“Jesus,” the student says. “It looks like a right AC day.”
“The IV gods are blessing me,” I say.
The man breaks loose. “Motherfucker!” he screams and swings at me, but because I am so tall the force of his punch hits my skin but falls just short of my jawbone. It is an excellent TV-type punch, which I take like a boxer with a jaw of steel.
“Be good,” I say.
“Fucker!”
“Please,” I say. “This will only take a moment.”
The guards have him back down. I grab a sixteen, fire that baby right in, get the flash, draw the bloods. Glenn hands me the line. I pop the caps off the dextrose and the injector, screw them together, and push it in the line.
Within moments, the madman Mr. Hyde is once again a calm, meek clerk. I hand the dextrose to the student and let him push the last half so he can get the feel of it.
The nurse gives me a hearty thumbs-up.
I’m feeling pretty fine. All in a day’s work, ma’am.
Later in the day, the student gets another shot, which he gets. “I was worried I was going to go zero for three,” he says.
“Don’t worry about it,” I say. “You get some, you miss some.” I don’t tell him I was ready to hang myself the day before.
We get a call for a person not feeling well. When we arrive, a teenager meets us outside and says his mom’s not feeling well. “What’s wrong?” Glenn asks.
“She’s been lying on the floor for three days.”
“What?”
“She been going to the bathroom on herself.”
“Does she respond to you?”
“She don’t say nothing.”
“You waited three days to call?”
The woman is tottering on a chair in the middle of the living room, while six family members look on. The woman is in her forties with thick track marks on her arms.
I look at her pupils, expecting to find them constricted, but they are dilated and barely reactive. She is very hot and can’t squeeze my hands or respond to any commands.
“She does heroin?”
“Yeah, but not for three days.”
She has shit and vomit all over herself. Her pressure is high, and she is definitely out of it. Once we have her in the ambulance, we look for veins. Her track marks run the length of her arms, like surgical scars. I have never seen them so long and so pronounced. I flip her wrist over and try for a narrow vein, but it blows. I feel the hand and find a tiny spot of sponginess. I use a twenty and get a flashback. I draw bloods and fill all four tubes. Glenn hands me the line and it runs. I try some Narcan to see if there is any heroin in her system, but there is no reaction. I am thinking either she got so conked out she became hypoxic and fried her brain, or else she has wicked out-of-control hepatitis. I run fluid through the line, and we head off to Saint Francis. Her temperature at the hospital is 105. She is very sick. The nurse cringes looking at the track marks. “You got a line?” she says. “Did you get bloods?”
“Yup,” I say.
“Nice job.”
Later in the EMT room at Hartford we are telling another paramedic about the call—the point being a lot of people call for an ambulance if they stub their toe, and these galoots didn’t have the sense to call with the lady lying there in the living room shitting on the carpet for three days. We tell about the track marks, which are the biggest, toughest things either of us has seen.
The other paramedic says, “Translation, no IV access.”
Glenn doesn’t say anything. I think he is waiting for me to say, “Oh, I got the line.”
But I am feeling so good, I say nothing.
I think it’s like Michael Jordan having to say, “I made the shot.”
As if anyone doubted. Nothing but net.
Tricks of the Trade
We’re called to Farmington Avenue for “something in the eye.” The address turns out to be an insurance company, where the guard tells us there is a man inside who got grease into his eye. As we wheel the stretcher down the hall, I am thinking: “Grease, grease. Now is that something you irrigate with water, or is that something that causes the eye to explode if you irrigate with water?” There are so many things in the paramedic textbook that when you are reading, you sometimes say, I’ll never get that one. There are twenty zillion substances that can get into eyes. Grease. Grease. Irrigate or leave alone. I am starting to get a little nervous, but I decide that, when I see the patient, I’ll look him over, and if it doesn’t come to me, I’ll call Medical Control or Poison Control and get the information that way.
The nurse meets us in the hall and says he has greasecutter in his eyes. She has already called Poison Control, and they told her to irrigate, which is what she is doing with saline. She hands us a printed pamphlet describing the greasecutter chemical.
“Great,” I say, relieved.
The man says his eyes burn. A nurse is putting a few drops at a time in each eye.
“We might want to up the flow,” I say.
Just then another nurse comes in. I recognize her as the nurse who was present when we did a diabetic there several weeks earlier. She smiles at me and says to the other nurse, “He’s the one who got the excellent IV that day.”
The nurse looks at me and says, “I thought you looked familiar.”
We get the man on the stretcher and take him down the hall. I run water on his eyes as we go. In the ambulance I have the nurse run water in his eyes while I hook up a device I heard about at the state EMS conference years ago. I spike a one liter bag of saline and attach it to a basic two-pronged oxygen cannula, which I tape to his nose. This creates a perfectly spaced flow of water into both eyes simultaneously. The nurse thinks it is a great idea. I thank her again for her help, and we’re off to the hospital.
When we come through the ED doors, the triage nurse stops and looks at my device and says aloud, “Look at that. Now I’m impressed.”
I am feeling pretty good about myself after this call, like I am already a pretty darn good paramedic.
My next call I stick my patient three times without getting an IV.
No rest for glory.
