News

Jan 31, 2024

It's Hard Out Here for an Oil

The emergency alarm went off just before sundown. For the oil-field medics of

The emergency alarm went off just before sundown. For the oil-field medics of Loving County, that sound means your world is about to get a shot of adrenaline. One minute you might be lounging on the couch with the guys on call, watching Lethal Weapon 4, nursing a post-brisket food baby, and the next you’re in the back of an ambulance, watching a ribbon of West Texas highway unspool behind you, cursing yourself for not using the restroom before hustling out of the clinic. Which is exactly where I found myself one stormy Friday evening last July.

An emergency medical technician named Justin Esthay was behind the wheel. Beside him, Anthony Luk, a paramedic trained for more-complex procedures, radioed to dispatch for directions. We were speeding toward a fire in a far-flung corner of the Permian Basin oil patch. Lightning had ignited a tank of crude, and a nearby drilling crew had called in the blaze. Several days of heavy rain had transformed the dry arroyos and bar ditches into churning rivers. A wind shear had blown through a few nights before and razed two dozen telephone poles like a sickle moving through hay. Line crews had worked day and night to restore power and clean up the mess. Now the roads, already in bad shape, were washing away into the muddy desert.

The ambulance we were in belonged to Occupational Health and Safety International, a company based in the Houston area that operates a scrappy medical network in this sparsely populated part of the patch, including the clinic we had just come from, near Mentone, about one hundred miles west of Midland. The medics and EMTs who work there treat everyone from oil-field workers with critical injuries to cowboys with broken bones to old-timers with indigestion. They also run Loving County's ambulance service. If you’re sideswiped by a sand hauler or T-boned by a welder on one of the region's few blacktop roads—one of which is known as "Death Highway" because of its lethal oil-field traffic—the members of an OHSI crew are your best shot at making it to a hospital alive. But first they have to make it to the scene alive. On this call, I wasn't sure we would.

We were barreling north on County Road 300 when the driver's side tire sank into a crater. The ambulance lurched to one side, and we skidded to a halt. Behind us, the lights of a semi grew closer and closer. The driver managed to stop before slamming into us, but just barely. A little farther down the road, we passed another ambulance. It was hobbled on the shoulder with a blown tire and twisted rim. That crew, hailing from another OHSI clinic in nearby Culberson County, had been the first to respond to the alarm. But they’d been less lucky with that pothole.

We finally turned off the asphalt and drove for another half hour down mud-choked caliche roads. At 10 p.m., just over an hour after the call came in, we arrived on the scene. Legs numb, I stumbled out and looked around. The drilling crew, smoking and chatting in dirty coveralls, was huddled around their company pickup waiting for the all clear to return to the rig. The only signs of fire were flares burning natural gas and the glow of the roughnecks’ cigarettes.

There was no sign of a proper fire engine either. Just an ancient, battered brush truck with "Balmorhea Volunteer Fire Dept." on the side. We shook hands with two dudes leaning against the vehicle who were dressed more like farmers than firefighters. They’d come about a hundred miles from Balmorhea. Other departments nearer to the fire had refused to make the trip, unwilling to risk the flooded low-water crossings. Between thick streams of tobacco juice, the men told us the blaze had nearly burned itself out by the time they got there. A good thing, considering they had little more than a couple hundred gallons of water and some shovels on their truck. The oil company had asked them to stick around until a drone equipped with a thermal camera flew over the area to look for hot spots. Having already made the trek, we were asked to stay as well.

Even though I had worked as a roughneck for a short stint after college, this was the most remote and isolated place I’d ever been in the patch. There was no cell service. It was pitch-black save for our headlights, a few flares, and the glowing pillars of drilling rigs scattered across the dark desert floor.

