I was the type of prepubescent girl who forever pestered Mom and Dad for a pony. I had horse posters, a zillion horse models, and bookshelves filled with horse stories, of which Black Beauty was my favorite. When I got to my teens, my folks finally relented and allowed me to lease a beat-up school horse, probably in an effort to keep me out of trouble, or at least to shut me up. My first horse was an old swaybacked creature named Carou, whom I loved desperately. He was absolutely bulletproof and remarkably forgiving. We could have hung from his nose and he wouldn’t have minded. A year later, I moved up to a monstrous Appaloosa gelding named Ulysses, and then a trim black mare, Targa. These horses patiently taught me how to care for them and how to ride. When I got to high school, boys and parties began to consume my interest and horses gradually faded from the picture. But I never lost that passion.

Later I rekindled that old romance. Stanley was a retired racehorse who belonged to a friend, Liz. Stanley had been fairly successful on the California circuit until he broke his leg on the racetrack and got a plate put in his ankle. Liz bought him and turned him into a pasture horse. Everyone on the ranch knew his sweet temperament and his enormous size, but no one thought he was anything more than an amiable lawn ornament.

I met Stanley in 1999, when Liz offered to let me go out and ride him occasionally. I was soon seeing him daily, riding in all weather, training him and slowly building him back up. Gradually, the real Stanley began to emerge—a perfectly conformed Thoroughbred. Sure, he had arthritis and couldn’t jump fences. On cold mornings he was stiff and I had a hard time keeping weight on him. But everyone who knew him was amazed by the transformation.

The following summer, Liz called to tell me she was giving him to me. She understood how much I loved him and she wanted us to be together. Mark had been fine when I brought home a cat and then a dog, but you can imagine his expression when I walked into the living room to tell him we now owned a 23-year-old Thoroughbred.

Stanley was like an 1,800-pound golden retriever. He was wise and gentle, but still had the stuff to give you a buck and a bolt to remind you he was once a magnificent racer. Over the next several years, we became inseparable.

Time eventually caught up with Stanley, and he began to fail. He became blind in one eye, and when his other eye started to go, he grew frightened, anxious and sometimes dangerously unmanageable. One day I walked into his stall and snapped a carrot. It was a noise he knew well, yet he spooked and nearly ran me over. He ended up in the corner of the stall, trembling with fear.

I had made a promise to him years earlier that when he was ready to go, I would make it easy for him. On January 21, 2006, we laid him down under an oak tree where he loved to graze. He died munching a carrot, and the last words he heard were “I love you.” It broke my heart, and I still miss his soft muzzle and our deep friendship to this day.

“Good heavens, what happened to you?” I asked, surveying Fred’s ankle fracture as the medics rolled him through the emergency department and toward the orthopedic room.

“Got my foot caught in the stirrup when a horse threw me, then he dragged me for a ways,” Fred replied, grimacing with pain. He held his leg still with both hands, as every tiny movement made the muscles spasm. The medics had kindly given him a great deal of morphine en route to the hospital from Half Moon Bay, but he was still obviously uncomfortable.

“Well, you certainly did a fine job of it,” I said. “OK, let’s gently lift him over to the gurney. On three. One, two, three.” Gently, we moved him to the bed. He was covered with dirt, and his injured ankle was still in a mud-caked riding boot bent inward at an unnatural angle. “Does your neck or anything else hurt? Did you pass out or hit your head?” I asked as I started helping him get undressed.

“I think I pulled a couple of muscles in my back when I got dragged, but everything else is OK,” he replied through gritted teeth. “I need to use the phone,” he added. “I have to make sure the horses got put away.”

“You can do that as soon as I get you settled in,” I said. “So what happened?”

“I’m the caretaker of a quarter-horse ranch down in Half Moon Bay. I was out riding on one of the mares who doesn’t like water. When I made her walk past a puddle she spooked and bolted. She reared up, I fell off, and my foot was still in the stirrup. Got dragged about a hundred feet down the trail through the mud until she stopped.”

“Is she always that bad?”

“She has her moments.” He winced as I pulled off his clothes.

While I helped him into a patient gown, I pushed the gurney over to the phone. “You go ahead and call to check on the horses. I’m going to get some more morphine and get the doc to take a look at this. It’s going to hurt a lot when we take that boot off. I can take the edge off with the morphine, but you’re going to have to hang in there with us, OK?” He nodded.

