The Man Who Saw Too Much

By Hampton Sides

Aspen’s Michael Ferrara is bringing attention to a little-known problem: post-traumatic stress disorder among the people who save our lives.

By Hampton Sides

Reprinted with permission by Outside Online.
The article can be seen here.

Looking back over his nearly 30 years as a highly decorated first responder in Colorado's Roaring Fork Valley, Michael Ferrara has trouble pinpointing the exact moment when his life began to unravel. His ordeal arrived not all at once but in a long spool of assaults on his soul and psyche. A plausible starting point, though, might be March 29, 2001, and a nightmare that occurred at the airport in Aspen.

One fine warm day this past August, Ferrara and I decided to walk over to the site. His six-year-old mountain-rescue dog, a German shepherd named Lhotse, led the way. Ferrara wore sweats and trail-running shoes. His skin was ruddy from the sun, his graying strawberry-blond hair cropped short. We stopped outside the Aspen airport's fence, which is designed, among other things, to keep herds of elk off the tarmac. Ferrara squinted through the sun as a Learjet taxied and then shot into the sky.

"I'm OK with this," he assured me. "I've learned to recount without reliving—it's part of the therapy."

The weather was snowy and cold on that evening nearly ten years ago. One minute past seven o'clock, a Gulfstream III came in on an instrument approach. Fifteen friends from Los Angeles, most of them in their late twenties, had chartered the jet for a few days of spring skiing to celebrate a buddy's birthday. Something went wrong on the final descent. The pilot apparently couldn't see the runway. A wing tip caught the ground, the plane flipped, and the tail segment broke off. Then the plane exploded into flames.

Ferrara, who at the time was both a Pitkin County sheriff's deputy and an assistant coroner, was among the first to arrive. Over the years, he had worked on a half-dozen small-engine-plane crashes in the mountains around Aspen. In other jobs as a paramedic, ski patroller, high-angle rescuer, and avalanche specialist, he'd often dealt with blood and trauma and heartache. Among scores of incidents, he was first on the scene when the late senator Robert Kennedy's son Michael Kennedy, 39, fatally struck a tree while skiing in Aspen in 1997. Ferrara was steeped in the stoic culture of the first responder, and instinctively knew how to take charge in chaotic situations. But he wasn't prepared for this.

In the swirl of the dome lights, through the flickering of a dozen fires, Ferrara drank in the surreal horror of the crash. The first charred and bloodied body he came upon was still buckled to his seat, his cell phone ringing in his pocket. Then, out of the corner of his eye, Ferrara saw something jammed into the elk fence: a hunk of flesh, dripping with serous fluid. Ferrara spent that terrible evening with fellow officers, assembling body parts into plastic bags. It was one of the worst tragedies in Aspen's recent history. All 18 people, including the crew, were killed. Ferrara got home at four in the morning, smelling like jet fuel. He stripped out of his gore-smeared clothes and left them in the front yard.

As he told me all this, he blinked and blinked, as though waiting for tears that wouldn't come. "The thing is," he said, "I drive by here every day. It's a reminder. A trigger. People jet here all year long to have fun in this playground. Nobody comes to Aspen thinking something like that is going to happen. They look at these beautiful mountains and see paradise. I look at these same mountains—and sometimes I see another side."

Ferrara, who has long been known around town as Mongo, is a genuine Aspen character. His nickname comes from the burly villain in Mel Brooks's Blazing Saddles—played by football star Alex Karras—who knocks out a horse with a single punch and deadpans the famous line "Mongo only pawn in game of life." Mongo landed in Aspen in 1979, after passing on law school in Buffalo, New York, near his rural hometown of Williamsville. He was 29, and in those early days he became known as a hard-charging, hard-partying, slightly outrageous but extremely competent tough guy who liked to live on the edge.

Ferrara quickly learned the calculus of thrill and risk that abides in this richest, fittest, most overachieving of alpine towns. He raced motorcycles and skydived and climbed desert spires and ran ultramarathons and skied like a beast. He risked his own life, but he also saved lives. In the town's highly accomplished world of mountain paramedics, he was one of the very best.

