by Jane Stern
I move on to the big adult-sized rubber mannequins. The female mannequin has blond plastic hair that looks like a 1950s swimming cap. All the mannequins’ mouths gape open like sex dolls’. Many of them are just heads and torsos without arms or legs. These are for working on with chest compressions and mouth resuscitations. One mannequin, Rescue Randy, is dressed in real clothing and looks the most human. He is filled with sand and weighs 160 pounds, and is designed to duplicate an unconscious adult male. I tug at his legs to move him. He doesn’t budge.
With the help of a classmate I haul Randy around the classroom, hitting his head on the desks and wooden baseboards. “You killed him!” Frank yells jubilantly at me. “He had a heart attack and now he has a fatal head trauma.”
By the end of the class I am in my usual trembling sweat. The sheer physical exertion of becoming an EMT is something I never thought about. It seems we are always moving, stepping, squatting, pushing on someone. We have to be careful not to step on their arms or legs, to walk over their chest, to further damage the patient beyond what is already wrong with them.
The big rubber mannequins look so inhuman it is easy to forget they are supposed to be people. I find myself pulling them around by their faces, or reclining against their armless torsos during the breaks as if they were toss pillows.
It is always good to take a break. We are given one midway through the class. All the smokers run outside. I join them although I don’t smoke. Frank smokes. He tells us that one of the big stresses for EMS personnel is bad health habits as he drags on his second cigarette.
I like it outside because the winter air is cold and dry and it wakes me up and dries off the sweat from working in the classroom. People still have not connected. There isn’t the usual stoop chatter one hears among coworkers. People smoke in silence.
At the end of the class I get my coat from the hooks in the back of the room and leave. I am the last to leave because I have helped stack the chairs against the wall, something the cops demand we do. In the quiet parking lot I see someone standing alone by her car. It is Dot. She looks upset. I stop and talk to her. She tells me she thinks people in the class hate her. She seems so beaten down and miserable that I talk to her for what seems like an hour.
My hands and feet are freezing but Dot seems to be unaware of the cold. “No one wants to work with me,” she moans. “When I join a group the guys completely ignore me or give me looks that could kill.”
I don’t know what to say to her, so I am honest. I’m not sure it is the best policy but I am too cold to think of anything better. “Maybe you should not raise your hand so much, just keep your opinions to yourself.” Basically I am telling a bright person to act stupid. This is not going over well.
She starts to argue with me.
“Think of this like boot camp,” I say. “The medics are here to weed out the weak. They want to break us down, so just get tough and don’t take it personally.”
As I am talking, one of the cops pulls out of the driveway in his patrol car. He yells, “Don’t park in our spaces!”
Frank, who has packed up his lecture notes, pulls out in his SUV. “Good-bye, Frank,” I call out and wave. He doesn’t answer.
Dot still looks miserable. I ask her what EMS service she is joining after we graduate.
“Georgetown,” she says.
The class is given its first test. I score an 80. I am devastated by how mediocre I am. I do nothing but study. This is a class filled with young cops and firemen, and I have a graduate degree from Yale. How can I be less than brilliant? I look at Dot’s paper; she has gotten 100. Frank has even scrawled “good job” on the top. I am wild with jealousy.
Because Dot has claimed the seat next to me and she is left-handed, everything she has on her desk is aimed right at my line of sight or resting on my right leg. She is also a sprawler. I am anal about my textbooks, my pristine white notebook, the boundary lines of my desk and beloved windowsill where I park my coffee. She is always fifteen minutes late to class, rolls in unapologetically after Frank has begun the lecture, and throws her backpack down on the floor. She is in many ways my exact opposite. While I smile at everyone, she glowers. Dot looks rumpled, while now that my depression has been replaced by a feverish study of emergency medicine I have standing orders at the Georgetown dry cleaner for my shirts to be laundered with extra starch. Dot always wears jeans, a big ungainly windbreaker, and hiking boots. My cowboy boots are custom-made and my jeans well ironed. Her casualness is one reason why I am in despair that she has gotten 100 on the paper. “You got an 80?” she says.
