Paramedic

by Peter Canning

  “So what do you think?” Tom asks me as we walk back down the hall.

  “I think he might have been having a heart attack. He had chest pain of ten. He looked crappy. The pain was stabbing and it went into his left shoulder. What do you think?”

  “I think he’s a drug addict who is chronically ill and who didn’t want to be at home, and his family didn’t want him there. Think for a minute about the questions you asked him. ‘Do you have chest pain? Is it stabbing? Does it go to the left?’ That’s like saying to a kid, ‘Do you want a piece of candy? How about a Hershey bar? Want a Twinkie?’ If that’s what he wants, he’s not going to say no. He played you for a fool. Think for a minute, how was he acting? What did he really look like, hiding behind his hand there?”

  I think for a second, then it comes to me. “He looked like the guys in the car accidents who are faking headaches and back pain.”

  “Exactly. Don’t ask yes or no questions. Don’t lead the patient anywhere. Ask: ‘What do you feel like?’ Say: ‘Describe the pain.’ Don’t give them the answers you are looking for.”

  We get called for seizures at the Weston Street Jail. En route I find myself trying to remember the protocol. If the person is in status epilepticus, a condition of nonstop full-body seizing without any interval of consciousness, I can give them five milligrams of Valium. But I have to call the hospital for permission. Our narcotics—Valium and morphine—are locked in the ambulance separate from our regular drug box. I wonder how it will go in the jail. We’ll probably have to take the person out to the ambulance as opposed to getting the meds and bringing them into the jail.

  When we pull up, a guard runs out and says, “He’s in status epilepticus. It’s been going on about fifteen minutes.”

  I look at Tom.

  “Let’s go in and see what we have,” he says.

  We pass through the metal detectors and through two doors that lock. Guards direct us into the gym where a young shirtless man is on a stretcher, his entire body shaking and covered with sweat. He is screaming that he doesn’t want to die and for someone to call his mother.

  “He’s been like this for fifteen minutes,” a woman says.

  “Has he had tonic-clonic motions?” I ask, demonstrating with my hands a squeezing, jerking motion.

  “Yes, he has,” she says.

  “Should we work him here or in the ambulance?” I ask Tom.

  “Have you finished your assessment?” Tom asks.

  I look at him and he is not having tonic-clonic motions; he is just shaking. I take his blood pressure. It is high—160/120. His pulse is rapid at 108. His respiratory rate varies between 20 and 50. His pupils are responsive, his lungs clear. There is no incontinence, which is common with seizures.

  The guard says he has no medical history. I ask if he did any drugs today; the guard says no. The guard also says he was scheduled to be transferred today. Another guard says he had a visitor earlier.

  “What are you thinking?” Tom asks.

  “I don’t know,” I say, thinking to myself, this is either a seizure or the guy is faking because he doesn’t want to be transferred. “I need to get a line in and call for Valium, I guess.”

  Tom takes out a little pad and writes on it. He sticks it in front of me. It says, “This is a cocaine overdose.”

  I look at him. He looks back at me.

  “Well, let’s get him to the ambulance,” I say. We transfer him to the stretcher with the help of the guards. In the ambulance while Tom drives lights and sirens to the hospital, I tie a plastic rubber tourniquet around his arm. He has beautiful large veins up and down his arms—the veins of a body builder. I stick in an eighteen gauge and see the blood flow back into the needle chamber. I advance the catheter over the needle and draw four small tubes of blood before attaching the saline line, which I set with the roller clamp at a slow rate, just enough to keep the vein from clotting. No hematomas this time. “All set,” I say aloud to myself. But the guy is not paying any attention to my success. He keeps saying, “I don’t want to die.” I ask him again if he did any drugs. “Oh, no, no,” he says. “Call my mother. I don’t want to die.”

  Afterward, Tom and I talk. “Something was going on inside him,” Tom says. “It’s awful hard to sweat like that and get your pressure up so high. The guard is not going to say he took drugs because if the guard knew about the drugs, he would have taken them from the guy. The guy is not going to admit he did drugs. When someone overdoses on cocaine, they get paranoid, their pressure skyrockets and they can sweat like that.”

