Scotty gets the tube down his throat, starts the ventilator. I take a scalpel; this is the part these children would never forget if they were to see it. A lifetime of nightmares. I cut his shirt away, insert the scalpel just below the ribs to make an opening. Finger thoracostomy. I’ve not done one in years, but when I move the tip of my finger in through the gap in his skin and feel the hot rush of blood spray out, I know it’s worked. The pressure slowly eases as the blood continues to drain from between the chest wall and lungs. Scotty, eyes wide now, rallies a second man to help us get the patient onto the stretcher. My finger is still there, holding the gap open to allow the blood to escape as we get him into the ambulance. He won’t die of asphyxiation now, but he’s a very high chance of bleeding out. I climb in, close up the doors and Scotty shoots us out through the parting traffic, the siren screaming, the wheels humming over the wet road.

The man’s blood pressure is still crashing. I peel his eyelid back, see the black ring, all pupil. That familiar sinking feeling inside me. The brain pressure has collapsed the iris. Brain death is now the best-case scenario. As we’re pulling into the hospital, I think about the children and feel the heat at the back of my eyes, unwanted tears forcing their way to the surface, but I won’t let them. A parent gone. I sniff, scrape my eyes across each shoulder before Scotty opens the back doors and pulls the stretcher out.

I know he’s a goner before the surgeons even start. I know that if we were faster today, if we picked it earlier and got him here sooner, he would have a chance. Not much chance, but a chance.

After we’ve finished at the hospital, we climb back into the ambulance. In the dark of the car park before I set out, I say Scotty’s name. He turns to me. I raise my flashlight and aim it at his eyes, he brings his hand up to block the bright light but it’s too late, I’ve seen what I expected. He was slow to blink, his pupils slow to contract and slow to dilate when he blocked the light. He’s medicated.

‘What are you doing?’ he says, irritated.

‘What have you taken?’

‘What?’

‘You’re on something,’ I say. ‘You’ve been off the last couple of weeks but it’s worse today. We missed our shot with him.’

He scoffs. ‘Come on, let’s go. Nothing would have saved that man and we don’t have time for this.’