Ambulance Girl

by Jane Stern

  I looked at Charlie’s face. He was going through the motions, but obviously couldn’t wait for me to leave.

  “What is it you wanted to look at exactly?” he asked.

  “Nothing really, I just have never been inside an ambulance,” I said and tried to imagine if I could squeeze myself through the space from the back to the front if I was freaking out in the back.

  “Thanks . . . I think I would really like to become an EMT.”

  I don’t know if he or I looked more shocked when I said those words. We both stared at each other mutely.

  He took me upstairs, where I filled out paperwork that would enroll me for the class that would begin in a month.

  As much as I hated the ambulance, I instantly loved the firehouse. It looked perfectly comfortable in the most manly, blue-collar way. The main room had a big-screen TV turned to a NASCAR race, comfortable couches, a bar area with open boxes of beef jerky sticks, a soda machine that delivered cans of Pepsi for free, a big pool table with a Budweiser sign over it, a pinball game from the 1950s, and a wooden shuffleboard table game called Horseshoe that looked like it was from the 1930s.

  It was GI-barracks neat. Old fire helmets were in a display case and patches from other friendly fire departments were stapled to a burlap-covered board. I wanted to sit on the big couches and eat beef jerky with the guys.

  I signed the paperwork and went home.

  I walked in the door that leads from the garage to the kitchen to find Michael boiling a pot of water for spaghetti.

  “Hi,” he said. “Where were you?”

  “At the Georgetown firehouse,” I said as I watched him slide his favorite imported pasta into the water. “Guess what?” I said. “I’m going to be an EMT.”

  Michael stirred the pasta in the pot and got a bemused look on his face, as if I had told him that I figured out Santa Claus really existed. I had seen this look before. I had seen it when I came home declaring that I was going to take up the bagpipes, and I had seen it when I said I was going to sign up for boxing lessons at a raunchy gym in nearby Danbury. It was the look of disbelief and of humoring me along.

  “Cool,” he replied. “When do you start?”

  I felt myself flush with annoyance. He thought I was just spinning my wheels.

  “I’m not kidding,” I insisted.

  “Did I say you were?” he said back. “What do you do as an EMT?” he asked.

  “You pull dying people from car wrecks and that kind of thing,” I muttered.

  Michael raised an eye at me. “That’s what you want to do?” he asked.

  “Absolutely,” I said, feeling weak in the knees.

  What Michael didn’t know was that I had started the process of becoming an emergency medic almost half a century before. I was the child who was always playing doctor. I even had a specialty: head transplants. The transplants were an innovative technique that involved my twin teddy bears, George and Soft Baby, and a pair of sharp scissors. The procedure was to cut their heads off at the neck and then switch them. George got Soft Baby’s head and vice versa. It was an elaborate and time-consuming operation. First the severed heads were placed on a clean towel, then a threaded needle from my mother’s sewing box was sterilized with Arpège perfume. Two lengths of brocade ribbon bought from the notions department at Bloomingdale’s were cut to size and the bear’s heads were laboriously sutured to each other’s bodies using the ribbon at the new neckline. I had perfected the operation after doing it at least a dozen times, so it was a shame when one day I got careless and accidentally knocked George’s severed head off the windowsill, and it lay in the courtyard of the fancy building on Fifth Avenue that abutted the townhouse in which I lived with my parents. No matter how I cried and pleaded, the doorman would not leave his post and retrieve my bear’s head from the courtyard. Formidable in his large great coat and cap, he sent me packing. He did not understand this was a medical emergency . . . a 911 call.

  I started my real EMT training course on a freezing winter’s day in the lecture room of the New Canaan police station. The cops behind the bulletproof window glowered as I entered. There were no kind looks given to me or the other forty people in the class who followed me in. We may not have been perps but we were interlopers in the cops’ sanctuary. Over the microphone and through the bulletproof glass we were told not to loiter in the lobby, not to talk to the police, not to park in the nearby spaces in the parking lot reserved for police cars . . . to generally get lost, sit down, and shut up.