Twenty milligrams of morphine later we had the boot off, and I was preparing Fred for surgery. The X-ray revealed a rather impressive ankle fracture that would require an operation to place a plate and screws to stabilize the bones. As I was finishing his paperwork, we started chatting about horses. Fred’s employer was an absentee owner who only showed up once or twice a year—someone who liked to say he owned a horse ranch out in California but was really uninterested in the whole affair. Fred cared for seven horses by himself, and lived in a small cottage behind the main house.

“It’s not as great as you think it might be,” he said. “The horses don’t get ridden nearly enough. It’s all I can do to just keep the place running and the stalls mucked out. Take Jake, for instance. He’s a purebred quarter horse, a former champion barrel racer. He should be worked every day. But I don’t have time to ride him. It’s a waste.”

“Jeez, I’d love to have a horse like that,” I said. “I’d do almost anything to get to ride regularly again.”

“Are you serious? If you want to come down and help me exercise the horses, it would really help me out a lot. Especially now. I don’t think I’ll be riding for a while with this ankle,” he said ruefully.

“I’d love to. Just tell me how soon I can come down, and I’ll be there. Like tomorrow?”

Fred laughed. “I think I should probably be there to show you around.” He thought for a moment. “OK, this is my offer. You make a commitment to come down at least twice a week, brush two horses and ride one, and we have a deal. What do you say?”

I was thrilled. “Of course. Can Mark, my husband, come along?”

“Does he ride?”

“He used to ride rodeo as a kid in Texas. He’s better than I’ll ever be.”

“Perfect. I’ll call you when they let me out of here.”

Mark and I went to the ranch a week later, and Fred hobbled around on crutches as he introduced us to the horses. My favorite was Jake, a large black quarter horse gelding with a wonderful disposition. And riding him—what a joy. He was smooth, responsive, and well behaved. He danced as he walked, kicking up his heels just for the fun of it. Fred insisted we stay in the ring until he was well enough to go out on the trail with us, but that was good enough for me.

Fred was grinning as Jake and I loped easily around the ring. “You better watch out, Mark. You’re gonna get some competition from that horse. I think I see a love affair starting.”

“You’re probably right,” Mark agreed. “Now she’ll never be home.”

“And Janice, don’t get too attached to ol’ Jake there. We’ve got other horses that need some ring time, too, remember.” I knew he was right, but I had already picked my favorite of the bunch.

Several weeks later, Fred was back on his feet, and we planned the big trail ride. Fred was going to be on his own horse, and I finally was going to be able to take Jake out. When I got to the ranch, Fred asked if I would first brush BJ, the horse responsible for breaking his ankle. After I got to know her, it didn’t surprise me that she was the one to hurt Fred. She really didn’t like people. Every time I went to get her out of her paddock, she would shy away. When I cornered her and got her halter on, she would rush the gate, running me over. When we finally got to the bar to groom her, she would nervously move around, reaching around to bite or step on any available body part. And forget about cleaning out the hooves. She seemed to enjoy taking aim and kicking. If you weren’t in kicking range, she’d try to reach around and bite. In short, she was mean, uncooperative and jittery. These are not good characteristics in a horse, particularly considering horses outweigh their riders at least by a factor of ten. I struggled with her for half an hour, and she nearly stomped my instep while I was trying to brush her. I was glad to put her back in her paddock where she couldn’t get at me.

Finally it was time for the ride with Jake, and I went to collect him. He stood sleepily while I brushed him, and obediently held up his feet for cleaning. While I combed out his mane, he leaned his head on my shoulder and nuzzled my neck. “You are too cute,” I whispered to him. When we got to putting the saddle on, he seemed to know that something was different. He began to stir restlessly, anxious to get on with it.

As I suspected, he was fabulous on the trail. We rode for nearly four hours along the rugged San Mateo coastline and ended up at the beach galloping through the surf. It was marvelous—one of those picture-perfect days Madison Avenue would have us believe are real.