"Among the SAR guys, Michael had the reputation as the smartest, the most passionate, and probably the one willing to take the most risks," says Doug Rovira, a climber and expedition physician in Snowmass who's worked with Ferrara. "I'm only half joking when I say that I'd lie there an extra hour to have him come rescue me."

Ferrara was trained as a paramedic, in rope work, in forensic pathology, and in the use of avalanche explosives and firearms. Mongo was Aspen's Mr. 911: tuned in, wired up, on call, at your service. When something dramatic or awful happened in Pitkin County, he was usually there, in one expert capacity or another, to help pick up the pieces.

Ferrara left Aspen on occasion to chase other adventures. He spent a good bit of time on Denali, in the Himalayas, on Rainier, and in the Yosemite Valley. He went to work for the Alyeska Pipeline, on Alaska's North Slope. For one year, he lived above the Arctic Circle at the base of Atigun Pass, near the western boundary of the Arctic National Wildlife Refuge. "I thrived on the stress and the darkness and the inclement weather," he says. "This is where I do well. I thought, Maybe I just suffer better than other people."

Practically everybody around Aspen knows Mongo—especially people who've been here awhile. When he tools through town in his beat-up but fundamentally trustworthy Ford Ranger truck, he elicits a flurry of waves and honks. Most people know his dog, too. Lhotse is canine royalty: born in Munich, he's worth more than $10,000 and comes from a long line of specially bred, specially trained rescue dogs. He's also a TV star: Lhotse appeared with Ferrara on the Today show in a segment demonstrating how rescuers find skiers buried in avalanches.

At work and at play, Lhotse has been Ferrara's constant companion. "He comes with me everywhere I go, good times and bad," Ferrara says. "Dogs pick up on whatever's happening in your life. As they say, it travels right down the leash."

Working with dogs has always been a part of Ferrara's life. Back in Williamsville, his Italian American father had been a hunter who trained teams of German shorthaired pointers. At a dog trial one day, when Ferrara was 15, his dad had a massive heart attack right in front of him and died. So from an early age, death and dogs in the outdoors became curiously conjoined themes in Ferrara's mind.

Ferrara is a handsome guy, a former bodybuilder with bulging biceps, a barrel chest, and a strong, clear voice that gets your attention. True to the dialect of Buffalo, faint echoes of Canada—"a-boat" for "about"—creep into his speech. He has frosty blue eyes and a chiseled face reminiscent of Clint Eastwood. He's in terrific shape for a man of 60, yet there are hints of pain in his step, from a life of sports injuries. He's had nine knee surgeries, two ankle operations, fractured ribs, a broken collarbone, a cracked sternum, a collapsed lung, a ruptured Achilles tendon, four compressed vertebrae, and four concussions "that I know of." Physical injury is "part of the equation you accept," he says. "If you play the games of the mountains, you're going to get hurt."

It was the possibility of emotional injury that Ferrara hadn't counted on. Yet in December of 2008, after several months of downward spiraling, he snapped. Ferrara experienced a devastating breakdown and was diagnosed with post-traumatic stress disorder that's required a regimen of comprehensive therapy that continues to this day.

Fellow Aspen first responders were momentarily shocked by Ferrara's news. PTSD was supposed to happen to soldiers, a malady incurred on jittery battlefields far from home, not in a Xanadu dedicated to strenuous good fun. But Ferrara had long suspected he had PTSD and wasn't surprised.

"Of course he got PTSD," says Pitkin County sheriff's deputy Alex Burchetta. "Mike always did it big. He climbed the biggest mountains. And when he was on duty, he seemed to get the biggest calls. Injury, trauma, death—for 30 years, that pager was on 24/7, and he couldn't get a reprieve. You'd have to be naive to think that he'd be impervious to it."