It was early summer, and I was nearing the end of the second week of three that I spent in Mentone, embedded with the medics of Loving County. I knew that this was where we’d be spending the rest of our Friday night. I’d been on several ambulance runs at this point and had learned that out here a single call could last twelve hours. The previous weekend, Anthony had rushed two gunshot victims, one of whom had brain trauma, from the town of Pecos to two different hospitals, hours apart, in Lubbock and Midland. He’d left the clinic at 2 a.m. and hadn't returned until 4:30 p.m. the next day.

This call was a cinch in comparison. I’d already been around long enough to appreciate our good fortune. Because when the emergency alarm rings, disasters far worse than snuffed-out fires often await the crews at OHSI.

At last, after two and a half hours, a rep from the oil company confirmed that the drone had detected no heat. As members of the drilling crew piled into their truck to head back to the rig, one of them, as if acting in some oil-field drama, hollered, "Let's make some hole!"

As we loaded back into the ambulance, it occurred to me that the OHSI crews weren't so different from the oil and gas workers they were here to help. The hard living, the time away from family, the macho culture, the insider lingo, the physicality of the job. Those who work in emergency medical services are essentially the roughnecks of health care. Although their job requires a high level of skill and knowledge, compared with other health-care gigs it is undeniably blue-collar and often treated as less than. But at least roughnecks are paid well, with many banking at least $75,000 a year. The same can't be said of EMS workers, who on average make less than half that. And yet here they were, EMTs and medics, proving their guts and grit in the heart of nowhere, their work known only to each other—and the people they save.

I found OHSI by accident. Though I’d grown up in the oil patch, in the small town of Andrews, about eighty miles northeast of Mentone, I’d never heard of an outpost of oil-field medics. Most folks haven't. OHSI doesn't advertise, and it's not the kind of outfit EMS workers flock to.

But in October 2020, I was reporting a story on the last county in the U.S. without a single recorded COVID-19 case, which happened to be Loving. A cashier at the Horseshoe, the only convenience store (or any kind of store) in the county, had mentioned a small clinic on the outskirts of Mentone where oil-field workers and locals could get tested for the virus. When I drove out there, Cary Skelton, a fifty-year-old paramedic and OHSI's West Texas program manager, was outside. He had on his typical uniform: a T-shirt, ball cap, cargo pants, and square-toed cowboy boots. He was chain-smoking Kool menthols next to a parked ambulance. A gray cat named Tigger was curled up on the vehicle's hood, and a shotgun named Bubba rested against the front bumper. Cary nodded at the gun. "Coyotes been getting too close for ol’ Tigger here."

We talked as the sun went down—about the pandemic, about how the clinic had been COVID-testing scores of workers every day, about the region. Loving County, Cary told me, is a tough sell. The 677-square-mile county is best known for being the least populous in the entire United States; just 64 souls claimed permanent residence there in the 2020 census. If it weren't for the courthouse, you might mistake Mentone (population 22) for an oil-field junkyard. It's quicker to rattle off what few amenities exist in town than to list everything that doesn't. In addition to the courthouse and a few abandoned buildings, there's the county annex, a tennis/basketball court, the Horseshoe, a post office (never locked), three food trucks, and one Tex-Mex restaurant that closes at three in the afternoon.

But to Cary, Loving County is more than a desolate frontier of sandstorms and creosote bush. This part of West Texas is his home. As a boy, he worked cattle on ranches, including his grandfather's, across the region. And today you’d be hard-pressed to find a more entertaining source of regional history than Cary Skelton. When he tells stories, his posture shifts and his voice changes, depending on the character he's enacting. He affects a lisp to imitate the late Newt Keen, a droll cafe owner in Mentone who lost a few front teeth after he took a bullet to the face. And Cary's eyes narrow when he takes on the role of Sheriff Elgin "Punk" Jones, the top lawman in the county from his first term, in 1965, till he hung up the badge in 1992.