  I immediately got so nervous I lost one of my favorite earrings, dropped my eyeglasses and bent the frames, and spilled the contents of my purse on the floor. None of the students made eye contact with each other. Everyone looked grim and nervous. The majority of the class were young men, firefighters or police trainees looking for their EMT certification.

  The class ran three hours. We were given the textbooks. I opened mine at random and saw a large color photo of a man with half his head missing and his brain pouring out like gray pudding. I turned the page. There was a photo of a partial amputation of a limb, the jagged white bone protruding from what looked like a steamship round of beef. I turned it again and there was someone with third-degree burns on his penis, his skin hanging like scarlet ribbons down his leg. I felt the latte I had brought to class from the nearby Starbuck’s roaring in the wrong direction up my gullet. Old, fat, and singleearringed, I prayed to not puke all over myself the first day. I tried to fade into the crowd.

  Our instructor was a paramedic named Frank Posca. I wanted Frank to like me but he made it clear he was not interested in friendship from anyone in the class. He was a tattooed ex-military man, a veteran of the streets of Bridgeport, where from the back of the ambulance he worked on a regular basis with crack addicts and glue sniffers and failed suicides. Frank was short and wide, a cinder block of a man with a closely barbered head and a tiny gold earring.

  When I look now at the big white plastic loose-leaf notebook I carried to the class over the long months ahead, I see how neat and tidy my writing was in those first few classes. How I copied down in a firm black pen such nuggets of wisdom as “Professional attributes of an EMT are a neat clean appearance, current knowledge and skills, attention to patient care.” I wondered if someone with their brain hanging out of their head would notice my “neat clean appearance” or my missing earring and bent eyeglasses.

  Printed and in large letters in my notebook were Frank’s words of warning that first day: “EMT is the most stressful job of all!” And below that, a list of the warning signs of stress, which included “anxiety, guilt, indecisiveness, isolation, fear of separation and being ignored.” Since I already had all these symptoms before I set foot in the class, I wondered how I would know when the job was getting to me.

  EMT training is like boot camp. This was a new way of learning to me. I was a product of exclusive Ivy League schools and progressive preps. My teachers were there to nurture me, to gently water the seed of my talents and coax it to the sunlight. The first day of class Frank had us all bellowing in unison the watchwords for becoming an EMT: “BSI . . . I’m number one!” we screamed.

  BSI means Body Substance Isolation, i.e., protective gloves and, if necessary, a mask and eye protection and perhaps full fireman’s turnout gear complete with self-contained breathing apparatus. If you are an EMT you do not go into a scene and you do not even think of touching patients without at least a barrier of rubber between you and them.

  “I’m number one” means that you are important to yourself and to the rescue unit. If you arrive at the scene of an emergency and someone is pointing a gun at you, the house is burning down, toxic fumes are clouding the air, or a psychotic is telling you the Martians have ordered him to kill you now, you do not attempt to be a hero. You run for cover and get help. That is what being number one is all about.

  When I left the first class I was so wrung out that my hands shook. I could hardly unlock my car door. As I drove home, it started to snow.
I felt the car skid as I made the turns on the back roads. What if I had an accident and had to call 911? Could I tell them I was sort of one of them?

  I got home shortly before midnight. It was late and Michael had gone to bed. I made myself a toasted bagel with cream cheese, sat downstairs in the den, and flipped the channel of the TV to an old Bette Davis movie. I thought of the gruesome pictures in the textbook and felt queasy again. I pushed the bagel aside, walked upstairs, and crawled into bed next to Michael, basking in his warmth. Safe for now.

  The class met three times a week. Being back in a classroom flooded me with memories of childhood. I was now significantly bigger than the last time I sat at a school desk, and I now found the chair with the writing board that swung around under my right arm constrictive. I also had a lot more “stuff” than I did as a kid—a purse, a coffee mug—and I was minus a locker or cubbyhole in which to stash it.

  I arrived chronically early to the class, scouted out my favorite chair on the far left of the front row, attractive to me because it was close to a window ledge where I could rest my stainless steel tankard of coffee, my handbag, and my textbooks.

