Usually, I lie. At a party, someone asks the question. It’s someone who hasn’t smelled the rancid decay of week-dead flesh or heard the rattle of fluid flooding lungs. I shake the ice in my glass, smile, and lie. When they say, “I bet you always get that question,” I roll my eyes and agree.

There are plenty of in-between stories to delve into; icky, miraculous ones and reams of the hilarious and stupid. I did, after all, become a paramedic knowing it would stack my inner shelves with a library of human tragicomedy. I am a writer, and we are nothing if not tourists gawking at our own and other people’s misery. No?

The dead don’t bother me. Even the near-dead, I’ve made my peace with. When we meet, there’s a very simple arrangement: Either they’re provably past their expiration date and I go about my business, RIP, or they’re not and I stay. A convenient set of criteria delineates the provable part: if they have begun to decay; if rigor mortis has set in; if the sedentary blood has begun to pool at their lowest point, discoloring the skin like a slowly gathering bruise. The vaguest criterion is called obvious death, and we use it in those bizarre special occasions that people are often sniffing for when they ask questions at parties: decapitations, dismemberments, incinera- tions, brains splattered across the sidewalk. Obvious death.

One of my first obvious deaths was a portly Mexican man who had been bicycling along the highway that links Brooklyn to Queens. He’d been hit by three cars and a dump truck, which was the only one that stopped. The man wasn’t torn apart or flattened, but his body had twisted into a pretzel; arms wrapped around legs. Somewhere in there was a shoulder. Obvious death. His bike lay a few feet away, gnarled like its owner. Packs and packs of Mexican cigarettes scattered across the highway. It was three a.m. and a light rain sprinkled the dead man, the bicycle, the cigarette packs, and me, made us all glow in the sparkle of police flares. I was brand new; cars kept rushing past, slowing down, rushing past.

Obvious death. Which means there’s nothing we can do, which means I keep moving with my day, with my life, with whatever I’ve been pondering until this once-alive-now-inanimate object fell into my path.If I can’t check off any of the boxes—if I can’t prove the person’s dead—I get to work and the resuscitation flowchart erupts into a tree of brand-new and complex options. Start CPR, intubate, find a vein, put an IV in it. If there’s no vein and you’ve tried twice, drill an even bigger needle into the flat part of the bone just below the knee. Twist till you feel a pop, attach the IV line. If the heart is jiggling, shock it; if it’s flatlined, fill it with drugs. If the family lingers, escort them out; if they look too hopeful, ease them toward despair. If time slips past and the dead stay dead, call it. Signs of life? Scoop ’em up and go.

You see? Simple.

Except then one day you find one that has a quiet smile on her face, her arms laying softly at her sides, her body relaxed. She is ancient, a crinkled flower, and was dying for weeks, years. The fam- ily cries foul: She had wanted to go in peace. A doctor, a social worker, a nurse—at some point all opted not to bother having that difficult conversation, perhaps because the family is Dominican and the Spanish translator wasn’t easily reachable and anyway, someone else would have it, surely, but no one did. And now she’s laid herself down, made all her quiet preparations and slipped gently away. Without that single piece of paper though, none of the lamentations matter, the peaceful smile doesn’t matter. You set to work, the tree of options fans out, your blade sweeps her tongue aside and you battle in an endotracheal tube; needles find their mark. Bumps emerge on the flat line, a slow march of tiny hills that resolve into tighter scribbles. Her pulse bounds against your fingers; she is alive.

But not awake, perhaps never to be again. You have brought not life but living death, and fuck what I’ve seen, because that, my friends at the party, my random interlocutor who doesn’t know the reek of decay, that is surely one of the craziest things I have ever done.

But that’s not what I say. I lie.

Which is odd because I did, after all, become a medic to fill the library stacks, yes? An endless collection of human frailty vignettes: disasters and the expanding ripple of trauma. No, that’s not quite true. There was something else, I’m sure of it.

And anyway, here at this party, surrounded by eager listeners with drinks in hand, mouths slightly open, ready to laugh or gasp, I, the storyteller, pause. In that pause, read my discomfort.

On the job, we literally laugh in the face of death. In our crass humor and easy flow between tragedy and lunch break, outsiders see callousness: We have built walls, ceased to feel. As one who laughs, I assure you that this is not the case. When you greet death on the daily, it shows you new sides of itself, it brings you into the fold. Gradually, or maybe quickly, depending on who you are, you make friends with it. It’s a wary kind of friendship at first, with the kind of stilted conversation you might have with a man who picked you up hitch- hiking and turns out to have a pet boa constrictor around his neck. Death smiles because death always wins, so you can relax. When you know you won’t win, it lets you focus on doing everything you can to try to win anyway, and really, that’s all there is: The Effort.

The Effort cleanses. It wards off the gathering demons of doubt. When people wonder how we go home and sleep easy after bearing witness to so much pain, so much death, the answer is that we’re not bearing witness. We’re working. Not in the paycheck sense, but in the sense of The Effort. When it’s real, not one of the endless parade of chronic runny noses and vague hip discomforts, but a true, soon- to-be-dead emergency? Everything falls away. There is the patient, the family, the door. Out the door is the ambulance and then farther down the road, the hospital. That’s it. That’s all there is.