Cary lights up when he talks about growing up out here. Like the time he was nine or ten, when he and a buddy decided to drive a go-kart the thirty miles from the Red Bluff Reservoir to Mentone in the dead of night. This was in the early eighties, some three decades before the shale boom brought heavy traffic and thousands of itinerant workers to the area. The roads were mostly empty then, but they could still be dangerous. Mexican cartels used them as improvised runways on which to land small aircraft loaded with cocaine or other illicit drugs. One night, Cary told me, the Texas Rangers were waiting for the traffickers. A plane landed, and, in the ensuing firefight, one of the narcos backed into its whirring propeller. "It was some straight-up Indiana Jones shit," Cary said. (The bloodstain left on the pavement marked the spot where Cary said he used to turn off for his favorite fishing hole.)

But the boys weren't worried about narcos on the night they set out in a go-kart for Mentone. They were on a mission. They strapped a five-gallon tank of gas to the tiny vehicle and clicked on a pair of Maglites to shine their way through the dark. "We were driving so fast," Cary remembered, "we were outrunning our lights."

The boys had almost made it to Mentone when they got lit up by Punk Jones. Punk was the archetypal West Texas lawman. He tucked his jeans into high-topped boots, wore a silverbelly Stetson with a roguish curve, and kept a silver star pinned to his pearl-snap shirt. His grim good looks gave off the same tough-as-leather vibe as Clint Eastwood. He strolled up to the go-kart.

"What are you boys doing?" he asked. "Well, we’re driving around," they told him. Punk shook his head. "I don't know if riding around on a go-kart in this part of the country is very safe." He loaded the boys and their go-kart into his truck and drove them back to their homes. Cary was sure he’d get a whupping for the stunt, but Punk never said a word about their adventure, not even to Cary's dad.

There have been a few changes since Cary was a kid. Thanks in part to the same Punk Jones, who drilled some of the county's first non-brackish wells, you can now turn on a tap anywhere in town and get drinkable water.

Still, potable water isn't much of a selling point in 2022, and besides the lack of modern conveniences, the OHSI staff also faces all the dangers and discomforts of the oil field. When they’re out on a call, they might encounter poisonous gases, homicidal drivers, and high-pressure wells that sometimes blow up. There are also the long hours and weeks away from home. The crew's hitches are two weeks long, minimum. They’re on call 24 hours a day during that time, which means that consuming anything stiffer than Red Bull is prohibited. On top of this, they must meet Cary's standards.

"Look, I don't have time to make someone an EMT or paramedic," Cary said. "They need at least five years of experience of doing this on the daily, thousands of patient contacts, before they come out here." In an urban environment, new medics can cut their teeth with less risk of fatal mistakes. "They’re ten minutes away from a physician and an ER to get them out of a jam," Cary said. Not so in Loving County, where the nearest level I trauma center is several hours away, in El Paso or Lubbock. "We have to bat a thousand. We have to get a base hit every single time," he said. "Otherwise, we could have some bad outcomes. We could lose someone."

Cary snubbed out his cigarette. "Give me another sweet," he told one of the EMTs who’d joined us outside. Another Kool was produced. Cary lit it. It was dark now. Above us, the Milky Way was smeared across the night sky as if someone had tried wiping chalk from a blackboard. The quiet was broken by a yelping chorus of coyotes not far from where we stood. "Out here, you’ve gotta be the cavalry," Cary said, exhaling smoke. "Because no one is going to come to help you."

Since the coronavirus pandemic began, politicians and corporations trying to gin up goodwill have heaped praise on first responders, including EMS workers like Cary. But many on the front lines say it's mostly a bunch of smoke. "EMS is the bastard stepchild of the planet," Cary told me.

Today, most of us take for granted that we can pick up the phone, dial 911, and someone will be at our side in minutes, capable of keeping us alive during the brief trip to a hospital awaiting with teams of doctors. But this convenience is a relatively new development. Texas's Department of State Health Services didn't include an EMS division until 1973.

In Texas and most other states, EMS, unlike police and fire departments, is not considered an "essential service." Instead, EMS workers are dispatched through a haphazard patchwork of municipal and county operations, hospital-affiliated services, nonprofit and volunteer associations, and private enterprise. That's where OHSI comes in.