Our hobby proved to be a wonderful diversion from the depressing world of medicine. We settled into a routine at the ranch, coming down twice a week to ride. If I could have gotten away with it, I would have just ridden Jake, but the other horses needed to get out as well. One afternoon, Fred asked me to saddle up BJ to take her out. He had been working with her, and wanted me to see if she had made any improvements. Getting her brushed and saddled was a chore, and every time I tried to get on her, she stepped away. When we got out on the trail, it was clear to me nothing had changed. She was spooking at every leaf and noise, and as we were trying to walk through a gate, she balked, then began to rear and buck.

“Don’t let up,” Fred advised, safe and comfortable on his own horse as BJ bounced in circles. “Just turn her around a couple of times, then walk her through.” I was getting increasingly nervous as she became more unruly. “Don’t let her get her way. Just keep insisting,” he yelled as we spun around. BJ knew she was getting the better of me. Finally, after a dig of my heels, she settled down and nonchalantly walked through the gate.

“Bitch,” I muttered under my breath.

Farther down, we encountered a large puddle stretching across the trail. BJ stopped abruptly and refused to walk any farther, making it clear to us her aversion to water had not changed. She refused and whirled each time I walked her up to it, becoming more adamant with each attempt. Finally I gave up.

“Fred, we’d better switch horses. I can’t get her to do this.” Reluctantly he agreed and I dismounted and held her reins. She seemed to know the boss was about to get aboard, and she stood still as Fred climbed up.

“Come on now,” he said to her as he turned her back to the puddle. She hesitated, turned several times, then bolted across the puddle, splashing mud all over herself, the saddle, and Fred. “This isn’t going to work,” he said. “I’m going to see if Niles will work with her. This nonsense has got to stop.”

Niles was a handsome young Austrian with a thick accent and a lovely Arabian mare. He was a gifted rider and was known in the area for sorting out problem horses. He had that perfect combination of patience and persistence. Sooner or later, even the densest or the most stubborn horse would get it. Of course, some took longer than others.

BJ continued to be troublesome all the way home, even with Fred in the saddle. By the time we got back to the ranch, she was covered in mud up to her ears, as was the saddle and bridle. Fred took the tack into the barn to clean it and I was left with her, struggling to clean her up. Niles walked into the yard as I was trying, for the fifth time, to get the mud off her nose.

“What’s going on?” he asked as we struggled.

“Just being bad again,” I said. “Fred had to ride her home.” Fred emerged from the barn, holding the bridle.

“It’s that water thing,” said Fred. “She just will not walk through anything wet. She almost threw Janice. I got on her and made her walk through the puddle, but it wasn’t a pretty picture. This is the result. Got any suggestions?”

“Why is she afraid of the water?” he asked.

“Don’t know. She was like that when she got here. I keep telling the boss to get rid of her, but he won’t ’cause of her papers. Want to take her out tomorrow and see what you can do?”

“Sure,” Niles agreed. “I’ll take her in the ring first and feel her out, then we can try a ride. Maybe we need to show her there’s nothing to be afraid of.”

They wandered away as they talked. I tried again to brush BJ’s legs, but she wasn’t having any part of it. I finally gave up and sneaked her past Fred when his back was turned. I quickly unloaded her into the paddock, hoping he wouldn’t notice her legs were still dirty. “Gotta go,” I yelled, closing the gate and beating a hasty retreat to my car.

I was scheduled at CALSTAR the next day, and it turned out to be beautiful. The sun shone brightly, and a gentle breeze cooled the hot summer air. The hills were golden brown, and the smell of barbecues wafted over the airport. Later in the afternoon we were activated to Half Moon Bay for a drowning.

Most of the time, drowning calls turned out to be dry runs. Often they were cases of mistaken identity—occasionally the missing person hadn’t even been in the water. If there actually was a body, the fire department would frequently be unable to locate it because the powerful tides and currents had washed it miles away. When that happened, there would be nothing left to resuscitate. Still, because it was such a lovely afternoon, we welcomed the helicopter ride to the beach. I was grinning as I called into dispatch.

“CALSTAR Base, CALSTAR One. We have lifted off at 14:48 en route to Half Moon Bay, rough ETA sixteen minutes, getting us there at 15:04. Ready to copy Thomas Brothers map coordinates and radio frequency.”

“CALSTAR One, Base. You have been activated for a drowning north of Half Moon Bay, map page 263 B4. Radio frequency will be Half Moon Bay Fire on Calcord, 154.280. Be advised they are unable to locate the victim. Fire department says he may still be immersed. This incident is not on the beach—the victim is reportedly in an irrigation pond east of Highway 1.”

