by Jane Stern
I look over at Dot, who is looking at the slide, her face a knot beneath her spiked hairdo. I look at one of the young firemen. “Gross,” he says, followed by “Cool.” He raises his hand. “Frank, do we get to see any autopsies?” That’s it. I get up and run outside to the fresh air to die alone with dignity.
There are things I love in class and things I hate. I love bones, they are white and clean and make sense in their architectural order. I love mentally altered states; the tragic drunks and psychos appeal to me. I love splinting and taping and wrapping the patient in what is called “a hospital ready package.” I like the cleanliness of white gauze and the four-by-four squares used to make occlusive dressings for sucking puncture wounds.
My hate list includes avulsions—big flaps of skin that hang like slices of corned beef from people’s scalps. The birth of a baby in the back of the rig is supposed to be every EMT’s happiest moment, but the movie we are shown in class of swollen pulsating vaginas disgorging placentas and pools of blood revolts me.
Dot, who has two daughters, digs childbirth. Because she and I will be on the same ambulance service, I write her a note and slip it to her: “I HATE this. . . . If anyone has a baby, YOU have to do everything.”
“It’s a deal,” she writes back.
I am also ill at ease with the machinery involved in prehospital care. I have never been a technological person. When my computer fails or the TV remote malfunctions, I am clueless. I wander into Michael’s adjoining office looking for help. Now I have to learn how to use machinery that will save people’s lives. I can no longer afford to stand dumbly and stare at it like I do when the TV goes on the blink. I have to learn how to use a semiautomatic defibrillator, a machine that analyzes and shocks a person’s heart rhythm back to normal. The machine, which is small and wildly expensive, is not nearly automated enough for my tastes. The semi in semiautomated means we still have to do things like turn it on and push buttons.
Shocking a person back to life involves shaving the hair off a patient’s chest (hopefully men patients, not women or relatives of Bigfoot) to assure correct contact between the skin and the pads. We have to apply the pads in the correct places, check to make sure there is no pulse, press the button, and let the machine analyze the heartbeat. If it is shockable, we have to yell, “Clear,” make sure no one, including us, is touching the patient, deliver the shock, recheck the pulse, do CPR, reanalyze, and reshock until the person is stable or still dead. It is a long process with great margin for error.
The goofiest thing is that the defibrillator talks to you, tells you what it is doing, and it has a built-in microphone that, when turned on, records every word you or anyone on the scene says. This is like having a spy in the ranks, someone who will rat you out if you make a mistake.
“What is the first thing you are going to say when you arrive at a scene and someone is in cardiac arrest?” Frank asks us. The class mumbles various answers. “No!” Frank says with authority. “You will all say, ‘Oh, shit!’” We all laugh, and Frank tells us to think it, not say it, and not to verbalize anything like, “I have no idea what I am doing” or “I am too incompetent to do this job,” because it will be preserved on tape for lawyers to have their way with for the rest of eternity.
Huge excitement. We are finally getting the stethoscopes and blood pressure cuffs that Frank has been promising us for weeks. They have arrived, and Frank, seeing the class’s excitement, has started yelling at us in his loudest voice over the buzz in the room. “Listen up, people,” he says, trying to shut us up as his assistant passes out the boxes that the medical supplies come in. Frank wants us to sit still like soldiers and open the boxes in unison, and let him explain the proper use of the things. But the class is wild with glee at the new official medical supplies. With a stethoscope around our necks we will look like real professionals, we will look like doctors on TV, like we stepped out of ER.
Dot and I decide we will take each other’s blood pressure. I have never done this before, nor has she. “Me first,” I say. She obligingly rolls up her sleeve. I notice how thin her wrists are, how small and white her arm is. Under her lumpy array of sweatshirts and down jackets she is tiny and womanly. I wrap the cuff of the sphygmomanometer around her upper arm, I place the stethoscope in my ears and the bell on the artery point near the crook of her elbow. I start to squeeze the bulb, I keep squeezing, I watch with glee as it rises, 110, 130, 160, 180, 200 . . . I keep squeezing. Dot is suddenly screaming in pain. Her face matches her maroon hair.
