, a parade or a protest in the city. In any event, the cops were too busy, spread too thin. They needed us to wait for the M.E.

I remained in the old man’s room for a minute or two after John left, and by the time I got outside, he was already sitting in the driver’s seat of the truck, earbuds in, engine idling. It didn’t seem like he was looking for company, so I headed straight for the back.

That was when I noticed her. The nurse, standing out on the curb, smoking a cigarette.

We had time to kill, so I figured there wasn’t any harm in making conversation. Maybe she saw more than John, or was at least more willing to admit it. I walked over, trying to maintain an appearance of calm, like my mind wasn’t abuzz with the feeling that something unwelcome was occupying it.

“Can I bum one?”

The nurse jumped a little, surprised by my presence, and turned to face me. She didn’t say anything for a moment, just looked, mouth open and eyes locked fearfully on mine, as if her unconscious mind had perceived a threat and was taking its time choosing between fight and flight. Catching herself, she closed her eyes tightly, shaking her head.

“Yeah. Of course.” She reached into the one big pocket on the front of her scrub top and pulled out a crumpled pack, opening it with one hand and holding it out to me.

I grabbed one between my thumb and my index finger, careful not to touch the butts of any neighboring cigarettes in case she was the kind of smoker-nurse who was also a germaphobe.

“Thanks,” I said as I placed it between my lips while the nurse fished a lighter out of the same pocket and handed it to me.

I shouldn’t have been smoking. I’m always quitting, two or three times a year at least. At that point, I probably hadn’t had a cigarette in two months. Given the circumstances, I felt one was warranted.

I lit the cigarette and took a drag. But the smoke, ordinarily welcome as a guilty pleasure, needled my scorched lungs like a hot shower aggravating a sunburn. I coughed violently and doubled over.

I stubbed out the cigarette on the ground and then stood and tried to avoid looking at the nurse. I recall feeling embarrassed in that moment, like the nurse would think I had wasted one of her perfectly good cigarettes performatively smoking to force a conversation with her.

If she had noticed, she didn’t show it. When, finally, I peered over from right next to her on the curb, she had returned to the same thousand-yard stare I had interrupted to ask for the cigarette. I stood in silence next to her for what felt like an hour but was almost certainly just a few minutes, hoping that she would save me from my desperation to talk by being the first to say something.

She didn’t, of course. So I asked, “how long were you taking care of the old man?”

She flinched at the question, looking away from me, and didn’t say anything for a moment. Slowly, her gaze softened, dark brown eyes filling with tears while her soft pink lips came to resemble something like a smile.

“He was the first resident I met when I started working here, not even two weeks ago. I just graduated from nursing school in May.”

“Wow.” I didn’t really know what else to say. I hadn’t been an EMT much longer than she’d been a nurse, the two of us just a couple of traumatized kids.

She never quite looked at me again but kept on about the old man. “When I would check on him in the morning,” she said, “he would always tell me about his wife. His late wife. She passed away a couple years ago, before his kids dropped him off here.” She sniffed and took another drag of her cigarette, blew out a cloud of white smoke. Nothing like what had come out of the old man. Still, it made me shiver.

“He told me how I reminded him of her. How she was when they first met.” She sniffed and chuckled a little before she continued. “Kind of creepy, I know, but at his age . . . it sounded like he really loved her. He missed her. I think it broke his heart when his kids left him here, cause he didn’t really have anyone else left.”

Finally, she turned and looked me right in the eyes. Her head tilted, the same curious look John wore when I asked him if he’d heard the old man.

The nurse asked me, “why do you think he said that?”

I’d forgotten for a moment, listening to her story, my unconscious mind putting the events of the day in a box, hidden away. The old man was just an old man. It was all very sad, tragic even. First he lost his wife, then his kids abandoned him. Then his life came to an unfortunate, but not unsurprising, end. Worsened, of course, by my intervention, but there was nothing particularly notable about it.

The nurse’s question brought me back, like I’d been kicked in the stomach while daydreaming. Heat radiated throughout my body, along with the unshakeable feeling that something or someone else had arrived and was biding its time before taking control.

“Why do I think he said what?”