  Buying the notebook and pens for the class was a rush of nostalgia. I had not handled three-ring lined notebook paper in years. I bought a plastic pouch to hold pens and pencils, colorful plastic dividers to segregate one class neatly from another. I arrived freshly scrubbed, bright-eyed, and eager. I smiled at everyone who came in. Few returned my glance.

  I was not the oldest person in the class. There were two people my senior. One was a small-boned woman, thin and jittery. The other was a man with a gray woolly head and thick glasses. My first thought when I looked at them was, They don’t belong here. They were too old, too dilapidated. I smelled trouble; they would have special needs, be slow, be irritating. Ungenerous in my assessment, I wanted them out. I dreaded that anyone might think I was like them. Sure, I was more than thirty years older than most of my classmates, but it was obvious these people were really old and didn’t belong here.

  The jittery lady lasted one class. She fidgeted through the lecture and I saw her handing her textbook back to Frank at the end. I tried to make eye contact with her as she left the room but she held her head down.

  The human body as I first learned about it as an EMT is a stick figure. That is what I drew in my notebook during the lecture. This stick man had lines going through him. Sideways he was cut into anterior and posterior segments, through the chest he was midclavicular, his twiglike fingers were distal to his medial section, his single line of a chest was proximal to his heart. The stick man’s spine was divided into four sections. His cervical spinal process, his thoracic region, his lumbar region, and his sacral region. A big black ink splotch on his anterior thorax showed the xiphoid process, “landmark for all CPR compressions,” we were told.

  I loved the words of the body’s geometry. They were poetry to me. Scapula, maxilla, ischium, meniscus, calcaneus, acetabulum: I moved them around in my mouth like smooth lapidary pebbles. I loved the word cyanotic, meaning blue from lack of oxygen. We saw slides. Dead was a gray blue like the churning waters off Gloucester, Massachusetts.

  I was immediately good in class, but it was only because I knew the bones of the body from my years as an art student. Art was what I had majored in as an undergraduate as well as a grad student for seven academic years (about as long as it takes to become a medical doctor). I sketched and painted the human body. I came to know it draped and disrobed, fat and thin, young and old. I especially loved anatomy, loved tracing my hand across the ivory bones of the class skeleton, loved the books that showed the body dissected to reveal flaps of muscle and cartilage. Like architects building a house, as artists we had to learn what held this thing called the human body together. We had to know how it moved, and what lay under the skin.

  I was strong coming out of the starting gate as an EMT. I had a leg up, I knew my tibia from my fibula. I hugged my white plastic loose-leaf to my chest as I left the class at the end of the night. I could do this. I knew things.

  My jump start didn’t last long. Was it possible that when I was younger and went to school five days a week that my brain could absorb as much information as I was getting now? Now I felt overwhelmed with facts. It was different than when I was a child. I remember classes and I remember homework, but this was unique. Maybe I cared more now, maybe my brain, like the rest of me, had slowed down. I wondered if the antidepressants were causing brain lock. I looked around the class and wondered if anyone else felt as overwhelmed and flooded as I did.

  I think that I cared too much. I was the one who sat taking notes like mad. I was the one who always had my hand in the air. What Frank said to the class seemed like the wisdom on the tablets God gave to Moses.

  Frank explains to us the correct placement of a plastic airway into the patient’s throat. I can see myself ham-handed in the back of an ambulance, inserting the airway the wrong way. I cringe, and turn around to see the slack faces of my fellow classmates. They do not share my intensity, my horror of missing any of the minutiae. I see one of the two identical-looking Spanish sisters who have joined the class pushing her cuticles back. She is not listening. I am thinking, What if she was the EMT in an ambulance when I stopped breathing? What if someone handed her the plastic airway and she had not remembered that Frank had said something about putting it in one way and then flipping it around the opposite way during insertion? It ceases to matter, because after two more classes both sisters dropped out. I ran into them on the streets of the town two weeks later and asked them what happened. “Too gross,” they say in unison. They didn’t like the slides of people with their brains spilling out.

