Sitting on the table, dressed in a hospital gown, I can feel the coldness of the room against my skin, which is already cold because it is winter and I have walked through the rain to the doctor’s office. So I curl my arms around my torso, massage the outer parts of my arms and shiver just enough to warm my body a degree or two. The room is cold, like a doctor’s office almost always is, and I leave my socks on because my feet are always cold, and I hate the feeling of having cold toes.

The doctor walks into the room, and I recognize her from the last time I was in her office, but she is not My Doctor. She is not My Doctor because my health insurance changed and I cannot see My Doctor unless I want to pay a lot of money to go “out of network.” So I visit My New Doctor, and she has changed her last name because she has gotten married since the last time I saw her, and I tell her I am here for my yearly checkup and to get new prescriptions for asthma medications.

But as long as I’m here, I tell her that My Doctor and Another Doctor—which is to say two out of three doctors—have told me that I have a heart murmur. I tell her, too, that I want to know if I actually have a heart murmur, and I tell her that she must listen to my heart for at least 60 seconds, because that’s how long I remember that My Doctor listened to my heart and told me that I do, indeed, have a heart murmur. She smiles when I tell her this because she knows that I am a paramedic, but I tell her that I have absolutely no experience in detecting a heart murmur.

She humors me, I think, and listens to my heart for at least 60 seconds. Then we talk about what she’s heard or not heard, and we discuss what this means or doesn’t mean. Later, when I leave her office, I am satisfied and yet not satisfied—I have no answers either way, and now the statistics are two who have heard a murmur and two who have not heard a murmur.

My work partner and I climb into the ambulance and drive to a coffee shop to meet another crew that’s on duty. I slide into a seat in a comfortable chair near the fire. It is a fake fire, but it sinks into my skin and warms me after the cold air outside has left me slightly shivering. I am too warm after a few seconds of sitting in the comfortable chair because I am dressed in too many layers—the number of layers that would keep me warm if I were outside in freezing temperatures for dozens upon dozens of minutes.

My coworkers talk idly and softly at first because the coffee house is not that busy. But soon the sounds gets louder as more customers walk through door and everyone needs to talk a little louder just to be heard. I zone them out, which I usually do, and read the newspaper (a newspaper printed on actual paper) and occasionally I read McSweeney’s or the New York Times on my iPhone. I am not a social person—have almost never been a social person—but I have learned skills that taught me how to interact in social situations so that it is not so terribly awkward.

I listen, occasionally, to what two of my coworkers are saying, and only because I am trying to act as if I am being social. Inside my chest and in the back of my throat, however, I can feel some type of flutter or pause. I call it that because I don’t know what else to call it, but I have been feeling this flutter/pause for some time now. It does not feel as if my heart is beating too fast, or too slow—instead if feels like a moment where my heart has forgotten that it belongs inside my chest. It happens here and there, usually in the morning when I’ve woken up, or at night when I’m reading a book and getting ready to close my eyes and sink into a hopeful sleep.

So I do what I always do when I feel this pause/flutter—I press two or three fingers of my right hand into the groove at the side of my neck. Sometimes, depending on how my fingers feel, I switch hands. I know how to find my pulse, know how to find it almost as quickly as my fingers touch my skin. Until this morning, however, my pulse has always felt regular in all the aspects that make a heartbeat regular when you palpate them with the tips of your fingers. Each time I have palpated my pulse when I feel that flutter/pause, it has felt totally normal.

But today was different. Today I could feel that my heart was skipping a beat each time I felt the pause/flutter inside my chest. This went on for 15 minutes or so, and it was happening in a rhythmical way that led me down a path of curiosity. I counted each time my heart pulsated and it was fairly normal save for the hiccup: beat, beat, beat, beat, beat, pause, beat, beat, beat, beat, beat, pause. When I walked out into the cold air, walked toward my ambulance, I could feel the flutter/pause happening every so often now, outside the one-every-six-beats pattern. Back at our station, after we pulled the ambulance into the bay, I wired myself to a heart monitor. I suppose this is one of the benefits of being a paramedic: free access to a heart monitor and minimal knowledge of how to interpret the results.

My heart was skipping a beat every five beats, until it decided it would skip a beat every six or seven or eight or nine beats. I printed this out to show My Various Doctors just incase they decided to question me or say that this was a figment of my imagination. After a while, the arrhythmia resolved and I could no longer feel the flutter/pause inside my chest, and it no longer appeared on my EKG. But I did a 12-lead EKG (a view of my heart at multiple angles) just because I could, but more importantly I know what to look for in terms of what is happening with someone’s heart.

Early in the morning, right around 03:00, my partner and I are woken up because someone has been involved in a snowmobile accident. I talk with my patient for about an hour, which is about how long it takes to get him from where he has had his accident to the closest hospital. He is, as it turns out, my age, and he is involved in the banking industry. We talk about many things—because we have almost 60 minutes to talk all the while I remain cognizant that he may have broken his femur—and I find out what he does for a living, how long he’s been married, how many kids he has, what kind of motorcycle he rides, and what has value in his life.

He asks how long I’ve been doing this paramedic thing, and I divulge little nuggets of information about my life: how long I’ve been a paramedic, what kind of motorcycle I ride, how I live my life in terms of being constantly aware that my life is one step shy of ending. He tells me, a fist slightly clenched, that many people aren’t seeing the larger picture: It’s not money we have, but time. And time, we both agree, is worth more than its weight in gold—no matter how you measure time or weight or value or substance.

We talk for a while longer, laugh here and there, and I realize that I’m connecting with someone on that level that I rarely connect with people. When I leave him at the hospital, I walk toward him with an outstretched hand to say goodbye, and he wraps my small hand in both of his large hands and thanks me in a way that his grip has weight, has value, has meaning. I smile, and he smiles, and we say goodbye.

I walk away remembering our conversation, remembering that the time we have here on this planet is worth more than anything attached to a dollar sign. And I reflect and wonder and question whether or not I am living my life like it is worth more than its weight in gold. But reflecting and wondering and questioning about Then doesn’t matter so much as the Now—and so I am reminded, again, of the brilliance of my life and how I am living it right now. And I do, indeed, live my life rather brilliantly, all the while knowing that there is more unknown brilliance to experience.

And I live it too, with an awareness of the inevitable end, and every time I flip the ignition on my motorcycle I think about this inevitable end … and this is when I inhale a little deeper, pull the throttle back a little more, and spend a few more minutes burning the outer layer of my shell in a fire so I can peel back another layer and live a little more richer—especially since I know there is a random pause in my heart’s beat.