Awkward text messages from exes, career uncertainties, generalized aches and pains: They all disintegrate beneath the hugeness that is someone else’s life in your hands. The guy’s heart is failing; fluid backs up in those feebly pumping chambers, erupts into his lungs, climbs higher and higher, and now all you hear is the raspy clatter every time he breathes. Is his blood pressure too high or too low? You wrap the cuff on him as your partner finds an IV. The monitor goes on. A thousand possibilities open up before you: He might start getting better, he might code right there, the ambulance might stall, the medicine might not work, the elevator could never come. You cast off the ones you can’t do anything about, see about another IV because the one your partner got already blew. You’re sweating when you step back and realize nothing you’ve done has helped, and then everything becomes even simpler, because all you can do is take him to the hospital as fast as you can move without totaling the rig.

He doesn’t make it. You sweated and struggled and calculated and he doesn’t make it, and dammit if that ain’t the way shit goes, but also, you’re hungry. And you’re alive, and you’ve wracked your body and mind for the past hour trying to make this guy live. Death won, but death always wins, the ultimate spoiler alert. You can only be that humbled so many times and then you know: Death always wins. It’s a warm Thursday evening and grayish orange streaks the horizon. There’s a pizza place around the corner; their slices are just the right amount of doughy. You check inside yourself to see if anything’s shattered and it’s not, it’s not. You are alive. You have not shattered.

You have not shattered because of The Effort. The Effort cleanses because you have become a part of the story, you are not passive, the very opposite of passive, in fact. Having been humbled, you feel amazing. Every moment is precise and the sky ripples with delight as you head off to the pizza place, having hurled headlong into the game and given every inch of yourself, if only for a moment, to a losing struggle.

It’s not adrenaline, although they’ll say that it is, again and again. It is the grim, heartbroken joy of having taken part. It is the difference between shaking your head at the nightly news and taking to the streets. It’s when you finally tell her how you really feel, the moment you craft all your useless repetitive thoughts into a prayer.

At the party, as they look on expectantly, I draft one of the lesser moments of horror as a stand-in. The evisceration, that will do. That single strand of intestine just sitting on the man’s belly like a lost worm. He was dying too, but he lived. It was a good story, a terrible night.

I was new and I didn’t know if I’d done anything right. He lived, but only by a hair. I magnified each tiny decision to see if I’d erred and came up empty. There was no way to know. Eventually I stopped taking jobs home with me. I released the ghosts of what I’d done or hadn’t done, let The Effort do what it does and cleanse me in the very moment of crisis. And then one night I met a tiny three-year old girl in overalls, all smiles and high-fives and curly hair. We were there because a neighbor had called it in as a burn, but the burns were old. Called out on his abuse, the father had fled the scene. The emergency, which had been going on for years, had ended and only just begun.

The story unraveled as we drove to the hospital; I heard it from the front seat. The mother knew all along, explained it in jittery, sobbing replies as the police filled out their forms. It wasn’t just the burns; the abuse was sexual too. There’d been other hospital visits, which means that people who should’ve seen it didn’t, or didn’t bother setting the gears in motion to stop it. I parked, gave the kid another high five, watched her walk into the ER holding a cop’s hand.

Then we had our own forms to fill out. Bureaucracy’s response to unspeakable tragedy is more paperwork. Squeeze the horror into easy-to-fathom boxes, cull the rising tide of rage inside and check and recheck the data, complete the forms, sign, date, stamp, insert into a metal box and then begin the difficult task of forgetting.

The job followed me down Gun Hill Road; it laughed when I pretended I was okay. I stopped on a corner and felt it rise in me like it was my own heart failing this time, backing fluids into my lungs, breaking my breath. I texted a friend, walked another block. A sob came out of somewhere, just one. It was summer. The breeze felt nice and nice felt shitty.

My phone buzzed. Do you want to talk about it?

I did. I wanted to talk about it and more than that I wanted to never have seen it and even more than that I wanted to have done something about it and most of all, I wanted it never to have hap- pened, never to happen again. The body remembers. We carry each trauma and ecstasy with us and they mark our stride and posture, contort our rhythm until we release them into the summer night over Gun Hill Road. I knew it wasn’t time to release just yet; you can’t force these things. I tapped the word no into my phone and got on the train.

I don’t tell that one either. Stories with trigger warnings don’t go over well at parties. But when the question is asked, the little girl’s smile and her small, bruised arms appear in my mind.

The worst tragedies don’t usually get 911 calls, because they are patient, unravel over centuries. While we obsess over the hyperviolent mayhem, they seep into our subconscious, poison our sense of self, upend communities, and gnaw away at family trees with intergenerational trauma.I didn’t pick up my pen just to bear witness. None of us did. And I didn’t become a medic to get a front-row seat to other people’s tragedies. I did it because I knew the world was bleeding and so was I, and somewhere inside I knew the only way to stop my own bleeding was to learn how to stop someone else’s. Another call crackles over the radio, we pick up the mic and push the button and drive off. Death always wins, but there is power in our tiniest moments, humanity in shedding petty concerns to make room for compassion. We witness, take part, heal. The work of healing in turn heals us and we begin again, laughing mournfully, and put pen to paper.

Daniel José Older is a Brooklyn-based writer, editor and composer. Salsa Nocturna, Daniel’s ghost noir collection, was hailed as “striking and original” by Publishers Weekly. He’s co-editing the forthcoming anthology, Long Hidden: Speculative Fiction From The Margins Of History and his urban fantasy novel The Half Resurrection Blues, the first of a trilogy, will be released by Penguin’s Roc imprint in January 2015. Daniel’s essays and short stories have appeared in The New Haven Review, Salon.com, Tor.com, PANK, Strange Horizons and Apex. His music, ponderings, and ambulance adventures live at ghoststar.net/ and @djolder. A version of this piece appeared first in the New Haven Review.

[ Image by Jim Cooke]