Difficulty Breathing

May 17, 2024
Raymond Alkakooz says clinical rotations for an EMT trainee ingrained the necessity of struggle to achieve improvement.

Heat, fuel and oxygen. These comprise the fire triangle. Lose one, no more fire.

I kept these firefighting 101 basics in my head as I arrived at Phoenix Fire Department’s (PFD) Station 45 for clinical rotations and to volunteer to help or ride along. (I currently am studying for two health/medical-related degrees while I work as an EMT for a third-party service.)

For the 24 hours that followed my arrival at the PFD, I was on call as an EMT trainee. Taking on a shift that was a true waiting game—no second of peace guaranteed, no idea of what each dispatch would hold and no understanding of which emergency would be my last—created a feeling of anxiousness.

Before my arrival, I attempted to prepare myself, bringing food, water and an open mentality to learn. However, after I arrived, I quickly realized that this wouldn’t be a steady-breath, close-read learning about fires and medicine. Exertion, engulfment and struggle became the most important lessons of all. In the moments when it becomes the most difficult to breathe, a peak understanding of how struggles indicate progress developed. It wasn’t just about fighting fire, but accepting it.



“These guys are scary,” I remember whispering to one of the other people who also were there for clinical rotations.

It was like I was reading a TV script. Six colossal guys who had a defined muscular brawn and the stride of an ox rolled out from the station gate, grinning at seemingly all of the possible ways that they were going to teach us youngster hotshots some lessons. That’s where the script ended.

With no greeting nor warning, the firefighters ordered us to do 30 consecutive pushups on the searing, cracked pavement. Those who couldn’t were sent home disgracefully.

It always fascinates me how time—so standard in its units—progresses differently in our mind. Every single pushup felt longer, more difficult and more unbearable as I tried to reach 30 of them. I grunted in pain, feeling the skin of my palms bake in the asphalt heat.

27 … 28 … I couldn’t do anymore.

“What are you? A wimp? Get your ass up and finish, or you’re out.”

A rage took hold of me, like feeding wood to a fire. The blood that pumped through my veins echoed through the abyss of my thoughts. At that moment, the pain was no longer physical.

I thought, “I do this, or I remain the same useless piece of garbage that everyone thinks I am.”


The consistency of my failures clouded my head. I embraced the heat of the flame.


I collapsed onto the pavement, tears in my eyes, blood on my hands. I fought to breathe against invisible hands that grasped my throat.

“Going through the fires of the furnace, eh?” laughed the captain.

“No, sir.”

It was a professional response that was given with the best at-ease countenance that I could muster, but the nonchalant gesture was nowhere near the signals that my body was sending. I had lit up like a Christmas tree of warning lights on a car’s gauge cluster. It was no furnace—rather, the ninth circle of hell.


The first call

As I followed the firefighters into the station, I muttered under my now stabilizing breath, “I don’t think I have ever been able to do that.”

Pride, pain, perplexity and profoundness of thought pranced along each of my neurons, jumping from synapse to synapse. In the face of struggle, I had burned a ceiling to my confinement, achieving a power beyond what I had been capable of. I felt different, a better different.

“Listen here, rookies,” the fire apparatus engineer interceded. “You three go wash the rescue. You two come with me inside to the dispatch comms.”

“Yes, sir.”

We followed the engineer into a plain, beige-colored server room that had a popcorn ceiling. The dim lights buzzed with the sound of the fans that kept the computers at operational temperature.

“Pay attention here.”

The engineer directed us to a small digital screen—an old one—that dispatch was relaying calls to based on location proximity and availability of each fire station. It was breathtaking how every little detail followed a set structural pathway as soon as a call came through.

Seconds later, the screen flashed. “Dispatch. MVC Difficulty Breathing!”

The lights went from dim to blinding, as if the gates of heaven had opened. Everyone started scrambling toward the truck, putting on their gear. We hopped into the engine, sirens blazing, heading to the location. The captain barked at us to put on safety vests. I hastily put one on, panting at the sudden urgency. The flame began to draw fuel.

“An MVC is a motor vehicle collision. Grab the gray bin with the oxygen supplies as soon as we arrive.”


‘This is scary’

We reached a gridlock, swarming with traffic, bystanders keen to view the misfortune of others. The metal of the automobiles that were involved in the wreck wrangled between one another. Each vehicle bled oil and coolant.

The captain slammed on the brakes.

“Move. Move. Move.”

Adrenaline surged as we filed out of the truck, grabbed the medical supplies and began to assess the scene’s safety.

“Triage, Cap!”

“Three patients. There are apparent fractures and bleeds on both drivers. Passenger isn’t moving any air.”

“Split. ABCs.”

We ran to the woman who was passed out in the passenger seat. Hearing her gasps for air, we quickly began to attach the nonrebreathing mask to the oxygen tank.

“A—airway. Ten liters a minute … correct psi … correct tank.”

I barely could breathe. The lady’s skin had lost its color, turning white, like a ghost. Her lips and fingers were a deep shade of blue. Her eyes were wide and desperate. The lady was taking shallow, rapid breaths.

“Fifteen liters a minute!”

The tension, ever-present at the moment, began to dissipate as she breathed easier.

“Get a pulse oximeter on her.”

“95 percent and climbing, sir.”


“Breathe in through your nose and out through your mouth, like you are blowing through a straw, ma’am.”

I did the same myself.

This is scary.

The rescue crew transported everyone who was involved in the accident to the hospital no more than 10 minutes after our assessments. However, the images stayed in my head.

“Breathe, Ray. Breathe.”


Struggle & growth

I began to disassociate myself as we returned to the fire station. Everything seemed far away, almost unreal. Everything felt like a copy of a copy of a copy.

“Gear disinfected?”


“Supplies level?”


“Fuel gauge?”

“Just under three-quarters of a tank.”

I gazed at the firehouse crests that were strewn along the walls and doors of the station. At the center of the crest, a flame and trails of smoke that unfurled toward the sky. The flame meant more than just fighting fires or living in a fire station. We didn’t just wear the flame on a patch, but we went through it. Burning corresponded to progress. The only way to find the best versions of ourselves was to embrace the excruciating heat and let it morph us into an improved being. The flame no longer carried the sole purpose of destruction. As fire needs oxygen to burn, struggle requires difficult times—difficulty breathing.

“Walk it off. You’ll be alright,” the firefighters told me.

Back home, my parents told me, “It’s nothing. You’ll get used to it.”

The same message echoed from everyone, but I never entirely agreed. Difficulties don’t exist to become accustomed to, but rather as necessary to improve. The struggle and the flame are one. Just as undergoing struggles isn’t meant to keep one down, the flame doesn’t act in isolated destruction. Fire cauterizes the wounds. It burns the detriments and then some, illustrating a necessary pain to find improvement.

A favorite quote of mine is, “The sicker the man, the more bitter the medicine.” Struggle doesn’t just become normal or a daily chore. Struggle leaves scars, figuratively and literally, in moving toward growth. I struggled, the lady struggled, and as a team, we struggled. We accepted our flames.

I hold on to the thought that whenever I do something without difficulty breathing, I’m not pushing through the obstacles and limitations hard enough.

About the Author

Raymond Alkakooz

Raymond Alkakooz is an EMT and researcher. He attends Barrett, The Honors College of Arizona State University in pursuit of a bachelor’s degree in biomedical sciences and a bachelor’s degree in global health. His work at Project C.U.R.E. and at Mayo Clinic's Mathematical Neuro-Oncology Laboratory has been published in scientific journals. Alkakooz earned the Advanced Placement Scholar Award, achieving the Capstone Diploma and AP Scholar with Distinction.

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