“Copy that, Base. Please check availability for Peninsula and Seton Hospitals.”

“Base copies. Will do.”

“Doesn’t look like this is going to turn into a transport,” I said into the intercom.

Tim agreed. “Yeah, but there are worse things to do on a Sunday afternoon than take a helicopter ride to the coast.”

As we cleared the coastal hills heading down to the beach, base called us back. “CALSTAR One, you have been canceled. The body has been located and the patient has expired.”

“Well, we’re almost there,” Tim said. “Want to just fly over the scene to take a gander and then we’ll head back home?”

None of us was in any hurry to go back and sit in quarters, so we continued on. As we approached the scene, I realized we were near the ranch. “Hey, you guys, I was just out here yesterday riding. See that barn over there? That’s the ranch where I’ve been spending time. We were just on that trail yesterday.”

Tim initiated a high orbit over the irrigation pond where Fred and I had ridden the day before. From our altitude, we could see the paramedics covering a body with a yellow sheet. Several horses standing nearby, restless from all the commotion and the noise of the helicopter, appeared ready to bolt.

“Tim, maybe we better get out of here. We don’t want to spook those horses and get somebody else hurt,” I said.

“Yeah, you’re probably right,” he answered and veered off.

When I arrived home the next day, there was a message from Fred on the answering machine. His tone did not relay his usual ebullience. “Call me as soon as you can,” was all he said.

I dialed his number, puzzled as to why he sounded so upset. Could he really be that mad at me for putting BJ away without cleaning her legs? Had I left a paddock gate open somewhere?

Fred answered on the third ring. “Fred, it’s Janice. I got your message. What’s up?”

Fred took a deep breath before answering me. “Janice, there’s not going to be any riding around here for a while.” I must have done something really horrible to be banned from the ranch. Never again, I vowed, would I ever put a horse away with dirty legs.

“We had a problem out here yesterday. I don’t know how to tell you this,” he continued. “Niles and BJ were killed.” I sank to the floor in disbelief.

“Oh, my God. What happened?”

“Remember how BJ was giving you such a bad time the other day?” he asked. “Well, Niles took her out to try and work with her a bit. We went over to that irrigation pond by the beach.” I had the horrible feeling that I knew what he was about to tell me. “Anyway, she wouldn’t get into the water. He was making her walk in and out of the water, and she started balking. The next thing I knew, she freaked and plunged into the pond and got her feet tangled underwater. She totally lost it, and started bucking and screaming. At one point, she reared up, and Niles slid off. As he did, she kicked him in the chest and he went under. I ran and jumped to grab him, but she was thrashing around, and I couldn’t get to him. Then she went down, too. I swam over to where they had been, but I couldn’t find them.”

He stopped and sighed heavily. “There were some people going by who had a cellphone, and they called for help. Then they got in the water too and looked for him. But by the time we found him, they had both drowned.” A long silence filled the space between us.

“Fred, I was on the helicopter yesterday. We were the ones orbiting overhead. I had no idea it was you and Niles.”

“Yeah, I figured that was you. That damn horse. I kept telling the boss to get rid of her, that she was dangerous, but he wouldn’t believe me.” He sighed again. “Do you want to know the real pisser? If that horse hadn’t been so crazy thrashing around like she was, Niles might have gotten away from her. He’d still be alive. When they pulled him out of the water, he had a perfect hoof mark in the middle of his chest. It wasn’t a bad enough injury to kill him. He just got the wind knocked out of him and couldn’t catch his breath long enough to get away from her while she was thrashing around. By the time we pulled him out, he was gone. They pulled BJ out, too, about an hour later. Her feet were tangled up in old baling wire. Anyway, there’s not going to be any riding around here till we get all this straightened out. I hope you understand.”

I never did go back to the ranch.

We only flew over the accident that killed Niles and BJ, without having to be involved in the interventions. Later, I had the displeasure of accompanying a colleague on a call that hit even closer to home. We knew it would happen someday.

“CALSTAR One, you have been activated for a scene call to Highway 1, three miles north of Davenport, for a bicycle accident. How do you copy?”