She has stopped one micron before saying the words I thought you were smart. “It’s not you,” she says. “It is this test. It is a semantic mess.”
As Frank lectures to us she scribbles wildly on her notebook so I can see it, something I haven’t done since the seventh grade. Dot tells me she has a Ph.D. in semantics, and she goes into furious detail about every flaw in the questions. I appreciate her making an excuse for me. To her way of thinking, I am simply too smart to take a dumb test. I don’t have the heart to tell her that the semantics really were not the problem, the problem was that I simply didn’t know the answers to 20 percent of the questions. I imagine standing over a dead body in the back of the ambulance and telling the grieving family that it was not my medical error but merely a matter of semantics that I failed to save their loved one.
I am having a problem my shrink tells me is often experienced by first-year medical students. I have every symptom of every disease Frank mentions in the classroom. I am no longer clinically depressed but instead am dying of everything simultaneously.
Now I have fancy words for what is wrong with me. I am no longer sweaty. I am diaphoretic. My hand wanders constantly to my neck to check my carotid artery to see if my pulse is thready or bounding. I am no longer breathing rapidly but I am suffering from tachypnea. I have all the symptoms of a heart attack, a stroke, an aneurysm. I feel impending doom, my heart races, my hands tingle, I can’t feel the right side of my face. When I am not enmeshed in my imminent death from medical problems, I am obsessing about all the impending scenarios of trauma waiting out in the world.
A car is not fun to drive anymore. It is a metal cage waiting to kill me in a dozen ways I have never thought about. I can get trapped inside underwater. The rescue personnel will not be able to free me thanks to Ralph Nader, a man I once admired but who now, as all EMTs know, is clearly Satan, having been responsible for cars whose doors do not fly open in a crash and come with safety glass that can’t be shattered easily to free the victim. When Nader’s name is mentioned the paramedics and firemen sneer and make the same spitting noise my Jewish grandmother made at the mention of the Nazis.
Terrible things can happen in cars. The seat belt can crush my intestines, my head can hit the dashboard and send my brain bouncing around inside my skull like a Pac-Man figure under siege. It isn’t just cars. After about ten classes everything in the world has become an accident waiting to happen. Dogs have teeth that cause severe puncture wounds, the propane gas tank on our outdoor grill can explode and level the whole block. Have a cocktail and you can get sloppy about chewing and choke to death on a hunk of steak. Bees can sting you and anaphylaxis can set in, causing you to suffocate. UPS trucks can carry up to seventy-five pounds of unnamed volatile chemicals. Babies and children are walking disasters, their big heads and delicate bodies designed for toppling, their large tongues for choking.
Frank stands before the class and tells us, “One out of twenty of you has a main artery that is congenitally faulty and will at some time hemorrhage. If you are lucky and it is caught in time, you will not die.” He looks at me while he talks. I am now cyanotic, diaphoretic, and my pulse is bounding. “Stern, take your hand off your carotid artery,” he says. “Pressure there can stop blood supply to the brain.”
So what? I think. I am almost dead anyway.
By the twelfth class I see my notebook is filled with marginalia written
from me to Dot and back. It bears the name of various physicians in the area. She wants to know who I use, who’s good, who returns phone calls. Clearly she is dying like me.
The next class has me writing my shrink’s name over and over in the notebook margin as a totem that everything will be okay. It says “TOM KNOX” down the page, as if those seven letters can stop fears the way Superman’s cape does a speeding bullet. I have also written the word bleech in large wiggly letters—a word I haven’t used since I was a kid and found the word while reading Don Martin cartoons in Mad magazine.
Bleech (pronounced blek) is a great all-purpose word of disgust. It comes in handy for class. We are learning about internal bleeding and feces, and how we have to see if someone’s shit looks like coffee grounds, is dark and tarry, or gushing bright red. I think not.
