by Ted Flanagan

When you die, and death doesn’t take, the return to Earth, a different kind of being born again, is a jarring experience. When you’re about to die, the transition seems distracting.

I’m guessing here. I’ve never died and come back, nor died and failed to return (yet). I’m a paramedic. I see this all the time, but I don’t understand it any better today than I did when I started two decades ago.

Once, a partner of mine asked a severely burned man if he had anything he wanted her to relay to his family. It seemed like a kind thing to do. Distraught over a custody battle with his ex, the man had doused himself with gasoline and lit a match. We were about to paralyze every muscle in his body, put a tube down the rapidly expanding, heat-ravaged tissues in his throat, which were swelling now because of the hot air and flames he’d inhaled. We were in a highway rest area far from this man’s home, from the home he’d never see again.

The idea was to keep a patent airway, oxygen in, carbon dioxide out, maintain the delicate pH balance in his body, keep the apparatus of life pumping, although the degree and extent of the burns made this moot, at best.

“You’re going to die,” my partner told him.

“That’s cold,” said a state trooper standing nearby.

“Do you have anything you want us to tell your family?” my partner said.

The man said his legs hurt.

I had a young patient from a factory explosion once, a worker who’d accidentally mixed two chemicals that can’t be mixed, now missing both legs below the knee, his chest and back seared by the blast wave and heat. Same thing: tube about to go in, patient survival questionable, leaning toward negligible. No last words, just screaming in intense pain. His legs, he said, his legs were killing him. He lived for a few hours in the hospital, but the damage was too great and his heart gave out.

Both of these patients disappeared behind the curtain of death, and I wish I could say that after nearly twenty years as a paramedic I had a better idea of what waits beyond that curtain. But I don’t.

During the Civil War, Dr. Samuel Gross was one of the Surgeon General’s most trusted advisors. Gross was one of the founders of what we would consider modern trauma surgery. Thomas Eakins painted his official portrait. There is a statue of him that once stood in the National Mall in Washington, DC, but has since been moved to Philadelphia.

Gross came up with my favorite definition for clinical shock He called it “the rude unhinging of the machinery of life.” It’s poetic in a way the medical profession is not these days.

From a purely objective standpoint, death is just that. The final breakdown of the machinery, the millions upon millions of biochemical interactions that take place every moment of our lives stopping in a moment of finality. Sometimes, when a patient’s heart beats too fast, we have to interrupt the process, give a drug called adenosine, which stops the heart for a few seconds, allows it a kind of reset. This brief period of standstill can be uncomfortable. A stopped heart, after all, is one half of the definition of clinical death.

The absence of the beating for some patients, no matter how short, is a moment of discovery. It’s the realization of a loss so profound, I think, as to overwhelm. Babies nuzzle their mother’s breast as much for the continued reassurance of that beating heart as for nourishment.

I’ve had elderly patients wail, bellow primal screams from the depths of their spirits, when the heart that’s thrummed inside their chests for seventy, eighty, even ninety years takes a five second hiatus. It’s their peek behind the curtain, and there are differing degrees of ready for that peek. Once in a while, I get the chance to bring someone back to our side of the curtain, and I’m still waiting for someone to report back on what’s out there. I’d probably settle for confirmation that out there even exists.

The closest I’ve come is one patient who went into cardiac arrest in our ambulance a few years ago. He was the service desk manager for a local car dealership. He’d been having chest pain for a couple days. The nametag on his work shirt was a white oval with red script that said Mick. This wasn’t our patient’s name.

We discovered he was having a heart attack. En route to the hospital, his heart stopped. We were on him in a second. When he regained consciousness, he said he’d watched us work on him from above, somewhere up near the ceiling.

I used to take naps on that same stretcher, crowded in on the sides by the narrow-gauge tubular black metal rails and the flat red paddle levers that raise and lower them. I’ve stared at the vanilla-colored plastic ceiling, a liner, really, insulating us against the cold metal skin of the box we rode in.

Look up and you see two rows of recessed lighting in column, pins for the moveable oxygen ports, an improbable scuff mark. If spirits gathered in my ambulance on their way to or from the Abyss, this box built in Georgia by the low-bidder on our ambulance contract hardly struck me as the place a benevolent God would choose as the portal for one of His creations.

Ultimately, I wanted more. I felt cheated, by this patient, and all the others who came back without information, without intel.

I wanted stories of tunnels of light and dead relatives waiting with open arms, vast green fields and infinite feast tables prepared by those who’ve gone before us.

All he saw was a few tired paramedics putting the hinges back together on his machinery of life.

Ted Flanagan is a graduate of Southern New Hampshire University's MFA in Fiction. He is a contributor to Cognoscenti, a branch of WBUR, Boston's NPR station.