Paramedic

by Peter Canning

  Good idea. I undo the tourniquet, and with the aid of the firemen lift the man up and get him on the stretcher. He is still glaring at me like he is going to hunt me down and kick my butt when he gets through this. What’s this idea of a numbskull like me taking care of him when The Undertaker is sitting on his chest, squeezing his heart?

  In the ambulance, as Tom starts for Saint Francis, I finally find a vein and get the IV, though I have trouble advancing the catheter all the way in. Still, it holds, and permits a small flow of saline into the vein. I give the man a nitro under the tongue. His heart rate falls to 140 and he feels some relief, though the pain is still crushing. I call Saint Francis and tell them we are coming in. I give him another nitro, and again give him some more relief, but he still has chest pain.

  At the hospital, I sense his relief as the team of nurses and a doctor gather around him and hook him up to their monitor, give him oxygen, probe him with stethoscopes and blood pressure and pulse monitors, get another IV going, and go to the drug cabinet for morphine.

  Tom and Debbie and I stand in the hallway and talk over the call. “He was nervous,” Tom says. “He’s better than that.”

  Debbie says she guessed that and what she was most interested in was my thought process for treating the patient, which was on target. She doesn’t mention I forgot the most important point of getting the patient moving along to the hospital if I am unable to get treatment initiated right away.

  I am glad that they have confidence in me. I do not feel it is warranted. The call has scared me—reminded me that there are calls ahead where I will stumble and won’t have someone there to get me back on the right track.

  Later we respond for an elderly woman not feeling well, and a woman with throat cancer having trouble breathing. I get all my lines, but am nervous and a bit out of sync on the calls. At three Debbie has to quit for a meeting, and she tells me as far as she is concerned I’m all set. I don’t feel I performed that well for her, and am worried that she is cutting me some slack because she knows me. Tom tells me not to worry. “You’re ready,” he says.

  Tom calls the office and tells them I’m cut loose. Though I do not hear it, the dispatcher announces it over the radio. Tom tells me a chorus of voices comes back from other crews saying congratulations.

  “They are proud of you,” he says.

  I call my friend Michelle that night from home and tell her I have been cut loose. She congratulates me and says I will do fine. That is little consolation to me. I am panic-stricken. About to be thrown in the water. I will hit with a big splash and will start to sink. Will I kick and fight and rise up to the sweet air and sunshine and wave to the adoring crowds who hold up “10” signs, or will I keep sinking? The crowds will go home to their lives, and I’ll keep dropping down into the darkness so deep they will forget all about me.

  I watch the red digital display on my clock all night as it nears the hour of my reckoning.

  The next day I am the paramedic and I have a basic EMT for a partner. My first call is for an eighty-five-year-old woman who the visiting nurse says has been having trouble breathing since early morning. She is lying in bed with her hands shaking, which the nurse says is normal. She is alert and oriented. Her skin is warm. There are wheezes in all lung fields. Her abdomen is tender. She complains of pain on inspiration and expiration. It hurts when I press against her chest. She says she has been coughing up white phlegm.

  I take her vital signs. Blood pressure: 140/80. Pulse: 106. Respirations: 34. I put her on oxygen by nasal cannula. On the monitor she is in a sinus tachycardia with occasional premature ventricular contractions (PVCs). In the ambulance, I give her a breathing treatment of .5 Ventolin, start an IV line using an eighteen gauge catheter, and hook up a bag of saline at a KVO rate, letting in just enough fluid to keep the vein open to prevent clotting.

  She says the treatment is making her breathing a little better. She still has wheezes in all fields. We take her to Saint Francis. There I give the triage nurse my report. Eighty-five-year-old female, not feeling well since this morning. Some shortness of breath, wheezing in all fields, a little feverish, coughing up white phlegm. The nurse gives me a room assignment, and I start to wheel the patient down the hall. Holding the bag of saline in my left hand, pushing the stretcher with my right and with the monitor strapped over my shoulder, I begin to sweat. The sweat starts to pour down my forehead. I feel my hands begin to shake. I understand what is happening. I am a paramedic now. I am on my own.