“Stop it, you’re killing me!” she wails. I have no idea how high to send the needle before I deflate it. I have no idea how to deflate it, I haven’t found the metal screw that controls the pressure.
Frank is still trying to get control. “People, people, I need you to take your seats and listen to me,” he is saying. Dot’s wails are drowning out his words. I finally find the screw that deflates the cuff, she collapses chestfirst on her desk and rips the Velcro cuff from her arm, which is now bright red. She accuses me of trying to kill her, to squeeze her to death like a python.
It is her turn. She squeezes the cuff in retribution, but I refuse to cry out in pain. “I can’t hear anything,” she says. “You have no pulse.” I tell her she has the ear part of the stethoscope backward, and that she has the bell part turned around backward as well. She adjusts everything. Now she hears my racing pulse. “Your blood pressure is high,” she says ominously. She tells me the number and I am surprised it isn’t higher.
I can hear my own heart slapping against my chest wall. “Please God,” I pray, “don’t let any of my arteries explode until after the national boards.”
The human head weighs between seventeen and twenty-two pounds. We are told this by Harry Downs, another paramedic, who shares the teaching load with Frank. Harry is very tall, talks in a commanding voice, and wears the uniform of a Norwalk Hospital paramedic. He has been doing this EMT job for a very long time, and amuses the class with stories from “the war zone.” He has come to deliver the lecture that he immodestly says is “the single most important thing we will ever learn in the class.” It is about the head and neck. He calls the brain’s nervous system the Big Kahuna. He tells us that without it, the body wouldn’t know to breathe, digest, regulate temperature, have a heart rate, or do anything else to sustain life. He gives us a dozen scenarios of hideous things we EMTs can do to screw up the head and neck. They all result in the same thing: irreversible paralysis, people who will end up unable to move from head to toe. One tiny movement of an injured person’s neck the wrong way and you have made a quadriplegic.
The handwriting in my notebook has become neat again as an homage to the seriousness of this subject. “Spinal cords don’t stretch,” I write in my best penmanship, almost calligraphic. We learn about whiplash (hyperflexion) and what happens when you dive into a swimming pool and hit your head on the bottom, jamming your neck (hyperextension). We learn about hangman’s injuries, the break in C1 and C2, the vertebrae that control the breathing nerves and the diaphragm’s rise. We learn the danger of dangling from playground jungle gyms, from sledding, from football, from wrestling, from skiing. The big seventeen- to twenty-two-pound head that sits atop your neck is just waiting to be smashed like one of Gallagher’s watermelons.
As if things could not be more dramatic we learn that men with spinal injuries develop a penile erection that will not deflate, a truly dire sign. I am obsessing about the permanent erection. Is this the silver lining to the dark cloud?
I am currently married to Xavier’s head. Xavier is a young Mexican-American man who works as a night security guard and wants to be an EMT. He is very big, very sweet, and very shy. I never see him talking to anyone. He looks constantly terrified. The only time I have seen Xavier happy is when he had to lift someone in class. He is immensely strong, and it was effortless.
Harry Downs is showing us how to avoid making someone a quadriplegic. At the accident scene we are to hold the victim’s head manually
in a neutral position (that is, straight on) and then have another EMT apply a rigid cervical collar and transfer the person onto the long, rigid spine board. Once the patient is on the board, we secure the head with stiff foam blocks and straps or tape. The main thing is to never, ever, under any circumstances allow the head to move. One tiny shift might be all it takes to paralyze him.
“You are married to that person’s head until you get them in a cervical collar,” Harry barks.
My hands are buried in Xavier’s thick black hair. I smell the lush tropical floral oil he uses on it. “Xavier, I am proud to be married to your head,” I say to him. He blushes. I don’t have the heart to apply the cervical collar as tightly as it should go. I am claustrophobic about such things myself and know this is only a test. I wrap it loosely around Xavier’s bull-like neck. Harry comes over to inspect my handiwork. He sticks two fingers in the space between the collar and Xavier’s tan flesh. He wiggles it, indicating that Xavier has room to move, room to become an instant quadriplegic. “You killed him,” Harry shouts at me. “FAIL!”