The risks associated with exposure to extreme trauma have been part of the human story since we evolved as a species. Matthew Friedman, a psychiatrist and executive director of the Department of Veterans Affairs' National Center for PTSD, says that humans have been dealing with post-traumatic stress disorder "since the days when we were getting attacked by saber-toothed tigers." According to Friedman, Homer describes something very like PTSD in The Iliad, and Shakespeare's Henry IV has what appears to be a classic symptom: a post-traumatic nightmare. Army physicians described a malady in Civil War troops that they called "soldier's heart." In World War I, the diagnosis was "shell shock." By whatever name, the condition was largely the same: an invisible injury, a hurt without blood or perceivable scars, an overpowering hopelessness that lasted long after a person's encounter with catastrophe or horror.

It wasn't until 1980 that the term "post-traumatic stress disorder" entered the lexicon of the American Psychiatric Association and its Diagnostic and Statistical Manual of Mental Disorders. PTSD's acceptance as a diagnosable disorder was greatly hastened by the experiences of veterans' hospitals treating soldiers, sailors, and marines who had returned from the Vietnam War. VA doctors found that the disorder manifests itself in a range of symptoms—panic, sleeplessness, nightmares, social withdrawal, emotional numbing. But the overriding symptom is a patient's tendency to reexperience traumatic incidents with a vividness and clarity that is often indistinguishable from the original event.

"In many ways, PTSD is a disorder of the memory," says Friedman. "It alters the neuro­circuitry and the neurotransmitters which balance retrieving memories. In terms of brain chemistry, they're different people than they were before. Through brain scans, we can observe the changes. In people with PTSD, an almond-shaped part of the brain called the amygdala becomes hyperexcitable—we can see it light up when PTSD patients are reminded of their trauma."

There are an estimated 24 million cases of PTSD in the United States alone, the majority of the patients likely being veterans. Over the past decade, however, PTSD has gradually become associated with civilian professionals as well: firefighters, police officers, emergency techs, and other first responders whose jobs routinely put them in harm's way and expose them to horrific scenes. A study published in The American Journal of Psychiatry in 2007 reported that 22 percent of volunteer emergency workers at the World Trade Center disaster site developed a wide range of PTSD symptoms. Traumas suffered by victims and relief workers in recent natural catastrophes such as the 2004 Indian Ocean tsunami and last year's earthquake in Haiti have further confirmed that PTSD extends far beyond combat scenarios.

Ski resorts and mountain communities have been slower in catching up with this trend, but alpine first responders are gradually beginning to recognize that PTSD may be widespread in their ranks, too. Dwelling in backcountry beauty does not inoculate one against tragedy. Whether you're in a tank or on a pair of teles, the psychological ramifications of dealing with bloodshed and trauma are the same.

"PTSD is a sneaky player," says Utah's Dean Cardinale, president of Wasatch Backcountry Rescue and ski-patrol director at Snowbird. "In the industry, it is probably one of those things that gets missed. These stresses do affect us—profoundly. We wouldn't be in this profession if we didn't have care and concern for the people we're trying to rescue." "I know half a dozen people who've had PTSD," says Tim Kovacs, a prominent wilderness paramedic and mountain-rescue specialist in Arizona. "For those of us who work in the backcountry, the old mantra was 'Take a lap, run it off, get over it.' Thankfully, it's slowly getting more attention. PTSD exists. The stress of this kind of work mounts on you. You either deal with it preventatively or it consumes you."

"The culture is slowly changing," agrees Skeet Glatterer, a Colorado-based search-and-rescue specialist and cardiothoracic surgeon who is chairman of the medical committee of the Mountain Rescue Association. "We basically used to say, 'Buck up, shake it off.' Now we're all painfully aware that seeing those kinds of sights does something to us."

After the Aspen plane crash of 2001, Ferrara continued to excel in his high-pressure work. Two years later, in 2003, Pitkin County awarded him a commendation for bravery for actions above and beyond the call of duty. His reputation as a rock-solid rescuer began to spread far beyond Aspen, and he found himself spending his vacations doing almost exactly what he had been doing at work: going climbing and pulling bodies, alive or dead, from the mountains. In 2005, Ferrara patrolled on Denali with the National Park Service High Rescue Team. That same year, he was part of a crew that discovered, identified, and reburied the almost perfectly preserved body of a man from Wyoming who had perished at 17,000 feet in the late 1960s.