WHIPPED
Baby Girl
A paramedic student asks me if I ever had any calls that kicked my butt. I think he is expecting me to give a reassuring answer—to say that I haven’t, that as long as you do what you’re taught, you’ll be all right. Instead I say, yeah, I’ve had a few that whipped me good.
It’s late in the afternoon when they call our number. It’s for a miscarriage within blocks of the hospital. Glenn shakes his head. Miscarriage is a routine call that often turns out to be nothing more than a little spotting or a stomachache. We don’t even bother to put on our lights and sirens.
I grab the blue bag and start walking up the steps of the apartment building when a woman comes running out. “You’re going to need the stretcher,” she says.
“She can’t walk?”
“The baby’s coming out! Hurry!”
I turn and shout to Glenn. “Grab the OB kit. The baby’s coming out.”
“There’s one in your bag,” he says.
“Get the stretcher. I’ll see you inside.”
I follow the woman who is running ahead of me now. We go in the front door. I tell her to hold up while I prop the lock open so Glenn can get in. We race up three flights of stairs then down several corridors. When we reach the apartment, she points to the bedroom. “She’s in there.”
It is a well-kept apartment. I enter the bedroom and find a woman lying prone on the bed, with a man holding her hands and comforting her. “What’s going on?” I say.
“The baby’s coming out,” he says.
She is wearing a dress. I lift it up. The sight stuns me. I see the motionless legs and behind of a baby hanging out of her.
“It’s coming out the wrong way,” I blurt out.
“She’s six months pregnant,” the friend says. “They should never have let her out of the hospital. T
hey should never have sent her home.”
I am in near panic, uncertain what to do. “Go help my partner in,” I say.
The baby is blue. I try to remember what it said in the book to do about a breech delivery. The baby isn’t making any progress. It is stuck. I am worried that the baby’s head is pressed against the umbilical cord, cutting off his supply of oxygenated blood. I try to put my gloved fingers in the mother to try to create a tiny breathing space for the baby.
The mother screams, and I say, “I’m trying to make an airway for the baby.”
The man says to her, “He’s trying to make an airway.”
Glenn shows up. “It’s a breech,” I say. “We’re going to need backup.”
He takes the radio and calls the company for another unit.
“We’re going to have to deliver here,” he says. Even though we are just blocks from the hospital, the baby is too far out to put the mother on the stretcher and try to make a run for it.
He takes the baby’s back and legs. As I tell the mother to push, I try to press her skin back and away from the baby’s head.
“Push,” I say.
I can hear her strain. I still haven’t seen her face.
“Push.”
Nothing is happening.
“Push.”
I see tiny toothpick arms now. Blue, lifeless.
“Push.”
It seems an eternity. I push her skin to the side.
Suddenly the head pops out and the baby falls onto the bed. I hold it in my hands. It is wet, slippery, and lifeless. Its eyes are fused together. I start doing compressions. The baby’s head is at the top of my fingers. Its feet dangle limply on my wrist. It is blue. Its skin is almost transparent. It looks like a creature from the movie Cocoon. It is a girl. “We need suction,” I say to Glenn.
He takes the bulb suction out of the OB kit and tries to suction the mouth and nose, but the tube barely fits into it.
“We need to get some oxygen going,” I say.
He hooks up a nonrebreather mask, which I try to hold over the baby’s face. We have told the other crew to bring up our pediatric kit, which has intubation supplies, but I don’t think I can get a blade in the baby’s mouth because it is so small. Even the pediatric ambu-bag we have in our blue bag is way too big to fit the baby’s face.
Suddenly, I feel it move. “She’s alive. Cut the cord and let’s boogie out of here,” I say.
Glenn clamps it in two places, and hands shaking, makes the cut. The other crew is just coming in the door.
“We’re taking the baby to the hospital,” I tell the mother.
The friend gives us a towel to wrap the baby in. It swallows her up.
We move quickly down the hallways. The neighbor holds the door open for us by the stairways, and we begin our descent. We go down four flights. We are in the basement and can’t find our way out.
“This way,” the neighbor shouts. “Up here.”
We retreat toward her voice, back up a flight of stairs. A trip that should have taken forty seconds is taking minutes. We are losing time.
“That way,” she says, pointing us down a long corridor. We race down it. Ahead I can see the door. We’re out.
In the ambulance, I put the baby on the stretcher and take the child ambu-bag and attach an infant mask to try to pump air into the lungs, but the seal is too big. I can’t get any air in. The baby moves again, a desperate agonal movement. “Come on, little baby,” I say. To Glenn, I call, “I can’t get any air in.”
“We’re two blocks away,” he shouts to me.
Moments later we’re out at the hospital. I climb out holding the baby in my hand, still doing tiny compressions with my fingers, the oxygen mask back over her face. We move into the ED, past the triage desk, and into the cardiac room. I am six foot eight; the baby can’t be more than ten inches. I lay her on the bed. Two doctors are there. They see the little thing and start shaking their heads. “No, no,” one says. “Look at it.”
I am still doing compressions.
“It’s too blue. When was it born?”
Glenn looks at the clock. “Seven minutes ago,” he says.