  PARTNERS

  Image

  Back in the 1970s there was a TV show called “Emergency,” about two firefighter/paramedics in Los Angeles, Johnny Gage and Roy DeSoto. They were two sort of “aw, shucks” guys who were always saving lives and delivering babies and burning dinner at the fire station. At the hospital they hung out with sage doctors and Dixie, the beautiful nurse, played by Julie London. I was about twelve years old when it ran. It was my favorite show.

  A lot of kids grow up wanting to be a firefighter. I may have briefly wanted to wear a fire hat when I was four, but mainly I wanted to be a baseball player and play right field for the Boston Red Sox like my hero Tony Conigliaro. Then when my Little League career ended with my striking out with one out and nobody on base in the last inning of a heartbreaking two-to-one loss in the state Little League regional finals, I decided I wanted to be a professional tennis player. And that ended when I decided I would rather sit at home drinking lemonade and watching the Red Sox play on TV than play three matches in the hot sun—especially since if I won, I’d have to stay overnight at some stranger’s house in some unfamiliar New England town, only to have to play more matches in the hot sun the next day. Then I guess I decided, what the heck, I might as well be president of the United States. In 1976, I went to work as an intern for Weicker in Washington, and showed enough dedication and energy to be hired for a salary of about six thousand dollars to answer constituent mail while I took a year off before college hoping I could get into Harvard on my second try. At age seventeen, I was the youngest Senate aide in Washington. I figured that made me the front-runner for president in 1996.

  Back when I was a kid I thought EMTs were nerds. In my town, they wore white uniforms and looked like janitors in mental asylums. When I was in the eighth grade we went on a field trip to Washington, D.C. The father of one of my classmates was an EMT, and my classmate often went on ambulance calls with him. We were eating breakfast when an old woman fainted in the breakfast line. He jumped up from the table, leapt over some plants, and knelt by the woman’s side. He didn’t seem to be doing anything, and the woman was coming around on her own. We all made fun of him for the rest of the week, calling his name for help, grasping our hearts and falling to the ground, kicking our feet for a few moments like the Three Stooges, and emitting gruesome dying groans, before lying still with our dead tongues hanging out the sides of our mouths.

  When I was at college, I lived in an apartment complex where the resident manager was this guy with shoulder-length hair and a sweeping black mustache who had the most beautiful tall, blond girlfriend. He was the kind of guy who was nice to everybody and was always suntanned and drinking a beer in the afternoon, but never drunk, and who in a league softball game would hit a line drive in the gap, race around the bases, and slide into home with the winning run, beating the throw by a split second. He always played great music on his stereo. He was also an EMT and had interesting stories about his calls. One day he got a bunch of people together to teach them CPR. I was going to do it but didn’t. I had given up the idea of being president by then and was into being a writer, which meant I always had the excuse that I had to go write.

  I’ve done a lot of jobs in my life. I was a cabdriver in Alexandria, Virginia, a job I loved—being on the road, meeting new people, being my own boss. I’ve been a cook in Iowa, worked in a hardware factory and a meat-packing plant in Minnesota, did telemarketing in California. I’ve unloaded trucks, done construction, assembled Christmas-tree stan
ds, written for a newspaper, and sold Bibles. I like seeing people and having new experiences. My life has switched back and forth between manual-labor jobs and working in government. My parents always liked it best when I was putting the suit back on, but I always felt I was selling myself out that way. While parts of it I loved—the status and respect—I never felt truly free. I was in someone else’s shadow.

  When I was taking my EMT class, a paramedic visited us and talked about the life of the street medic. He was an impressive figure—tall, wearing his uniform like a soldier, telling tales from years in New York City. I wanted to be a hero just like him until he started saying derogatory things about minorities.