Ferrara not only held up through all this strenuous work; he seemed to thrive on it. "I loved it," he says. "I got to do all this great physical work in the outdoors that had a purpose. People said I was a pillar of strength. And for a long while, I really believed them."

Yet without being fully aware of it, his profession was taking a toll. Ferrara began to withdraw from friends. He developed a blank stare. He went through several relationships. He started using Percocet, a narcotic painkiller, and became indifferent to former pleasures. Throughout the day, for reasons he couldn't explain, he would cry for a few minutes, consumed by an overwhelming sadness referred to by some PTSD sufferers as "flooding."

"He hid it well, but the people closest to him could tell something was really wrong," says his sister, Janet Ferrara, who lives in nearby Carbondale and works at the Given Institute, a think tank at the University of Colorado's School of Medicine. "He couldn't interact. There was no laughter anymore. He just wasn't there."

At other times, he was overtaken by what he called "the slide show," a cruel flickering of mental images he couldn't control: an eviscerated body, a father in the ambulance with his critically injured skateboarder son, those charred figures on the runway. He could hear the sound of Michael Kennedy's children saying the Lord's Prayer while gathered around their dying father in a mountain glade. He could see the icy, waxen face of a drowned woman who'd fallen off a log bridge while hiking Conundrum Creek Trail. He could hear the wailing of a mother as she held her baby who'd just died of sudden infant death syndrome (SIDS).

It was a horror show, crowded in his head like a Hiëronymus Bosch scene, and the images wouldn't stop. He reacted to them with a surge of adrenaline, a stab of fear, a complex of real and present emotions. His eyes would drop; he'd lose visual contact with his surroundings. His blood pressure would spike and he'd find himself hyperventilating. He wasn't just remembering these traumas; he was reliving them.

"The pictures were burned into my mind," Ferrara says. "They were happening right here, right now. My subconscious didn't know it wasn't actually real."

Ferrara was clearly in serious trouble, but he didn't seek help. After a fatality, he and his teams typically held something called a Critical Incident Stress Debriefing, but all that meant, really, was that he and his fellow first responders sat and talked for a while. In all his years of training, no one had ever impressed upon him the notion that rescuers themselves might need rescuing from the cumulative stress of their job. Like those in many ski towns, Aspen's subculture of mountain athletes and first responders is a rarefied and often hypercompetitive world that places a high premium on toughness and takes note of every stumble. "It's a super-intense town to work in, and the crowd Michael ran with was really charged up," says Dave Hahn, a world-renowned mountain guide and ski patroller in Taos, New Mexico, who has spent time with Ferrara in Aspen and on Everest. "If you fail, you do it publicly. It's very difficult to keep your place in the hierarchy."

In Ferrara's view, an admission of weakness was tantamount to an admission of failure. "My identity and self-esteem were wrapped up in this life," Ferrara says. "How could I admit I was so broken? I'd been doing this for more than 25 years. There weren't a whole lot of other jobs I could do. I'm not going to be very good in a bank."

Ferrara's age also figured into his predicament. He was in his late fifties and couldn't keep up the ferocious intensity of his twenties and thirties. "In Aspen," says Janet Ferrara, "people go 120 percent. None of us likes to admit it when age starts to slow us down." For all these reasons, Ferrara felt he couldn't show the slightest crack in his armor. When the slide shows played in his head, he just tried to ignore them. As he recalls: "I thought to myself, I'm professional. I'm well trained. I can do this."

"The thing about Michael was that he didn't know how to disengage," says John Barstis, Ferrara's best friend from Buffalo, now an oncologist in Los Angeles. "His idea was, if something is wrong in your life, just get in better shape. Go run another ultramarathon. Go climb another Himalayan peak. He had no peaceful way to release the pressure."