In my heart and my mind, but not out loud of course, I was begging the nurse not to repeat what the old man had said. To let me return to crafting a delusion that what happened didn’t happen.

But it did, so she said, “it’s yours now. What’s yours now?”

I was collapsing in on myself, trapped by her question in the terror of terrors that had cast forth from the old man. As I looked into the nurse’s eyes, all I could manage was a whisper, “I don’t know.”

The nurse didn’t say anything about what happened after either. Seems that part had just been for me.

“Well,” she said, dropping the butt of her cigarette on the ground and crushing it under her shoe, “I’ve got to get back to work.” She started turning back toward the entrance, and I shouldn’t have done this, I know. I don’t know what I was thinking, other than that I needed to keep talking to her. I reached as she turned and grabbed both of her forearms. Stopped her. She looked down at my hands and then back up into my eyes. This time, there was real fear in them. I realized what I’d done and let go. She turned and walked, nearly ran, back into the nursing home.

I stood for a second before walking back to the truck, my heart thudding in my chest and in my ears, my lungs on fire like it wasn’t just the muggy Houston air I was breathing, but the living smoke.

Then, I saw John. Sitting in the truck, headphones in. Looking more relaxed than I’d seen him in weeks. He hadn’t seen anything. Just had some time to kill while he waited for the M.E. A few quiet moments without an emergency. The sight calmed me, a bit. Things were okay.

He was a really nice guy, you know. The kind of guy who never snapped at you for getting something wrong, no matter how dense you knew you were being. Always patient, happy to help because he remembered what it was like to be new.

I still don’t like to think about what ended up happening to him. Freak accident.

Anyway, I didn’t bother him that day, sitting in the cab of the truck. Instead, I climbed in the back and sat. Told myself to relax. And then told myself again, and again. The M.E. showed up after another half hour or so, and we went on with the rest of our shift. We only had one more call that day, a slip-and-fall outside of a post office, nothing notable.

I felt almost normal when I drove home that night, keeping my mind away from what happened. As long as I didn’t look too closely at the memory of the living smoke, I could ignore it, pretend I couldn’t feel it inside of me.

I stripped my shirt off the second I walked in the front door, like I always do, eager to remove myself from the sweat of the day. I turned right toward the kitchen, looking forward to grabbing a Gatorade and winding down for the night, when the hall mirror caught my eye.

Burns, all over. Not, blistering, third-degree burns. But wide, pinkish-red lines encircling my chest and back. Like I’d been tied up tightly with a massive rope, or squeezed by a colossal hand.

I froze, forgot about the kitchen and the Gatorade. I looked down at my chest and with the damp shirt in my hand tried wiping it. Like the red was a stain that would come off with a little elbow grease (it didn’t). I winced. The skin was raw. Burned, obviously. I don’t know how I’d made it through the whole day without noticing. Too preoccupied with not thinking about what happened to recognize the sensation.

I stopped wiping and looked up, into my own eyes in the mirror.

It wasn’t me looking back. Or it was, I recognized myself, but my eyes weren’t my eyes. They were pitch black, and I could feel something terrible looking back at me.

I put my shirt back on and walked straight out of the house. I fell stepping off the porch and landed hard, hands on grass and knees on pavement, I gasped for air, tried to slow my breathing and calm down. When I managed to get myself under control, enough not to be shaking or wheezing, I stood up. Dusted my hands and knees off, turned, and walked back into the house.

Instead of passing the mirror again, I turned left in the entryway, toward the bedroom that had been mine when this was still my mom and dad’s house. I collapsed onto the small bed and, eventually, fell asleep.

The next day, I got up and went to work. Didn’t think about what happened.

I must have smelled awful, because I never changed the shirt. Didn’t want to take it off again and be reminded. If I didn’t look, the burns wouldn’t be there. Like nothing happened. I wore that same shirt three days in a row. John didn’t say anything.

By the time my day off rolled around, I couldn’t stand the grimy feeling of the polo with my name on the chest and days of dried sweat in the fibers. I stripped it off to take a shower, and the burns had faded. Nothing left to remind me of the old man and the living smoke. No feeling that something had stayed with me, waiting to show itself.

As long as I didn’t think about it.