Chapter 1


Sixty minutes ago, I had everything.


We had just pulled up to the emergency entrance at Saint Mary’s with a 39-year-old woman who looked a hard 50 and smelled like she’d taken a bath in Jim Beam. Like most drunk patients, she’d fought and cursed all seven minutes of the ride from the bar, and blood from an eight-inch gash in her left forearm was smeared all over the gurney, the floor of the rig, my uniform shirt. 


Darrin and I had wheeled her into the ER and handed her off to the crew, and then I’d gone in search of a spare scrubs top to change into. I’d found one in the EMT lounge and taken it and a biohazard bag into a men’s room hardly anyone used. I was looking forward to a few minutes of quiet before heading back out.


I had washed my hands, taken a leisurely piss, washed again. Unbuttoned my shirt and stuffed it in the bag, washed my hands one more time, and pulled the scrubs top on over my head. It was a 3X and only a little roomy. I’d made a face in the mirror before pulling another paper towel to grab the door handle.


Darrin was standing in the hallway holding two cups of coffee. We’d bullshit for a few minutes about the call, the bar fight that precipitated it, the pothead we ran on yesterday whose open fracture was way more painful and serious than Ms. Jim Beam’s cut but who was totally calm and agreeable, and how we’d much rather run on a stoned patient than a drunk one, any day.


I could see colored lights from another rig, not one of ours, reflecting off the tile floors at the end of the hall. We could hear shouts and calls over the PA for more docs. We’d started to head back toward the ER suite to see if they needed help.


Paula at the admissions desk had seen us and jumped up, running at us like we’d crossed a tripwire. She was breathing in gulps and telling me not to go in.


Darrin had pushed past her. She’d let him go.


I’d asked her what was going on. I could feel my heart speeding up. 


She’d been close to tears. She’d made me promise to wait there until she got somebody. She’d brought her arms halfway up like she wanted to give me a hug, but then a sob had burst out and she’d spun away, holding one palm over her mouth. 


I’d set the coffee down on the nearest flat surface - a cabinet? - and suddenly the floor felt tilted. I’d leaned on the cabinet with both hands and the cacophony from the ER had grown muffled. I’d slowed my breathing, tried to blank out my mind. One breath. Two.


Dr. Randall had come up behind me, saying my name softly. He was explaining they’d tried to find me but I must have been in the restroom. I’d nodded to let him know I’d heard him, but I didn’t want to turn around - because when I did, he was going to tell me the absolute worst thing I could possibly hear. 


“There’s been an accident.”


The five words no one ever, ever wants to hear. The five words that steered me away from police work, away from medical school and toward paramedicine - because I never, ever wanted to be the one to say them.


“Is it Anni?” I’d whispered.


Anni was fine, he’d told me. She wasn’t involved.


Oh god.


“Joel, your dad was driving with Matt in the car. There was a three-car pileup at an intersection.”


My eyes were squeezed shut and I was gripping the edge of the cabinet so hard I felt I was going to break it. My lungs were paralyzed.


“Matt was shaken up some, but it doesn’t look too bad. They’ve got him in the ER now and I’m sure they’ll be taking him to Radiology any minute.”


A gigantic bubble had burst in my chest and I’d felt a sob of relief escape. My hands had unclenched from the cabinet and I could finally find my footing to turn and face Randall.


He didn’t have that look of confidence and optimism I was expecting. His face was actually gray. 


“Your father …” He’d looked at the floor, then back at me. “We did everything we could …”


I’d finished his sentence in a whisper. “ … but his injuries were too severe.”


The explosion of gratitude and relief imploded back on itself and all time and light and sound stopped. I knew I should feel something - hello, my father’s dead - but everything inside me was empty and dark. 


Dr. Randall was saying something. In slow motion I’d looked up at his face but I couldn’t make out the words. He’d put his hands on my shoulders and the pressure felt like anchors. My knees had started to give out. 


Next thing I knew, I was in one of the red upholstered lobby chairs. My only conscious thought was Why would they put chairs like this in the ER waiting room? Why not plastic or vinyl that would be so much easier to clean? It pissed me off that that’s what my brain thought was important right then. 


Paula was kneeling in front of me with a bottle of water, and Dr. Randall was sitting in the chair to my right. He was telling me they were getting ready to take Matt to Radiology, asking me if I wanted to go in and see him.


The mental picture of my little boy, already so tormented by the world around him, being shouted over by strangers, poked, prodded, and hurting - had broken my heart. He needs me right now, and the rest - the grief, the emptiness and the darkness - can wait. 