  As an EMT, I always looked at the paramedics with a certain awe. It was hard enough just doing the basic stuff. These people had detailed medical knowledge, they did IVs, pushed drugs, intubated, shocked. They dealt with the bad ones and used their heads and finely developed skills under the worst conditions to save lives.

  At East Windsor, we frequently called for paramedic intercepts. We’d load the patients and start to the hospital, and the medic would meet us en route. Our driver would pull over, and a few moments later, the side door would open, and a paramedic would climb aboard, confident, relaxed. He’d listen to my report, then put the patient on the heart monitor, start an IV line, push drugs, while we stood aside. He had the situation under control.

  I read once that the paramedic was the second most admired job in the United States, and doctors, lawyers, businessmen, and politicians were rated near the bottom. That may be so, but ask parents who they’d rather have their daughters marry.

  During my paramedic intern time, I ran into a doctor I knew from the State Medical Committee. “I’ve heard you’re going to paramedic school,” he said. “Given your political skills, why would you want to be a paramedic?” I was a bit taken aback. I muttered something about being tired of sitting behind a desk.

  * * *

  When I started working at Eastern Ambulance, I was getting $5.50 an hour. I could have made more working at Burger King. Today, as a paramedic I make $14.00 an hour, which makes my annual salary about $24,000 a year. I get five vacation days and five sick days after a year of work. At the health department, I made $57,500 with three weeks of paid vacation, three weeks of paid sick time, and twelve paid holidays every year. That for working a thirty-five-hour week.

  Every town has a paid police force. Most have paid fire services. Only a few have paid EMS exclusive to that town. In those that do, the EMS is usually part of the fire department. Most towns have volunteer ambulance services and most cities contract out to commercial ambulances. Cops have to wear guns and face down bad guys who may also have guns. Firefighters have to enter burning buildings. Paramedics often enter uncontrolled situations where patients are violent, sometimes armed. Though they are trained not to enter a scene until it is safe, sometimes you learn it is unsafe too late. Also, paramedics have to stick needles into people whose blood could kill the paramedic if he accidently got stuck with the contaminated needle. Cops and firefighters all have lucrative pension deals and other benefits. Few people in EMS stay long enough to collect pensions. Most places don’t even have them. The burn out is so high. My employer, Professional Group, has a new plan, where it will contribute a small amount to a 401 (k), but I won’t be eligible until I have worked there for a full year.

  I go on a call in West Hartford for a young woman having a diabetic problem. It is a rainy night, and the woman lives in a very posh house. “You’re tracking mud on the carpet,” her mother says as we bring the stretcher into the house. I almost say, “Where do you hide your silver?”

  When we go to nursing homes or corporations, they always make us use the rear entrances by the trash bins and loading docks.

  * * *

  In most movies the EMTs stand around at the scene with their hands in their pockets, doing nothing. Once they have the patient loaded into the ambulance they get in the front together to let the patient be alone with the star, who holds his hand as the patient utters his last words.

  I get a call to respond as the second ambulance to a motor-vehicle accident on Wethersfield Avenue. It is dark. Ahead we see the lights of another ambulance and two police cars. There are at least three cars involved.

  I report to Joe Stefano, who has taken charge of the scene. He points to a car that has run up an embankment. “The woman in the car has neck pain,” he says, “The car’s unstable. Wait for the fire department before you touch her.”

  My partner helps the other crew extricate a patient from another car.

  My patient is the driver of a green LTD. One of the rear wheels is on the sidewalk, the other is on the first step of some stairs. The front wheels are on grassy embankment. I tell the woman not to move, that the fire department is on the way.

  A TV crew shows up and starts filming the scene with a portable shoulder camera that has very bright lights. They are filming the car on the embankment from the other side. I find myself in the camera’s glare—standing around with my hands in my pockets. I move my position, only to find the cameraman has also shifted. I think I haven’t been on my own a week and here I am hogging all the screen time. I move right, he moves right. I move left, he drifts left. I guess after years of looking he has finally found an EMT of movie-star quality.

