The call came in two hours before my shift ended. The situation sounded bad, a five-year-old fell from a climber at a local playground. Keith and Tom, our best critical care transport team, took the call. It was wrong that I looked forward to their arrival. I’d snuck glances at Keith since I’d been hired into this position. But I was the attending trauma doctor and Keith was a paramedic. In our line of work, we were worlds apart.

Years of experience told me what to expect. I pushed thoughts of Keith aside, and grabbed Tim Sanders, one of the pediatric emergency fellows, to join me. When I had been in his shoes, no one had taken the time to teach me this part of the job. Books taught about disease and how to cure it. Clerkships, residencies, and fellowships honed our skills in patching together the worst the world threw at hapless victims. But this? No one taught us how to deal with what was about to come through that door.

Two minutes out and my trauma team was ready. Tim looked too eager, bouncing on the balls of his feet, probably thinking about all the procedures he’d get to do.

Time to reel him in. “Tim!” My sharp voice cut through the ordered chaos of a waiting trauma bay.

“Yes, Dr. Peters?”

“Five-year-old, witnessed fall. Top priorities? Go!”

The bouncing stopped. Every case was a learning opportunity in my world. “Airway, breathing, circulation.”

“Obvious. Then what?”

“Secondary injuries.” He ran through our standard barrage of tests.

“The kid fell. What do we need to be most concerned about?”

My first year fellow stared blankly. The wheels in his head were spinning.

“You don’t have time to think,” I snapped. He flinched at the bite of my words, but I had no patience for those not at the top of their game.

Nancy, our senior trauma nurse pointed at her head, pantomiming head trauma, trying to give the poor guy a clue.

“Cervical spine immobilization?” Tim asked.

In the world of trauma there was no room to question the next move. “Wrong,” I snapped again, losing my patience. “Head CT. Think subdural, epidural bleeds, and brain swelling. Call your specialists the moment you get this kind of call. Think about the mechanism of trauma and pre-plan the next step.” I’d alerted the neurosurgeons to be on standby. Radiology already had the CT scanner waiting. This wasn’t my first rodeo.

Sirens sounded outside, announcing the arrival of our patient. My team surged forward.

Keith and Tom off-loaded the stretcher, a tiny body lay on the adult-sized bed. Tom squeezed a self-inflating bag, breathing for the child and rattled off vital signs to Tim.

My mouth gaped as Keith straddled the small form, squatting on the stretcher while he pushed on the child’s tiny chest, performing CPR. We’d never really spoken, but his eyes cut to mine, a simmering sadness reaching out to me. In that look, he told me all I needed to know. This wasn’t one we’d be saving. I stepped aside, my gaze zeroing in on the mother climbing out of the ambulance looking scared, lost, and traumatized.

I gave Nancy a jerk of my chin, and without words she understood. Nancy flagged down Janice, a junior nurse, to join me.

I offered my hand to the mother. “Hello, my name is Dr. Peters, I’m the trauma attending and I am going to do everything I can for your child.”

The woman sobbed. “Thank you. My husband will be here soon.”

I put a hand on the woman’s shoulder. “What’s your son’s name?” First lesson, knowing patient’s names showed the family I cared, their loved one wasn’t some nameless diagnosis to me. Names had immense power.

She looked at me, red-rimmed eyes swelling. “Caleb. His name is Caleb.”

“This is Janice,” I introduced Janice. “She will explain what is happening. I’m going to take care of Caleb. Janice will take you where you can see everything we’re doing for Caleb.”

Except everything wasn’t possible. Caleb returned from the CT scanner, the results the worst I’d ever seen, a large bleed and his brain was swelling. The neurosurgeons didn’t have any options. Caleb’s heart stopped beating coming out of radiology. We brought him back, stabilizing him, but his heart showed signs of slowing again. It was time.

“Tim, we need to talk with them.”

I explained my process. How I set up the room, the words I used. How I looked parents in the eye to deliver bad news, telling the truth. I told him the importance of using names, of not using too much medical lingo, but speaking clearly, allowing for silence to stretch—sometimes for as long as it needed to. I told him not to forget to bring in tissues. I even admitted I usually cried, and to expect I would this time too.