I am at this point determined to specialize in shitless EMT events. I am also placing vomit on the no-can-do list. Frank tells us that a great many 911 calls will have us finding the patient in the bathroom, having taken a swan dive from the toilet. Sorry. But I will not do toilets. I begin to wonder if Georgetown will let me have a specialty involving only coming to calls where people are fully dressed and dry of ass. I am still thinking about blood as an option, but I have already decided that shit and vomit will not work for me.
Chad Howard has rescued us from Frank’s odious world of “bleech.” He is giving a class on the most innocuous practical subject: physical fitness. How not to strain our knees and backs while lifting people.
Chad is a young physical therapist. He is also a major hottie, blond and rippling with muscles and dressed in an endearingly dissolute preppy manner. Dot and I have pulled our desks closer together to better assess this situation. The margins of our notebooks are filled with lascivious scribbles. “He is WAY too cute,” she writes to me. I feel like we are preteen fans of ’N Sync.
I ask her how old she is.
“40,” she writes back. “You?”
I write “53.” I am more than twice Chad’s age. Dot and I don’t listen to a word he says. We don’t really need to pay attention to what he says; it is all written down in the instruction sheets we will get at the end of class. Instead we watch him squatting and lifting the Rescue Randy, and we see his corded tan forearms flex and the muscles in his thighs under his chinos expand as he shows us how to flex at the knees to save our backs. His cute butt is in the air, his shirt rides up to show six inches of smooth hairless back.
Frank is hanging out in the back of the room and looks like he desperately needs a smoke. He calls a break, and Dot and I swoon like schoolgirls, or maybe like vile old leering men at a topless bar.
When the class resumes Frank and Chad call on a volunteer to play an unconscious patient. My hand shoots in the air. Maybe I think Chad will lie on top of me and we can make out. I don’t know what I am thinking, until I am lying on the linoleum floor with my eyes closed and I hear Frank tell the class that he and Chad will now hoist me in the air and place me in the stair chair (a piece of rescue apparatus used when a stretcher is too big to fit the surroundings).
I have for the first time in my life forgotten that I weigh a lot. I mean, I really weigh a lot. I never tell anyone my weight, I would never volunteer to have anyone gauge how heavy I am. The last time I even approached the situation of being airborne was twenty-five years ago when I weighed a lot less and a male friend and I were doing a jitterbug. He tried to lift me and swing me over his knee and after getting me six inches off the ground, he gave out with a huge grunt and collapsed on the floor.
Now for some unknown reason I have offered up my bulk to this young blond god, and Frank-who-I-think-hates-me. What is worse is that there are almost forty people as an audience to watch them try and hoist me in the air. I say the name of my shrink over and over under my breath like a Hail Mary.
It is easy for them to get me upright in a sitting position. I feel Frank’s short muscle-bound arms wrap themselves under my bosom. He locks himself in, Chad grabs my legs. I am self-conscious about my legs, they are thick and heavy. All of me feels ungainly. I feel them give me a little tug to assess how hard they will have to lift. I feel my body’s resistance as they pull me against gravity. I keep my eyes closed. I pretend I am dead or unconscious. The class thinks this is method acting but I am simply trying to disappear. Trying to will myself to be as light as helium. To my amazement I am suddenly airborne. It is a revelation. I honestly thought I was un-liftable. I can feel them strain, but I am four feet in the air and then gently plopped into the stair chair. I peek out of one half-opened eye. No one is laughing.
I don’t think I will become an EMT legend in the annals of the unbelievably fat. Already I have heard the stories about the 600-pound people who needed twelve firemen to lift them off the bed. I am ecstatic. I am again a seven-pound baby in her mother’s arms. I am in love with Frank and Chad. I dream of them carrying me everywhere.
4
It seems that much of what we are lectured about in class is what not to do. “EMTs do not diagnose,” we are told repeatedly. “Do not tell the patients they are okay, they may not be. . . . If a patient tells you he is about to die, do not argue with him; he probably will die.”
