We worked in teams, worked quietly, orders almost whispered. One person doing chest compressions, one bagging, one person writing. I was looking for a place to start an IV. The smell of wood smoke was everywhere. We would wear it home that morning, would try to shower the scent out of our nostrils.

He was six years old and asleep for the first time in the wooden duplex where he, his brother and his mother had moved. His mother was tired and exhaustion finally defeated that last before-bed cigarette.

He was six and his brother was three. They slept in side-by-side beds in the ED. They slept completely. My own daughters, also three and six, slept soundly in their beds at home, their breathing easy, they dreamed.

I found a vein and cleaned off the skin. Cleaned off a layer, really, the tissue falling away like onion skin. I knelt next to him, slipped the needle into his vein and connected the tubing. Into the vein went epinephrine and atropine and our prayers. We searched his face, his chest, for any sign of response.

In most cardiac arrests there comes a point when everyone knows the out come, but there are still things to be tried, work to be done. That's the point at which we relax, make macabre jokes and quietly luxuriate in our alive-ness. This night there was only measured silence. We made eye contact, as if asking each other, "You see it, too, right? This really is quietly, calmly horrible, right?"

At nearly the same moment, both teams called it quits, leaving both boys still undisturbed in their sleep. The doctors walked slowly to their desk to complete the paperwork that attends the dying. The respiratory therapist unhooked the ambu-bag from the breathing tube. The other nurse, Maggie, and I began to disconnect IV's and make him presentable. I got a wet washcloth and wiped the soot away from his face, his eyes. We moved him to a clean sheet and covered him, moved him to a quiet room to await the coroner. There was no family there to wail and scream and ask God "Why?". It was quiet and we quietly did our jobs.

I went home that morning, my wife already at work and the girls in school and daycare. I made some toast and read the paper. I went to bed and slept soundly, dreams untroubled. Later that afternoon, I picked up the girls and we stopped at the store. I don't remember what I went there to buy. I only remember pushing the cart, Kit sitting in the kiddie seat, and knowing suddenly that we had to leave right now. I couldn't tell what I was feeling, but I knew it wasn't good. We got home and I turned on Sesame Street and left them in front of the tv. I went back into the kitchen and called my friend Harry.

"Hey, Harry. How's it going?"

"Not bad. How about with you?"

"OK, I guess. There was a fire last night and they brought these two kids. . ." and that was as far as I got. The horror and the grief came pouring out of me, drowning my words and it seemed like forever before I could get it out. I told him the story as best I could and he did the only thing he could do, the only thing I needed then. He listened. I had been fine at work, slept soundly, continued my day as always. But the feelings came over me like a thunderstorm - the first warning rumbles of trouble, my mood darkening like the skies, lightning crackling around me, then a moment of calm before the deluge. And I stood outside myself and observed it all happening and was amazed.

Of course I went back to work the next night because - why not? We all went back to work. We watched people try to hide their fears and pain, dealt with drunks who called us "motherfucker" when we tied them to the bed to keep them from fighting or falling to the floor, listened to the inevitable "When am I going to get waited on? Shit! - a person could die around here before. . ." and we talked again about the night before. That's how we deal with things - by talking, by telling the story and listening to other people's versions of the story, comparing notes, adding details.

When people find out I work in a trauma center, they always say some variation of, "Boy, I'll bet you see a lot!" And I smile and allow as how it can get "interesting" sometimes. And I may tell whatever funny story I can think at the time. This is the only story I never tell casually, though, and this is the only story that has stuck so closely through the years.

One morning after a long, grueling shift, I walked along side another nurse as we headed toward our cars. She stopped and looked at me for a moment. "You know," she said, "there's no way they can pay you for what this job takes away."
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