Experts in SAR say that it's often people like Ferrara—the best and brightest in their communities—who end up having the most acute problems with PTSD. "The bigger they are, the harder they fall," says SAR specialist Tim Kovacs of Arizona. "They think they can out-think it, outrun it, out-ski it. Some of them can hide it for damn near a lifetime. But eventually it eats them up."

In 2006, Ferrara quit the sheriff's department, but he was still working as a ski patroller on Aspen Mountain and as a paramedic at the Aspen Valley Hospital ER—while also volunteering for mountain rescues and recovery operations. He spent two more high-pressure seasons dragging hurt skiers off the mountains, tending to traumatic injuries, digging corpses out of avalanches, and, at times, making dreadful calls to loved ones.

On the mountain, the drumbeat of injury and death was steady. Highland Bowl, Snowmass, Pyramid Peak, Independence Pass, the Maroon Bells: everywhere he looked, he could find a trigger that might set off memories. Says Ferrara: "I spoke with a mother whose son had just tumbled 600 feet off the back side of South Maroon"—a young athlete whose terribly mangled body he had found and recovered. "She was remarkably stoic. She said, 'The mountains take a great toll on our young men.' It was like she was talking about a war. I'd long thought my work was like a war at home, and it was never-ending. And the casualties were all civilians."

SAR veterans often speak of the particular horror of encountering free-fall victims like the one Ferrara removed from South Maroon. Marc Beverly, an SAR trainer and mountain guide in Albuquerque, New Mexico, says he's never fully recovered from a 1996 incident in which three climbers fell off an 850-foot-high cliff.

"You pick up an arm and it disarticulates, you see eyeballs exploded, you see brain matter in the trees, and the birds are eating everything," he says. "You're picking up people's teeth and putting them in Nalgene bottles. When you experience something like this, it's with you forever. When you go back to that spot, it's haunted. It's no wonder some people in SAR cross over and never come back."

It wasn't until December 2008 that Ferrara's life truly came apart. One Sunday evening, he was working in the emergency room when a fellow paramedic told him, "There's been an avalanche on Aspen Mountain, in the Mid Country. The patrolmen just found a skier. Michael, it's Cory." Cory Brettmann was a beloved figure in Aspen, a veteran ski patroller and family man—and he was Ferrara's best friend. They were kindred spirits and former roommates. They'd ice-climbed together, spent time in Alaska together, traveled widely in the spirit of adventure.

Ferrara cried when he heard the news, then he met the ski patrol near the 1-A lift at the base of Aspen Mountain. He opened up the litter and pulled back the blankets. Cory still had a tube in his mouth from the paramedic's resuscitation efforts, and his hair was caked with snow and blood. He'd suffered blunt trauma. Tumbling in a wall of moving snow, he'd pinballed through a stand of trees, breaking a femur and multiple ribs before finally suffocating. Ferrara washed Cory's face and combed his hair so he'd be presentable to his wife. Then he took his friend to the morgue.

"Any emotional armor I had left, Cory's death shattered it," Ferrara says. "I was in a fog of despair. I couldn't see beauty anymore, only darkness." He withdrew into himself. He couldn't sleep, couldn't think. On his days off, he wouldn't leave the house. The slide show played without cease.

By this point, Ferrara had begun to seriously abuse Percocet. "All I wanted was to medicate," he recalls. "I lived every day in fear of the next call. I couldn't go back out there and face the mountain. I just couldn't do it anymore. I got all the Perc I could get my hands on." Ferrara's dependency fit in with the established literature on PTSD, which has a very high "comorbidity" with substance abuse. Some studies show that nearly 50 percent of male PTSD sufferers—military and civilian alike—simultaneously battle addictions.

As his substance abuse worsened, Ferrara burned bridges and frustrated colleagues on the mountain, interacting with them as little as possible. Then, in early February, after working an ambulance house call that proved to be a SIDS death, he hit bottom. He was using morphine and downing four Percocets at a time. When the head of Aspen Mountain ski patrol confronted him about his erratic behavior in February 2009, Ferrara confessed to his addiction.