The nutty idea of opening a for-profit clinic in the country's least populated county was Dustin Hoffpauir's. I met Dustin during my first week at the clinic. He arrived from Houston in his King Ranch Ford bearing a load of boiled crawfish, a nod to his Cajun roots. Dustin had come to EMS through the safety departments of several oil and gas companies. After graduating from the University of Louisiana at Lafayette in 1998, he worked as a fire watchman on offshore rigs in the Gulf of Mexico.

He eventually migrated to dry land and a small Lafayette-based safety company, doing contract work for bigger oil and gas companies. One of those was Anadarko Petroleum, which hired Dustin in 2005. For the next thirteen years, he served as one of its lead safety officers. The job frequently took him west to the Permian Basin, where he spent days driving the lease roads of Loving and its neighboring counties. Dustin was headed for a comfortable retirement with the company, but then a trip to West Texas made him change course.

Several years ago, Dustin was on his way to tour a natural gas plant when an accident at the facility left two contract workers severely burned. Though he’d completed basic EMT training, when he arrived Dustin didn't have any equipment with him to start caring for the victims. He waited helplessly for EMS to get there. It took more than an hour and half, an eternity to Dustin. "And that's when I really started thinking about the challenges associated with providing medical care out here, and the lack of resources," he said. "The same thing kept on reoccurring. Delayed response. Unfortunately, some lives were lost."

"The same thing kept on reoccurring. Delayed response. Unfortunately, some lives were lost."

Three years ago, for instance, in Culberson County, just west of Loving, a worker died of an apparent heart attack. His coworkers were forced to sit with his body for more than two hours while waiting for the sheriff, who drove more than 150 miles on bad roads to get there. When no ambulance could be found, the sheriff had to haul the body back to Van Horn in his truck. One of the coworkers later spoke at a county commissioners’ meeting, imploring the officials to invest in EMS, cut down on response times, and give the deceased a bit of dignity. "My God, people," he said, his voice choked, "what have we come to!"

Dustin and his wife, Mandy Hoffpauir, a registered nurse, made a plan. Dustin recalled his time working in the Gulf: the challenges of providing medical care on offshore oil rigs mirrored those in the Permian Basin. He figured he could replicate the model he’d learned out there.

First, he tackled the economics. Most ambulance companies don't get paid unless they transport a patient. Out in a rural area like Loving County, the relatively low volume of transports, compared with the number carried out by city services, can make it hard for a company to keep the lights on between calls. If a patient doesn't have insurance and is deemed indigent, the ambulance company often eats the bill. But Dustin knew that the oil and gas industry was desperate to find solutions to the problems it had brought to the region: the traffic accidents, the thousands of itinerant workers needing basic care for chronic conditions or medical emergencies, and the work-related incidents (well blowouts, rig injuries, flash fires, heat exhaustion, and so on) that are often more serious than those that occur in other industries.

Dustin pitched the idea for a remote medic service to some of the major companies operating in the region. They asked whether he could also open a clinic that would perform on-site drug testing, issue some medications, and perform basic medical procedures such as treating minor wounds and conducting X-rays. Dustin agreed to that. In a rare move for fiercely competitive oil companies, several banded together to form a consortium. Their pooled resources guaranteed a steady income for OHSI, regardless of the volume of calls.

In late 2017, Dustin leased land outside Mentone and hauled in an old army barracks to convert into OHSI's flagship clinic. He and a friend did most of the remodeling themselves, spending nights in sleeping bags on the floor while they worked. The product was functional, if not exactly luxurious.

Dustin knew that it wasn't only oil-field workers who could benefit from OHSI's services. The locals of Loving County needed access to health care too. That's where Cary Skelton came in.