5
By the midpoint in our EMT training we are laying hands on one another on a regular basis. We hear lectures and we take notes but we also spend a significant amount of time rolling, lifting, wrapping, splinting, and feeling each other’s bodies, looking for imaginary bullet holes, leg breaks, and flash burns.
This Thursday is a special class. Instead of being at the police station we are meeting at the town fire department, where we will practice placing each other on stretchers or stair chairs and carrying each other down flights of stairs. Like second-graders going to a museum we are lectured by Frank to be on our best behavior. “Do not touch anything. . . . Do not talk to the firemen. . . . Do not ask them questions.”
All thirty-two of us file silently into the firehouse at 7 P.M., our hands close by our sides. We resist touching the big shiny fire engines or gawking at the men and the equipment. We are led upstairs to the great room, where the stretchers and stair chairs are laid out with their straps. The firemen are even more annoyed than the cops by our presence. They sit in a semidarkened room watching HBO on their big-screen TV and mutter as we walk by. We are plebes, probies, maggots. We are invisible and meaningless beings.
There is no ladies’ room, just a men’s room with urinals and one stall. I have to pee. I walk in and find a fireman using the urinal; he glowers at me and I run out. We are not allowed to touch anything but no one said we couldn’t look.
The decor of the upstairs of the firehouse is funny as hell. Miss Manners would have felt at home. New Canaan is a rich town with lots of old money and the firemen’s private digs have mahogany piecrust tables, well-polished old silver loving cups, charmingly thread-bare Oriental carpets, and tasteful wing chairs. It looks like the Yale Club with a few fire hats strewn around.
In this cozy collegiate atmosphere my worst nightmare is about to begin. My Achilles’ heel in this class has been my age. I am over fifty and not in great shape. I know that much of this class is about brawn, about the ability to carry people down stairs, out of the woods, up from holes they have fallen into. One of our guest instructors is Anne, a woman paramedic from Norwalk Hospital. She is solid sinew from head to toe. When I wrap my arms around her midsection to practice the Heimlich maneuver I can feel her abdominal muscles beneath her uniform shirt. Even Frank, who looks to the casual observer to be out of shape, is as strong as a bull.
The first part of the class is not too bad. We load each other onto stretchers and four of us carry the “wounded” one around. By nine at night, after two hours of stretcher work, it is time to practice the stair chair. The stair chair is a folding chair used to carry someone in a sitting position down the stairs. It is useful for people who cannot be placed in a prone position or who need to be transported down narrow stairwells where a stretcher cannot go. Frank calls out our names. We are divided into groups of five. My group are all men, huge men. The biggest of them is Sven, a twenty-three-year-old Swede who is six feet six and weighs a good 250 pounds. Sven is teased in class about his formidable bulk. Frank decides I will be the one to carry Sven down three flights of stairs. To make matters worse, the lights in the stairwell have burned out or been turned off. I can’t get a straight answer why the staircase is dark, but Frank insists that “it duplicates conditions we will encounter in real life.” Sven will be placed in the stair chair and strapped in so his arms will not be free to reach out and grab the banister. I am to carry him down accompanied by one other member of the class.
With the stair chair you can be either at the head or the foot. To be at the foot means you have to walk backward down the stairs, in this case in a darkened stairwell. What Frank does not know about me is that I have no sense of balance. In my own home, with the lights on, in broad daylight, on a familiar staircase with broad carpeted stairs, I hold on to both the wall and banister when I descend. I have always had a phobic fear of falling. I am clumsy, I lurch about. Walking down stairs with no banister is impossible for me. Now I have to do it in the dark, holding up a giant Swede.
I opt to take the head so I can walk forward. I station myself behind Sven, who is strapped to the chair. Normally jolly, he now looks grim. He thinks I will drop him and he will tumble in the stair chair three flights down. “Don’t worry,” I lie. “I’m really strong.”
Nobody, me included, wants to acknowledge that perhaps I should be trying to lift someone lighter. I refuse to whine. I bend my knees, place both hands on the hand grips of the chair. “On my count of three,” I say to my partner, who has taken the foot end of the chair. “Three!” I yell, and with all my might lift this immense person high enough into the air to clear the steps. I walk down five steps. I start to wobble.