  I am amazed I have stuck it out this far.

  Frank is our main teacher but he is joined by five different paramedics from time to time who come in to lecture us. They seem to me to be a good ol’ boys club. I think they regard us students as insignificant fleas skirling about on the surface of emergency medicine. During the breaks they ignore us and laugh and talk with each other.

  Even though they hang together they all have different personalities. There is Ralph Miro, a trim, neatly dressed man who comes to lecture us wearing a well-cut suit and tie instead of the coplike uniform that Frank and the others must wear on the job. Despite his sartorial style he is the one who brings the most horrific slides to show us, and clearly delights in raising the squirm factor. He wants to scare away those who can’t take it, or who think EMT is holding the hand of an attractive person with a hangnail and offering comfort and a bandage.

  Ralph’s photos are straight from the hospital and autopsy room. They are a gallery of freakish events. A man who fell on an iron fence railing that pierced his chest, a woman having an allergic reaction whose tongue has swollen to the size of a shoe. A man who was hit in the face straight on with a shotgun and whose nicely cut hairdo now frames what looks like a dish of eggplant parmesan. I am fascinated by what is left intact on these unfortunate people. We are supposed to be looking at a bloody stump of a wrist and I am seeing the grace of the hand that is left behind, the attractive nails and elegant ring on the good hand, the silky skin or the curve of a hip, the svelte fleece of pubic hair that glistens despite being a neighbor to disaster a few inches away.

  I think I am weird to notice this, but I am looking for comfort in the midst of chaos. Maybe I am trying to remember these are people and not body parts. By the fourth class things have gotten so intense that I have taken to writing the name of my shrink in the well of my notebook over and over, in an attempt to keep from running out of the room.

  I plead my case to the gods of medicine. “Let me get through this,” I say. I think it can’t be worse than sitting in the plane. I am listening to Prozac, but it hasn’t told me everything will be all right.

  The class is like a living and changing entity. Cliques form. There are now popular people and pariahs. During the breaks the same people talk with each other. The cops still give us dirty loo
ks and yell at us about parking in their spots. The paramedics hang together, daring us to come near them, and I have made an uneasy alliance with a girl named Dot. At least a decade my junior, Dot wears her hair cut short, dyed purply red and spiked with gel.

  Each of us takes our same seat each class. I hold on to the one near the window ledge with the force of a pioneer homesteader. I love this seat because the cracks of the window caulking leak just enough air to make me feel I will not pass out when the lecture gets too visceral. Dot has taken up residence in the seat next to mine. We are both front-row types—intense, educated, verbal. The difference between us is that she fails to understand that this is boot camp and the best way to survive is to be invisible. You don’t want to piss off the paramedics. They clearly hate us just for being new and dumb and are looking for any excuse to make our class time more hellish. Somehow Dot doesn’t get this, or if she does, she doesn’t care, as she raises her hand every five minutes. She questions them, she argues with them, she corrects their grammar. I am wishing she was far away from me; I worry they will think I am in cahoots with her. “Shut up, shut up, shut up,” I whisper under my breath. But she doesn’t.

  We are starting to get up from our desks and do what are called practicals. This involves Frank dividing the class into groups of six and practicing things like CPR or trauma assessments with each other instead of just sitting at our desks learning things theoretically. Dot is in a different group than I am. Frank has broken up the groups by last names rather than seat assignments.

  I am having a wonderful time because I like the hands-on part. I now get to touch living people, my fellow students. Maybe it is my age or my training as an artist, but I am not at all shy about placing my hands on a stranger’s body.

  With the help of the paramedics we learn how to apply traction splints and cervical neck collars and how to cut off someone’s clothing fast and look them over for bullet wounds that have entered and exited. We use each other and we use rubber mannequins to practice on. I am given a rubber baby doll and told to save it from choking. I do the pediatric Heimlich maneuver so hard the baby’s head flies off and lands ten feet away in the corner of the room. This is not good.