  “I got hooked into thinking it was a seizure,” I said.

  “Don’t trust what anyone says. Focus, rule out, do your assessment. You need to get your head into the game. You were sitting in Foxboro Stadium while they were kicking off down in the Meadowlands.”

  I am worried. I feel the year-long layoff while I worked on my friend’s campaign in Massachusetts is setting me back. I am not performing up to the level I reached during my internship in Bridgeport, and even that level is not high enough.

  “Don’t worry,” Tom says. “While you’re precepting, what happens is just between you and me. I don’t expect you to be perfect, but it’s my job to make you as close to it as I can. Anyone asks me how you’re doing, and they will, I will say nothing. I will never bad-mouth you.”

  Too Young

  Tom and I are parked across from the old G. Fox building on Main Street in L&M Ambulance 472. G. Fox was once the leading department store in Hartford, a place where as a boy I did my Christmas shopping on trips into the city, enjoying each floor’s treasures and riding the escalators all the way up to the top floor where Santa Claus and his toy shop held reign. For years now, the building has been empty.

  We’re eating hot dogs we bought from a street vendor and watching people hurry across the street to avoid the winter chill. We’ve done a couple of calls today, but nothing taxing. I am a little on edge. I haven’t had a real call that has forced me to prove myself yet. I wonder if I will ever relax, if I will ever have Tom’s ability to sit back in his seat and fall peacefully asleep. I’m tense.

  “Four-seven-two,” the Hartford EMS dispatch calls over channel nine.

  Tom picks up the mike. “Four-seven-two.”

  “Four-seven-two. Infant unresponsive on Kensington Street. Respond on a one.”

  “Kensington Street on a one.”

  Tom hits on the lights and does a U-turn. The address is in Stowe Village, a squalid public housing complex in the north end. Traffic is moderate. Cars pull to the right as we race down the street. Others stop dead in their tracks and force us to maneuver around them. Tom modulates the siren to wail and phaser. We stop briefly at each intersection. At Main and Albany a pickup blows right through the light in front of us.

  “Nice move,” Tom says.

  A moment later, he has to hit the brakes again as two young mothers push strollers across the street in the middle of the block.

  “Nobody’s got any sense in this city,” he says.

  As we approach the village, Tom shuts off the siren—a precaution against drawing attention or random gunfire. He takes the portable radio that links us to police dispatch. We take no equipment. “If the baby is not breathing, we’ll grab it and beat feet to the ambulance,” Tom says.

  We enter the building. Amid the graffiti in large red letters is written: “Fuck Everyone!” On the adjoining wall: “Fuck the World!” An expressionless woman on the second-floor landing gestures for us to come up the concrete and iron stairwell. She leads us into an apartment that is dark. It is cold—there is no heat. The apartment reeks of garbage. Water runs slowly from the faucet. The stove, sink, and countertop are piled with black crusted dishes. I can make out two men asleep on decrepit couches.

  We turn a corner and there are three people around a bed.

  “It’s the ambulance,” a man says. “They here.”

  I reach onto the bed and pick up the baby.

  “He won’t wak
e up,” a young woman says to us.

  The baby is cool, but breathing. His eyes are closed. His lungs sound junky even without a stethoscope. I can hear another baby crying.

  “Are you the mother?” I ask.

  She nods. She is a young girl with buck teeth wearing a snow jacket unzipped and a Snoop Doggy Dogg T-shirt. She doesn’t look more than eighteen.

  I ask her what hospital she wants to go to. She shrugs and says Hartford.

  “Let’s go then.”

  I carry the baby out of the scene. It is too dark in the apartment for a thorough assessment. I want the baby out of the squalor. I ask the girl what happened as we walk. “He just went limp for about twenty minutes, then he wouldn’t wake up,” she says.

  “Has he been sick?”

  “He been okay. I haven’t been too well. I’ve got a cold.”