When the former manager at OHSI stumbled upon his résumé on a jobs listing site, Cary was working in El Paso and looking for a new gig. He was tired of the relentless pace of the city's emergency rooms and urgent care centers. He’d never dreamed he’d be able to find work in Loving County, yet here was an opportunity to do something meaningful for his community. Cary jumped at the chance to come home. "But the other part of it was, I had to produce. This is my granddad's stomping grounds, and I cannot mess this up."

Cary understood Loving County. "Oil-field workers and rodeo cowboys, they don't go the doctor unless something is sticking out," he said. "People don't even take their prescriptions out here because it's seen as a sign of weakness." Cary's dad is like that: he once showed up at the clinic with a busted head. He refused to get out of his truck, so one of the medics had to staple the wound through the window. OHSI ultimately made inroads with county officials, including Judge Skeet Lee Jones, one of Punk Jones's sons. The county purchased its first ambulance, and OHSI signed on to staff it around the clock. (OHSI also provides health care to Loving County residents for free.)

Although the Mentone clinic is still the heart of its operations, OHSI has expanded. There are now two more small clinics, one in Culberson County, near the revived ghost town of Orla, and another in Pecos, 23 miles south of Mentone. OHSI also dedicates an ambulance to serve Kermit and Monahans (55 miles east of Mentone), moving patients from one hospital to another.

The presence of OHSI is a comfort to even the most treatment-hesitant locals and the itinerant workers who, however briefly, call Loving County home. But for the EMTs and medics who make their living and spend more than half the year at the clinic, their sacrifices add up.

My first hitch, which would last two weeks, began in late June. On a Tuesday morning, I arrived at the clinic, a metal structure the same beige as desert camouflage. The clinic abuts a rodeo arena just to the east. Otherwise there is little but sun-scorched pastures of mesquite and greasewood, the occasional pump jack, and a few rusted skeletons of old trucks and tractors. As Cary and I walked up the entrance ramp, Tigger and her kittens scattered from a heaping plate of food. In front of the door was a bloody rabbit's foot. "That was probably Tigger," Cary said, catching my stare as he swung open the door. "Not the first time she's gotten a cottontail. And, hey, that's good luck!"

Touring the clinic didn't take long. The building is divided in half. One side includes an examination room, X-ray room, and dispatch office. The other side serves as the living quarters for the staff: a cramped kitchen; a common room with an overstuffed brown sofa, an easy chair, and a TV on the wall; a bathroom; and two bedrooms, where the crew members sleep two to a room. There are plain white walls and scuffed linoleum floors throughout. The vibe is a mix of college dorm and military medical outpost.

As the fresh crew trickled in, the EMTs and medics who’d been on duty headed home, to El Paso, Lubbock, and as far away as Louisiana. One by one, I met the guys I’d be shadowing for the next two weeks. First was Steven Hutson, an EMT from the flyspeck of Kirvin, a town eighty miles southeast of Dallas. The youngest of the bunch at 25, he had a hefty frame and Bambi eyes that had earned him the nickname Baby Huey. Next was Dominic Sanchez, a 26-year-old Albuquerque transplant with a boy-band smile and muscles on his earlobes. Dom was responsible for dispatching crews to calls for help, a duty he performed while wearing a pair of pearly white Crocs. And finally there was Anthony Luk, a 29-year-old paramedic who grew up far from West Texas, in the Asian grocery store his family managed in Houston. These three, along with Cary, would be responsible for running the clinic 24 hours a day for the next fourteen days, as well as responding to emergency calls.

Days at the clinic varied wildly. One might be mind-numbingly slow: hardly anyone would show up for treatment, and the emergency alarm stayed quiet. The next, the team might be slammed from morning to night with workers dropping in for COVID screenings, for drug and alcohol tests, or with physical maladies. A welder came in with a metal shaving lodged in his eye. Another patient arrived needing an X-ray after falling from a catwalk between two tall tanks. Several workers, their accents suggestive of places a long way from Texas, came in suffering from dehydration. And one evening a man hobbled in with severe burns on his leg. He and his wife had gotten sideways at dinner. She’d doused him with hot gravy.