“Don’t touch the railing,” Frank yells at me. “Keep both hands on the chair or you will drop him.”
I feel faint, I am falling, I can’t breathe. “I have to stop,” I yell, and Sven is put back down on the steps. I try to catch my breath.
Frank suggests that I take the foot part of the chair. I hate this even more, although he tells me it is a little lighter to carry the foot of the chair. It means I have to walk backward down the stairs. I am scared. Frank comes behind me and grabs the waist of my jeans to help guide me down. I am too polite to tell him he also has my undies and that he is giving me a major wedgie. He is going to steady me as I walk down the stairs; he will tell me when to step off.
“Lift” he says, and I bend over, my underpants tight in the crack of my ass. “Step,” Frank says. I do not move. Sven feels even heavier holding him this way. “Step!” Frank yells at me. “Don’t let him just hang in the air.” Frank is pulling me down the darkened stairs by my underpants. Sven is swaying left and right. He knows he is going to be dropped. He frees a long arm out from the restraining straps and grabs the banister. I drop my end of the chair. Frank is still holding on to my pants. I hear a rip. Sven crashes down, groaning as he hits the concrete stairs. The four guys in my group all look away, embarrassed. “FAIL!” Frank yells. “Stern, see me after class.”
I am bathed in sweat. My heart pounds, I can’t breathe. I run past the guys on the stairs and look for a safe place to collapse. There is a couch in the darkened TV room where the firemen are congregated. I fall on the couch and they pretend not to notice me. I pull at my underpants; I try to breathe; I can’t stop sweating. I start to cry. I think I am having a heart attack. What a way to go, surrounded by EMTs. I have crawled away into a dark corner like a dog to die. I can’t call 911 because they are already here. I have failed, so why would they save me? Slowly I start to come around. I stagger to my feet and sneak out the side door and drive home. When I get there Michael is asleep. I don’t wake him up. I stay up until 3 A.M. taking my pulse and blood pressure repeatedly. I press my carotid artery hard just as Frank warned me not to do.
That is it, it is all over. FAIL! The word rings in my ears. Move over and make room for the young and the strong, for women with six-pack
abs, for giant Nordic gods like Sven. I can’t even walk down a fucking flight of stairs without holding on. What good am I? What a waste of time this whole thing is.
The next day I call Melanie Barnard, a friend who is an EMT in New Canaan. She is small-framed and not all that young. I tell her my trauma with Sven. “Big deal,” she says. “That’s what the cops and firemen are for—to help you lift people.” I am cheered: big, young, strong men, at my command. Suddenly I feel better.
At our next class I know I have to face Frank. Not only was I unable to carry Sven but I did not “see him after class” as I was told. Before class begins I summon up the courage to confront Frank with my FAIL. It doesn’t seem to be as make or break as I thought it was. He looks at me somewhat sympathetically and says, “Do some weight training.” It is not the end of the world. I buy a treadmill and do an hour a day on it while I watch Trauma Center on the Learning Channel to toughen me up to the gore factor.
Pretty soon my postclass routine of going home, having a bagel, and watching old movies on TV has changed. I am now watching the Tape. The Tape costs $49.00 and is ordered through the mail from a medical book publishing company. The title is blunt: Pass EMT-B. We are now halfway through the class, we have about eighty hours of classroom work behind us and a dozen tests.
At the beginning of the last class Frank has brought up the subject of the national boards. We will have to pass this grueling two-day exam to become EMTs. The boards are given after all classroom work is done, after we have interned at a local hospital ER, and after we have passed Frank’s finals. We then drive an hour and a half away to a vocational school in the boondocks of central Connecticut, where we are given the two-day exam. Frank tells us the odds of us passing it are 50/50. He tells us that many of the people we will see there will have already failed the test once or twice and are trying yet again. He tells us that the trick to passing is to memorize every word he has said and every word in our textbooks and then to get a copy of the Pass EMT-B tape and learn it by heart.