“Base, CALSTAR One. We copy you 10-2. We have an ETA of approximately seventeen minutes, getting us there at 13:37. Ready to copy map coordinates and ground frequency.”

Rose and I grinned at each other as we lifted off toward the coast. She was one of my favorite partners. She’s exceptionally bright and somehow has a smile and a hug for everybody. In the midst of chaos and tension, Rose always maintains a calm exterior. She is also acutely aware of the human side of our care, reminding us these are not simply bodies we are salvaging, but human beings with lives and families. Her perspective calms patients, families and co-workers, and I often wish I could emulate her style. Unfortunately, if I allow myself to consider the personal lives of my patients, I can’t concentrate on the work at hand. It becomes too painful.

We welcomed this particular flight. The summer weather was warm and clear, and we had been itching to get out of quarters on such a lovely day. A helicopter ride out to the spectacular San Mateo coast was a special treat. We didn’t expect the patient to be too critical. More often than not, we were called not because of the severity of injuries, but because of the remote location and long transport times.

As we circled the scene, the CDF firefighter began giving us landing zone instructions. “CALSTAR, we’re going to land you on Highway 1, as there are no appropriate LZs nearby. There is a set of wires crossing the road a quarter-mile to our north, but no other obstructions. The wind is negligible. Let us know when you’re on short final, and we’ll have CHP shut down traffic.” We acknowledged the radio call and scanned the LZ for potential problems. On my side of the helicopter, I saw our patient lying on a backboard with the paramedics assisting respirations with a bag-valve mask.

“Uh-oh, Rose. Looks like this isn’t going to be a cakewalk after all. I can see the medics bagging him. Doesn’t look like he’s intubated yet.”

“Great,” she said. “Get over to me as soon as you can get the helicopter secured, OK?”

“You want me to hold your hand, right?” I teased. She whacked my arm as a reply.

As soon as we landed, I handed her the trauma bag and she scurried off to the patient. I offloaded the litter and took a last look around to ensure the helicopter was secure. To my horror, I saw a reporter and his cameraman running toward the patient, with the helicopter squarely in their path. Clearly intent on getting gory footage for the evening news, they appeared unaware they were about to run directly into our tail rotor. Frantically I waved them off. Aside from the mess they would make if they killed themselves, we already had one patient and we didn’t need to add to that number. I glanced over at Rose and the medics. She was lying on her stomach in the gravel trying to intubate the patient. She obviously needed some help, and I was wasting time because of these nitwits.

I ran around the rotor diameter and collared them. “If you come any closer to the helicopter, I’m going to rip your throats out. Get over to the ditch on the side of the road and stay there.” They both nodded obediently and sank down into the ditch. I ran over to Rose and the medics who were struggling to secure the patient’s airway.

This was not someone who had simply fallen off his bicycle. Half his face was ripped off, and worst of all, one of his eyes stuck out at a crazy angle, dangling by the retinal stalk. He had an open deformity to his chest wall, and through the jagged wound I could see air and blood bubbling out. His trachea was pulled way over to the left, indicating his right lung had collapsed. With every breath he took, more air got trapped in his chest, compressing the good lung and the heart. Because of this crowding in the thorax, his blood pressure was falling dramatically. So was his oxygenation.

Rose was searching for the vocal cords with the laryngoscope. “Got it,” she said finally, and slipped the tube into place. I got out the stethoscope and listened for breath sounds. “He’s really hard to ventilate,” Rose said, and I slapped an air-occlusive dressing over the wound so no more air would get sucked in.

“Rose, I’m only hearing breath sounds on the left. You’re going to have to needle his chest.”

“I know,” she said. “Want to prep him while I get the stuff out?”

I nodded and began to prep his skin with Betadine as she got her equipment ready. “He’s got a huge flail segment over here,” I said, indicating the multiple rib fractures surrounding the chest wound. Rose nodded and started feeling for her landmarks.

“Yeah, that’s the side he was impacted on,” she said as she eased the big needle into his chest, releasing the pressure that had built up inside. There was an explosive release of air and blood.

“He’s a lot easier to bag now,” the medic said.

“Impacted?” I asked. “What happened? I thought he fell off his bicycle.”