I am already arguing this point in my head. When I feel sick, I get scared and I often think I am going to die. I was sure I was going to die on the stalled plane. If somebody told me I was probably right, I would likely now be dead from fright. How can I not diagnose, at least to myself? Someone has crushing chest pains radiating up their jaw and down their arm, they are sweaty, have a sense of impending doom, are nauseous, and have a pocketful of nitroglycerin pills. Is it a dislocated kneecap? Doubtful. If someone is telling me the Martians are talking to him through his tooth fillings, do I think he has appendicitis? Nope.
Chad the physical therapist comes back for the next class. This time he is not lifting any of us but helping Frank lecture us about splinting broken bones. We are told that our firehouse will supply us with scissors for cutting people’s pants off to see their injuries. Chad shows us a slide of a broken femur, the big leg bone in the thigh. In the picture it has not only broken but has pushed through the person’s skin. It resembles the main mast of a sailing ship, stark and white, standing upright. The patient’s pants flutter around it like a deflated sail.
Again I find myself noticing the ephemera of the scene. The man is wearing attractive gray flannel pants. I can’t see his face or even upper body but imagine that he is a wealthy stockbroker who got in a car wreck driving his Lexus to the train station to commute into the city. Chad tells us that a broken femur can cause serious blood loss, enough to send the person into deathly shock. What we have to learn to do is to put the bone back in place.
The way we do this is with an apparatus called a Hare Traction Splint. The top end of it is wrapped with black Velcro bands around the top of the thigh, the foot is secured at the other end, and then with a crank like that of a medieval torture rack we pull the victim’s leg apart until the broken leg bone is realigned. “You can expect the patient to complain,” we are told. This I suspect is a serious understatement.
I am not taking notes; instead I draw pictures of a handbag I saw at Neiman Marcus, I draw crucifixes with jewels on them, I make a shopping list of food I need to buy for tomorrow’s dinner. I am looking for comfort, for anything not to have to think about stretching a stockbroker’s leg until his bones snap back into place.
Sometimes I think I am too stupid for this class. I cannot remember how many liters of oxygen is in an M-sized O2 tank. Other times I think the class is too stupid for me. We are lectured on the following things:
Do not try to replace someone’s organs if they are hanging from their body.
Do not give CPR to a severed head.
Do not try to revive someone who is in a state of advanced decomposition.
If you have a patient whose leg or arm is partially amputated, do not pull it off to make things “neat.”
I wonder
who would do these things: I think the pancreas goes here; this looks like a gallbladder, let’s shove it in here.
I imagine myself doing chest compressions on a headless body from a car wreck and then running twenty feet down the highway blowing air into the mouth of a severed head. I scribble a note to Dot, who looks as aghast as I do. She seems to think that they are covering all the bases, I seem to think they wouldn’t mention this if someone hadn’t tried to do it.
I imagine myself as the Martha Stewart of EMTs, pulling off ragged limbs to make the victim look more tidy. Maybe I could sew a calico edge along the wound, or crochet a lace trim on the cusp of an amputated leg, like I did with Soft Baby, my teddy bear.
Frank gives us one of the acronyms we will live by: DCAP-BTLS, which stands for deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling. With the inevitable macabre slide show we see examples of each of the above. For abrasions we see a slide of someone who was wearing a T-shirt when he dumped his motorcycle at seventy miles an hour. Seasoned EMTs call motorcycles donorcycles because so many people die on them and their organs go to the waiting list of needy people. The man in the picture looks like Johnny Depp but he has no skin on his back. “Bad case of road rash,” Frank says flatly.
In my notebook margin I have written a note to myself: “If you have to get up for air, just go.” Underneath, I sign my shrink’s name, imitating the unique loopy signature that I have seen on my prescriptions. And then another quote of his from his days as a medical student at Johns Hopkins. “You get used to it,” he told me. I wonder if I will.