“Um…Dr. Peters,” he said, “I’m not really comfortable talking to parents.”

“No one is, but we’re going to go in there and do it as best we can. This is their son.”

Caleb’s father looked at the clock. “There’s nothing you can do?” He hadn’t taken his eyes from the clock since I delivered the bad news. He couldn’t look me in the eye.

I shook my head. “I’m sorry, no.”

His mother stroked Caleb’s head, her crying stopped for now. “Is he in pain?”

Another shake of my head. “No.”

“Can I hold him?” Her voice pulled at me, a mother needing to provide comfort.

“Of course you can.”

“I don’t want him hooked up to tubes.” The man hugged his wife, who gave him a nod, some deep communication passed between them.

I sensed something happening.

Tears pooled at the corners of his eyes. “Do you think there’s any possibility he’ll survive?”

For the third time, I shook my head.

Her husband stood, pulling his gaze from the clock. “We want to take him off life support…to die a natural death. We discussed…” He cleared his throat, then continued. “If possible, we’d like to donate Caleb’s organs so another child can live. Can we do this?”

They both looked expectantly at me.

I grabbed the box of Kleenex and pulled out a wad, dabbing at the tears in my eyes. “Yes, yes of course. And you can definitely hold Caleb.”

“Thank you,” the wife said. She grabbed a piece of paper from her purse and scribbled a note. Her hands shook. “Is it possible to give this to—to…” She pulled Caleb into her arms and broke down crying.

* * *

I found Dr. Sheldon, the transplant surgeon, at the end of my shift, staying over to find out if they’d found a recipient for Caleb’s organs. To my surprise, a child in our hospital was a match.

I handed him the note Caleb’s mother had written. “The mother of the donor wanted the parents to have this.”

He took it from me. “I’m headed to speak with them now. Do you want to give it to them yourself?”

Did I? I wanted to know what a mother would say.

“Yes.”

Dr. Sheldon led me to the waiting room where Josie and Mark Peterson waited.

“Their daughter’s name is Kelly,” he said.

“What organ is she getting?”

“Kelly is in kidney failure. She’s been on dialysis a long time.”

I walked into a waiting room and picked out the couple on sight. These were old timers, parents used to the rhythms of hospital life.

Dr. Sheldon introduced me.

I handed over the note. “I was asked to give this to you.”

The woman took it from me, her lips moving as she read the words. When she was done she held it to her chest.

Her husband, Mark, asked, “What does it say?”

Josie read the note out loud. “It’s from his mother, she says, ‘It wasn’t supposed to be like this. I wasn’t supposed to lose my son, but if his death means your child might live, then his life had meaning. He was my little hero.’”

Mark reached over and took my hand in his. “Please tell her, he’s ours as well.”

I never found the mother. Never relayed that message. Instead, I finished out my shift, my thoughts turning to the loneliness of my bed. The life of a trauma surgeon left little time for forming relationships, dating, or finding love. Hell, I hadn’t been laid in years. The closest I came were the dreams of Keith struggling to save a life. I imagined him crouching over me, breathing life into my dead lungs, and kickstarting my frozen heart. I hadn’t felt the excitement of anything beyond the cold words of a medical textbook, or the adrenaline rush of a trauma code, in nearly a decade. I needed more than a fuck. I needed someone else to make the life and death decisions in my world. My life sucked.

* * *

I sat in the report room, drinking coffee and wishing it was tequila, and one hell of a lot of it. My report was electronically filed, and I swear I could almost taste the tequila. But I was on duty through the night until 7:00 in the morning. It was always tough with kids. In fifteen years working a 911 truck, I’d seen more carnage and horror than any decent man should be forced to face.

That kid Caleb … shit like that was burning me out. And there was nobody to blame, for Pete’s sake. A careless kid and an oops, and now he was dead. From the medical standpoint, I was glad Dr. Peters was there. She’s the brightest star in one hell of a constellation of doctors here. Fair being fair, she’s also the coldest and bitchiest of them. I’m close with a few of the doctors here, and with many of the nurses, and we can unburden to one another. But whatever humanity the woman has was reserved for her patients and their families. To the staff, she was all business, and zero emotion. I think she’d have been happier if patient care was entirely done by fucking robots. Sometimes, I think I’d be happier that way as well, and should get a job as a bank teller or some shit like that.