Banished from the patrol room, his paramedic license rescinded, Ferrara broke down. He was evaluated by Aspen Mental Health. Then he entered a Carbondale-based intensive rehab program and began, with the guidance of his sister, to consult a series of psychiatrists at the University of Colorado's Depression Center.

The specialists there had no trouble diagnosing Ferrara's underlying problem. He had many signs of PTSD: the combination of debilitating anxiety and severe depression, the withdrawal from the world, the emotional flooding, the insomnia, the lack of eye contact, the memories stuck on merciless "play." It was a textbook case.

I first met Ferrara on a misty, cold afternoon last winter, when he was in the throes of his recovery. Though he was still persona non grata in the Aspen Valley Hospital ER and in the Aspen Mountain patrol room, his paramedic's license had been officially reinstated and he had a new job working on the Snowmass Ski Patrol.

On his day off, Ferrara picked me up at my hotel at the base of Buttermilk, where ESPN television crews were furiously building sets for the 14th annual Winter X Games. Lhotse restlessly whimpered in the back as we drove on slushy roads to the log-cabin headquarters of Mountain Rescue Aspen on Main Street. Inside, we sat at a table in a locker room stuffed with crampons, sleds, ice axes, helmets, Avalung packs, and countless miles of coiled rope. It was a kind of war room where Ferrara had prepared many a rescue—and a place where both he and Lhotse obviously felt at home.

Mongo was 11 months into his therapy at this point. He stroked the soul patch on his chin and spoke of his malady with thoughtful detachment. He wasn't out of the woods yet, he insisted, but he felt he was well on his way. "I've got joy again," he said. "I'm running. I'm climbing. The slide shows have stopped. My eyes are up again—I'm here."

He had successfully confronted his substance abuse and had been clean for a year. He was taking the antidepressant Zoloft and had sat through many months of cognitive-behavior therapy sessions—sessions designed to "unpack" bad memories and relearn ways to store and think about trauma. He had also experimented with more esoteric techniques such as eye-movement desensitization and reprocessing (EMDR), which involves staring at a rhythmically moving light or holding rhythmically alternating buzzers while concentrating on traumatic experiences. The theory behind this therapy is that when one's neurological activity is steadily shifted from side to side, something happens to the way the brain processes memory.

"EMDR activates the connector between the right and left lobes—so that both halves of the brain start working together to process the trauma," says Barbe Chambliss, a Carbondale psychotherapist who knows Ferrara.

Ferrara has found a similar restorative power in physical activity that involves a rhythmic, left-right-left-right action, which may physically mimic EMDR. Soldiers diagnosed with PTSD have widely found that vigorous repetitive-motion exercise such as ice skating and rollerblading can be extremely helpful in keeping the disorder's symptoms at bay. For many PTSD sufferers, though, the most helpful sport of all seems to be nordic skiing. Ferrara has taken to it with a vengeance.

In fact, he's made cross-country skiing a central part of his recovery. Ferrara says it stimulates an entirely different brain chemistry from the more intense sports he's used to—releasing endorphins instead of adrenaline. Nearly every winter day, Ferrara and Lhotse have hit the endless miles of trails that twist like capillaries through Aspen's surrounding mountains.

It was during those long hours of brisk solitude, hearing his own breath and falling into a healing rhythm, that Ferrara hit upon the idea that's animated him over the past year: the First Responder Recovery Project. In November, he launched a new Web site——filled with information about civilian PTSD, the disorder's symptoms and warning signs, and its treatment—with links to psychiatrists, therapists, clinics, and hospitals across the country. "In the first-responder world, there's no doubt that PTSD is rampant," Ferrara says. "The more I've gotten into this, the more people I've found who had it. It's an iceberg—we're just seeing the tip. We need to create a whole new culture in which civilian first responders can openly talk about it, and we need to make good PTSD treatment as readily available to them as it is to soldiers. Corporate and government bureaucracies aren't going to help us—we've got to help ourselves."