  In the ambulance, I hold the baby and try to listen to his lungs with a stethoscope. He grabs at it with his hand and tries to move it away. His pulse is 160, his respiratory rate 42—both a little fast for his age. There is crusted snot in his nose. I pry an eyelid open with my finger. He looks away from me. I shine a light into it. His pupils react to the light. We head to Hartford Hospital on a priority three—nonemergency.

  When I have finished assessing him, I hand him back to the mother, who gives me her state medical card. On it are the names of five children; only two share the same last name. After I have written down the information, I take the baby back and hold him. His eyes are scrunched closed. I try to bounce him on my knee.

  “What time did he go to sleep last night?”

  “Two. I think he slept all the way till ten though. Is he going to be all right? Why won’t he look at me? Why won’t he laugh?”

  I hear a burp too late to move and he pukes on me, white milky vomit on my leg and the ambulance floor.

  She laughs. “He got his eyes open now.”

  I look to the front and see Tom laughing at me in the rearview mirror. One of the marks of a good paramedic is to be able to anticipate and get out of the way of puke. I fail this test.

  The baby looks at me with cold eyes. He is fourteen months old. He looks like a baby pit bull, staring me down.

  “It’s okay, little man,” I say.

  In the ER, I give a report to the triage nurse who sends us back to the pediatric clinic, where the girl and child take a seat in the overcrowded waiting room.

  “No kid should live like that,” Tom says to me in the cramped EMT room as I sit in a folding chair in front of the small metal desk, writing up my run form. He has a three-year-old at home.

  “She gave me a different address as their home,” I say.

  “Good, she takes her kid with her to score crack,” he says.

  He is still upset as we drive down Capital Avenue. “They ought to take her kids away from her,” he says. “She doesn’t know the first thing about being a mother. If you can’t be responsible, you shouldn’t be allowed to have kids, much less keep them. I’m sorry, Pete, this one just gets me.”

  I think of all the years I worked for Weicker, in Washington and in Connecticut; how we fought for kids, for prenatal and expanded health care, the school lunch program, Head Start, and other programs that were going to change their world. I remember how excited I was my first days at the health department and how I told the top staff there that things were going to be great now that Weicker was governor, and Susan Addiss was the new commissioner and I was the executive assistant, that health care and kids were going to be a priority and that we would all have an impact. And they all sort of looked at me as if I didn’t have a clue. Right now I feel like none of it made any difference—not the legislative victories in Washington, not the programs in Connecticut. I know that’s naive and that maybe things would be far worse if nothing at all had been done, but walking through the poverty that these kids live with every day—the cold dark, dirty apartments, the drug abuse and broken dreams of their parents—you can’t help but feel failure if you have ever been in a position of power.

  We pass the capitol, where they are taking down the grandstands from the inauguration of the new governor.

  “What do you think the mother’s childhood was like?” I ask.

  “Probably just the same,” he says.

  Maytag Repairman Syndrome

  It’s a slow day. Most of the calls have been for colds and flu or general “not feeling well.” Nothing life and death. At best, I can put some of the patients on the cardiac monitor, give them a little oxygen by nasal cannula, put in an IV, and draw blood. I haven’t given any medications in over a week. We sit in the ambulance reading the paper or trying to sleep. I want to do as many “bad” calls as possible while I am still precepting so I will be better prepared when I am on my own, when I am in charge, working with a basic EMT as a partner. I wonder what kind of person I am. I fancy myself a kind, caring, compassionate man of the people, pledged to uphold the public health and do no harm, yet here I am wishing harm on some unspecified person who may at this moment be bouncing a grandchild on his knee, or closing his eyes and puckering to receive a first kiss, but soon will be clutching at his chest in terror or seizing on the ground with a bullet in the head.

  Back when I was a basic EMT working for Eastern Ambulance, every Saturday I worked a sixteen-hour shift in Long-meadow, Massachusetts, with my partner David Hanley, another basic EMT. Longmeadow was a sleepy little town. We’d show up at work with rolls of quarters for our Pac-Man marathons. We knew all the hot babes on “Soul Train” and every line of dialogue on “Cheers.” We’d cruise the town, checking out girls. We’d go to Bay Path Junior College hoping to spot bikinied coeds sunning on the lawn, but it was just about always empty because most of the students went home on the weekends.