  Finally, the fire department arrives on scene. A firemen charges up the embankment, opens the car door, and looks in at the woman. The fireman turns and says angrily, “Why doesn’t this woman have a cervical collar on?”

  “The car’s not stable,” I say.

  He looks down at the front wheel, then at the back wheels, which teeter on the steps. Oops.

  “Let’s get this car stabilized!” he shouts.

  After we extricate the patient on a backboard, we load her into the ambulance, with the camera still on us. With thirty-five-millimeter dreams in my head, I debate climbing in the front with my partner and driving away to a perfect Tinsel Town ending. Instead I get in back to attend my patient. A person has to have his integrity.

  I haven’t been on my own two weeks when I run into Vinny Cezus of Hartford Hospital. Vinny is a friendly registered nurse (RN) and paramedic, who is Debbie Haliscak’s counterpart at Hartford. He helped teach the EMT-Intermediate course I took a few years before and he has served on some of the state committees I helped set up. “So what are you going to do next?” he asks me.

  “Huh? I just became a paramedic. I think I’m going to do this for a while.”

  “You don’t want to be a paramedic the rest of your life. You have to look to the future. Maybe go to PA school and become a physician’s assistant.”

  “I’m going to just try to do this for right now. I want to be good at this.”

  “You don’t want to get caught short. You should start planning.”

  “I just want to be good at this,” I say. “Maybe I could be a PA later.”

  Partners

  Your partner is the most important part of your job. A good partner will make going to work fun and he’ll save your butt on more than one occasion. A bad partner is worse than sitting in a dentist’s chair. Spending twelve hours a day with someone shift after shift is hard. You have to learn to deal with each other.

  I was lucky to have a string of great partners when I first got involved in EMS back when I was working for Eastern Ambulance in 1989. Steve Cote, my Thursday partner, was an Amway salesman who mesmerized his patients with his concern and careful attention to their comfort. I saw many patients get so caught up with him they forgot they were in an ambulance en route to the emergency room. David Hanley was my Saturday partner—a nineteen-year-old kid going on forty who could lecture a drunken peer about the stupidness of drunk driving while plugging the gash on the head and deftly catching vomit in the emesis basin. Later, watching a nightclub scene on cable, he would ask innocently how people pay for their drinks in bars. He was a nursing student, and each week he would teach what he had learned in hi
s most recent classes, whether it was about childbirth or geriatrics. My first day at Eastern I rode as a third with Kevin Andrews and Steve Czyprenea. Steve was an intermediate and an EMT instructor in his late forties—he worked sixty hours a week at Eastern and another forty hours a week at the Belchertown State School, in addition to teaching a regular EMT course. He’d been there almost ten years. Kevin was a quiet ex-cop and black-belt karate coach. He’d been there for four years and although still a basic EMT, was one of the most respected EMTs in the city. The two of them had a great time together, with Steve introducing themselves to nurses as “Bert and Ernie.” In between calls they made the rounds of the Dairy Marts, refilling their coffee, buying lottery tickets, and joking with the clerks. When they had to respond, they were among the best in the business, both in medical and patient care. Kevin, who became my Monday-night partner when Steve Czyprenea went out with a back injury, was as tough and gentle a friend as you’d ever want. We’d stop in at his neighborhood community center to attend the C.R.A.C.K. watch meeting or at his mother’s house, where some of his twenty or thirty siblings and cousins were always gathered, to pick up a sandwich or pass some talk. I never worried when I went on a call with him. He gave me confidence.

  The unwritten rule of the street is you protect your partner at all costs. When it’s the two of you out there, you have to watch each other’s back and know it. Whether it’s reminding you to do something you forgot—like put oxygen on the patient—or jumping on someone who just punched you or is about to punch you, you have to know your partner is there behind you. Every now and then you may be called on to reaffirm that trust, and you have to respond. When it comes to violence against your partner, it can range from pulling them away from it, to taking payback, to looking the other way when someone else does.