For the most part, evenings were peaceful. The guys would retreat to the living quarters after six or seven, offering a little prayer that no one else would show up or call 911. We’d make a family dinner, which could be Steve's deer-sausage spaghetti or a Korean barbecue dish Anthony whipped up. A game of Texas Hold ’Em might start up, one of the many firearms stashed around the clinic might be fetched for cleaning, or a haircut attempted, but more often than not, someone would turn on the television, and, after settling on a movie, the guys would sit shoulder to shoulder on the couch, eating off TV trays as if they were kicking back at a middle-school slumber party.

"Everyone knows each other's backstory so well," Anthony told me, "we don't really have to talk about that anymore." They repeated some details for my sake. I learned that Anthony's parents had immigrated from Hong Kong before he was born. He’d lived in Houston until he left for Lubbock to attend Texas Tech. Going from Houston's humidity to the dry heat, he’d suffered nosebleeds constantly that first year. I learned that Steve had gotten married just seven months prior and that he hated broccoli and loved Mel Gibson. (I was subjected to three Gibson films during my stay.) And Dom was the group's Casanova, practicing his charms, without much success, on a clerk at the Horseshoe.

Everyone caught hell for something. Steve for his diet ("He’d eat the ass out of a dead rhino"), Dom for his footwear, and Anthony for his skin-care routine, which revolves around his FaceTory, a small mint-green refrigerator he hauls with him that's full of serums, oils, and face masks he wears at night. "If you can't take the ribbing," Cary said, shrugging, "this outfit ain't for you."

Cary was at the center of it all. He acted as the group's big brother, camp counselor, and, occasionally slipping back into his military background (he served overseas as a cavalry scout), drill sergeant. He often quizzed the guys on what meds or protocols to use in various situations. "These are perishable skills," he explained. Because OHSI doesn't run calls every day like city ambulance services do, "you have to be studying. You have to be practicing. You have to be putting your hands on equipment." But for all the grief he gives them, Cary is fiercely loyal to and proud of his crew. "A lot of people think that because we’re out here in Hickville, we’re going to deliver some type of substandard medicine. No way. I would put my guys up with anybody out there."

When that emergency phone rings—and eventually it does—life-and-death situations await the OHSI crews. Their memories are full of the kind of gore that most of us see only in horror films: a road-rage victim shot point blank in the belly, guts slopping out like uncooked sausage; an F-150 crushed like a Coke can under an eighteen-wheeler; a three-man roustabout crew charred in a flash fire. One driver was covered in tar after his tanker exploded. Onlookers had poured water on him to relieve his pain, but that had only made the tar harden onto him. By the time OHSI delivered him to a hospital, his skin was peeling off in chunks.

Just a couple of weeks before my hitch, a worker had been up on a catwalk removing a flange. Maybe he had heard a hiss of pressure and realized he was in danger. He’d apparently turned to run, but before he could get to the stairs nearby, the enormous pressure now leaking from the loosened bolts blew the metal cover off the flange. It struck him smack in the back of the head. He was dead by the time OHSI arrived on scene, but before the site could be opened back up, Cary had to scrape gray brain matter off the railing of the catwalk. Because the area is so remote, the OHSI crews are also the de facto biohazard team in this part of the patch.

This tension between normal life at the clinic and the arrival of the next emergency was something I could never quite adjust to during my time at OHSI. It was hard to sleep, knowing that at any minute the alarms could call us out into the night.

You won't find much sympathy talking about the woes of a forty-hour week with EMS workers. For them, long hours are the norm. Justin Esthay, the EMT driving the ambulance on the call that took us to the flare fire, told me he regularly worked sixteen-hour shifts and once put in twenty hours straight for an ambulance service in Louisiana. The schedule at OHSI, with its occasional stretches of downtime, was a relief. Still, it was hard not to notice the dark circles around Justin's eyes.

