December 2, 2021 Last night I was plagued by nightmares in my sleep; recurring dreams in which I was dying through a series of tragic events. I spent the duration of yesterday thinking about my 22 year fire department career. Last night I as I lay awake, I realized that there is a ceiling in the darkness, and now is the time that I need to finally tell my story. These are the critical incidents I now think about, sometimes up to 10 minutes out of every day. The memories are always with me; they never go away, and time does not heal the wounds. Incident #1:When I was a new medic, I was a work talking to a coworker of mine about the weekend shift. We were both scheduled for a double shift on the upcoming Saturday and Sunday and we were making plans to get the crew together and have a BBQ at the station. My coworker knew a local butcher and we were planning to cook up hamburgers and hotdogs. Before we could finish our conversation, a call went out for a medical assist, and my coworker said, “Tom, I’ll see you Saturday, don’t forget.” He jumped into the ambulance, his partner jumped into the back of the ambulance, and from the drivers seat, he radioed in to dispatch that his unit was responding. A few minutes later, we got a second call for a motor vehicle accident. I responded with my medical unit while a few of my other coworkers responded with a fire engine. We arrived on scene moments later to find that my coworker who was responding to a 911 medical call had been struck by a drunk driver traveling the opposite direction. He was pinned at the wheel of the ambulance and was killed instantly. His partner in the back of the ambulance was unharmed because he was rear-facing and restrained with his seat belt. He was transported to the hospital, and I will never forget the blank emotionless stare on his face as he lay speechless on the stretcher as we transported him to the hospital. Incident #2:At 3 in the morning, a call went out for a critical car accident with one confirmed fatality. I responded from the station and less than a minute away from the scene. I responded with the Paramedic fly car and the police were already on scene. As soon as I arrived, a rookie police officer came towards me with tears in his eyes and he told me not to look. I told him it was okay, and that I had to because it was my job. I approached the scene and determined that there were two patients; one was not wearing their seat belt and had been ejected through the windshield of their vehicle at high speed and had struck a tree. Their body lay at the base of the tree, wrapped like a ribbon around the tree, obviously deceased. The second victim was a seat-belted driver of a smaller car that was traveling the opposite direction. Due to the impact, the driver was crushed into the back seat of the car with the driver seat pressing into the lid of the trunk. They were still alive and as soon as I approached the car, we made eye contact. With utter disbelief, I yelled out, “we have a survivor in this car”! I directed the crew to bring over rescue tools, and I started to provide care to the victim. I looked directly into his eyes and told him, “it’s going to be okay, I will take care of you, and take you to the hospital.” The victim looked at me, now with a look of confidence that they were going to be okay. At the time, I had just completed extensive training in vehicle rescue, so I started to cut the car apart while another Paramedic took over patient care. After several minutes, the patient had been rescued and placed into the ambulance. The patient started to crash, and an older Paramedic said that there was no time. The patient asked me if I would pray with them, which I did. Holding their hand as they died, the whole time I expressed how I was sorry. The last words the patient said were, “it’s okay; you did whatever you could, you were a hero, and I am at peace now.” They passed away and I could feel the life leave their body. The senior Paramedic took my hand away from the patient, and covered them in a white sheet. The next thing I remember was sitting on the back step of the ambulance crying and feeling as if I had somehow failed. Incident #3:I was doing city work, and responded to a 911 call for an unknown medical problem. As soon as I arrived on scene, I found a small child who had reportedly fallen down a flight of stairs and had two broken arms. The mechanism of injury did not match the injuries, but I nodded in agreement to the parents, and took the child to the hospital with my partner. I removed the clothes from the child, and noticed that they had a lot of bruises that were in various stages of healing; a few were fresh, many more were older. Upon my arrival at the hospital, I documented my findings, including suspected child abuse, notified the emergency room doctors, then finally submitted a report to child protective services. At work two weeks later, I was sent a form letter that stated that the incident had been investigated and that there was, “no evidence of abuse found”. At that moment, I was satisfied that the system had worked, and for whatever reason, I must have simply been overzealous in my reporting. About a month later, I responded to another 911 call at the same location, and again, found the same small child. This time, they had suffered severe burns. The parents stated that their child had, “accidentally touched the stove when it was on.” I again took the child to the same hospital, made a second report to the doctors, and a second report to child protective services. Two weeks later the same form letter arrived in my mailbox at work, stating that the second reported claim was investigated and that “no evidence of abuse found”. This time, I called child protective services by phone and reported that this was the second time I had reported obvious cases of abuse; the only response was that, “both reports were investigated and nothing was found”. A few months passed, and I continued at work as usual. One afternoon we were dispatched to a non-emergency request for assistance by the police. I assumed that it would simply be a standby for the police department, but we were requested to respond directly to the scene. As soon as my partner and I arrived on scene, we both recognized the location. The child was found deceased and wrapped in black plastic garbage bags. Because I was the Paramedic who had treated the child most recently, I was called in and asked if I could identify the patient as being the one I had transported twice before. I confirmed, to the best of my ability, that it was the same child. The coroner requested that since we had previously treated and transported the child on more than one occasion, that we had to transport the child to the hospital morgue, which although unusual, sometimes happens. My partner and I were sent for at-work counseling and a trauma therapist was called in. My partner at the time had a very difficult time getting past this incident. We were both eventually offered better jobs at different departments, and although we were no longer working together actively, we kept in touch. Suddenly, I stopped hearing from my friend and former partner. My friends family called me one morning to let me know what my friend had taken their own life, and left a note that stated that they could no longer handle the incident that the two of us were involved with, and that they were sorry. Incident #4:While I was working in a rural area, I was called as backup to a shooting call one Saturday afternoon. When I arrived, there were police everywhere, and the police officers rushed me into a house where I found a small child on the floor. They instructed me to start life saving procedures. During the time my crew and I were on scene, the child’s mother came home from work and somehow managed to get past the police officers and she walked into the scene. My crew and I were actively doing CPR on her child, and she was not made aware of what had happened. Finally, after working the code for several minutes, I decided to declare the patient deceased. Everyone was escorted out of the house, and the police started their investigation. The mother of the child came up to me and began to try and drag me by the arm towards the house to help her child. I told her that her child had been shot in the head with a hunting rifle and that there was nothing that we can do to help. I will never forget the look of sheer terror that came across her face. She fell on the grass outside her house in a catatonic, almost comatose state, before she eventually sat up and began moaning and rocking forwards and backwards. We transported her to the hospital where she stayed for a few weeks for psychiatric care before being released. Incident #5:The worst incident I ever responded to was a report of a house fire at 4 AM during Christmas vacation. Upon arrival on scene, my crew and I were presented with a fully-involved house fire with a family of four trapped in an upstairs bedroom. The house was fully involved, and there was no chance to save the house or its occupants. The decision was made to withhold water until the screaming stopped because by fighting the fire, we would only be prolonging suffering, as the family had no chance whatsoever of surviving. I am forever haunted by their screams being only partially drowned out by the smoke alarms that were sounding. It was reported that the cause of the fire was likely a Christmas tree catching fire at the base of the stairs in the house which caused a massive fire that spread quickly and prevented anyone from escaping the flames. We later found their charred bodies in a pile in the front upstairs bedroom. ColophonDiary entry Thursday, December 2, 2021; the names, locations, departments, and time periods have been omitted from this published article. AsidesPTSD, Suicide, and Despair: The Silent Perils of Being a Firefighter | Make it Stop | The aching red: Firefighters often silently suffer from trauma and job-related stress | Why every firefighter hates the ‘worst call’ conversation