Randall and Paula had walked with me to Matt’s ER bed. He looked asleep. His face was pale above bare shoulders bruised red and purple. Two IVs pierced the backs of his small fragile hands and I couldn’t help feeling the same sting in mine. 


I’d leaned in close to his forehead. “Hey Matt, it’s Dad,” I’d said, trying to keep my voice calm and steady. “I’m here and everything’s going to be OK.” The straw-colored lashes lining his eyelid had twitched. I’d reached out to stroke his hair, but my hand had stopped short. I didn’t know the extent of his injuries and I could never cause him more pain. 


“Buddy, the doctors and nurses are going to take really good care of you. They’re going to take you somewhere to make sure you’re not hurt anywhere they can’t see, and when you come back I’ll be right here with you. So don’t be scared, OK?”


His eyelids had fluttered again and then opened, and my heart felt like it could explode. I hadn’t realized how much I needed to see those beautiful gray-blue eyes again. I’d looked at his right hand, with the giant IV sticking out of it - it seemed uninjured - and I’d gently taken his fingers in mine. “I’m here, Mattie.”


I was prepped for the meltdown. On a typical day, my five-year-old would lash out screaming, sobbing, kicking and punching every three or four hours, whenever the world became too much for him to handle. We’d come to know that all he needed was a calm, quiet place. Sometimes he wanted one of us close, rocking, humming … sometimes he just needed a darkened, silent room. 


The ER’s icy brightness, the random eruptions of noise and motion, the needles and machines and plastic tubing - I could only imagine how terrifying it must all be to a very small, very sensitive boy. I’d waited for his frightened eyes to find mine and for the hysterics to begin.


He’d only stared blankly at the rectangular lights overhead. I knew he was hurting, but for my hyperactive, autistic son, keeping still for even a few seconds was something we weren’t accustomed to. “Mattie?” I’d said, thinking he must still be in the process of waking up. He didn’t blink.


I’d asked Dr. Randall if the medics had given him anything. He’d picked up the tablet hanging off the side of the bed and tapped the screen. “Only oxygen.”


Two radiology techs had come in and were prepping the bed for moving him. We’d heard raised voices and a scuffle in the lobby, and then Anni had burst into the ER. I’d never seen her eyes so dark and wild. It scared me. 


Seeing him lying so still, eyes wide open, was more shocking to her than if he’d been bandaged and bloody. “What’s the matter? What’s wrong?” she’d asked in a frantic whisper. But she was looking at Dr. Randall, not at me.


He’d looked up from the tablet screen, and I could see the questions behind his eyes. But his training was good. He’d calmly told her the most important thing right then was to get a CT scan so they could be sure there weren’t any internal injuries.


They’d wheeled Matt off, and Anni had gone with Paula to get some water. I’d made my way back to the lobby and sunk back down into the red polyester, leaning forward and resting my eye sockets on the heels of my hands, with my elbows digging into my knees. The pressure on my eyeballs felt like it was squeezing all thoughts out of my head. I didn’t want to think about anything - not Dad, not Mattie, not Anni. I just wanted to push it all back.


I don’t know how many minutes passed, but when I heard my name and lifted my head, yellow fog flooded my vision and I’d blinked to make it fade faster. As the clouds cleared I could make out Anni, though the voice coming out of her wasn’t her clear Scandinavian singsong. It was guttural, almost a growl, a mother wolf fighting for her pup’s life. “Did you bring him in,” she’d said. It was a statement, not a question.


“No. I was here, finishing up another call,” I’d told her. I’d started to stand up and move toward her, to hold her and breathe with her and let her start to refill my empty, hollow core, but she’d turned away.


“Did they let you see your dad?” The growl had only softened slightly.


I’d closed my eyes. Mattie had been the only thing in the universe that mattered for … how long since they brought him in? I’d realized with shame that I had not devoted a single thought to my father. I couldn’t answer. I’d shaken my head.


Anni had started listing off things that needed to be taken care of: getting in touch with the funeral home, calling my brothers to see what they wanted to do about a memorial service, talking to the cemetery, getting an obituary to the papers …


Each phrase from her was like a sheet of paper torn off a notepad and drifting into a pile, covering me. Smothering me. “Anni, just stop,” I’d said. “I can’t --”


She’d whirled around. Her eyes were still feral. “No, Joel. You don’t get to wait until it’s convenient for you. You have to step up and do your duty as a son. It’s your price for not doing it as a father.”