Locally, Ferrara started a first responder's self-help group, an open-door meeting of his peers that gathers in Aspen the third Thursday of every month. Only a handful of people turned up for the inaugural meeting, in August, but Ferrara says the numbers are picking up each month. "All that's required," he says, "is that you show up willing to listen—and unwilling to judge."

Finally, to raise national awareness for the First Responder Recovery Project, Ferrara has done a most Ferrara-like, most Aspen-like thing: he's hatched an ambitious adventure. Starting the second week of March, he plans to ski across Alaska, south to north, from the Pacific Ocean to the Arctic Ocean, from Valdez to Prudhoe Bay. Lhotse, of course, will be trotting along at his side the whole way. The 900-mile trek, which is being sponsored by Eddie Bauer First Ascent, should take about 70 days. It will be "one giant EMDR session," he says, good for mind, body, and soul alike. And, he thinks, it will be a first for the record books: according to his research, no one has ever skied across the entirety of America's largest state.

It's an altogether ridiculous and beautiful idea, and one that is calling upon Ferrara's considerable organizing and logistical skills. Working with first responders and search-and-rescue specialists in Alaska, he's been planning the route for months. He's arranging regular drops of food and supplies. At carefully spaced intervals, he will pass through villages where he can get a hot shower and a square meal—and where Lhotse can see a veterinarian if the need arises. In the end, Ferrara says, "it will be a long walk to clear my head—and to raise awareness so that maybe others who're hurting can avoid what I've gone through."

What Ferrara will do when he gets back from Alaska is less clear. What does any wounded hero do once he's hit a wall and can go no further? To pay his bills over the past year, he's had to patch together an assortment of odd jobs. He's bucked hay on a nearby ranch, assisted at a home for developmentally disabled adults, done a little janitorial work, and served as a fitness trainer at Aspen's five-star Little Nell hotel, dispensing advice on how to get chiseled abs or where to find a first-rate facial. A modeling agency in Aspen even approached him to be a "mature fitness model" on television. If these jobs seem beneath the dignity of a man of his training and experience, the fact is he's grateful for the work.

Whatever happens next, Ferrara knows he has to reinvent himself. He can't go back to ER work, and the search-and-rescue assignments he does accept will be fewer and further between. He's talked about teaching, or touring the country to "spread the gospel" about civilian PTSD. "It's OK to dial it back," Ferrara says. "And it's OK to quit. That's what I learned. I don't need the boldest job—I don't want to be that guy anymore."

One day this summer, Ferrara, Lhotse, and I spent an afternoon walking through Aspen together. We wound past the boutiques and sushi bars, beholding the plastic surgery on display in the crowds. Coming out publicly about his PTSD has been hard for Ferrara; rescuing himself has taken more courage than any highstakes save in the mountains. I could sense that he still worries, just a little, how people in town now view him.

We passed the fire department, where the big garage doors were thrown open. Two young firemen got up, came over, and shook Ferrara's hand. "Hey, Mongo!" they said, and he flashed a big smile.

Then we wandered over to Wagner Park for Lhotse's daily romp with the village hounds. Some of his friends were already there—a Labradoodle and a mutt—and Lhotse bounded across the field for a tussle beneath the rugby goalposts.

It was a perfect, crystalline day, the kind that made Ferrara proud to be an Aspenite. "I'm the luckiest guy in the world," he said. "Despite everything, I don't think I could ever leave this place." Beyond the field, Aspen Mountain rose steeply, its swaths of emerald grass zigzagging through high shimmering groves. The lifts hummed toward the summit, where we could see a lone hang glider dancing in blue skies.

Then a siren punctured the quiet. An ambulance screeched around the corner, lights pulsing. It raced right past Wagner Park and disappeared, bound for someone in distress. It didn't even register with Mongo. He just kept watching Lhotse—a $10,000 rescue dog emphatically off duty.