The first time I set foot on the step and looked into the back of the ambulance, I felt something change in a way that I couldn’t place. Anxiety, fear, excitement-a heady cocktail of epinephrine inducing emotion that set my heart to racing and the butterflies in my stomach doing back flips. There was also something underlying that rush, though: a feeling of belonging and connection that I’d never before experienced. I felt centered. My preceptor must have sensed this combination of feelings-goodness knows, I wasn’t anywhere close to his first student rider-and worked throughout the shift to encourage that inclination I felt toward belonging to a career greater than any one practitioner of our art and science.

My first real patient-the type that anyone thinks of when they imagine ambulance work-was a woman who had driven drunk with her two children in her car, and had managed to wrap herself around a telephone pole. One of the children escaped unscathed, the other was placed in a full spinal package-a increasingly obsolete concept in EMS which describes strapping a patient onto a long, hard board and encasing their neck in a cervical collar. Their mother received the same treatment, and I was assigned by my preceptor to care for her during the ride to the hospital. During that transport, I learned the importance of unconditional care for my patients, regardless of how they had become my patients or what wrong they might have done.

By the end of that ride, I was hooked. I knew I was meant to be in this field, and I wanted to be in that uniform more than anything. I progressed through school, and I pursued my goal with a dogged determination. When I got certified as an EMT in January 2011, I put in my application at the service where I’d taken that first ride, and I pestered that poor HR representative until finally, in September of that year, I put on that uniform for the first day of what would become a seven-year journey with that service.

In that seven years, I would end up transporting hundreds of patients of all ages, from the tiniest, hours-old newborn clinging to life, to the fading centenarian going home from the hospital to die. I would have a front-row seat to joy, pain, triumph, and tragedy. I would bring a patient back from the edge of death, and I would stand, head bowed, in front of a family member and tell them that we did everything we could-although in my heart, I would never believe it myself.

I would have a repeat patient-a homeless alcoholic-stop me in my tracks by replying to my rote question, “Do you hurt anywhere?” by staring into my eyes and, with breath wrapped in the odor of his liquid amnesia, whispering, “Just in my soul, man.”

I would hear the father of a terminally ill newborn beg the physician for consent to take his child to the rooftop garden of the hospital, so that he could feel sunshine on his face one time before they had to let him go.

I would witness the macabre results of one human being’s inhumanity to another at murder scenes, and see the results of desperation and helplessness after a patient drank a bottle of bleach and then, amidst inhuman wails of agony, begged me to end his suffering.

I would also watch a firefighter risk his own safety to pull an accident victim out of a wrecked and unstable vehicle. I would see a sheriff’s deputy wrap a towel around his arm to smash out the window of a flaming house and reach inside to pull the family’s dog to safety, and have the honor of observing what can only be described as the ballet of a professional and well-trained ER trauma team working a critically injured patient as he clings to life.

I would push my way through long shifts, spend my days and nights off working my way through paramedic school, and come home to a quiet, dimly lit house. I would promise my sleeping children as I spoke to the empty air that tomorrow would be different. Tomorrow, I would tell them, I will be home earlier, and we can play together then. Tomorrow-that magical time, that fairy tale land we call tomorrow, I would play with them, I would cook them their favorite meal, I would sing lullabies to them, and I would hold them close to me as they drifted off to sleep.

Tomorrow, and tomorrow, and tomorrow, and it was, indeed, a tale told by an idiot, signifying nothing.

I would see two of my brothers buried, develop-and break-an opioid addiction, and watch dozens of others set their uniforms and badge on the counter in our ready room and walk away, right up to the day when I elected to do the same.

But it’s a truly exquisite kind of torture, this life we lead as paramedics and EMTs. Like Samuel Johnson’s patriotism, it can be the last refuge of a scoundrel. Cheat on your wife, drink like a fish, neglect your children, and you’re condemned by those who know you for it. Put on that uniform, hop on that truck, and push Narcan to revive someone’s honor student who’s broken into his parents’ medicine cabinet, and suddenly you’re a hero, even if you’re going to go home at the end of your tour and pop those same pills yourself. No self-esteem? No problem. Slap some stickers on your car and pull on a T-shirt with a Star of Life on it, and practice your humble smile in the mirror for all the people who will “thank you for your service.” It’s the perfect way to avoid seeing your failings, or dealing with your shortcomings.

Until, one day, it’s not.

The reason why the ride will end is different for everyone. Some of us will sustain an injury that takes us off the ambulance, relegating us to the relative insignificance of a tech position in an emergency room, where we’ll pass the time while stocking patient rooms and IV carts swapping war stories from our “glory days” with anyone who will listen. Others will push the envelope too far, one too many times, and after yet another visit to the “principle’s office” for a lecture with “some snot-nosed, wet-behind-the-ears Lieutenant” who was in diapers while we were EMTs, we’ll decide it’s not worth it anymore, and draw an early retirement.

And others of us will take time off for the first time in years, realize that it’s nice not to have to wake up before the sun comes up and work until after it goes down, see a psychiatrist to get rid of those voices that have made themselves at home inside our heads for so long, and give our children that magical “tomorrow.”