Anthony explained that EMTs and medics work such ungodly hours in part because the pay for EMS workers is shockingly low and they need the overtime. With the mean annual wage for Texas EMS workers clocking in at about $37,550, many work two or even three jobs to eke out a living.

As an EMT in Lubbock, Anthony had started out making $11 an hour. "But I also picked up a lot of overtime. That's the thing: in EMS, picking up overtime is where we make our money. It's also a big reason why there's a lot of burnouts." The annual turnover rate for EMS workers is about 30 percent.

"You’re constantly working," Anthony continued. "It's hard on marital life, social life, all life outside of work. Relationships are hard to sustain because, like, for us here, you’re gone for two weeks. It's terrible to say, but out of the guys who’ve had partners or were married, a good forty to fifty percent are no longer."

Anthony's fiancé, William, is a composer in Lubbock. I met him briefly when he made the three-hour one-way trip to deliver a set of keys Anthony had accidentally left at their apartment. It was the only time William had ever set foot in the clinic where Anthony spends more than half the year.

"When you go home, you don't want to do anything," Anthony said, speaking generally. "You just want to rest, and your partner doesn't always understand. Plus, you don't want to tell them everything because you don't want to relive it. Like, if you had a bad day at work where you had to do CPR on a kid who drowned . . . that's traumatizing. Even though most people seem to shake it off and move on, you’re still overwhelmed with sadness."

According to one study, EMTs and medics are about ten times more likely to have suicidal thoughts than workers in other professions. And yet many first responders never seek professional help for their mental health. Cary chalks this up in part to EMS culture, in which the ability to put on a tough front and "silently suffer" is highly valued. Others don't seek counseling because they can't afford it. (A couple of the OHSI workers I spoke with said they’d opted out of the company's plan because they felt the premiums were too high.) This means EMS workers find other ways to deal with their trauma. "I know a lot of EMS guys who have pretty bad vices," Anthony said. "That's the way that they wind down, whether it be a massive amount of alcohol or a massive amount of partying."

According to one study, EMTs and medics are about ten times more likely to have suicidal thoughts than workers in other professions.

While the crews are on call at OHSI, they temper certain bad habits they might indulge at home. A couple of them funneled their energy into working out at Mentone's only gym, a tiny collection of weights set up inside a shipping container. Some dipped tobacco, smoked, and guzzled an endless stream of energy drinks to ward off stress, boredom, and weariness. But without exception, all the guys leaned heavily into a dark humor specific to their profession.

That night in Culberson County, for instance, as we stood around waiting for the drone to finish its search for any lingering hot spots from the fire, Justin told a story from a few years back. He’d just finished an ambulance shift and was walking out to the parking lot to head home. "This car comes hauling ass in, pulls right up, and almost hits me. The window rolls down, and the driver leans over: ‘This guy just OD’d on heroin.’ " The man in the passenger seat was barely breathing. Justin got him out of the car. "I start doing CPR on this dude. I’m dripping sweat, absolutely drenched because it's so hot." Justin managed to get the guy to the hospital alive. The patient woke up, "and he's thanking me, blah, blah, blah. For a while, I felt like, ‘Wow, I really saved somebody.’ I felt kind of good about it, even though the circumstances were crappy. So I come back to work the next day. The EMT I’m relieving is like, ‘Hey, remember that guy you saved yesterday?’ I’m like, ‘Yeah.’ ‘He left the hospital and immediately OD’d again and died.’ I’m thinking, ‘I sweat my ass off, and it was all for nothing.’ " He and Anthony both laughed at the irony.

As an outsider, I was initially horrified by stories like this. But I came to understand their necessity. Anthony and Justin didn't think the story was funny; they laughed because that's how they deal with the grief and suffering they witness all the time. For EMS workers, black humor is the shared tongue, a coping mechanism, a survival tool.

