"Pulse ox 60," says respiratory, like I might not be noticing. "How about a smaller tube?"

"How about a trach tray," I say. Winnie rockets out.

During the brief time she's gone, I do a lot of thinking. I think about the other surgical airways I've done, all three of them. Each had been supervised by a critical care instructor. One was on a cadaver and two on anesthetized dogs. Now, flying solo after midnight, it all feels different.

I also think about why, as one of the oldest docs in our ED, I'm still here. Who wouldn't feel like a fossil when the department's two most recent hires are your kids' ages? At my medical school reunion last spring, half of the people at my table had either retired or were working part time. When he hit 50, one ophthalmologist had quit doing all surgical procedures. God, why didn't I have the sense to do that? Now, I'm working hard just to tug latex gloves onto my sweaty fingers.

Winnie's back, and the trach tray's open. I throw two towels over Alonzo's chest and snap a #15 blade onto the scalpel. Alonzo's neck is getting bigger all the time. This little ridge under my index finger might be the cricoid cartilage. It might not be. Sure feels different on dogs.

I grab the scalpel, take a big breath, and plunge the blade into what I hope is the cricothyroid membrane. The blade sinks in without any trouble. I cut a three-centimeter horizontal incision. I twist the scalpel, grab a new ET tube, and shove it at the hole.

Magic! The tube slips in with absolutely no resistance. I angle it downward and backward and feel it bump the inner wall of the trachea. I'm in.

Finally, Alonzo has an airway. Respiratory attaches a vent bag to the tube, and squeezes hard. Alonzo's chest rises. Within 20 seconds, he pinks up, and after two minutes, his oximetry reads 100 percent.

After this, a ton of things happen. Some of them go blurry fast, like the chest X-ray, arterial blood gases, my phone call to our tertiary referral center 30 miles away. The University Hospital at the University of Virginia says Yes, they'll take Alonzo.

But some things go a lot slower, like talking to Alonzo's wife, Betheen. She was at home in bed when triage called. She broke all the speed limits to get here. She's wearing a wrinkled orange and white shift, and on her head there's a corona of lavender curlers. I take my time reviewing her husband's critical illness and our initial and ongoing treatment. I tell her the truth—I don't know what caused this medical catastrophe. Maybe a blood vessel ruptured, but, if so, we don't know why. Right now, her husband is stable. We're hoping for the best.

Also slow—think lame turtle slow—is the interhospital transfer. July thunderstorms have grounded the copter, so Winnie tracks down an ambulance and a crew. It's 3:00 a.m. before Alonzo, Betheen, respiratory, and the rest of the gang tear out of the parking lot.

As the taillights fade, my adrenaline surges. Suddenly, I'm a teenager again, supercharged. I feel as if I could sprint down the road and beat that ambulance to Charlottesville.

Two days later, Alonzo's UVA surgeons fax the first follow-up. The diagnosis is a stunner—right vertebral artery aneurysm with spontaneous rupture. A thoracotomy/vascular bypass is successful.

More faxes come, one every few days. Alonzo rebleeds. He has a second respiratory arrest. Pneumonia. Two more surgeries. Rehab. Finally, 24 days after he walked into our ED, he walks out of UVA. Neurologically fine, the final fax says. He's returning to work in another six weeks.

All of this happened months ago, but I'm still sorting it out. To have finally used a skill that had always been just another academic merit badge was very fulfilling. It reset some clock inside my head. Now, I'm glad I didn't take the shingle down at 50, like the eye guy did. I feel rejuvenated, revved up, all set to roll down the road. Getting older doesn't have to mean becoming obsolete. Boomers can still boom.

Which is a very good thing: Tonight I'm working another midnight shift.