I’d stared at her. I was utterly at a loss. What the hell did she mean by that?


I’d searched her face for some spark of connection, solidarity, shared experience … but all I saw was an adversary. There was so much pain brimming behind her eyes, and I’d realized with horror … I was the cause.


“You think this is because of me?” I’d whispered.


All her rage and terror had erupted at once. “You KNEW he shouldn’t be driving! You knew it wasn’t safe for him to be on the road, and you let him get behind the wheel! You let him take our son and I will never, ever forgive you for that!” 


I saw my beautiful, strong wife, twisted into raw, ugly shreds of blame and resentment, and I knew something pure had vanished forever. Our trust, unsullied for 16 years, was gone. Gone, along with my father’s presence, and maybe my son’s. He wasn’t out of danger yet.


But now Dr. Randall was walking toward us from Radiology. I’d tried to scan his demeanor for clues to what he was going to tell us, but either my judgment had disappeared along with everything else, or he had a good poker face. 


Anni was still feverish with emotion. Hoarsely, she’d whispered, “Is he going to be all right?”


He’d reassured us there was no major organ damage or evidence of internal bleeding. He had a couple of fractured ribs. Anni had just nodded silently.


I was still fixated on what my son must be going through, what he must have experienced. What it must have felt like, being violently smashed into and rocked about, lying there in pain, terrified as all the sirens and voices and rescuers started converging on him … and I wasn’t able to help him through all of that. I needed to be with him now.


I’d asked if we could see him, and Randall had led us back into the ER. Anni and I didn’t say anything on the way to Matt’s bed.


He still lay there in unnatural calmness, staring at nothing.


Though I desperately wanted to hold my son, I’d let Anni gently sit down by his side. She’d softly moved a lock of white-blonde hair off his forehead and started quietly singing to him, a simple Swedish nursery rhyme that usually helped him calm down and focus.


I wanted this to be our fairy tale moment, where Anni would look into my eyes and all would be forgiven and we would never speak of her accusations again. 


But she only had eyes for him, and he needed her as much as he needed me. I’d turned away and stepped into the hallway to give them some time.


As I was looking for the nearest water fountain, my pocket had started to vibrate. I’d taken out my phone and clicked the screen off without even looking at the number, but the black slab in my hand had felt 10 times heavier than it should have, like it was made of cast iron. I couldn’t let myself put it back in my pocket, even though it would be so easy … and the next two calls I’d have to make would be the hardest thing I’d ever had to do. I’d dialed my brother Martin.


Before I could tap the green button to connect, I’d heard someone saying my name.


I’d looked up to see Dr. Whitlatch. She’d been seeing Matt since he was 3 and I was instantly grateful she was there.


She’d explained in a voice warm with concern that Dr. Randall had paged her about Mattie, and asked, “Is he done with the CT yet?”


“He’s back in the ER with Anni,” I’d told her, pocketing the phone. “He’s not … something’s not …” I’d felt my throat close and my nose start to sting as tears welled for the first time.


Whitlatch had put her hand on my arm. She knows our family and the challenges of dealing with Matt every day. And she also knows we wouldn’t trade a single minute of the past five years with him.


“Let’s go see him,” she’d said, squeezing my arm and leading me back into the ER.


Anni was still rocking and humming to Matt, though I could see the lines of tears on her cheeks. She’d stood up and hugged Dr. Whitlatch, who’d offered her a tissue and given her just the right amount of reassurance that they’d figure out what was going on.


Whitlatch had taken her penlight out of her coat pocket and flicked the beam into each of Matt’s eyes. She’d slipped two fingers under his left hand and lifted it slightly, watching for his fingers to curl around hers, but they stayed limp. Moving around to the end of the bed, she’d untucked the sheet and folded it over onto his shins, exposing his bare feet. She’d taken a stylus and run it up the sole of each foot. My own feet had twitched just watching. His hadn’t.




Sixty minutes ago, I was having a typical day at work, wrestling a bleeding 110-pound drunk woman in the back of my ambulance. I had a father who loved me and helped our family the best he could. I had a beautiful, special son who’d put me through tests that made me become more of a man than I ever believed I could be. I had an incredible wife who hardly seemed like a separate person, our connection was so intimate and so intrinsic.


Now, my father is gone. Forever.


My son has been terrified into disappearing within his own mind, to someplace where I don’t know if I can save him.


My wife … my god, have I lost her too?


The noises in the ER are growing muffled again and I feel the darkness starting to expand, swallowing me from the inside.


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