The Dichotomy of Saving a Life

"DOES ANYBODY KNOW CPR?!"

A phrase that serves as both interrogative and demand. On one hand, it's a question seeking help. On the other, it's a request for help to help—an invitation to cross the invisible line between witness and participant, between the paralysis of watching and the burden of doing.

A few months ago, a coworker and I administered CPR to the victim of a heart attack. That day in the middle of an office lobby—flanked by DoorDash orders growing cold on one side, a group of determinedly not-looking bystanders on the other, and the echoes of a familiar female voice anyone who has taken a CPR class knows moving from "Analyzing rhythm. Do not touch the patient" to "Shock advised" to "No shock advised. Begin CPR"—we achieved what's known in emergency medicine as a "field save," to some or a ROSC (rosk-ee): Return of Spontaneous Circulation to others.

One minute: a pulseless body, absent of breath. The next: a beating heart, expanding lungs, and the weight of keeping it that way. We waited with clenched jaws and controlled urgency, willing that pulse to hold until help arrived. It was cinematic in its tidiness—we got their pulse back before the ambulance arrived. Two weeks before Christmas, a life hung in the balance, and through immediate action, we helped tip the scales. Weeks later, our patient returned to life, recovered, and ready to resume the ordinary business of living.

By conventional measures, this was a moment of unqualified success. We saved a human life. What could be more straightforward, more clearly positive than that?

Yet that night, neither my coworker nor I slept.

The Professional Ghosts

The dichotomy began revealing itself in those sleepless hours. While everyone else saw only the miracle of a life saved, we couldn't help but see it against the backdrop of all the lives we couldn't save during our careers as EMTs and paramedics.

The faces themselves blur—a composite of indistinct features—but the scenes remain crystalline. The banker who'd lost everything in the market crash, found by his wife who left her lipstick smeared across his lips in desperate attempts to breathe him back. The grandparent who made it to Christmas morning but not past it, leaving us to navigate the particular cruelty of covering a body while unwrapped presents waited under the tree. The teenager whose parents kept saying "he was just here, just talking to us" as if proximity to life could argue against death.

Each call had its own geography of grief: kitchen tables where morning coffee turned cold, bedrooms where one pillow remained undented, driveways where car doors hung open from someone's rushed return home.

The questions circled relentlessly: Why was this one successful when so many others weren't? What made the difference? How many others might have survived if circumstances had been different?

These aren't just abstract questions for former first responders. They attach themselves to specific addresses, specific times of day, specific sounds—the particular pitch of a spouse's disbelief, the rhythm of compressions that didn't work, the silence after you stop.

Success, counterintuitively, can sometimes throw failure into sharper relief. The same professional knowledge that allowed us to act effectively in that office lobby also burdens us with understanding exactly why other resuscitation attempts failed. We know which calls never had a chance. We can catalog the missing links in the chain of survival: too much time, too much damage, too late.

The Statistical Reality

Emergency medicine operates within brutal statistical constraints. Despite advances in training and technology, survival rates for out-of-hospital cardiac arrest remain stubbornly low. Each successful resuscitation represents a victory against overwhelming odds.

I have eight. After fifteen years and hundreds—maybe thousands—of attempts. Eight.

But the real weight lives in the denominator. I couldn't tell you a single name among those eight saves, but I can still feel my hands running through a patient's hair while stuck in 5 PM traffic, out of medical options, mumbling agnostic prayers under my breath because sometimes that's all you have left to give.

During our careers, we operated within these constraints daily. We understood intellectually that most cardiac arrest patients wouldn't survive regardless of our actions. We learned to define success not just in lives saved but in proper procedures followed, in comfort provided to families, in dignity maintained even when revival wasn't possible.

But intellectual understanding doesn't always translate to emotional acceptance. Each loss still weighs on the conscience, raising questions about what might have been done differently.

Our recent save was textbook perfect—immediate recognition, immediate CPR, immediate access to a defibrillator, trained responders already on scene. Most cardiac arrests occur without these advantages. Most patients never have the same chance.

That's the first part of the dichotomy: reconciling this perfect success with the statistical reality that made many of our previous attempts nearly impossible from the start.

The Value Paradox

The second part of the dichotomy cuts deeper, touching on questions of value and worth in our society.

I left emergency medicine because I couldn't afford to live on $32,000 a year. Thirty-two thousand. That's what society decided was fair compensation for someone who could restart your heart. Less than what most people spend on a car. Despite being trained to perform life-saving procedures, despite bearing the emotional weight of watching people die on Tuesdays, I couldn't pay my bills. My coworker left for similar reasons.

Now I earn a consultant's salary. My financial situation has improved dramatically. I'm considered "successful" in ways I never was as a paramedic. Doors have opened and invites have come from the simple possibility of business advancement—far more than they ever did when I was just someone with the ability to bring you back from the dead. 

Yet there I was, using my old paramedic skills to save a life in a way my new job never allows. The irony wasn't lost on me—I'm "valued" more for creating PowerPoints that will be forgotten by Friday than I was for work that literally kept people alive.

This is perhaps the sharpest edge of the dichotomy: society places infinite moral value on human life while assigning minimal economic value to the humans dedicated to saving those lives. We'll hashtag heroes all day long, but pay them like we're embarrassed they exist.

Finding Meaning in Contradiction

We didn’t just save one life.

We saved another one.

Another in the long, uneven ledger of this work—one that tilts hard toward loss, even when everything is done right. To the outside world, it was a miracle. To us, it was rare, but not unfamiliar. We’ve been here before. We know what it’s like when a pulse returns—and what it’s like when it doesn’t.

The “thank yous” and congratulations came quickly. They always do. But they arrive alongside quieter echoes: the ones only we hear.

The crying in back hallways. The fists against metal lockers in empty firehouses. The weight of numbers pressing harder than we admit, long after the sirens fade.

That’s the real story. Not just that we saved a life—but that we carry all the others with us, even when this one went right.