“But it has a heartbeat,” a nurse says.
“No.”
My compressions slow to none. My fingers linger for a moment on her chest.
It is the tiniest thing I have ever seen. Her legs are as blue as the darkest ocean. Her face is purple. She moves again but can get no air.
I feel the room staring at me.
“If it had been intubated, maybe, but look at it.”
They get a tiny stocking cap and put it on her head. They pull a towel up to her neck. Lying on the huge stretcher, she looks like a mouse.
“It hasn’t a chance.”
A few people rush in the room with an incubator, but the doctors shake their heads.
Glenn and I stand there, looking at the baby. While we know she doesn’t have a chance, it is hard to just stand there and not do anything. I feel dazed, like we’ve just raced across the country to catch a boat and we’re too late. It’s already left shore—still in our sights but unreachable. No words come from my mouth.
We walk down the hall together, silently.
I sit in the EMT room and stare at my blank run report. I am distraught, overwhelmed by the baby’s death. I feel responsible. A half an hour before I was sitting in the ambulance, bullshitting with Glenn, and now I have experienced the most horrible of events—a baby, entrusted to my care, who came into the world directly into my hands, lies on the hospital stretcher, blue, cold, her tiny heart beating slower, her lungs unable to get air. I failed at saving her. It could have been, it should have been the most joyous of calls. I should be jumping about like Rocky, lighting cigars and passing them out, proclaiming, “It’s a girl! It’s a girl!” thrilled at having brought life into the world, feeling as alive as twenty men. Instead, I sit with head in hands, beaten.
Shawn Kinkade, who is writing his own run form, looks at me and knows something is wrong. He puts down his pen and starts talking to me. He gets me to tell him what happened, and we go over what I did, and in quiet kind tones he tells me about similar calls he’s had. It is not that he makes me feel better—but he keeps anguish from overtaking me, keeps me from feeling completely alone.
“You think we’ll get stork pins?” Glenn says later when we are just sitting outside by the ambulance. They give tiny pins shaped like storks to EMTs who deliver babies in the field.
“I don’t want one,” I say.
When we leave the office that night after turning in our run cards, we shake hands.
“Maybe we’ll have a better day tomorrow,” he says.
“You’re a good partner,” I say.
I have a bad night. I get home and call Michelle, but we haven’t been getting along great, and she has a lot of work to do for her PA school. I want to tell her about the call, but it’s not a good time, and I don’t want to use it to get sympathy to get back in her good graces. I keep quiet about it.
I have a bad night. I can’t sleep. I stare at the ceiling. I keep seeing the baby pop out and lie there lifeless in my hand. I wonder what the mother thinks of me. I wonder if she holds me responsible.
The next day I ask Debbie Haliscak about the call and whether I should have intubated. She says I did the right thing. I probably wouldn’t have been able to get the blade in the mouth anyway. I did the right thing. A lot of preemies don’t even have lungs developed enough to breathe.
I see one of the doctors who was there, and she tells me I did a good job. She said her only regret was that medicine hadn’t advanced enough emotionally to help the baby die. She wishes someone could have held the baby to help her over to the other side.
Glenn and I talk about it. It was the first delivery for both of us. He says, “We were with the little girl when she came into the world. She spent most her life with us.”
As the days go by, I read what I can, even go to the bookstore and buy a book that h
as pictures of babies in various stages of development.
I am still bothered. I sit at my computer. I feel my body start to shake. I weep.
At my request, Debbie sets up a meeting for me with a neonatologist so he can answer the questions that stay with me. I tell him I want to know what I could have done better so that next time, if the baby has a shot at all, I can give it one. He tells me I was right not to intubate, unless I was sure I could do it. He says bagging is the most important thing, even more important than compressions, because if the baby gets more air, it will stimulate the heart. He shows me the proper equipment. There is a tiny neonate mask and a tiny ambu-bag, neither of which we carry. He says it sounds like I did the best I could under rather traumatic circumstances.
Though I am not religious, I feel I need absolution.
They have all told me that I did the best I could, but I know different. I was there. I held a tiny new life in my hands. I felt it try to breathe like a little fish out of water. I know I didn’t keep her warm enough. I moved too quickly to get air into her new blood. Another medic—a Michelle Gordon, a Shawn Kinkade, or a Tom Harper—might have let her lungs better know the soft feel of pink air. I hear the mythic story of a paramedic who, on delivering a baby of twenty-six weeks, intubated that newborn, the light from the laryngoscope blade lighting up the entire baby through its translucent skin. I don’t know if that baby lived or died, but I believe it got better care than I gave this child. I sit alone for hours, dwelling on it. No other medics are there. Only me. Not that I could have saved you, but I know I could have given you a better chance. I should have been able to get more air into you. Please, forgive me.
Paramedic Amputates Leg on Scene to Save Life
On Monday, the day before I begin my three-day shift, I get a phone call from Michelle, who asks me if I heard about the call in West Hartford that morning. I haven’t and she says something about a dump truck running over two women, killing one instantly and the other had to have her leg amputated on scene. We both wonder who was there working the call and what the situation would have been like for a surgeon to come out and amputate the leg.
Paramedic Page 18