The medic looked up while he was helping Rose stabilize the pleural needle. “Hit and run. Witnessed by that guy over there,” he said, leaning his head toward a small group of people gathered on the other side of the two-lane road. “Car was speeding and veered into this guy, throwing him over forty feet. We found him on the side of the road with his bicycle helmet cracked in half. Driver didn’t even stop—just kept on going. He’s gotta have some damage to his car. The CHP is looking for his sorry ass right now.”

Rose took over bagging the patient as the medics and I finished packaging him. We loaded him into the helicopter as quickly as we could, anxious to get him to the trauma center. As we lifted off, I noted we dusted off the reporters pretty well, much to my satisfaction. Maybe next time they would be a little less intrusive.

Once in the air, Rose began to attach the monitors. I grabbed and arm, looking for an IV. “I HAVE A GREAT ANTECUBITAL OVER HERE!” I yelled, not realizing she had switched us to hot mike. “Oops, sorry. Your ears OK? Anyway, you want me to get the IV started?” She nodded, and I began the fluid resuscitation. Meanwhile, Rose gently placed saline-covered gauze over the enucleated eye, protecting it until somebody could put it back where it belonged. I breathed a sigh of relief. Some say the eyes are the windows to the soul, and such a disfiguring injury is unnerving.

We were in the trauma room in fifteen minutes. As we rolled in, the trauma team took over our care with their careful routine. Rose gave report as we handed over care.

“This is a gentleman we estimate to be thirty years old who was struck at freeway speeds out on Highway 1 while on his bicycle—a hit and run. He was wearing a helmet but”—she gestured to remnants of the helmet, lying in pieces between the patient’s legs—“you can see it was split in half. He was thrown about forty feet, and was found unresponsive with agonal respirations.” She lifted the gauze gently off the eye. “As you can see there is an enucleation, as well as the obvious facial trauma. He also has a large flail segment, and we found him with a tension pneumothorax, with no breath sounds on the left and tracheal deviation. We intubated him, and did a pleural decompression with an immediate improvement of breath sounds and vital signs. There’s one large-bore IV on the right; we didn’t have time to start a second one.” We backed out of the room with our litter and allowed the trauma team to start their work.

I rooted our patient’s wallet from his cut and bloodied clothes, retrieved his driver’s license and handed the rest of the wallet to the control nurse. “I’ll be back with this in a minute so we can get a name and address, OK?” She nodded and I ambled into the break room to start the never-ending ream of paperwork that was generated with each flight. Sitting down heavily, I took a deep breath and stretched. We always became very focused and intense with such a critical patient on board, and I needed a few minutes to decompress before tackling the chart. Rose came clomping into the room, banging the door shut behind her. She was smiling and put her hand up for a high five.

“Eh, how about that?” she said. “What a bitch.”

I slapped her hand. “You were fabulous, as always,” I said.

She smiled and pulled out a chair, picking up the license. I pulled over the chart, preparing to write the name. “What’s his name?” I asked, looking down and ready to copy it onto the front sheet. I heard a choking sound, and looked up. Rose had gone white and was shaking.

“Oh my God, I know this guy,” she whispered. She sat down heavily and buried her face in her hands. “He’s an artist down in Santa Cruz. He runs a little glass and ceramic shop.”

“Oh, Rose. Are you OK?”

She sat quietly for a moment and said, “I have to call Jill, his wife. Where’s the phone?”

“Rosie, wait. Maybe there’s been some mistake,” I said. “Maybe you should go take another look at him before you call her. You better make sure it’s really him.”

“I don’t know if I can look at him right now,” she said dully. “But I can’t let some stranger call her.” She sat quietly for a minute, trying to decide what to do. “Will you come with me?”

I nodded and grabbed her hand. Together we walked back into the trauma room, which had become a very busy place. The surgeons were placing bilateral chest tubes, and general chaos reigned. I spoke quietly to the control nurse. “May we go take a look at this guy again?” I asked. “We think this is a friend of Rose’s. She didn’t recognize him because of the facial trauma, but it’s him on his license.”

She put her arm around Rose’s shoulders. Together they sidled up to the head of the gurney. Rose looked at him for a minute, dropped her head and cried. “That’s him,” she said. I followed her as she slowly walked out of the trauma room.

“Do you want me there?” I asked.

“No, I’d rather have some privacy,” she said. She walked to the desk and reached for the phone.

The artist died two days later.