My thoughts returned again to Dr. Laura Peters, MD. She had a string of other letters following her name, embroidered in blue against her starched bright-white lab coat, which to me looked like a steaming pot of alphabet soup. She’s an ice queen. She’s also drop-dead beautiful, if the truth be known, long and slender, really even elegant. If she showed a bit of humanity, I could even have a crush on her. But that wasn’t going to happen. I’d been through five girlfriends over the past two years. They were a good match in my dungeon and in my bed, but ultimately, four of them said I was simply too cold for them. The other simply couldn’t handle the hours I worked. Working 48-hours on-duty, and then 96-hours off-duty, had good and bad points, but meant I seldom had an entire weekend off work. Who knows, I considered. Maybe I’ve become a robot, but if so, why am I sitting here fighting crying about Caleb and his parents who looked destroyed?

I guess the reverie could’ve lasted all day and into the night, but my walkie-talkie toned, a man-down call at Marson Park. Tom and I trotted to the ambulance, then drove to Marson Park, where we found a wino passed out drunk, reeking of things I didn’t want to consider. Jimmy Fletcher, a frequent flyer who needed to dry out. Again. We ran him to the VA, my third time to transport him in the past year, and God alone knew who else ran him how many times.

I wasn’t hungry, but needed to eat, so we went out of service and found a burger joint near the VA hospital, where I ate a burger and fries, washing it down with a Coke, barely tasting any of it while brooding about poor Caleb. Tom was a good guy, I guess, but he was pretty much a basic EMT driver, eight months out of school, twenty-one or maybe twenty-two years old, green as a gourd … he simply didn’t understand yet. One way or another, I wasn’t fond of him and we certainly hadn’t bonded. But I was patient. What the hell, I had been much the same way when I’d been a greenhorn like him, a total trauma junkie with very little empathy. But I’m older now. Maybe I’m even wiser.

Fortunately, the rest of the night went quietly. There was one COPD patient who called around 10:00 that night and was a routine transport on oxygen and an IV of D5W. The lieutenant asked if I was willing to work to 11:00 AM for comp time, and I declined. Actually, I think my exact words were “fuck off and die,” if I’m going to be brutally honest here. I had four days off and meant to spend them blitzed on booze. I was home at 7:30 and drunk as fuck by 8:30 before I dropped onto my couch to find a movie on HBO. I woke up at noon, hung over and needing to piss. After, I built a ham sandwich, I noted I’d need to hit the grocery store before long.

I ate the sandwich, brooding while I watched TV and slowly sobered up. Already, I knew I’d be drinking myself to sleep. But I had to get the fuck out of my house for a while. It was too lonesome and too depressing. I was still brooding about that poor kid Caleb. And for reasons I couldn’t explain, my thoughts also kept circling to Laura Peters, M.D. and a whole pot of alphabet soup.

At 6:00, I fired up my pickup truck to drive into town. It was an ancient 1980 GMC K-15 that I kept in immaculate condition. It had belonged to my father, who’d died when I was 17. Mom bumped it down to me and I’d kept it ever since. It was a relic. It even had an 8-track stereo system. The original red paint had grown dull, and a hell of a lot of it had flaked away, but I spent a small fortune having it restored into an enviable glittering candy-apple red. I’d even won blue ribbons for it at three antique auto shows held hither and yon.

I drove to Louie’s, a steak place out on Highway 11, and went in, then ordered a huge porterhouse and a pitcher of Budweiser. Like a cop, I sat at a table with my back to the corner, facing the crowd and the door. Life had made me a bit paranoid, I guess. I was surprised to see Dr. Peters alone at a table thirty feet from me, with a bottle of wine before her, eating what looked to be a piece of baked chicken. I pondered saying hello to her, but decided against. I drank my beer and reflected on her beauty as opposed to my feelings about her. I kept circling the fact that I don’t like her and sure the hell didn’t want to socialize with her. My steak dinner arrived and I attacked the 24-ounce Porterhouse. But my eyes remained on Dr. Laura Peters, M.D. and a pot of alphabet soup.