  We’d get to talking about how we’d really like to do a call. Some EMTs would joke about throwing ice water on the back steps of churches in the winter. Driving up behind senior citizens and blasting the air horn. Giving alcohol to minors. Stringing razor wire across the minibike trails. Anything for a call.

  You say you don’t wish harm on anyone, but if harm is going to come to someone, let it come on my shift. I wonder if presidents ever feel this way: I’m bored, we need a crisis, a good conflict to arouse us, and get our juices and economy flowing. Let me show some leadership and raise my place in history above James Polk and Warren Harding. I want to be a Washington, a Lincoln, a Roosevelt.

  I had it get so slow, I used to think about renting myself out to communities as their EMS system. Hire me and you will have no emergencies in your town because I don’t get calls anymore. I once worked eight Thursday nights in a row in East Windsor without doing a call.

  No one wants to be a novice. You hear other people talking about their calls, about the blood and guts, and the difficult extrications, the helicopter coming in to fly the patients out, and you wish you had been there. Some people say that after all the wishing for trauma, when you get in the middle of it, you wish it hadn’t happened. For me, that’s true when it is a kid who is hurt, but the honest to God’s truth is when it’s a faceless adult, I am sort of glad I am there because it is my job to help. Though if something personalizes them, then I feel badly. Once back in East Windsor, when I was working a traumatic arrest (not breathing, no pulse due to trauma inflicted on the body) of a young woman whose car had been hit by a truck late in the night, I saw her driver’s license on the seat next to her. In the photo, her eyes were smiling, not bulging and lifeless, and her head didn’t spurt blood with each chest compression. She had the stamp of a nightclub on her wrist; her home was just a few miles up the road. I thought about her for days, wondering what she had been like. Would she have turned my head if we passed? What kind of laugh did she have? How devastated must her family feel, awakened in the middle of a rainy night to such flesh-tearing news?

  It is easy to forget the link between person and patient.

  When I was riding in Bridgeport, I needed to get a field intubation,
where you pass a plastic tube through someone’s vocal cords into the trachea to secure their airway and better ventilate them. I had done nine in the hospital operating room (OR), but during my paramedic class ride time had never had an attempt in the field. I was going to be taking a leave of absence from the health department to work on my friend’s campaign for Congress in Massachusetts and wanted to keep my skills up by working part-time on an ambulance up there. While I was certified in Massachusetts as a basic EMT, I needed to get certified as a paramedic to work as one. In EMS most every state has a different set of requirements. Massachusetts required certain documented field skills, including intubation and defibrillation. (In the end it was impossible for me to complete the required paperwork and additional testing in time.)

  We were busy every night I worked in Bridgeport, call after call, all shift long, but no opportunities for a tube. No tube after the first twenty hours. No tube after fifty hours. No tube after eighty hours. I’d work Tuesday, then come back Thursday and they’d tell me I missed one on Wednesday. It got so bad I didn’t know if they were busting my balls or if I was just picking the wrong nights to ride. From the disappointment on my face, they even stopped kidding me, stopped telling me I’d missed a bad one the night before.

  Everyone in the company knew I needed a tube. Instead of a nod and a hello, people would nod and say, “Get your tube?” Nope. Not yet.

  We responded to a woman unresponsive. Airway kit in hand, I charged through the door. The woman was as cold as ice. Her jaw stiffened to her neck. “Sorry, Pete. I don’t think we’ll be able to work this one,” John Pelazza, my paramedic partner, said to me.

  I felt bad hoping that somebody would keel over while I was on duty.

  Finally, it came. While we were in Bridgeport Hospital Emergency Department (ED), John heard a call for a “man down” not far from the hospital. Though it was dispatched to another unit, he said, “Let’s do it.”

  We arrived just after the other unit.