After my hitch ended, the price of oil climbed and the patch got busier—and so did OHSI. They’d had some rough calls: a few bad wrecks and a fire that had burned a crew of three. Plus, a surge in COVID cases had forced the crews to work even longer hours, as they had to transfer patients to hospitals farther and farther away. There had been some personnel changes too. Dominic Sanchez had left OHSI for a medical gig nearer to his home in Killeen. And Steven Hutson had found work with an ambulance service close to his wife and family in Kirvin. Anthony Luk is still at OHSI but has been preparing to apply to medical school. He hopes to start later this year. Cary hates to lose good workers, but he doesn't blame anyone for leaving.

Sometimes when we spoke on the phone, Cary sounded bone tired. Finding replacements hadn't been easy, and the crews were stretched thin. At times he felt as if OHSI were barely hanging on. And lately, bigger ambulance companies have started to home in on the Permian Basin. Cary explained that big companies can choke out a small independent operation by offering their services more cheaply—at least until they run the competition out of business. He knows how precarious the state of rural EMS is right now. He's seen companies come and go.

For Cary, the mission goes beyond the balance sheet. It's about the camaraderie of doing a difficult job in an unforgiving desert. It's about providing his community the comfort of knowing that someone will answer when they have an emergency.

It was Cary who answered the alarm one cold, windy day last January. Punk Jones had been ill for going on a month, but he’d told his family, "I ain't going to the hospital." The nearest was in Kermit, half an hour away, and to get advanced care, he’d have to travel all the way to Lubbock, nearly two hundred miles northeast. Most of the wards were overloaded with COVID patients anyway. But Punk did acquiesce to his wife Mary Belle's urging to visit the OHSI clinic.

The 93-year-old former lawman had been diagnosed with pneumonia. And so twice a day, every day, Cary or another OHSI medic drove out to Punk's ranch to check on him. On that cold Saturday morning, Cary had been on his way back to the clinic from Kermit when he received a panicked call from Punk's family. "He's not breathing well. He's doing bad."

Cary and the family started making calls. They finally managed to find a hospital bed for Punk in Amarillo, about three hundred miles away. Cary sent an ambulance to Punk's house and summoned a plane to Winkler County Airport, outside Kermit, to transport Punk the rest of the way. Meanwhile, Cary had been speeding toward Punk's place. He arrived just before the ambulance and went inside. Punk's daughter, Mozelle Carr, was there with him. So was Mary Belle. She told Cary, "I want you to do everything you can." "I will," he promised.

He and the OHSI medics got Punk on the stretcher and into the ambulance. They were flying down the road, hooking him up to monitors, starting an IV, when Punk squeezed Cary's hand. He wagged a finger up at Cary. Then he pointed down. Punk Jones had made it clear: he wanted to die in Loving County.

Cary knew Punk wouldn't make it to Amarillo. He told the EMT driving the ambulance to pull over in the parking lot of the county courthouse. There, Cary did as he promised: he and his fellow medics tried everything they could to save Punk. They intubated him and gave him fluids through an IV. When Punk's heart stopped, Cary did compressions on his chest until it started thumping again. Eight times he was able to get the heart rate monitor to register a rhythm.

Cary phoned Punk's family. The Jones clan trickled into the parking lot, congregating at the ambulance. Cary held Mozelle's hand, and they cried together. Punk's heart stopped again. This time, Cary could not bring him back.

At OHSI, Cary and his crews fight every day to keep folks from dying in Loving County. Of course, they can't save everybody. And being able to provide dignity at death, to allow someone to die in the place they call home, can be just as important. It's these moments, however weighted with tragedy, that keep Cary working overtime in Loving County, making plans to ensure that basic health care is here to stay—no matter what happens at OHSI or to the fortunes of the oil patch.

A week later, Punk was laid to rest at his ranch. During the funeral, Cary offered his condolences to the Jones family. Tom, one of Punk's sons, told him, "I’m glad you were with him, Cary."

Cary nodded. "It was an honor."

This article originally appeared in the January 2022 issue of Texas Monthly with the headline "There Will Be Blood." Subscribe today.